|Year : 2022 | Volume
| Issue : 3 | Page : 96-101
Understanding daily routine and schedule of children with attention-deficit hyperactivity disorder: A qualitative study
Divesha Shikerkar1, Pooja Vivek Vajaratkar2
1 Department of Paediatrics, Goa Medical College, Bambolim, Goa, India
2 Department of Orthopedics, Goa Medical College, Bambolim, Goa, India
|Date of Submission||31-Jan-2021|
|Date of Acceptance||10-Jul-2022|
|Date of Web Publication||16-Nov-2022|
House No. 92, Dilasa Building, Kapileshwari, Ponda - 403 401, Goa
Source of Support: None, Conflict of Interest: None
Background: Attention-deficit hyperactivity disorder (ADHD) is characterized by diminished sustained attention, hyperactive and impulsive behavior and is known to have an impact on the daily routine and self-regulation of children. There is a dearth of evidence for understanding the routine of the children with ADHD and their parents, which is necessary for organizing and scheduling the routine for the better management of daily occupations. Objectives: This study aimed to understand the daily routine and schedule of children with ADHD in Goa. Study Design: A qualitative, descriptive study design was conducted. Methods: This pilot study was conducted in resource rooms and schools in Goa, India. The recruitment of 10 parents of children with ADHD was done by the convenient sampling method and parents were administered a semi-structured questionnaire and in-depth interview was undertaken to understand the children's daily routine. Results: Ten parents (mean ± standard deviation [SD] age 45.4 ± 7.97 years) of children with ADHD (mean ± SD age 9.5 ± 1.85 years) participated in this study. The study understood and described in depth the extent of the organized schedule and routine present, child's home and school routine and schedule, how the routine of the child affects the child and the family in terms of their socialization and how important is a routine for the family. Conclusion: The study inferred that the parents of children with ADHD have difficulty in managing the daily routine of their child at home as well as in school, including the self-care routine, meal-time, bed-time routine, and study schedule. The study helped understand the importance of an organized routine with a well-defined structure in the daily life to carry out timely meaningful occupations.
Keywords: Attention-Deficit Hyperactivity Disorder, Daily Routine, Occupations, Schedule
|How to cite this article:|
Shikerkar D, Vajaratkar PV. Understanding daily routine and schedule of children with attention-deficit hyperactivity disorder: A qualitative study. Indian J Occup Ther 2022;54:96-101
|How to cite this URL:|
Shikerkar D, Vajaratkar PV. Understanding daily routine and schedule of children with attention-deficit hyperactivity disorder: A qualitative study. Indian J Occup Ther [serial online] 2022 [cited 2022 Nov 30];54:96-101. Available from: http://www.ijotonweb.org/text.asp?2022/54/3/96/361347
| Introduction|| |
Attention-deficit hyperactivity disorder (ADHD) is a neuropsychiatric condition affecting preschoolers, children, adolescents, and adults characterized by a pattern of diminished sustained attention, and impulsivity or hyperactivity in their behavior, occurring in 3% of school-age children with males affected more than females. The symptoms usually begin before the age of 12 years, and the diagnosis is made from 4 years to 16 years. The symptoms are usually long-lasting and impair the functioning and development of children.,, The children show disinhibition in social relationships and poor adherence to social norms, and lack of caution with low self-esteem.
ADHD has an impact on the quality of life, routine and daily activities of children and their family, irrespective of their cultural boundaries. A child with ADHD has difficulties in managing the chores, scheduling the daily activities and significant impairments in occupational performance,,, with difficulties to fit in at school, restless behavior, and failure to finish the classwork are also present in children with ADHD.,,
The impact on child's routine and daily functional performance is believed to be due to the presence of core symptoms of ADHD,,, deficits in sensory processing abilities, and/or poor time processing abilities and daily time management skills. Children with ADHD having sensory processing disorder can show inattentive and impulsive behavior leading to functional impairment in family, school, life skills, and social activities due to too little or too much sensory system input.
An occupational therapists' role is to manage the engagement of children with ADHD in their daily functional performance efficiently by managing their sensory system issues,, managing their time processing abilities and daily time management skills, and by providing an organized structure to manage their self-care, dinner-time, and bed-time routine.
It is of utmost importance to understand the daily routine of children with ADHD thoroughly to be able to provide assessment and intervention to effectively manage the routine and schedule with a focus on the areas affected. Hence, the objective of this study was to understand the daily routine and schedule of the children with ADHD.
| Methods|| |
The present study was conducted on parents of children with ADHD residing in Goa, India, after its approval and ethical clearance from the Institutional Ethics Committee at Goa Medical College, Goa (dated February 07, 2020), over a period of 6 months, using the qualitative descriptive study design., The participants in the study were provided with comprehensive information about the study and informed written consent was obtained from all parents, before recruitment.
