Online ISSN : 1687-8329

    




Quick Search 
 
Author  
Year    
Title  
Vol:  

 
 
July2005 Vol.42 Issue:      2 Table of Contents
Full Text
PDF


Prevalence of Attention Deficit Hyperactivity Disorder Among Elementary Schools Children in Assiut City-Egypt

Hamdy N. El-Tallawy1, Wageeh A. Hassan1, Abd El-Rakeep A. El-Behary2, Ghaydaa A. Shehata1
Departments of Neurology and Psychiatry1, Psychology, Faculty of Education2, Assiut University

ABSTRACT

Objective: To estimate the prevalence of ADHD among elementary schools children in Assiut City of both sex with age ranged from 8-10.5 years, and searching out the possible risk factors responsible for ADHD. Method: we studied 1513 students, distributed geographically.  The students were subjected to the following tools; Children's Attention and Adjustment Survey (school and house forms), WISC; Diagnostic criteria of DSM-IV (APA, 1994) for ADHD, social scale assessment, and a special questionnaire for detection of risk factors of ADHD Data were collected among one academic year. Results The study revealed that the prevalence rate of ADHD was 6% among elementary schools, the subtypes were: ADHD-predominant hyperactive-impulsive type 3.3%, ADHD-combined type 2%, and ADHD-predominant inattentive type 0.7%, male to female ratio was 1.5:1.  Risk factors for ADHD were: large family size (29%), convulsion (11%), trauma to the head during the first two years of life (7.7%), isolation of the child from one or both parents for a time in inattentive subtype of ADHD (50.5%), and artificial feeding (12.1%), family History of ADHD was higher among families with ADHD than control group.  The first and last births had relation to ADHD.  Conclusion, we can conclude that the prevalence rate of ADHD among elementary school children in Assiut City, 3rd grade was 6%.  This helped us to estimate the magnitude of this problem among the elementary school children which lead to proper design of a preventive and therapeutic intervention programs; also our study revealed that ADHD was associated with many risk factors.  So dealing with these risk factors may lead to decrease the incidence and prevalence of these cases and its associated disorders.

(Egypt J. Neurol. Psychiat. Neurosurg., 2005, 42(2): 517-526).

 




INTRODUCTION

 

                Attention deficit hyperactivity disorder (ADHD) is a heterogeneous disorder of unknown etiology.  It is one of major clinical and public health problems because of its associated morbidity and disability in children, adolescents, and adults.  Its consequences on society are enormous in terms of financial cost, stress on families, impact on academic and vocational activities, and negative effect on self-esteem1.

                Attention deficit hyperactivity disorders (ADHD) is a common neurodevelopmental disorders with a high degree of associated behavioral problems2.

                ADHD may be associated with a number of comorbid psychiatric conditions as well as with impaired academic performance and with both patient and family emotional distress, while it was previously thought, the disorder remitted before or during adolescence. It has become well established that many patients will have an illness course, that persist well into adulthood3.

According to DSM-IV4 the prevalence of ADHD increased from 9.6% according to DSM-III-R5 to 17.8% according to DSM-IV4 among Germany school children primarily because of new cases identified as ADHD (inattentive type) and to a lesser degree ADHD (Hyperactive-Impulsive type), So application of DSM-IV criteria increase the total ADHD prevalence rate by 64% and identified the majority of children with academic and/or behavioral dysfunction6.

The current study estimate the prevalence of ADHD and its subtypes among elementary school children (3rd grade) in Assiut city and searching out the possible risk factors of ADHD.

It is hypothesize that children with ADHD are at risk for developing other psychiatric difficulties in childhood, adolescence and adulthood, including antisocial behaviors, substance abuse and mood disorders. Thus prevention of ADHD through determination of different risk factors (especially avoidable risk factors) and early diagnosis, follow up and possible treatment are our aims to carry out this study.

