Soni Mathunni, Sunita Sharma, Adarsh Kohli, Sandhya Ghai
Abstract : Attention Deficit Hyperactivity Disorder (ADHD) is the most commonly diagnosed neuropsychiatric disorders in children. The prevalence of ADHD in children is approximately 5% but it has not acknowledged adequate sensitivity in developing countries like India. Studies have shown that some ADHD children continue to reveal the symptoms in adulthood also. Boys outnumbered by a large margin (9%) as compared to girls in a clinical sample (3%).1-3 The present study was a descriptive study conducted for identification of ADHD among primary school children in the age group of 5-12 years in selected three Government schools in Chandigarh (UT) during July- September, 2016. Out of total 1605 primary school children 165 children were selected through stratified random sampling i.e. 5 from each class. The tool used was Vanderbilt ADHD diagnostic teacher rating scale. The results showed that almost 62.4% children were having the disorder whereas around 37.6% did not show any symptoms of the disorder and in the subtypes of ADHD, 32.7% of the children were having combined Inattentive/Hyperactive symptoms. In other co-morbid disorders, Oppositional Defiant disorder (ODD) /Conduct disorder was found in 46.7% of the children. The study concluded that the prevalence of ADHD among primary school children in selected schools of U.T. Chandigarh was found to be 37.8% and hence screening of the children was helpful for early identification of the disorder. Therefore, the study can prove beneficial for early behavioural management and academic interventions of the children identified with ADHD and referral of the clinically significant cases to the experts.
Primary school children,ADHD (Attention Deficit Hyperactivity Disorder), ODD (Oppositional Defiant disorder)
Dr. Sunita Sharma
National Institute of Nursing Education (NINE), PGIMER, Chandigarh
Mental health is one of the most crucial component in a child’s holistic development. Children who are mentally healthy have a constructive value in their lives and are able to perform their roles and functions well at home, in school or in community. Mental health problems occurs when a child is incapable of learning healthy behavioural/ social/coping skills or lags behind in achieving the developmental and emotional milestones necessary for problem solving. Recent evidence by WHO indicates that childhood neuropsychiatric disorders will upsurge proportionately by over 50% by 2020 and would be the most common foundation for illness, mortality and debility among children.4,5
ADHD is the utmost common neuro- developmental conditions of childhood. The DSM-Vdefines ADHD as a condition of repeated patterns of inattention and/or hyperactivity-impulsivity that interferes with functioning or development in which 6 or more of the symptoms have continued for at least 6 months to a degree that is inconsistent with developmental level and symptoms are present in 2 or more settings for e.g. at home, school, or work; with friends or relatives or in other activities which has a uninterrupted harmful impact on the social, academic or occupational functioning of the child and several symptoms necessarily have been present before the age of 12 years. 1,6
It is significant to recognize the early signs and symptoms of ADHD to avoid complications in later life. The recent trend in the field of mental health is a shift from hospital to community based care or community mental health which has mental health care in schools as one of the main components. A mental health professional can function much more effectively by taking care of both preventive and promotive aspects, by being sensitive to the presence of problems in mental health among school children in the schools, recognizing the needs and problems of such children and handling them effectively in the classroom or referring them to the experts at the right time. Hence, the current study was an endeavor by the researcher to promote early detection of ADHD cases among primary school children.
To determine the prevalence of attention deficit hyperactivity disorder among primary school children in selected three Government Schools of Chandigarh.
Materials and Methods
The study design is descriptive research and it was conducted among primary school children studying in 1-5th classes of selected three Government schools in Chandigarh (U.T.) Schools within 10 kms of PGIMER, Chandigarh were selected by simple random sampling technique (Lottery method) in which 1 school was senior secondary, 1 was middle school and the other was high school. Permission was obtained from the concerned authorities for conducting the study. Data was collected during the months of July-September, 2016 by using interview schedule which included socio- demographic profile of the children and Vanderbilt ADHD diagnostic teacher rating scale. Permission was obtained for using the scale. The scale is a standardized tool having 43 items with a likert scoring on two parameters-behaviour and performance (academic and classroom behavior) Consent was taken from the study subjects and their parents after explaining the purpose and procedure of the study. Respect of human dignity as well as anonymity and confidentiality of the subjects was maintained throughout. Data collection was done through observation of the children and interviewing the teachers as per interview schedule. After the data collection, data was coded, tabulated and analyzed by relevant descriptive statistics.
