Advances in Social Science, Education and Humanities Research, volume 133

3rd Asean Conference on Psychology, Counseling and Humanities (AC-PCH 2017)

The Role of Psychological Intervention to Improve Attention ADHD Child

Novil Cut Nizar

Master of Psychology
University of Muhammadiyah Malang
[email protected]

Abstract. Children with ADHD (Attention Deficit Hyperactivity Disorder) have problem with attention that are very difficult to
maintain on a particular task. Children with ADHD have problem when in a social institution such as a public school. Patients
diagnosed with ADHD are increasingly prescribed with drugs such as methylphenidate (ritalin, concerta), dexafetamine,
atomoxetine (strattera), tricyclishe, anatidepresive, nortiplyline, pemoline, or imipramine usage of stimulant medication may result
in side effects such as insomnia, loss of appetite, abdominal pain, headache, anxiety, stress, and nervousness. stimulant medication
works only short-term and symptoms return once medication is stopped. The purpose of this study was to determine the role of
psychological interventions that are widely used in ADHD children in increasing their attensiveness. The method used is journal
literature or literature review. And the result is a token economy is a much-conducted intervention and gives significant results to
the increased attention of children with ADHD. Then play therapy is also able to increase attention to ADHD children by combining
with other therapeutic techniques. While Music and Tone also mmberikan significant results only still lack of researchers to do this
research.

Keywords: Pschological Intervention, Attention, ADHD

forgetful in daily activities, etc (Gehan & Samiha,

INTRODUCTION 2011; Schultz. et. al, 2011; Månsson1. Et. al, 2017).
Children with ADHD have less attention resulting
Attention-Deficit/Hyperactivity Disorder (ADHD) in difficulties when in a social institution such as a
is one of the most common behavioral health concerns public school when absorbing a lesson at school
in children and adolescents, with a prevalence rate of (Dupaul, Weyandt, O’Dell & Varejo, 2009). And
2% to 9% worldwide. Children with ADHD present children who have ADHD usually have time to
with executive functioning impairments and concentrate that is about 6-10 seconds depending on
behavioral challenges that negatively affect their daily the severity.
functioning across everyday settings. These Research on individuals with ADHD has been
difficulties place them at greater risk for suffering widely practiced. Researchers are doing more research
adverse outcomes throughout the life span, including on the effect of treatment on individuals with ADHD
disruptions in relationships (with parents, peers, and by performing various approaches either by providing
teachers), academic problems, chronic behavioral stimulant drugs or with various psychological
difficulties, and delinquency and substance abuse in therapies. Patients diagnosed with ADHD are
adolescence. ADHD is more common in men than increasingly prescribed with drugs such as
women in the general population, with a ratio of about methylphenidate (ritalin, concerta), dexafetamine,
2: 1 in children and 1.6: 1 in adults. Women are more atomoxetine (strattera), tricyclishe, anatidepresive,
likely than men to experience innattentive (Curtis,. et nortiplyline, pemoline, or imipramine. Many clinical
al, 2013; APA, 2013). ADHD begins in childhood. trials have found the core symptoms of hyperactivity,
The requirement that several symptoms be present impulsivity, and lack of attention indicate statistically
befeore age 12 years conveys the importance of significant cure and better academic achievement,
substantial clinical presentation during childhood. association with family and peers and behavioral
ADHD in the Bahasa is gangguan pemusatan problems, and drugs can even reduce the risk of
perhatian dan hiperaktivitas (GPPH) which is difficult subsequent psychiatric comorbidities .
to concentrate on the tasks assigned to them. Even if Other researchers have found that side effects
they have good motivation, they are harder to do, and mean that pharmacological intervention is not always
even if they do they spend a lot of energy when acceptable for parents, children, or even some
compared to other children. ADHD has symptoms of clinicians. Negative effects such as loss of appetite,
attention disorders and concentrations, impulsivity weight loss, difficulty falling asleep, trembling, dry
and hyperactivity (Paternotte & Buitelaar, 2010). mouth, nausea, abdominal pain, low energy,
Hyperactivity and implusivity symptoms:squirms irritability, diarrhea, muscle tension, grinding teeth,
in seat, talk excesively, blurts out an answers before a and rare but important cases of sudden death due to
question has been completed, etc. Innatenttion pre-existing hidden cardiovascular problems may
symptoms: doesn’t not seem to listen when spoken to prevent continued use of psycho-stimulants (Curtis,
directly, doesn’t follow through on instructions and 2013).
fail to finish schoolwork, avoids, The token-economy system is one of the most
widespread for managing and measuring
dysfunctional behavior. Children’s parents and other

Copyright © 2018, the Authors. Published by Atlantis Press.