 

METHODS

 

Participants:

                Our study was carried out on 1513 students of both sex, 772 males (51%), and 741 females (49%) in the 3rd grade of elementary schools in Assiut City, their ages ranged from 8-10.5years, the selected schools represent all geographic areas of Assiut City.

All eligible students and their parents, were given oral and written information about the aim, the content, and the duration of the interviews. They were assessed that the interviews and tools used in this study would be confidential and that refusal to participate would not influence their treatment. Participates were interviewed in the schools, homes and Assiut University Hospital.

The protocol of this study was approved by ethic committee  of our faculty.

 

Materials:

In this study we used the following tools:

1-        Children's Attention and Adjustment Survey-School form (CASS-S)7: We used this scale as a screening test for all students included in this study (1515 students), to pick up all suspicious cases with ADHD.  This test was applied by the researcher with the help of teachers of the selected schools. The suspicious cases with ADHD were 140 children (9.3%).

2-        Wechsler Intelligence Scale for Children (WISC)8: Was applied for all suspicious cases with ADHD (140 students) to exclude students with mental subnormality and those with borderline intellectual functioning (i.e. I.Q less than 84).

3-        Children's Attention and Adjustment Survey-House form (CAAS-H)7: This scale was applied for all suspicious students (100 students), after exclusion of all students with mental subnormality and borderline intellectual functioning.  We visited those children (100 students) in their homes, meeting their parents (one or both), the parents of 98 of them agreed to continue their participation with compliance rate of 98%, while 2 student's parents refused to participate in the study (so we exclude the 2 students from the original number 1515 to become 1513).

4-        DSM-IV diagnostic criteria for ADHD (4): We used the diagnostic criteria for final diagnosis and for classification of students with ADHD into its different subtypes (Hyperactive-impulsive, combined and inattentive types).

5-        Social scale assessment9.

6-        Clinical evaluation: A special neuropsychiatric questionnaire was prepared specifically for this study which aimed to inform us about different predisposing risk factors for ADHD.

 

Control group:

                Correlated sheets include comparable data to ADHD were applied for the following items:

1-        WISC (Wechsler Intelligence Scale for Children): We applied WISC upon 182 students at the same schools, age, and sex.

2-        Social scale assessment: We applied the same social scale upon 273 students at the same schools, age and sex.

3-        The special neuropsychiatric questionnaire designed for this study was applied upon 100 students of the same schools, age and sex for all risk factors except:

A.      Consanguinity, the number of control group was 3000, they was taken from10.

B.       Order of birth and birth rank, the number of control group was 300, also they were taken from10.

 

Statistical analysis:

                Data obtained from different studies were fed into an IBM compatible computer.  Dummy tables were structured to obtain required tabulated forms of data.  Descriptive statistics (mean, standard deviation, frequencies and percentages) were calculated using a computer software package SPSS and analysis was performed using the student's T-test, Chi-square X2 and Z test.  Analysis of variants (ANOVA) was applied to compare mean values of more than two groups, P values <0.05 were considered statistically significant.

 

RESULTS

 

                The results of the present study can be demonstrated in the following tables:

Table (1) shows that the prevalence rate of ADHD among the studied sample was 6%, and the prevalence rate of different subtypes in order of frequency was as follows; hyperactive-impulsive type (3.3%), then combined type (2.0%), and lastly inattentive type (0.7%). The prevalence in males were (3.6%), while in females (2.4%). Male to female ratio was 1.5:1. The prevalence of males were common than females in the hyperactive-impulsive and combined types, while the reverse in the inattentive type.

                No statistical significant difference could be detected between the patients and control groups regarding the social state (not shown in table).

 

Table (2) shows the results of comparison  between school  and  house forms, we found highly significant scores among house form in impulsivity, ADD, hyperactivity and ADHD, while the reverse was observed in conduct disorder in school form.

 

Study of possible risk factor among children with ADHD and control; a significant difference regarding trauma (P<0.05), convulsions (P<0.05), and artificial feeding (P<0.001), among children with ADHD than the control group.

