Barns uppfattningar och hanteringsstrategier av sin ADHD - en pilotstudie Correlations between appraisals, management strategies and psychological stress among children and adolescents with ADHD - A Pilot Study 2025-146-1 SU-317-0056-23 https://doi.org/10.58141/gcfa-tp98 Swedish National Data Service Svensk nationell datatjänst Landing page Barns uppfattningar och hanteringsstrategier av sin ADHD - en pilotstudie Correlations between appraisals, management strategies and psychological stress among children and adolescents with ADHD - A Pilot Study 2025-146-1 SU-317-0056-23 https://doi.org/10.58141/gcfa-tp98 10.1007/s10567-017-0245-2 10.1016/S0897-1897(05)80008-4 10.1007/BF03004176 10.1080/23311908.2019.1608032 Ringer, Noam Ringer, Noam Swedish National Data Service Svensk nationell datatjänst Landing page Mental and behavioural disorders Psykiska sjukdomar och syndrom samt beteendestörningar (F00-F99) Attention Deficit and Hyperactivity Disorder (ADHD) Attention Deficit and Hyperactivity Disorder (ADHD) (Fördjupningskod) The data is based on questionnaires completed by 97 children and adolescents with ADHD regarding their perception of the cause of their symptoms, the strategies they use to manage them, psychological stress, sex, age, age at diagnosis, additional diagnoses, and use of medications. [See further description under Method and outcome.] The original data file is in SPSS format .sav. A copy of it converted to .csv is also available. Data är baserad på enkäter som 97 barn och ungdomar med adhd har fyllt i om hur de uppfattar orsaken till sina symptom, vilka strategier de använder för att hantera dem, psykologisk stress, sex, ålder, ålder vid diagnos, ytterligare diagnoser, samt användning av mediciner. [Se vidare beskrivning under Metod och utfall.] Originaldatafilen är i SPSS-format .sav. Den finns också tillgänglig som en konverterad csv-kopia. 2024 2025 IndividualIndividual IndividIndivid Single studiesSingle studies Enskilda studierEnskilda studier Data were collected using the Children's Appraisals and Management of ADHD (CAM-ADHD), a questionnaire developed for the study, the questionnaire Stress in Children (SiC), and demographic and medical questions. The aim of CAM-ADHD is to collect data on how children with ADHD assess the causes of their symptoms and the strategies they use to manage them. The development of the questionnaire was based on the method suggested by Davis (1992). First, we created a pool of 80 statements describing different appraisals of symptom causes and management strategies. Based on previous studies (Ringer, 2019; Wong et al., 2018), the items covered three types of appraisals of causes—biological, environmental, and personality-related—and three types of management strategies: self-control, asking teachers for adjustments, and withdrawal. An independent group of five experts in the field (two psychologists, two special educators, and one occupational therapist), recruited through professional networks, rated the relevance of each statement for the purpose of the questionnaire on a four-point scale (1 = not relevant, 2 = somewhat relevant, 3 = quite relevant, 4 = very relevant) (Davis, 1992). In total, 24 statements that were assessed by all raters as very relevant were selected to form the initial instrument. To examine the comprehensibility of the statements, a group of five children aged 10 to 16 years, all diagnosed with ADHD, were interviewed about how they understood the statements. They were asked to explain the meaning of each statement in their own words. Statements that were unclear were reformulated. All statements refer to the school context. For example, statements describing appraisals of biological causes include “I lose my patience because of my brain” and “I am restless because of my brain”. Statements describing appraisals of environmental causes include “I am restless because the classroom is messy” and “I lose my patience because other people talk for too long”. Examples of statements describing personality-related causes include “I am restless because that is who I am as a person” and “I lose my patience because that is who I am as a person”. Statements describing self-control management strategies include, for example, “If I am restless in class, I try to control myself even more” and “If I lose focus when working in class, I make an effort to stay focused”. Statements describing management by asking teachers for help include “If I am restless in class, I ask my teacher for help” and “If I lose focus when working in class, I ask my teacher for help”. Statements describing withdrawal or releasing control include “If I am restless in class, I walk around or leave the classroom” and “If I lose focus when working in class, I leave the assignment”. The instruction for the appraisal statements is: “Here are statements that describe different ways of thinking. How common is it for YOU to think that way? Choose the option that describes you best: Never, Sometimes, Often, Always.” The instruction for the management strategies is: “Here are statements