This is an open access article under the CC BY-NC license (http://creativecommons.org/licenses/by-nc/4.0/). 113
 Advances in Social Science, Education and Humanities Research, volume 133

caregivers keep a record of daily or weekly LITERATURE REVIEW

occurrence of target behaviors initially formulated
Attention ADHD Child
together with the child or teen. For children with
Children with ADHD have problems fails to gives
ADHD, some researchers have suggested printing out
close attention to details. This difficulty is not caused
these predetermined behaviors (rules) on cards.This
by disturbing external stimuli to maintain attention.
technique uses as consequence strategy awards of
Unable to concentrate or make careless mistakes in
points or tokens for desirable behavior (positive
many activities, difficulty maintaining attention to
contingency reinforcement) and may condition
tasks or play activities, seeming not listening when
significant impairments to display of inappropriate
spoken to directly, not completing tasks, difficulty
behaviors such as withdrawal of a previously gained
organizing tasks and activities, avoiding, disliking or
token (response cost). DuPaul et al. reported
being reluctant to engage in tasks that demand
efficacious strategies for behavioral interventions
ongoing mental endeavor (such as schoolwork or
applicable in the school setting using the token
homework), loss of objects essential to a task or
economy system as a strategy that may lead to
activity (for example, toys, stationery, schoolwork),
improved behavior for task completion, and found
disturbed by unrelated stimuli, and forgetfulness in
clinically significant improvements in task-related
daily activities (Flanagen, 2005; Paternotte & Buitelar,
attention as well as productivity and accuracy of work
2010 ).
done in class, especially when combined with the cost
Unlike hyperactive–impulsive or combined type
response system (Dupaul, 2011; Reitman, 2011;
ADHD patients, adults who are primarily inattentive
Andez de la Cruz. et. al, 2017; Hedges. et. al, 2013).
often do not report as many behavioral problems at
Some studies also indicate that methylphenidate
home or at school when they were. Rather, inattentive
can ease most of the time deficits and normalize the
adults were likely to have experienced academic
functioning of networks involved in ADHD, yielding
problems and received feedback from teachers noting
to an improved performance in cognitive tasks. In this
their need for more supervision in completing work,
sense, we think of music, as an eminently temporal
to pay better attention in class, and to develop better
and rhythmic art that displays lively, spontaneous,
study skills. Their grades were likely to suffer from
emotional, and motivational dimensions that could
turning in assignments late, incomplete, or forgetting
possibly be of great help in studying aspects of time
to turn them in altogether. Because their difficulties
processing in children with ADHD. Our study
generally were internalized and did not lead to
investigated how the perception of time is related to
disruptive behaviors that would capture the attention
the modulation of attention, executive, and inhibitory
of teachers, these patients’ difficulties often were not
control of impulsive behaviors related to self-
identified until college or later in adulthood. Not
regulation, planning, and control of motor actions
surprisingly, predominantly inattentive symptoms are
through sound and music (Career, 2015).
often associated with comorbid internalizing disorders,
Treatment with behavioral therapy with or without
such as anxiety or depression (Ramsay & Rostain,
medications leads the children to do well at school
2008).
and college and become productive adults.
Multimodal behavioral programs integrating play
therapy, exercise, and reward systems using Psychological Intervention
psychologists have been shown to help the majority of The results of many studies reveal that
children with ADHD. Yoga with meditation modified psychological intervention has significant effect on
for children was chosen as the physical exercise children with ADHD. Psychological interventions
component. Yoga also needs limited space, no such as token economy and play therapy.
equipment, is easy to learn, and also culturally well
accepted. There is strong belief but limited evidence Token economy
to show that yoga and meditation help focus and This therapy is used to increase attention
attention (Metha., et al, 2012). organizing tasks and activities because individuals
Individuals with ADHD are at risk for a variety of with ADHD often loses things necessary for tasks or
negative outcomes including poor peer relationships, activities (Robert, Alexander & Michalla, 2005).
higher rates of delinquency and substance abuse, low Token economy technique has been widely used for
self-esteem, lower educational attainment, and operant conditioning in children showing
educational underachievement (Miller & Lee, 2013). inappropriate and disruptive behavior cases presenting
Based on the above description, the growing behavioral problems with lack of empathy, guilt, and
treatment and interventions developed to increase self-monitoring difficulties (callous – unemotional)
attention to ADHD children. Therefore, researcher may present resistance and even behavioral
want to study the role of various intervention deterioration if interventions involve cost of response
programs through the results of previous research by or punishment. Interventions that maximize rewards
experts. with positive reinforcers appear to be most effective
(Tarbox, Ghezzi, Wilson, 2006).
The token-economy system is one of the most
widespread for managing and measuring
dysfunctional behavior. Children’s parents and other
caregivers keep a record of daily or weekly