 

Also there was a significant higher percent (P<0.05) of upper birth rank of patients with ADHD than control group.

 

Table (3) shows a significant delay of social smile (P<0.05) in all subtypes of ADHD, and a significant delay in identification of mother\s face (p<0.001) except in the inattentive type than control group.

 

Tables (4 a, b) show a significant lower score (P<0.05) among ADHD in comparison with the control group in the following subtests; comprehension digit span and similarities in all subtypes except inattentive subtype), and significant delay in picture completion and mazes in all subtypes.

 

As regard the effect of sex, it was observed that a significant lower (P<0.01) scores among female cases with ADHD than female of control group in the following subtests; information, and picture completion. A significant lower score in male cases of ADHD than male control in picture completion (P<0.01).  However as regard sex difference among ADHD, there was significant lower scores among females than males in arithmetic and mazes subtests  (P<0.01).


 


Table 1. The prevalence of ADHD and its subtypes among the studied sample.

 

Item

Total cases

Hyperactive- impulsive

Combined

Inattentive

No.

%

No.

%

No.

%

No.

%

Total sample

1513

100

-

-

-

-

-

-

Prevalence of ADHD

91

6.0

50

3.3

31

2.0

10

0.7

Male

54

3.6

33

2.2

18

1.2

3

0.2

Female

37

2.4

17

1.1

13

0.8

7

0.5

M:F: 1.5:1

 

 

Table 2. Comparison between Mean ± SD of children's Attention and Adjustment Survey (school and house forms).

 

Item

School form

(N=91)

House form

(N=91)

Inattention

12.3±4.0

12.9±3.1

Impulsivity

7.3±2.1

8.9±2.7*

ADD

19.6±4.5

21.9±4.7

Hyperactivity

12.7±2.6

17.6±3.8**

ADHD

39.5±6.3

42.7±7.2*

Conduct Disorder

18.8±5.4

14.6±3.2*

DSM-III-R ADHD

20.2±3.7

20.6±3.6

**P<0.001

 

 

Table 3. Mean±SD (in months) of developmental milestones in ADHD and control groups.

 

Item

Control

(N=100)

ADHD

(N=91)

Hyperactive-impulsive

(N=50)

Combined

(N=31)

Inattentive

(N=10)

P – value

by multifactor analysis

Identification of mother face

1.4±0.2

1.6±0.3**

1.6±0.3*

1.6±0.3*

1.6±0.0*

N.S

Social smile

1.3±0.0

1.5±0.1**

1.5±0.1**

1.5±0.1**

1.5±0.1**

N.S

Teething

6.4±1.3

6.2±0.8

6.2±0.8

6.0±0.2

6.2±1.1

N.S

Creeping

9.4±2.5

9.1±0.7

9.2±0.8

8.9±0.2

9.1±0.7

N.S

Walking

13.1±3.9

13.1±2.5

13.3±2.8

13.0±2.2

12.6±1.9

N.S

Speech

18.0±3.5

17.5±4.1

17.3±5.3

17.5±1.6

18.0±2.8

N.S

Control of micturition

22.6±3.6

19.5±3.9*

19.7±4.0*

19.2±3.6*

18.6±4.4**

P <0.05

Control of defecation

19.2±3.1

15.3±3.9*

14.9±3.7*

15.5±4.3*

16.2±4.0*

P <0.001

* P£0.05                                 **P<0.001*

 

Table 4a. Mean±SD of IQ and its subscales among children with ADHD "different  subtypes” and control group.

