Bobot Pengaruh Cognitive-Behavioral Play Therapy (CBPT) Terhadap Masalah Perilaku Anak Attention Deficit Hyperactivity Disorder (ADHD) di RSJ PROF. DR. Soerojo Magelang

Ressa Nurzakiyah Z, Dr. dr. Budi Pratiti, Sp.KJ / Dr. dr. Carla R. Marchira, Sp.KJ(K)

2023 | Tesis-Spesialis | SP PSIKIATRI

Latar belakang: Attention Deficit Hiperactivity Disorder (ADHD) merupakan gangguan perkembangan saraf umum pada anak, dengan gejala utama berupa inatensi, hiperaktif, dan impulsif. Sekitar 79% gejala ADHD menetap sampai dewasa dan akan memengaruhi pencapaian akademi, interaksi sosial, dan well-being. Tatalaksana ADHD meliputi medikamentosa (seperti methylphenidat, amphetamin, guanfacine, atomoxetin) dan non medikamentosa (seperti terapi perilaku, pelatihan, bermain dan aktivitas fisik). Cognitive Behavioral Play Therapy (CBPT) merupakan perpaduan dari Cognitive Behavioral Therapy (CBT) dan terapi bermain yang bertujuan mengubah persepsi disfungsional tentang diri, masa depan dan lingkungan sekitarnya sehingga tercipta perilaku yang lebih adaptif. Perpaduan bermain dalam terapi ini akan membuat anak terlibat aktif dalam proses terapi, mendorongnya untuk menjalani dan mempertahankan melakukan terapi. Diharapkan jika intervensi CBPT efektif, dapat digunakan sebagai salah satu terapi adjuvan ADHD sehingga risiko efek samping akibat pemakaian obat jangka panjang bisa diminimalisir.

Tujuan Penelitian: Mengukur bobot pengaruh CBPT terhadap masalah perilaku pada anak dengan ADHD di RSJ Prof. Dr. Soerojo Magelang.

Metode: Penelitian quasi eksperimental nonequivalent control group design pada anak dengan ADHD di RSJ Prof. Dr. Soerojo Magelang. Responden penelitian adalah anak ADHD usia 7-14 tahun (usia Sekolah Dasar) yang menjalani rawat jalan di Instalasi Kesehatan Jiwa Anak dan Remaja RSJ Prof. Dr. Soerojo Magelang. Kelompok kontrol mendapatkan terapi standar ADHD (methyphenidate), kelompok intervensi mendapatkan terapi standar dan 10 sesi CBPT. Masalah perilaku diukur dengan instrument Strengths and Difficulties Questionnaire (SDQ). Analisis data menggunakan Uji T-test dan Uji Regresi Linier Berganda. Tingkat kemaknaan uji < 0,05

Hasil Penelitian: Hasil:  Terdapat perbedaan bermakna rerata skor SDQ pada kelompok kontrol sebesar 3±1,061 dan intervensi 10 sesi CBPT sebesar 6,06±2,106 (n = 17, p < 0,001). Hasil uji Independent T Test mendapatkan beda selisih skor SDQ pada kelompok intervensi dan kelompok kontrol signifikan (p < 0,001).

Kesimpulan: Intervensi CBPT sebanyak 10 sesi setiap 1 minggu sekali berperan terhadap masalah perilaku (skor SDQ) pada anak dengan ADHD di RSJ Prof. Dr. Soerojo Magelang.

Background: Attention Deficit Hyperactivity Disorder (ADHD) is a common neurodevelopmental disorder in children, with main symptoms of inattention, hyperactivity, and impulsivity. Approximately 79% of ADHD symptoms persist into adulthood and will affect academic achievement, social interactions, and well-being. Treatment for ADHD includes medication (such as methylphenidat, amphetamines, guanfacine, atomoxetin) and non-medical (such as behavior therapy, training, play and physical activity). Cognitive Behavioral Play Therapy (CBPT) is a combination of Cognitive Behavioral Therapy (CBT) and play therapy which aims to change dysfunctional perceptions about oneself, the future, and the surrounding environment to create more adaptive behavior. The combination of play in this therapy will make children actively involved in the therapy process, encouraging them to undergo and maintain therapy. It is hoped that if the CBPT intervention is effective, it can be used as an adjuvant therapy for ADHD so that the risk of side effects due to long-term drug use can be minimized.

Objectives: Measuring the influence of CBPT on behavioral problems of children with ADHD at RSJ Prof. Dr. Soerojo Magelang.

Method: Quasi-experimental study with nonequivalent control group design in children with ADHD at Prof. Dr. Soerojo Magelang. The research respondents were children with ADHD aged 7-14 years (elementary school age) who were undergoing outpatient care at the Child and Adolescent Mental Health Installation at RSJ Prof. Dr. Soerojo Magelang. The control group received standard therapy for ADHD (methyphenidate), the intervention group received standard therapy and 10 sessions of CBPT. Behavioral problems were measured using the Strengths and Difficulties Questionnaire (SDQ) instrument. Data analysis using the T-test and Multiple Linear Regression Test. The significance level of the statistical test was stated at p < 0,05.

Results: There was a significant difference in the mean SDQ score in the control group of 3 ± 1.061 and the 10 sessions of CBPT intervention of 6,06 ± 2,106 (n = 17, p < 0,001). The results of the Independent T Test found that the difference in SDQ scores in the intervention group and the control group was significant (p < 0,001).

Conslusion: The CBPT intervention of 10 sessions once a week contributes to behavior problems (SDQ scores) in children with ADHD at RSJ Prof. Dr. Soerojo Magelang.

Kata Kunci : ADHD, Masalah perilaku, Play Therapy, CBPT