that describe different ways of reacting. How common is it for YOU to react that way? Choose the option that describes you best: Never, Sometimes, Often, Always.” SiC is a self-rating questionnaire designed to assess stress in children (Osika et al., 2007). It includes 21 items describing experiences related to stress. The questionnaire uses Likert-scale response categories with four alternatives: “never”, “sometimes”, “often”, and “always”. Participants are asked to indicate the option that best describes their experience. Items describe physical experiences (e.g., “I have a headache”, “I have a stomachache”), emotional experiences (e.g., “I get angry”, “I feel happy”), and social experiences (e.g., “When things are hard, there's an adult I can talk to”, “When things are hard, it helps to be with my friends”). SiC was developed and validated in Sweden and has been shown to have good psychometric properties (Osika et al., 2007). Data samlades in med hjälp av Children’s Appraisals and Management of ADHD (CAM-ADHD), ett frågeformulär som utvecklades för studien, frågeformuläret Stress in Children (SiC) samt demografiska och medicinska frågor. Syftet med CAM-ADHD är att samla in data om hur barn med ADHD bedömer orsakerna till sina symtom och vilka strategier de använder för att hantera dem. Utvecklingen av frågeformuläret baserades på den metod som föreslagits av Davis (1992). Först skapades en pool av 80 påståenden som beskrev olika bedömningar av symtomorsaker och strategier för att hantera dessa. Baserat på tidigare studier (Ringer, 2019; Wong et al., 2018) omfattade påståendena tre typer av orsaksbedömningar — biologiska, miljörelaterade och personlighetsrelaterade — samt tre typer av hanteringsstrategier: självkontroll, att be lärare om anpassningar och tillbakadragande. En oberoende grupp av fem experter inom området (två psykologer, två specialpedagoger och en arbetsterapeut), rekryterade genom professionella nätverk, ombads att bedöma relevansen av varje påstående för frågeformulärets syfte på en fyrgradig skala (1 = inte relevant, 2 = något relevant, 3 = ganska relevant, 4 = mycket relevant) (Davis, 1992). Totalt valdes 24 påståenden som av samtliga experter bedömts som mycket relevanta ut för att utgöra det initiala instrumentet. För att undersöka begripligheten intervjuades en grupp av fem barn i åldrarna 10 till 16 år, samtliga diagnostiserade med ADHD, om hur de förstod påståendena. Barnen ombads förklara innebörden av varje påstående med egna ord. Påståenden som upplevdes som otydliga omformulerades. Alla påståenden relaterar till skolkontexten. Exempel på påståenden som beskriver bedömningar av biologiska orsaker är ”Jag tappar tålamodet på grund av min hjärna” och ”Jag är rastlös på grund av min hjärna”. Påståenden som beskriver bedömningar av miljörelaterade orsaker är ”Jag är rastlös för att klassrummet är stökigt” och ”Jag tappar tålamodet för att andra pratar för länge”. Exempel på påståenden som beskriver att personligheten är orsaken är ”Jag är rastlös för att det är så jag är som person” och ”Jag tappar tålamodet för att det är så jag är som person”. Påståenden som beskriver strategier för självkontroll är till exempel ”Om jag är rastlös på lektionen försöker jag kontrollera mig ännu mer” och ”Om jag tappar fokus när jag arbetar i klassen anstränger jag mig för att hålla fokus”. Påståenden som beskriver att be lärare om hjälp är till exempel ”Om jag är rastlös på lektionen ber jag min lärare om hjälp” och ”Om jag tappar fokus när jag arbetar i klassen ber jag min lärare om hjälp”. Påståenden som beskriver strategier för tillbakadragande är till exempel ”Om jag är rastlös på lektionen går jag runt eller lämnar klassrummet” och ”Om jag tappar fokus när jag arbetar i klassen lämnar jag uppgiften”. Instruktionen för påståenden som beskriver bedömningar lyder: ”Här är påståenden som beskriver olika sätt att tänka. Hur vanligt är det att DU tänker så? Välj det alternativ som passar dig bäst: Aldrig, Ibland, Ofta, Alltid.” Instruktionen för påståenden som beskriver hanteringsstrategier lyder: ”Här är påståenden som beskriver olika sätt att reagera. Hur vanligt är det att DU reagerar så? Välj det alternativ som passar dig bäst: Aldrig, Ibland, Ofta, Alltid.” SiC är ett självskattningsformulär utformat för att mäta stress hos barn (Osika et al., 2007). Det innehåller 21 påståenden som beskriver erfarenheter relaterade till stress. Formuläret använder svarsalternativ i form av en fyrgradig Likert-skala: ”aldrig”, ”ibland”, ”ofta” och ”alltid”. Deltagarna ombeds ange det alternativ som bäst beskriver deras erfarenhet. Påståendena beskriver fysiska upplevelser (t.ex. ”Jag har huvudvärk”, ”Jag har magont”), emotionella upplevelser (t.ex. ”Jag blir arg”, ”Jag känner mig glad”) och sociala upplevelser (t.ex. ”När något är svårt finns det en vuxen jag kan prata med”, ”När något är svårt hjälper det att vara med mina vänner”). SiC utvecklades och validerades i Sverige och har visat goda psykometriska egenskaper (Osika et al., 2007). Numeric The inclusion criteria for participation in the study were a formal