AİLE-ÇOCUK ETKİLEŞİM TERAPİSİNİN (AÇET) DİKKAT EKSİKLİĞİ HİPERAKTİVİTE BOZUKLUĞUNA SAHİP BİR ÇOCUK ÜZERİNDEKİ ETKİLERİ

Abstract

THE EFFECTS OF PARENT–CHILD INTERACTION THERAPY (PCIT) IN A CHILD WITH ATTENTION DEFICIT HYPERACTIVITY DISORDER

Parent training programs have proven the most effective way to treat child behavior problems. Without effective treatment, disruptive or problem behavior problems related long-term outcomes include academic difficulties in late school years unemployment, family problems, and mental health problems such as depression, anxiety disorders, addiction, and antisocial personality disorders. Additionally, maltreated children have high rates of physical aggression, noncompliance, and antisocial behaviors. These children exhibit an array of problem social behaviors, which includes poor emotional regulation, distractibility, negative affect, and a resistance to following directions. As an urgent need, a variety of psychotherapies have been developed to improve the well-being of these children and their families. Parent–Child Interaction Therapy (PCIT) is an evidence-based approach and commonly used by clinicians to treat externalizing behavior problems. By training parents, it is possible to enhance abusive parents’ functioning, reduce negative parenting, and increase the numbers of positive interactions, resulting in better outcomes for children. Also, with PCIT it possible to educate parents about appropriate developmental expectations, child management strategies, and increase parents’ self-awareness because dysfunction in the parent-child relationship may cause problem behaviors in children. In order to overcome dysfunction in the parent-child relationship ‘Coercion hypothesis’ can be used for the development and maintenance of deviant behaviors in the child and the disrupted parent-child relationship. According to this hypothesis, parents and children establish a pattern of interaction in which parents escalate their disciplinary strategies over time to include harsh and abusive actions to keep pace with their children’s similarly escalating aversive responses. PCIT involves two phases, the first phase is child-directed interaction (CDI) and it aims to encourage warm, secure, caregiver–child relationships including praise, verbal reflection, imitation, behavioral description, and enjoyment. The second phase is parent-directed interaction (PDI), and it aims to increase child compliance and decrease disruptive behaviors. Specifically, we address the following research questions in an 8 year old boy with ADHD: (1) What are the effects of PCIT in reducing child’s disruptive behavior problems? (2) What are the effects of PCIT on other, related child and parent outcomes? In order to observe the change in disruptive behavior problems a single subject design was used with the addition of pre-posttest applications (State-Trait Anxiety Inventory for Children and Rorschach Inkblot Test). First results put forward positive results where participant’s parents reported significant more improvements in terms of child disruptive behavior problems. The child showed an adaptive approach. He achieved secondary gains by ensuring his participation in the process and was able to communicate positively with his mother. The mother has improved her intellectual capacity about situations like recognizing the distinction between prohibitions and restrictions. Additionally, she was able to put well developed sexual borders, and raised the level of awareness of the situation that exposed the child to anxiety. Final results of the study show that the PCIT is effective in reducing destructive behavior problems, supporting parental interactions in a positive way, supporting the positive change of the home atmosphere and family wellbeing, and establishing an independent individual by making a healthy separation of the participant from the mother possible.

Key words: Parent–Child Interaction Therapy, ADHD, disruptive behavior problems, projective tests

ÖZ

Ebeveyn eğitim programları çocuk davranış problemlerinin üstesinden gelmek için yararlanılan kanıtlanmış en etkin yolardan biridir. Etkili sağaltımlar kullanılmaksızın rahatsız edici veya problem davranış olarak saptanan istenmeyen davranışların uzun dönemdeki etkileri arasında daha sonraki okul yıllarında yaşanma ihtimali olan akademik zorlukları, işsizliği, aile problemlerini, depresyon, kaygı bozukluğu, madde kullanımı ve anti-sosyal kişilik bozuklukları gibi zihinsel sağlık problemlerini sayabiliriz. Ek olarak uygun olmayan iletişim tekniklerine maruz kalan çocukların fiziksel saldırganlık, uyumsuzluk ve anti-sosyal davranış oranlarının da yüksek olduğunu söylemek mümkündür. Bu çocuklar zayıf duygusal düzenlilik, dikkati dağıtma, olumsuz etki ve takip eden yönergelere karşı direnç içeren bir dizi problem sosyal davranışları sergiler. Bu çocuklar zayıf duygu kontrolü, kolay dikkat dağılması ve yönergelere karşı direnç gösterme gibi bir dizi problemli sosyal davranışlar sergileyebilmektedirler. Acilen bir ihtiyaç olarak, bu çocukların ve ailelerinin iyi olma hallerini iyileştirmek için çeşitli psikoterapiler geliştirilmiştir. Aile-Çocuk Etkileşim Terapisi kanıt temeli bir yaklaşım olup klinisyenler tarafından dışa dönük davranışlar sergileyen çocuklar üzerinde sıklıkla kullanılan teknikler arasında yer almaktadır. Ebeveynleri eğiterek, kötüye kullanılan aile işleyişini olumluya çevirmek, olumsuz ebeveynlik etkileşimlerini azaltarak olumlu etkileşim sayısını artırmak, böylelikle çocuklar için daha iyi sonuçlar elde etmek mümkün olabilmektedir. Ayrıca, AÇET ile ebeveynleri uygun gelişim beklentileri, çocuk yönetim stratejileri hakkında eğitmek ve ebeveyn-çocuk ilişkisindeki işlev bozukluğu çocuklarda sorun davranışlarına neden olabileceği için ebeveynlerin benlik bilincini arttırmak da mümkün gözükmektedir. AÇET iki aşamayı kapsar; birinci evre, çocuklara yönelik etkileşim olup, övgü, sözlü yansıtma, taklit etme, davranışsal tanımlama ve keyif gibi sıcak, güvenli, ebeveyn-çocuk ilişkilerini teşvik etmeyi amaçlar. İkinci aşamada ebeveyn yönlendirmeli etkileşim uygulanmaktadır ve bu aşamada çocukların uyumluluğunu artırma ve yıkıcı davranışları azaltma amaçlamaktadır. Araştırmada, dikkat eksikliği ve hiperaktivitesi olan 8 yaşındaki bir erkek çocukta aşağıdaki araştırma sorularına yanıt aranmıştır: (1) AÇET’in çocuğun yıkıcı davranış problemlerini azaltmaya etkisi nedir? (2) AÇET’in, ilgili diğer çocuk ve ebeveyn sonuçları üzerindeki etkileri nelerdir? Yıkıcı davranış problemlerindeki değişimi gözlemlemek için, tek denekli araştırma modelinden ve buna ek olarak ön test-son test (Çocuklar için Durumluk Sürekli kaygı Envanteri ve Rorschach MürekkepTesti) sonuçlarından yararlanılmıştır. Araştırma sonuçları, AÇET’in katılımcının yıkıcı davranış problemlerini azaltmada etkili olduğu, ebeveyn etkileşimlerinin olumluya dönmesinde destek sağladığı, ev atmosferinin ve ailenin iyi oluş halinin olumlu değişimine destek sağladığı ve katılımcının anneye bağımlı olma durumundan sağlıklı şekilde ayrılarak, bağımsız bir birey olma yapılanmasını oluşturmaya yönelik harekete geçtiği gibi gelişmeleri ortaya koymaktadır.

Anahtar kelimeler: Ebeveyn-Çocuk Etkileşimi Terapisi, dikkat eksikliği hiperaktivite bozukluğu, yıkıcı davranış problemleri, Projektif testler

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