 

Item

Control [n=182]

ADHD [N=91]

Hyperactive-impulsive

[n=50]

Combined

[n=31]

Inattentive

[n=10]

Full IQ

98.1±9.8

99.6±8.2

99.9±8.1

98.9±8.6

99.9±7.9

Verbal IQ

103.1±11.2

104.6±9.3

104.7±8.8

104.4±9.1

104.3±12.9

Information

10.6±3.1

10.2±2.1

10.3±2.1

10.2±2.9

9.0±2.3**

Comprehension

10.9±3.3

10.1±2.7*

9.8±2.6**

10.2±2.9*

11.0±2.0

Arithmetic

4.2±1.9

4.4±1.8

4.5±1.1

4.2±1.5

4.1±1.9

Similarities

12.2±2.4

13.9±2.2*

13.9±2.5*

13.7±1.6*

13.3±2.6

Vocabulary

6.8±1.8

7.9±1.9*

7.7±1.8

8.4±1.8*

7.4±2.1

Digit span

8.0±2.1

7.3±1.9*

7.5±1.8*

7.0±2.0*

7.7±2.2

Performance IQ

92.8±9.7

94.3±7.6

94.6±7.2

93.2±8.5

96.4±6.0*

Picture completion

10.6±6.4

9.2±2.2*

9.6±2.3*

8.7±1.9**

8.7±2.5*

Picture arrangement

7.1±1.6

7.1±1.4

7.1±1.6

7.0±1.0

7.3±0.9

Block design

8.2±2.1

7.5±2.0*

7.2±2.1

7.9±1.7

7.8±2.1

Object assembly

5.3±1.6

6.1±1.6

6.1±1.5

6.0±1.7

6.8±1.9*

Object symbol

8.5±3.4

9.8±2.1

10.0±2.1

9.4±2.3

10.3±1.2

Mazes

5.1±2.3

6.2±2.0 *

6.4±2.1*

5.9±1.7*

6.5±1.8*

P<0.03*     P<0.001**

 

Table 4b. Mean±SD of IQ and its subscales among both sex of children with ADHD and with control groups.

 

Item

Control

Male

[n=107]

Control

Female

[n=75]

Male

ADHD

[n=54]

Female

ADHD

[n=37]

Full IQ

97.9±9.2

98.4±10.6

100.6±8.9

98±6.8

Verbal IQ

102.8±10.6

103.6±12.2

105.9±9.7

102.5±8.4

Information

10.1±2.9

11.0±3.4

10.4±2.2

9.9±1.8b

Comprehension

10.7±3.1

11.2±3.5

10.4±2.8

9.6±2.5

Arithmetic

4.0±1.6

4.4±2.1

4.6±1.3

4.0±1.4c

Similarities

12.4±2.4

11.8±2.4

14.1±2.3

13.6±2.0

Vocabulary

6.9±1.8

6.6±1.8

8.1±2.0

7.6±1.7

Digit span

8.1±1.9

7.9±2.4

7.5±2.1

7.1±1.6

Performance IQ

92.5±8.8

93.3±10.9

94.8±7.9

93.6±7.1

Picture completion

10.2±2.1

10.2±2.4

9.3±2.3a

9.0±2.1b

Picture arrangement

7.1±1.5

7.2±1.8

7.0±1.4

7.1±1.3

Block design

5.2±1.5

8.2±2.3

7.6±1.9

7.3±2.1

Object assembly

5.2±2.2

5.5±1.8

6±1.5

6.3±1.8

Object symbol

8.5±3.4

9.3±6.5

9.8±2.3

9.9±1.9

Mazes

5.3±2.2

4.9±2.4

6.6±2.1

5.7±1.7c

a: Significant (p£001) difference between males control and males ADHD.

b: Significant (p£001) difference between females control and females ADHD.

c: Significant (p£001) difference between males and females ADHD.


DISCUSSION

 

                In this study the prevalence rate of ADHD among students of elementary schools in Assiut City was 6%.  This was in agreement with Leung et al.11, who found that the prevalence of ADHD among Chinese school boys was 6.1%.  However Tannock12 estimated the prevalence of ADHD was 3-6% from diverse cultures and geographical regions.  While our results were in disagreement with Castello et al.13, who reported that, the prevalence of ADHD was 2%.  Also our results were rather lower than other studies in Canada (9.0%)14, Newzeland (10.8%)15, United Kingdom (16.6%)16, and United States (19.0%)17.

