Loneliness in Adolescents with Attention Deficit Hyperactivity Disorder (ADHD)

Introduction: Attention deficit hyperactivity disorder is a disorder of children’s growth and development with neurodevelopmental disorders characterized by symptoms of inattention, hyperactivity, and impulsivity. ADHD in children can persist into adolescence in about 2.6% of the general population. About more than half of people with ADHD experience loneliness, a condition that is often not reported by patients but is evident in the negative emotions and behaviors they display. To explain the risk factors and impact of loneliness in adolescents with ADHD. Methods: Literature review. Results: The use of gadgets in today’s digital era increases the risk of increasing internet usage so that more contact is made online, which causes obstacles for adolescents in fostering social relationships and an increased risk of loneliness. Adolescents with ADHD have a negative assessment of themselves; they feel useless, lack confidence, and lack intelligence when compared to their peers. Economically, low-income family conditions and inappropriate parenting increase the risk of loneliness in ADHD adolescents. Adequate treatment will cause it to develop into other mental disorders such as anxiety, depression, defiant attitude disorder, and adolescent behavior disorder. Conclusions: Adolescents with ADHD are prone to experiencing loneliness. Parenting problems, family socioeconomics, past trauma, bullying, and several internal factors such as low self-confidence, insecurity, low adaptability, and lack of emotional control can cause loneliness.

Keywords: ADHD, Adolescents, Loneliness, Mental Health, Psychological Well-Being

INTRODUCTION

Attention Deficit Hyperactivity Disorder (ADHD) is a disorder of child development with neurodevelopmental disorders characterized by emotional symptoms, hyperactive behavior, and lack of focus. The prevalence of this disorder is about 3-7% in children in the USA. ADHD can persist into adolescence and even adulthood with a lower prevalence than in children[1]. The tendency to settle down until older people also exists, but with a smaller percentage than adults. The prevalence of ADHD in adolescents is about 2.6% in the general population. There are three typical symptoms in children with ADHD, namely inattention, hyperactivity, and impulsivity; in adolescents, the symptoms of hyperactivity and impulsivity decrease; inattention symptoms also decrease but often persist until adulthood. Gender also distinguishes the symptoms that are often seen in adolescents with ADHD. In men, the dominant symptoms are hyperactivity and impulsivity, while in women, the dominant symptoms of inattention are more visible. ADHD symptoms in high school- aged adolescents will affect their academic achievement at school and problems in their social environment[2]–[4].

Adolescents with ADHD will show unstable emotions where they are easily angry and aggressive with their family or friends. Parents who do not understand the condition or symptoms of ADHD in adolescents will sometimes get emotional and blame adolescents for ADHD. This condition will cause ADHD adolescents to become more aggressive; parents tend to ignore and allow their child’s behavior. Some parents feel upset and become indifferent to the dominant behavior of the child in the form of externalization. Adolescents with ADHD also tend to be shunned from social interactions with their friends due to the destructive and disruptive behaviors of their friends. ADHD adolescents will lose their attachment objects because their parents neglect them, in addition to feeling shunned and bullied by

their playmates. The risk of ADHD adolescents feeling lonely is increasing. About more than half of people with ADHD experience loneliness, a condition that is often not reported by patients but is evident in the negative emotions and behaviors they dis- play[1][3][5].

ADHD teens in today’s digital age are more focused and enjoy spending more time with their gadgets. Excessive use of gadgets often results in internet addiction in ADHD adolescents. There exists a bidirectional association between internet addiction and ADHD. Adolescents with ADHD have a greater risk of having internet addiction and prolonged use of the internet would make ADHD symptoms worse. Internet addiction causes people to forget about other activities, including socialization so that they tend to withdraw from society and will feel lonely, and vice versa; loneliness causes ADHD adolescents to become addicted to the internet. Loneliness is a feeling a person feels due to the absence of a close or good relationship with others. Loneliness can increase the risk of stress in adolescents, accompanied by anxiety and depression disorders and even suicidal behavior. Loneliness also causes a decline in their performance, and adolescents in school experience a decline in learning achievement. Loneliness almost mostly causes low self-well-being, both physical and psychological, and a decrease in quality of life. The impact is large and can last throughout the patient’s life, so it is necessary to understand that adolescents with ADHD have a risk of experiencing loneliness, which hurts the quality of life of adolescents with ADHD later[6]–[12].

Loneliness in ADHD Adolescents Adolescence is a transition phase from childhood to adulthood; in addition to changing the sense of responsibility, adolescents also have problems related to these changes. Adolescents begin to focus on their work or school, focus on finding their identity, and begin to leave their homes and families for education or work. These changes in terms of social environment and social contact tend to lead adolescents to the risk of feeling lonely. In addition to parents or older people, adolescents are also vulnerable groups who will experience loneliness. A study showed that around 51% of the population felt lonely, and the age at which they often felt lonely was 18-25 years old. In Indonesia, the loneliness rate was dominant in adolescents aged 18 to adults aged 24 years[5],[9]. Research in Jakarta found that adolescent girls have a higher prevalence of loneliness compared to adolescent boys[13].

Loneliness in adolescents increased in 2012 when, at that time, technology was developing rapidly, dubbed the digital era. Teenagers focus more on the world of social media than on real activities, so they seem to be isolated[9]. For adolescents with ADHD, the symptoms are psychomotor hyperactivity, shown by the inability to sit calmly, think a lot, and talk a lot; there is difficulty maintaining focus so it is not easy to listen and communicate sometimes inconsistent, as well as impulsivity disorders that appear from unstable emotions, ignorant behavior, and behavior that tends to hurt those around them[1]. Adolescents with ADHD also have problems with socialization with peers and the sur- rounding environment. Research on adolescents with ADHD found that more than 50% of ADHD children experience disorders in self-adjustment so that they have few friends and are unable to maintain friendship relationships, which causes feelings of loneliness in ADHD adolescents[14]. The rate of ADHD in the world has reached 5-13% in children and adolescents[1][9][15].

Loneliness is a complex emotional condition experienced by a person. Loneliness can be grouped into three groups.

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