Table 1 depicts that 44.2 % of the primary school children were in the age group of 5-6 years, 29.7% were in age group of 7-8 years and 23% were in age group of 9- 10 years. Majority (77.6%)of the children were males and 33.3% of the children were studying in 1st grade.
Prevalence of Attention deficit hyperactivity disorder as per Vanderbilt ADHD diagnostic teacher rating scale
Figure 1 shows that among 165 children 62.4% were having the ADHD disorder whereas around 37.6% did not show any symptoms of the disorder as per Vanderbilt ADHD diagnostic teacher rating scale .
Table 1: Socio demographic profile of the Primary School Children
|Personal characteristics of children||n (%)|
Table 2 shows that among the subtypes of ADHD, 32.7% of the children were having combined inattentive/ hyperactive symptoms whereas only 18.2 % children were predominantly inattentive and only 11.5% children were predominantly hyperactive/ impulsive. In other co-morbid disorders, ODD/Conduct disorder was present in 46.7% of the c h i l d r e n w h e r e a s
Fig.1: Prevalence of Attention deficit hyperactivity disorder as per Vanderbilt ADHD diagnostic teacher rating scale
anxiety/depression symptoms were present in 31.5% children and 29.7% children also showed learning disability.
The subtype of ADHD, predominantly inattentive was more in the age group of 7-8 yrs (33.3%) and 9-10 yrs (36.6%), among male children (63.3%) and children of grade 3 (30%). Predominant hyperactive and impulsive children were mainly male (78.9%), in the age group of 5-6 yrs (68.4%) and studying in 1st grade (63.1%). Combined inattention/hyperactive was observed in higher percentage in 5-6 yrs old children (48.1%), male children (83.5%) and among 1st grade children (31.4%). Other Co-morbid disorders i.e. ODD/ Conduct, Anxiety/Depression was common among male children in age group of 5-6 & 7-8 yrs old children grade 1 children whereas learning disabilities were more common in 7-8 yrs of children (44.8%), males (81.6%) and among 3rd grade children (38.7%)
Table 2: Frequency of the Primary school children as per the subtypes of ADHD and other co-morbid disorders as per their socio demographic variables
|Subtypes of ADHD||Other Co-morbid disorders|
Table 3 depicts that almost 103 children had ADHD symptoms and 62 children were not having the disorder. Majority of the symptoms were seen in the age group of 5-6 years in which most of them (76.6%) were males and about 33.9 % children were studying in 1st school grade. There was no statistical significant difference (p value >0.05) between scores of the children on Vanderbilt ADHD diagnostic teacher rating scale and their age (p=0.35), gender (p=0.72) and school grade (p=0.25)
Table 3: Association of the mean score of Primary School Children with their socio demographic variables
|Personal characteristics of children||ADHD||2
z , df value
|Absent (%) n=62||Present (%) n=103|
**Statistically significant (p<0.05), NS: Statistically not significant (p>0.05)
ADHD is the utmost common mental illness in childhood. This disorder is associated with the core symptoms of inattentiveness, hyperactivity and impulsivity and a range of disturbing classroom behaviors (e.g., shouting out, leaving seat, disturbing activities etc.). Also they may present with wide range of impairments affecting multiple domains of psychopathology such as cognition, interpersonal, school, and family functioning. Additional difficulties resulting from secondary problems often develop in later life. These difficulties include low self- esteem, poor academic performance and poor interpersonal skills. Subsequently, it is not unanticipated that these students are at susceptibility for school failure. Sometimes the parents are also uninterested and hostile to discuss their children’s mental health issues. It has been seen that it is important to recognize, suspect or diagnose ADHD as these symptoms usually disturb the academic performance or disrupt the rest of the class. Furthermore, the diagnostic criteria in the DSM for Mental Disorders requires that the symptoms of hyperactivity- impulsivity or inattentiveness should be present in two or more settings for e.g., at school and at home.7-10
There are many scales available to screen the children with this disorder and the most commonly used scales are Vanderbilt ADHD diagnostic teacher rating scale, Conners teacher rating scale, ADHD rating scale, Behavior assessment system for children, SNAP-IV teacher rating scale. Various studies have been conducted in India by using Vanderbilt ADHD diagnostic teacher rating scale. A study conducted by Khemakhem K et al in 2015 used the Conners questionnaire on 513 school children aged 6 and 12 years old for other Indian studies have shown prevalence rates ranging from 9%-14%.11,14 However in the current study the prevalence rate was comparatively higher and the clinically significant cases were referred to the experts in the field of psychiatry in PGI.