                Canino et al.,(18) revealed that prevalence of ADHD was 8% among 1886 child in Puerto Rico (Spanish). Burd et al., (19) in his  population-based  study in North Dakota (USA) reported  prevalence of ADHD was 3.9% among 7745 child with speak prevalence at 10 years of age.

                This difference in our results in the prevalence of ADHD could be attributed to a wide variation in selective criteria of the different key symptoms (inattention, impulsivity and hyperactivity)20.

                These significant differences in cultural perceptions of the symptoms may explain the wide variation of epidemiological data especially those concerned with behavioral disorders among different countries.  However, if rating scales and behavioral observations are used as primary diagnostic tools, for example, even though the prevalence rate of ADHD in China, are reportedly similar to those in the United States, it remains unclear whether boys considered hyperactive in China would be diagnosed as hyperactive in the United States or Japan.

                In our study, we reported higher prevalence rate of ADHD among males (n=54, 3.6%), than females (N=37, 2.4%), with male to female ratio was 1.5:1. This was in partial agreement with Sandberg21 who reported that male to female ratio is 2.5:1, and Tannock12 who reported that an over-representation of boys by approximately 3:1, while Hudziak and Todd22 reported males to have ADHD 2-9 times as frequently as females.  The explanation of difference of ADHD among both sexes was so difficult because, most of the etiopathogensis and acquired risk factors reported in the pre-peri, and postnatal periods (first two years) can not differ as regard sex.

                However, we can explain that according to Brut23, who reported the slightly larger heads of males might have render than more susceptible to pressure and head injury at birth.  Also the skeletal immaturity of boys relative to girls, which may render boys more vulnerable to damage24, and that will lead to minimal brain damage which may predispose later on to develop ADHD among those children.  Also, we could be attributed that to genetic variations.

                  Our results, reported that ADHD predominant hyperactive-impulsive type (n=50, 3.3%) was the most prevalent type followed by ADHD, combined type (n=31, 2.0%) and lastly ADHD predominant inattentive type (n=10, 0.7%).  These results were in disagreement with study of Wolraich et al.25, who mentioned that ADHD predominant inattentive type (5.4%) was the most frequent type of ADHD, followed by ADHD predominant hyperactive-impulsive type (4.4%) and lastly ADHD combined type (3.6%).  We could attribute these differences to the increase observation of hyperactive child in our country, more than the inattentive type, in which the hyperactive child usually considered as a source of troubles in his family and the reverse for inattentive type who are usually discovered later on after school entry and their diagnosis of inattentive type.          

In this study, there was no significant difference as regard social state between cases with ADHD and control group, these results were in disagreement with Frey et al.26, who reported that ADHD found in families with high social states in which the child is spoiled. Biederman et al.27, reported that, the low social class was considered as one of the risk factors for ADHD. Also Pelferey et al.28, reported low maternal education and low social class considered as important adversity factors in ADHD.

                We can explain the differences between our results and others on the basis of; small sized sample of our study, and our sample was limited  to schools in Assiut City where the variation of social states in so limited in comparison to wide variation in rural areas.

                We found that the mean±SD of Children Attention and Adjustment Survey-House form was highly significant (P<0.001) than school form in the following items: impulsivity, attention deficit disorder, hyperactivity and attention deficit hyperactivity disorder, while the reverse occurred in conduct disorder in which, there was lower significant score (P<0.001) in house form than school from.

                In our opinion these differences could be attributed to over evaluation by parents as long contact with their children and lack of experiences in evaluation the symptoms of ADHD.

