Relationship between self-injurious behavior, cognitive flexibility and pharmacological treatment in adolescents with attention deficit hyperactivity disorder

Aim: Our study aimed to evaluate the relationship between self-harming behavior, cognitive flexibility, self-compassion and pharmacological treatment in adolescents diagnosed with Attention Deficit Hyperactivity Disorder. Materials and Methods: Our study included 63 patients diagnosed with ADHD who applied to child and adolescent psychiatry and were found to be suitable for the study conditions (33 patients who had received ADHD treatment for at least 6 months and 30 patients who had not received ADHD treatment) and 60 healthy young people with similar demographic characteristics. Participants and their families were informed about our study and written informed consent was obtained from them. All young people were evaluated using the "Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version-Turkish Version" (ÇDŞG-ŞY-T). The young people were administered the 'Cognitive Flexibility Scale' (CFS), the 'Self-Compassion Scale' and the 'Self-Harm Behavior Assessment Inventory' (SBAAS). Results: It was found that patients with ADHD exhibited self-harming behavior more frequently than participants in the control group. Untreated ADHD patients had higher expectations and/or searches for self-harming behaviors and regulating interpersonal relationships than treated ADHD patients, and it was also understood that these untreated patients continued their harmful behaviors due to their autonomic regulatory benefits despite the increase in their awareness of options. Although the consciousness levels of patients who met the ADHD diagnostic criteria and did not receive treatment for the diagnosis increased, patients continued their self-harming behaviors due to some interpersonal functions. In young people with ADHD who received treatment and self-harmed, it was found that the nature of the harmful behavior to take revenge on the environment decreased with the increase in cognitive flexibility and self- efficacy levels, and as awareness of options increased in these young people, self-harm for the purpose of gaining and protecting autonomy decreased. Self-sensitivity levels of adolescents with ADHD were lower than those in the control group, and cognitive flexibility-self-efficacy levels were lower in the untreated ADHD group compared to the control group. In all three groups, participants' cognitive flexibility and self- compassion scores were found to be positively correlated. Conclusion: Drug treatment initiated for ADHD adolescents who exhibit self-harming behaviors can prevent factors that motivate and maintain behaviors by supporting cognitive flexibility and self-awareness skills. In addition, interventions to develop cognitive flexibility and self-awareness skills can be effective in the management and prevention of behavior in all adolescents with self-harming behaviors. Our results will help us make inferences on skill training and medical interventions that can be applied for follow-up and protection purposes in these cases. Longitudinal studies are needed to clearly understand the effects.