In a study conducted by Malhi P et al (2000) at Psychology Outpatient services identification of ADHD.11 However, in the using DSM-1V based questionnaires the present study, Vanderbilt ADHD diagnostic teacher rating scale was chosen as it is based on DSM-5 criteria and it assesses the children on two parameters-behaviour and performance both academic and classroom behavior and it is also applicable to diverse age groups ranging from preschoolers to adolescents.
A study was conducted by Naik A et al (2016) in Rourkela, Odisha on prevalence of ADHD in a rural Indian population by using Vanderbilt ADHD diagnostic teacher rating scale for the adolescents in the age group of 8-15 years. The results showed that the male: female ratio in children with ADHD was 2:1 and among the 42 identified ADHD students, 16 students were predominantly inattentive and 26students were having combined subtype.12 However, in the present study, the male: female ratio was a little higher i.e .approximately 3:1 and among the 103 identified ADHD children, 30 children were predominantly inattentive whereas 54 children were having combined subtype of ADHD.
In a study done by Shabana S in Nellore on prevalence of ADHD among 100 primary school children aged 5-12 years concluded that among 100 children, 35% children had ADHD symptoms.13 Our findings were little higher as compared to this study. Some parents and teachers reported behavioural problems in 60% of the ADHD children including non-compliance, aggressiveness, destructive-ness, temper tantrums, bed wetting, thumb sucking, nail biting, lying and stealing. All the identified children (100%) had ADHD-Combined Type who showed more of the problem behaviours while 70% of the children had ADHD- Hyperactivity and 29% of the ADHD- Attention deficit also had behavior problems15 In the present study , behavioural problems such as forgetfulness, fearful of making mistakes, difficulty sustaining attention, fidgeting with hands,non compliance with adult’s requests and easy distraction were reported by teachers in 32.7% children. Almost 62.4% children were identified as having the disorder with almost 32.7% of the children showing combined inattentive/hyperactive symptoms while 18.2% children were predominantly inattentive and 11.5% were having predominantly hyperactive symptoms as per the Vanderbilt ADHD diagnostic teacher rating scale.
A continuing medical education cum workshop on skill building for assessment and management for ADHD was conducted in PGIMER whereby experts said that nearly 40 new ADHD cases among children are reported in a week at the child and adolescent psychiatric clinic.16 In the present study, out of 165 children, 62.4% had ADHD i.e. 103 children. From the results of this study, it was found that the prevalence of ADHD among primary school children in selected schools of U.T. Chandigarh was found to be 37.8% and the study was helpful in screening children for early identification of the disorder as many of the children remain undetected due to ignorance of the problem behavior. Hence, the study can prove beneficial for behavioural management and academic interventions (curriculum adaptations) of the children identified with ADHD at an early stage. A similar study can be replicated in other settings e.g. other Government and private schools with a large sample and a longer duration observation of the students to support the findings. In addition, the study can help in sensitizing the teachers regarding the presence of mental disorders among children and help them to make appropriate referrals of the children having problem behaviour to an expert. Also the needs of such children can be better understood and met in future.
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- Shastri P, Shastri J, Shastri Research in child and adolescent psychiatry in India. Indian J. Psychiatry. 2010 Jan; 52(Suppl1): S219–S223.
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- Khemakhem K, Ayadi H, Moalla Y, Yaich S, Hadjkacem I, Walha A et al. Attention deficit hyperactivity disorder at schools in sfax- Tunis Med. 2015 May; 93 (5) : 302-307.
- Naik A, Patel S, A Biswas.Prevalence of ADHD in a rural Indian population.IJMHS.2016 Mar-Apr 2; 6:45-46
- Shabana Prevalence of attention deficit hyperactivity disorder among children in selected schools at Nellore. Narayana Nursing Journal. 2014;3(2):43-45.
- Manjunath R, Kishor M, Kulkarni P, Shrinivasa B, Sathyamurthy S. Magnitude of attention deficit hyper kinetic disorder among school children of Mysore IntNeuropsychiatr Dis J. 2015 Nov 21; 6(1):1-7.
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