Ten parents (n = 10) of children with ADHD currently residing in Goa were recruited for the study using a convenient sampling method. Parents of children aged from 7 to 12 years and diagnosed with ADHD, going to schools with resource rooms were included in the study. Whereas children not in accordance with the diagnostic criteria of ADHD, suffering from other diseases that seriously affect their quality of life and children and going to special schools were excluded from the study. The sample size was determined by data saturation and when the repetition of salient points was achieved.,
Face-to-face in-depth interview in the English language was conducted over a varied duration ranging from 30 min to 1 h with parents of children with ADHD using a semi-structured questionnaire consisting of open- and closed-ended questions, developed based on the review of literature and included the demographic information and description of the child's daily routine and schedule by the parent and consisted of questions about child's home routine, school routine, and the time structure child followed. The questionnaire also considered how important is the routine for the family's and the child's functioning. The interview was conducted with consent audio-taping (n = 02) or a pen and paper administration (n = 8). The analytic process is shown in [Figure 1].
The author and co-author of this study transcribed the interviews, and meaningless utterances were eliminated to aid in the clarification of analysis and readability. The interview recordings were transcribed from audio files and from the paper forms to elaborate the written documents by the author. Thematic analysis was used. The interview themes were developed iteratively, starting with a set of questions by the authors [Annexure 1]. Information in each interview and the entire collected data were organized.
The data were organized and codes from the data were identified by both the authors using the manual method of coding on the Excel sheet. The transcripts were analyzed and the final coding system was formulated using inductive coding and themes were formulated according to the codes identified. The codes were refined in an iterative manner and four major themes were identified to describe the data obtained from the in-depth interviews.
The analysis aimed at in-depth description of the understanding of the structure of routine, home and school routine, effect of the routine on child and the parents and importance of routine in daily life of parents and children with ADHD.
| Results|| |
Demographic Characteristics of Parent and Child Participants
A total of 10 parents [Table 1] (age in years, mean ± standard deviation [SD]: 45.4 ± 7.97) of children with ADHD (age in years, mean ± SD: 9.5 ± 1.85) were interviewed for this study. All results are presented in an anonymous fashion with the least possible identifying, and the confidentiality of the obtained information is maintained. This study describes the understanding of the daily routines and schedule of children with ADHD.
Four key themes [Table 2] emerged from the data analysis: (i) structure of routine; (ii) home and school routine; (iii) effect of this routine on the child and parents and changes expected; and (iv) importance of routine in daily life.
Structure of Routine
As reported by all the parents (n = 10), their child had no fixed routine for daily chores, no fixed free time/playtime and parents reported of having a difficulty in managing the daily routine and schedule of their child.
“She/he doesn't realise the time to do any chores and keeps on running around in the house unless I force her to do her work.”
Most of the parents (n = 8) said that the child carries out all his/her daily routine activities only when provided with continuous verbal cues and the children do not follow the commands of their parents.
“He is free whenever he wants to be, he gets irritated if I try to limit/restrict his free time/playtime.”
“He escapes the house if I reduce his free time.”
Few of the parents (n = 6) said that their child does not like following any daily routine and escapes from the house and goes to play when he is being asked to follow a certain routine.
Some of the parents (n = 6) also said that the child has most of the day as his/her free time/playtime. Most of the parents said that their child is okay if the routine is not followed up and he/she is set free throughout the day.
Routine in Home and School
As reported by all parents (n = 10), their child had difficulties in managing the routine at their house and in the school, with difficulties in carrying out self-care, mealtime, and bedtime activities and difficulty in being punctual and follow the study schedule in school.
All the parents (n = 10) reported that the child does not have any time to carry out his/her self-care, mealtime, and bedtime schedule, and takes very little or too much time to do daily routine tasks such as bathing, brushing, or eating.
“He eats when he feels like, doesn't do bathing if he doesn't wish and he does the routine activities only when asked or forced to do it.”
“He takes more than 30 minutes to bathe himself or to eat his food”
“He doesn't sleep at night, unless the lights are not put off”
Most of the parents (n = 9) said that their child keeps moving around in the house and does not go to bed until he/she is been put to bed, the lights are put off and either of the parent sleeps with the child.
Routine in School
All of the parents (n = 10) said that their child is not punctual to go to school and is late most of the times.
“He misses the bus and then I drop him to school.”