ADHD diagnosis and the ability to read and understand the Swedish language. With the ambition of achieving variation among participants, recruitment was done via special educators at schools as well as nurses and clinical psychologists at child and youth medical clinics in the city of Stockholm. The children and their parents received written information about the study immediately upon scheduling a time to meet at the school or clinic. Parents, and children aged 15 and over, who agreed to participate gave their written consent, and the children completed the questionnaire on site. The families were assured of the participants’ anonymity, as well as the children’s right to quit or not answer questions. The completed questionnaires and the signed consent were then collected by the first author.The inclusion criteria for participation in the study were a formal ADHD diagnosis and the ability to read and understand the Swedish language. With the ambition of achieving variation among participants, recruitment was done via special educators at schools as well as nurses and clinical psychologists at child and youth medical clinics in the city of Stockholm. The children and their parents received written information about the study immediately upon scheduling a time to meet at the school or clinic. Parents, and children aged 15 and over, who agreed to participate gave their written consent, and the children completed the questionnaire on site. The families were assured of the participants’ anonymity, as well as the children’s right to quit or not answer questions. The completed questionnaires and the signed consent were then collected by the first author. Non-probabilityNon-probability Icke-sannolikhetsurvalIcke-sannolikhetsurval Non-probability: PurposiveNon-probability: Purposive Icke-sannolikhetsurval: syftesurvalIcke-sannolikhetsurval: syftesurval The present study employed a correlational design in which data were collected via a paper-format questionnaire administered to children with ADHD. Recruitment procedure The inclusion criteria for participation in the study were a formal ADHD diagnosis and the ability to read and understand the Swedish language. With the ambition of achieving variation among participants, recruitment was done via special educators at schools as well as nurses and clinical psychologists at child and youth medical clinics in the city of Stockholm. The children and their parents received written information about the study immediately upon scheduling a time to meet at the school or clinic. Parents, and children aged 15 and over, who agreed to participate gave their written consent, and the children completed the questionnaire on site. The families were assured of the participants’ anonymity, as well as the children’s right to quit or not answer questions. The completed questionnaires and the signed consent were then collected by the first author. Instruments Data were collected via the Children’s Appraisals and Management of ADHD (CAM-ADHD) – a questionnaire that was developed for the study – as well as the Stress in Children (SiC) questionnaire and demographic and medical questions. CAM-ADHD The aim of the CAM-ADHD is to collect data on how children with ADHD appraise the causes of their symptoms, as well as what strategies they use to manage them. The development of the questionnaire was based on the method suggested by Davis (1992). Firstly, we created a “pool” of 80 statements describing different appraisals of what causes ADHD symptoms as well as ways of managing them. Based on the results of previous studies (Ringer, 2019; Wong et al., 2018), the items covered three types of appraisals regarding causes (biological, environmental, and personality causes) and three types of management strategies (self-control, asking teachers for adjustment, and withdrawal). An independent group of five experts in the field (two psychologists, two special educators, one work therapist), recruited through professional networks, was asked to rate the relevance of each statement for the purpose of the questionnaire, based on a four-point scale (1=not relevant, 2=somewhat relevant, 3=quite relevant, 4=very relevant) (Davis, 1992). A total of 24 statements that were assessed by all raters as very relevant were selected for the initial instrument. To examine the comprehensibility of these statements, a group of five children aged 10 to 16 years who were diagnosed with ADHD were interviewed about their comprehensibility. The children were asked to explain in their own words the meaning of every statement, and statements that were unclear were reformulated. All statements are situated within the school context. Those that describe appraisals of biological causes include, for instance, “I lose my patience because of my brain” and “I’m restless because of my brain”. Those that describe appraisals of environmental causes include “I’m restless because the classroom is messy” and “I lose my patience because other people talk for too long”. Examples of statements that describe the child’s appraisal that their