                In our study we explored many risk factors, within the family of children with ADHD (marital discord, large family size, and isolation of the child from one or both parents).  We reported that children with ADHD who had large family size (29%) were significantly higher (P<0.02) in combined type of ADHD than in control group (12%).  However, isolation of the child from one or both parents (50%) in inattentive type of ADHD was significantly (P<0.001) higher than control group (6%).  These results were in agreement with Arnold and Jensen29 who reported that negligence and parental deprivation increase risk for ADHD as isolation of child from one or both parents for a long time.  Also our results matched well with Rutter30, who reported six factors of adversity which correlated significantly with childhood mental disturbances; severe marital discord, low social class, large family size, paternal criminality, maternal mental disorder, and foster placement.

                Study of other risk factors such as pregnancy, delivery and postnatal risk factors among children with ADHD reported a significant higher percent (P<0.05) in trauma, especially head trauma. These results correlated with Arnold and Jensen29 who reported that the trauma is one of the risk factors which lead to ADHD.  We can explain that as, these trauma may lead to minor damage in the central nervous system which may be either anatomically, biochemical or even in distribution of blood circulation in the brain which lead to appearance of ADHD among those children.

                In this study we found that artificial feeding in children with ADHD (12.1%) was significantly higher (P<0.001) than control group.  Again this could be attributed to deprivation of the child from warmth feeling and contact with mother's breast feeding.

                We showed that there were no significant differences between different grades of consanguinity and ADHD in comparison with control group. These results were in disagreement with study was done by Gill et al.31, who reported that genetic factors share at least in part of familial transmission of ADHD and revealed that according to this study to dopamine-transport gene.

                In this study we found that, there was significantly higher (P<0.001) percent in the first birth order (46.1%) in comparison to control group (19.7%). In trial to explain the previous result; we put some suggestions as: Deficiency in experiences of mothers in dealing with their first baby that may lead to disorders in activity and attention.  First birth child has a special position in some families, that may act as one of the risk factors for ADHD (e.g. over protection and spoiling), and this was in agreement with Frey et al.26, who reported that the child who has special position in family as over protection and spoiling is more liable to develop ADHD than other children. First birth child may be liable to some troubles during pregnancy and labor such as, lack of prenatal care, narrow pelvis may be in primigravida more than multigravida, that may lead to difficult labor or complication of labor.

We found that, the first and last birth orders (73.6%) were significantly higher (P<0.001) than control group (36%) and this may be related to the significant higher values in the first birth order and the higher insignificant score in the last birth order than the control. We can explain these results by some suggestions as: The last birth in some families may be spoiled. The last birth may come from large family size in which it had many troubles between brothers and sisters regarding hyperactivity and impulsivity. In some mothers of last birth may be old with decrease interesting in rearing their last child.  The old age of some mothers led to some medical complications especially chromosomal aberrations of the last child with associated abnormal behaviors.

                Burd et al.19, reported that the prevalence of conditions comorbid with ADHD varies widely, with rates of general medical conditions decreased and rates of most mental disorders increased,

                Study of developmental milestones revealed a significant delay in social smile (P<0.01) in all cases of ADHD and its subtypes in comparison with control group.  Also a significant delay in identification of mother's face (P<0.01) in ADHD and its subtypes except (inattentive type) than control.  These results were correlated with Taylor et al., (32) who used cluster analysis to identify a group of severely hyperactive and inattentive children, and showed that group membership was associated with sensory-motor incoordination and history of developmental delay.

                In this study, we found a significant higher (P<0.001) percent of family history of ADHD among our cases. These results were correlated with Fraone et al.33 studies, who reported that relatives of probands with ADHD with and without learning disabilities had significantly higher risks of ADHD than did relatives of normal comparison probands.   

                Also, correlated with study done by Biederman et al.27, who studied children of 84 referred adults with clinical diagnosis of childhood onset of ADHD, he found that the children of parents with ADHD, were at a higher risk for meeting diagnostic criteria for the disorder, 84% of the adults with ADHD had children with ADHD at least one child with the disorder, and 52% had two or more children with the disorder.

                The results can be explained according to Faraone and Biederman34 who mentioned that twin, adoption, and family studies suggest a strong familial component to the transmission of ADHD, also genetic factors were important in at least some cases of ADHD.