“Teacher always complaints to me that he keeps moving around in the class and tears the pages of his books.”
Some of the parents (n = 6) said that they get complaints from teachers as the child does not sit at one place, does not copy anything from the board or write in class and is always found hyperactive and running around. The child keeps tearing the pages of his notebooks and snatching everyone else's notebooks.
“He has to be forcefully made to sit to study, otherwise he is never willing to write.”
Effect of Current Routine on Parents and Children and Changes Recommended In Routine
Most of the parents (n = 8) reported of disturbed sleep and poor schedule of other family members and decrease in socialization, negligence toward other children, and imbalance in their family finances as some of the effects on their routine and as per the parents, this current schedule is affecting the child's productivity, behavior, and indirectly his/her future.
The changes most of the parents (n = 7) wanted in their child's routine included decrease in free time, structuring the daily routine, increase in study time, reducing the moving around and hyperactive behavior, and engaging the child as much as possible throughout the day.
“There is an impact on our financial condition.”
Some of the parents (n = 5) also expressed their concern on the financial condition of the family as the mother had to leave the job and stay at home to look after the child.
“I always have to leave the work I am doing and run behind him.”
“Because of his extra free time, he is hardly productive and keeps moving around.”
All of the parents (n = 10) said that their child needed some changes in their current routine.
“He has to structure his day, be productive and calm down.”
Few of the parents (n = 4) said that the child needs to change his current routine and follow a more structured and time-oriented schedule so that his hyperactivity reduces and academic performance improves.
Importance of Routine
All of the parents (n = 10) said that having a routine in life is very important.
The parents said that having a routine in life helps them have a balance in family and work life, plan things properly, have a discipline in life and shape behavior.
“A good and structured routines set a balance in life, thus shaping behaviour.”
Very few of the parents (n = 2) said that a good routine will help set a balanced life and shape the behavior of the children in the family as well as help the adults stay well-disciplined and well-mannered.
“A good routine helps inculcate good habits.”
One parent said that a good routine will help the child learn good habits in life such as punctuality, discipline, and being well-mannered.
| Discussion|| |
This study explored the daily routine and schedule of families of children with ADHD and the difficulties the parents faced to manage and structure their child's routine. The major finding of this study was parents' difficulties in managing the child for carrying out the daily life activities in managing self-care and bedtime routine. These findings were identical to another study in which the parents reported that ADHD children experienced challenges throughout the day from the morning until their bedtime and the parents had a tough time managing them for the child.
This study highlighted how the unstructured daily routine of poor self-care, bedtime, and mealtime of the child affected the parent's life leading to disturbed sleep schedule, lack of rest, poor socialization, financial difficulties, and negligence toward the other child in the form of lack of attention and affection. The data from this study also indicated that the current routine of the child with ADHD had altered the routine of the child, parents as well as other family members, thereby hampering the performance of productive and meaningful occupations. These findings are complementary to the research conducted on the responses of the preschool children with and without ADHD to sensory events in the daily life which states that the level of hyperactivity in ADHD led to an impact on their daily life and meaningful occupations.
The finding of this study also revealed some of the school routine difficulties of children such as poor punctuality, poor study schedule, mischievous, and hyperactive behavior. This was closely resembling the study conducted in Goa which revealed that problems in academic performance or the child's mischievous school behavior were one of the main concerns of parents for which they wanted to seek the help of the professional.
The study also stated the importance of routine for the parents and family members as something that balances the life of their child, helps plan ahead, have a disciplined life, and shape behavior for a bright future. This is complementary to another study conducted which also spoke about the routine skills to be developed in children anticipating the near future of the child and the routine skills parents wished to facilitate in a child to enhance his/her future.
The findings of this study also highlighted the parent's consideration of the routine of the child and their own self. The study findings identified the areas problematic for the parents to be managed, which needed some coping strategies, routine building strategies, or intervention planning.
Research Implications and Limitations
This study will help occupational therapists to develop an assessment tool for the evaluation of the daily routines and schedules in children with ADHD and help to have an intervention to manage the affected routine areas.
There are limitations in this study as well as in the generalizations of the findings of the study due to the specific context (in Goa) and comparatively small study group and due to the inability to randomize the sample recruiting method. The family profile and socioeconomic status of the families recruited for the study are also one of the limiting factors in the study. The semi-structured questionnaire developed with the help of the existing literature is not validated for this pilot study.