personality is the cause of their ADHD include “I’m restless because that’s who I am as a person” and “I lose my patience because that’s who I am as a person”. Statements that describe management strategies of self-control include “If I’m restless in class, I try to control myself even more” and “If I lose focus when working in class, I make an effort to stay focused”. Statements that describe management by asking teachers for help include “If I’m restless in class, I ask my teacher for help” and “If I lose focus when working in class, I ask my teacher for help”. Statements that describe management by releasing control include “If I’m restless in class, I walk around or leave the classroom” and “If I lose focus when working in class, I ignore the assignment”. The instruction for statements describing appraisals is “Here are some statements that describe different ways of thinking. How often do YOU think these ways? Choose from: Never, Sometimes, Often, Always”. The instruction for statements describing management strategies is “Here are some statements that describe different ways of reacting. How often do YOU react these ways? Choose from: Never, Sometimes, Often, Always”. Stress in Children (SiC) SiC, a self-rating questionnaire for assessing stress in children (Osika et al., 2007), includes 21 items concerning experiences related to stress. The questionnaire uses Likert-scale response categories with the four alternatives “Never”, “Sometimes”, “Often” and “Always”, and participants are asked to indicate the alternative that best describes their experience. Items describe physical experiences (e.g. “I have a headache”, “I have a stomachache”), emotional experiences (e.g. “I get angry”, “I feel happy”), and social experiences (e.g. “When things are hard, there’s an adult I can talk to”, “When things are hard, it helps to be with my friends”). SiC was developed and validated in Sweden, and has been shown to have good psychometric properties (Osika et al., 2007). Data analysis Statistical analysis was performed using SPSS (version 27 for Windows, Chicago, IL). Standard statistical methods were used for identifying outliers, missing values, and descriptive statistics, and for determining the variables’ distributions. For the factor analysis of the CAM-ADHD we used exploratory principal components analysis. For identifying the relations between the participants’ characteristics and the CAM-ADHD subscales we used linear regressions, with the subscales’ scores as dependent variables. For associations between the CAM-ADHD subscales and the SiC global scores we used Spearman’s Rho. Statistical significance was set at p (two-tailed) <0.05. Cronbach’s alpha was used for the analysis of internal consistency.The present study employed a correlational design in which data were collected via a paper-format questionnaire administered to children with ADHD. Recruitment procedure The inclusion criteria for participation in the study were a formal ADHD diagnosis and the ability to read and understand the Swedish language. With the ambition of achieving variation among participants, recruitment was done via special educators at schools as well as nurses and clinical psychologists at child and youth medical clinics in the city of Stockholm. The children and their parents received written information about the study immediately upon scheduling a time to meet at the school or clinic. Parents, and children aged 15 and over, who agreed to participate gave their written consent, and the children completed the questionnaire on site. The families were assured of the participants’ anonymity, as well as the children’s right to quit or not answer questions. The completed questionnaires and the signed consent were then collected by the first author. Instruments Data were collected via the Children’s Appraisals and Management of ADHD (CAM-ADHD) – a questionnaire that was developed for the study – as well as the Stress in Children (SiC) questionnaire and demographic and medical questions. CAM-ADHD The aim of the CAM-ADHD is to collect data on how children with ADHD appraise the causes of their symptoms, as well as what strategies they use to manage them. The development of the questionnaire was based on the method suggested by Davis (1992). Firstly, we created a “pool” of 80 statements describing different appraisals of what causes ADHD symptoms as well as ways of managing them. Based on the results of previous studies (Ringer, 2019; Wong et al., 2018), the items covered three types of appraisals regarding causes (biological, environmental, and personality causes) and three types of management strategies (self-control, asking teachers for adjustment, and withdrawal). An independent group of five experts in the field (two psychologists, two special educators, one work therapist), recruited through professional networks, was asked to rate the relevance of each statement for the purpose of the questionnaire, based on a four-point scale (1=not relevant, 2=somewhat relevant, 3=quite relevant, 4=very relevant) (Davis, 1992). A total of 24 