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occurrence of target behaviors initially formulated The development of psychological interventions for
together with the child or teen . ADHD children
Content analysis technique consists of three main
stages: (1) pre-analysis – organ-izing materials to 1.Token ekonomy
systematize initial ideas, demarcating what will be
used, formulating hypotheses and goals, and finally Token economy is an approach that comes from
compiling indicators to be analyzed; (2) exploration of behavioristik. This therapy has long developed along
material – categories are defined by coding and with the development of behavioristic theory itself.
identifying in recording units for the categorizing and Which of these treatments by Skinner (1971) gives
frequency counts; (3) results are processed for significant results in ADD children or those now
interpretation (Coelho, et al., 2015). called ADHD. There have been many studies that use
this therapy to increase attention to ADHD children
Combination of Other Therapeutic Techniques whose research conducted by Reitman and other
and Playtherapy colleagues title “The influence of a token economy
Yoga with meditation modified for children was and methylphenidate on attentive and disruptive
chosen as the physical exercise component. Yoga also behavior during sports with ADHD-diagnosed
needs limitedspace, no equipment, is easy to learn, children” which is significant to the behavior of
and also culturally well accepted. There is strong ADHD children.
belief but limited evidence to show that yoga and Tarbox's research, et al (2006) token economy is
meditation help focus and attention. Pilot studies one example of extrinsic reinforcement that makes a
using this as family based therapy for ADHD in 8 person do something to achieve that can increase
boys have been reported to show promise. Additional attention both from the level of tenacity and from the
theoretical basis may be the increase in dopamine level of vigility, the goal is to change the extrinsic
release in the CNS from yoga. In ADHD, reduced motivation into intrinsic motivation, it is desirable that
dopamine levels are seen in the CNS, and strategies to the desired acquisition of behavior can be rewarded
regulate these levels are suggested as possible for maintaining new behaviors.
therapies (Metha., et al, 2012).
When doing play therapy, play time is also 2. Playtherapy
considered because it relates to the development of
attention and ability to learn. Dynamic temporal According to research conducted by (Hall,
patterns, such as the rhythm of speech, can be Kaduson, & Schaefer, 2002) for over 60 years, play
important to learn. In addition, performance therapy has been a trusted treatment in treating
improvements with exercises involving the transition ADHD children in clinical practice. One reason for
from reactive to predictive time, so different types of using play therapy is that it has proven to be a very
time need to be done. effective approach for children when the abstract
Furthermore, the Adventure-based counseling reasoning and verbal skills needed to articulate their
(ABC) technique can make ADHD children complete feelings, thoughts, and behaviors have not developed
their tasks combined with Adlerian play therapy. optimally. This is also supported by previous
Adlerian's play therapy focuses on four delinquency researches in the journal psychology (Pykhitna,
goals: attention, power, revenge, and disability Balaam, Wood, Pattison, & Oliver, 2011) play therapy
(Portrie-Bethke, Hill & Bethke, 2009). researchers with the title “Designing for attention
deficit hyperactivity disorder in play therapy: the case
Music and Sound of Magic Land” that play therapy can help children
who have difficulty remembering, concentrating and
ADHD involves cognitive and behavioral aspects concentrating on ADHD. Then research conducted by
with impairments in many envi-ronments of children (Ray, 2008) play therapy researchers with the title
and their families’ lives. Music, with its playful, “Impact of play therapy on parent-child relationship
spontaneous, affective, motivational, temporal, and stress a mental healt training setting” states that play
rhythmic dimensions can be of great help for studying therapy empirically been validated as an effective
the aspects of time processing in ADHD. In this intervention to mengtasi children's problems
article, we studied time processing with simple sounds especially ADHD. In addition, research conducted by
and music in children with ADHD with the hypothesis (Burtch, 1999) play therapy researcher with the title
that children with ADHD have a different “The use of play therapy in the private clinical
performance when compared with children with setting” states that play therapy is the most possible
normal development in tasks of time estimation and method to treat and also widely used and accepted in
production (Carrer, 2015). handling children's problems. child.
And research conducted by (Ray, Bratton, Rhine,
& Jones, 2001) play therapy researcher with the title
“A meta-analysis of the play therapy outcome
research from 1947 to Present” stated that play
therapy gives a large positive effect based on the
results treatment across the population, sex, clinical
and non-clinical populations, the environment and on

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theoretical thinking. In addition, the positive effects of METHOD

play therapy can be greater if there is a parent fully
involved in child care. Some play techniques can be The method used is journal literature or literature
used to deal with ADHD children, playing “tower review.
building” for example can be used to improve focus
and concentration. Playing "where my house" for CONCLUSION
example can be used to control behavior in rough
motor, so the child can increase the intensity of his Based on the above description it can be
attention more focus on game game given by concluded that the researchers token economy is a
researcher. much intervention done and provide significant results
to increase attention of children ADHD. Then
3. Music and Sound playtherapy is also able to increase attention to
ADHD children by combining with other therapeutic
Russell A. Barkley (Benzon, 2002) argues that techniques. While Music and Tone also give
ADHD is essentially disoriented in time. This note significant results only still less researchers do this
explores the possibility that music, which is well research.
tuned in favor of temporal cognition, may play a role
in improving ADHD. However, given the fact that REFERENCE
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