                We found a significant (P<0.05) lower scores among children with ADHD in some subtests of WISC.  These results were partially correlated with a study done by Biederman et al.35, in which he applied WISC-R upon 128 child with ADHD, and he reported that there were significant impairment in block design, digit symbol, digit span, and arithmetic achievement scores.

                Also, we found that in cases with ADHD there was significant higher values (P<0.001) in VIQ than PIQ, our result, were in agreement with Okasha36, who reported that, if the verbal IQ is significantly higher than performance IQ, this may be an indication of decline in the intellectual functions or the presence of an organic involvement on the right side hemisphere (in right handed individuals).

                Also, our results were correlated with Nijiokiktjien and Verschoor37 who studied children with low performance IQ versus children with low verbal IQ relatively by applying WISC-R to the children visited their learning clinic between "1990-1996" and then applied DSM-IV to detect the ADHD among those children, then they found that, the ADHD was more frequent among children with low performance IQ.

                The association with right hemisphere and the clinical experience of those with attention deficits seem to be prevalent in children with low performance IQ made us wonder whether we could find a link between ADHD, right hemisphere dysfunction and low performance IQ38. These results led us to say as Nijiokiktijien and Verschoor37, who reported that: Several studies suggest that right hemisphere contains a network for directed and sustained attention. In children with relatively low performance IQ, have a significantly higher chance of ADHD than children with a relatively low verbal IQ. In children with so called developmental right hemisphere syndrome, ADHD in found.

When we studied WISC with different subtypes of ADHD, we found that, there were significantly (P<0.001) lower scores in some subtests of WISC compared with control group, with the least affection in the inattentive type of ADHD, followed by the combined type of ADHD, with greatest affection in the hyperactive- impulsive type of ADHD.

This may be related to some characters of this type of ADHD as, failure to get attention to details, make careless mistakes, difficulty in sustaining attention and mental effort, and failure to finish activity.  Those symptoms were more apparent in the hyperactive- impulsive type than other types of ADHD.

 

REFERENCES

 

1.      Dickstein, L.J., Roba, M.B. and Oldham, J.M. (1997): Review of psychiatry.  American Psychiatric Press.  Washington, DC. London, England.

2.      Kadesjo C, Hagglaf B, Kadesjo B., Gilberg C.(2003): Attention deficit-hyperactivity disorder with and without appositional defiant disorder in 3-to 7-year old children. Dev. Med. Child Neurol., Oct; 45(10):693-9.

3.      Goldman, LS., Genel, M., Bezman, RJ. And Slanetz, P.J. (1998): Diagnosis and treatment of attention deficit/hyperactivity disorder in children and adolescents.  Journal of the American Medical Association, Augast 79-86.

4.      American Psychiatric Association (APA) (1994): Diagnostic and Statistical Manual of Mental Disorders, 4th edition, DSM-IV, Washington D.C.

5.      American Psychiatric Association (APA) (1987): Diagnostic and Statistical Manual of Mental Disorders, 3rd edition (Revised), DSM-III-R, Washington D.C.

6.      Baumgaert, A., Wolraich, M.L. and Dietrich, M. (1995): Comparison of diagnostic criteria for Attention Deficit Disorders in a German Elementary School Sample. J.AM. Acad. Child. Adolesc. Psychiatry, 34(5):629-638.

7.      El Behery, A.A. and Aglan, A.M.(1997): Test for assessment of Attention in children. Recent Nahda Library – Egypt.

8.      Wechsler, D. (1949): Wechsler Intelligence scale for children Psychological Corporation, New York.

9.      Fahmy, S.I., El-Sherbini, A.F. (1983): Determining simple parameters for social classification for health research.  The Bulletin of the High Institute of public Health, Vol. V111, No 5.

10.    Hassan, W.A., Kandil, M.R., Demerdash, A.M. and Temtamy, S.A. (1991): A study of Mental Subnormality in Assiut. M.D.in Psychiatry. Thesis, Faculty of Medicin-Assiut University. P.P. 153-159.