This indicates the need for carrying out an extensive future research with a large randomized sample size in the field of daily routine and schedule in children with ADHD for stronger evidence in this area.
| Conclusion|| |
Overall, this is pilot research in understanding the daily routine of children with ADHD. The study inferred that the parents of children with ADHD have difficulty in managing the daily routine of their child at home as well as in school, including the self-care routine, meal-time, bedtime routine, and study schedule. This altered the family's way of living and socialization. The study also discovered the effect of this routine on the child as well as the parents and helped understand the importance of routine in the daily life to carry out meaningful occupations.
Financial Support and Sponsorship
Conflicts of Interest
There are no conflicts of interest.
| Annexure|| |
Annexure 1: Semi-Structured In-Depth Interview Guide
A. Demographic Information about Participants
- Name of the child:
- Date of birth:
- Age of the child at the time of diagnosis:
- Name of the participant:
- Age of the participant:
- Gender of the participant:
- Contact number:
- Relationship with the child:
- Consent: Yes/No
2. Semi-Structured Qualitative Questionnaire
- Describe your child's routine from morning till night on:
- A weekday
- A weekend
- Does your child have a fixed timing for his/her? Self-care tasks such as bathing, eating
- Getting up in the morning and going to bed (fixed bed-time)
Does your child have a free time/play time in his/her daily routine?
If yes, is the free time fixed?
Is your child punctual to go to school? Is he/she regular in school?According to you, does your child have a fixed routine? Yes, or No?Do you feel that your child needs some changes in his/her current routine?Does your child get restless or upset when his/her day's routine is not followed up?How does your child's routine affect yours or your family's routine?According to you, how much is it important to have a routine?How does a fixed routine help your child and you?
| References|| |
Sadock B. Synopsis of Psychiatry. 11th
ed. New York: Wolters Kluwer; 2015.
Ahuja N. A Short Textbook of Psychiatry. 6th
ed. New Delhi: Jaypee Brothers Medical Publishers; 2006.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th
ed. Washington DC: American Psychiatric Publishing; 2013.
Case-Smith J. Occupational Therapy for Children. 6th
ed. Maryland Heights: Mosby/Elsevier Publication; 2010.
World Health Organization. ICD-10- Classification of Mental and Behavioural Disorders. 10th
ed., Geneva: World Health Organization; 2004
Riley AW, Spiel G, Coghill D, Döpfner M, Falissard B, Lorenzo MJ, et al.
Factors related to health-related quality of life (HRQoL) among children with ADHD in Europe at entry into treatment. Eur Child Adolesc Psychiatry 2006;15 Suppl 1:I38-145.
Yochman A, Parush S, Ornoy A. Responses of preschool children with and without ADHD to sensory events in daily life. Am J Occup Ther 2004;58:294-302.
Justesen T. Teaching Children with Attention Deficit Hyperactivity Disorder. U.S.A: Education Publications Centre; 2004.
Minnesota Brain Injury Alliance. Routine Building Strategies. Minnesota: MBI publication; 2011.
Wennberg B, Janeslätt G, Kjellberg A, Gustafsson PA. Effectiveness of time-related interventions in children with ADHD aged 9-15 years: A randomized controlled study. Eur Child Adolesc Psychiatry J 2018;27:329-342.
Spagnola M, Fiese B. Family routines and rituals – A context for development in the lives of young children. Infants Young Child 2007;20:284-299.
Aspers P, Corte U. What is qualitative in qualitative research. Qual Sociol J 2019;42:139-160.
Ragin CC, Nagel J, White P. Workshop on Scientific Foundations of Qualitative Research. Virginia: National Science Foundation; 2004.
Dhar R. Living with a developmentally disabled child: Attitude of family members in India. Soc Sci J 2009;46:738-755.
Cropley A. Qualitative Research Methods: A Practice-Oriented Introduction for Students of Psychology and Education. 2nd
updated, revised, and enlarged ed. Riga, Latvia: Zinātne; 2019.
Schaaf RC, Toth-Cohen S, Johnson SL, Outten G, Benevides TW. The everyday routines of families of children with autism: Examining the impact of sensory processing difficulties on the family. Autism 2011;15:373-389.
Coghill D, Soutullo C, d'Aubuisson C, Preuss U, Lindback T, Silverberg M, et al.
Impact of attention-deficit/hyperactivity disorder on the patient and family: Results from a European survey. Child Adolesc Psychiatry Ment Health 2008;2:31.
Wilcox CE, Washburn R, Patel V. Seeking help for attention deficit hyperactivity disorder in developing countries: A study of parental explanatory models in Goa, India. Soc Sci Med 2007;64:1600-1160.
Kellegrew DH. Constructing daily routines: A Qualitative examination of mothers with young children with disabilities. Am J Occup Ther 2000;54:252-259.
[Table 1], [Table 2]