statements that were assessed by all raters as very relevant were selected for the initial instrument. To examine the comprehensibility of these statements, a group of five children aged 10 to 16 years who were diagnosed with ADHD were interviewed about their comprehensibility. The children were asked to explain in their own words the meaning of every statement, and statements that were unclear were reformulated. All statements are situated within the school context. Those that describe appraisals of biological causes include, for instance, “I lose my patience because of my brain” and “I’m restless because of my brain”. Those that describe appraisals of environmental causes include “I’m restless because the classroom is messy” and “I lose my patience because other people talk for too long”. Examples of statements that describe the child’s appraisal that their personality is the cause of their ADHD include “I’m restless because that’s who I am as a person” and “I lose my patience because that’s who I am as a person”. Statements that describe management strategies of self-control include “If I’m restless in class, I try to control myself even more” and “If I lose focus when working in class, I make an effort to stay focused”. Statements that describe management by asking teachers for help include “If I’m restless in class, I ask my teacher for help” and “If I lose focus when working in class, I ask my teacher for help”. Statements that describe management by releasing control include “If I’m restless in class, I walk around or leave the classroom” and “If I lose focus when working in class, I ignore the assignment”. The instruction for statements describing appraisals is “Here are some statements that describe different ways of thinking. How often do YOU think these ways? Choose from: Never, Sometimes, Often, Always”. The instruction for statements describing management strategies is “Here are some statements that describe different ways of reacting. How often do YOU react these ways? Choose from: Never, Sometimes, Often, Always”. Stress in Children (SiC) SiC, a self-rating questionnaire for assessing stress in children (Osika et al., 2007), includes 21 items concerning experiences related to stress. The questionnaire uses Likert-scale response categories with the four alternatives “Never”, “Sometimes”, “Often” and “Always”, and participants are asked to indicate the alternative that best describes their experience. Items describe physical experiences (e.g. “I have a headache”, “I have a stomachache”), emotional experiences (e.g. “I get angry”, “I feel happy”), and social experiences (e.g. “When things are hard, there’s an adult I can talk to”, “When things are hard, it helps to be with my friends”). SiC was developed and validated in Sweden, and has been shown to have good psychometric properties (Osika et al., 2007). Data analysis Statistical analysis was performed using SPSS (version 27 for Windows, Chicago, IL). Standard statistical methods were used for identifying outliers, missing values, and descriptive statistics, and for determining the variables’ distributions. For the factor analysis of the CAM-ADHD we used exploratory principal components analysis. For identifying the relations between the participants’ characteristics and the CAM-ADHD subscales we used linear regressions, with the subscales’ scores as dependent variables. For associations between the CAM-ADHD subscales and the SiC global scores we used Spearman’s Rho. Statistical significance was set at p (two-tailed) <0.05. Cronbach’s alpha was used for the analysis of internal consistency. Self-administered questionnaire: PaperSelf-administered questionnaire: Paper Självadministrerat frågeformulär: papperSjälvadministrerat frågeformulär: papper Access to data through SND. Access to data is restricted. Åtkomst till data via SND. Tillgång till data är begränsad. restrictedAccess Davis, L. L. (1992). Instrument review: Getting the most from a panel of experts. Applied nursing research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4 Davis, L. L. (1992). Instrument review: Getting the most from a panel of experts. Applied nursing research, 5(4), 194–197. https://doi.org/10.1016/S0897-1897(05)80008-4 10.1016/S0897-1897(05)80008-4 1992 Osika, W., Friberg, P., & Wahrborg, P. (2007). A new short self-rating questionnaire to assess stress in children. International Journal of Behavioral Medicine, 14(2), 108–117. https://doi.org/10.1007/BF03004176 Osika, W., Friberg, P., & Wahrborg, P. (2007). A new short self-rating questionnaire to assess stress in children. International Journal of Behavioral Medicine, 14(2), 108–117. https://doi.org/10.1007/BF03004176 10.1007/BF03004176 2007 Ringer, N. (2019). Young people’s perceptions of and coping with their ADHD symptoms: A qualitative study. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1608032 Ringer, N. (2019). Young people’s perceptions of and coping with their ADHD symptoms: A qualitative study. Cogent Psychology, 6(1). https://doi.org/10.1080/23311908.2019.1608032 10.1080/23311908.2019.1608032 2019