11.    Leung, P.L., Luk, S.L., Ho, T.P., Taylor, E., Mak, F., and ShoneJ.B. (1996): The Diagnosis and the prevalence of Hperactivity in Chinese School boys. British Journal of Psychiatry, 168;486-496.

12.    Tannock, R. (1998): Attention deficit hyperactivity disorder advances in cognitive, Neurobiological and genetic Research. J Child Psychol. Psychiat. Vol. 39, No1.

13.    Castello, E.J., Castello, A.J., Edelbrock, E., Burns, B.J., Dulcan, M.K., and Brent, D. (1988): Psychiatric Disorders In Pediatric Primary Care.  Arch. Gen. Psychiatry, 45:1107-1117.

14.    Szatmar, P., offord, D., Boyle and Ontario, M.H. (1989): Child health study: prevalence of ADD. J. Child Psychol. and Psychiatry, 30: 219-230.

15.    Anderson, J.C., Williams, S., Mc Gee, R. and Silva, P.A. (1987): DSM III disorders in preadolescent children. Prevalence in a large sample from the general population.Archives of General Psychiatry, 44:69-76.

16.    Taylor, E., Sandberg, S. and Thorley, G. (1991): The epidemiology of childhood hyperactivity institute of psychiatry maudsley monographs (33) London Oxford University Press.

17.    Shekim, W.O., Hshan, J. and Beck, N. (1985): The prevalence of Attention Deficit Disorders in a rural mid-western community sample of nine-year- old children.  Journal of the American Academy of Child Psychiatry, 24: 765-770.

18.    Canino G, Shrout PE, Rubio-Stipec M, Bird MHR, Brava-M, Ramirez R, Chanvez L, Alegria M, Bauermeister JJ, Hohmanna, Ribera J,, Garcia P, Martinez-Taboas,(2004). The DSM-IV rates of child and adolescent disorders in puerto Rico: Prevalence, correlates, services use, and the effects of impoirment. Arch Gen Psychiatry Jan. 61(1): 85-93.

 

19.    Burd L, Klug MG, Coumbe MI, Kerbeshian J, (2003): The attention deficit hyperactivity disorder paradox: 2. Phenotypie variability in prevalence and cost of comorbidity. J. Child Neurol. Sep; 18(9): 653-60.

20.    Sherman, D.K., Mc. Gue, M.K. and Iacono, W.G. (1997): Twin concordance for attention deficit hyperactivity disorder: a comparison of teachers and mothers' reports. Am. J. Psychiatry, 154; 532-535.

21.    Sandberg, S. (1996): Hyperkinetic or Attention Deficit Disorder. British Journal of Psychiatry, 169: 10-17.

22.    Hudziak, J.J., and Todd, R.D. (1993): Familial sub typing of attention deficit hyperactivity disorder, Current Opinion in Psychiatry, 6:489-493.

23.    Brut, C. (1950): The backword Child. Third edition, U.L.P.

24.    Tanner, J.M. (1961): education and Physical growth up.

25.    Wolraich, M.L., Hannah, J.N., Pinnock, T.Y., Baumgaertel, A. and Brown, J. (1996): Comparison of diagnostic criteria for attention deficit hyperactivity disorder in a county wide sample.

26.    Frey, C. wyss- Senn, K. and Bossi, E. (1995): Subjective evaluation by parents and objective findings in former prenatal risk children.  Z-kinder-Jugenpsychiatr, Jun. 23 (2): 84-94.

27.    Biederman, J., Faraone, S.V., Mick, E., Spencer, T., Wilens, T., Kiely, K., and Guite, J., Ablon, S., Reed, E., and Warburton, R. (1995): High risk for Attention Deficit Hyperactivity Disorder among children of parents with childhood onset of the disorder: A pilot study. Am. J. Psychiatry; 152:431-435.

28.    Pelferey, J.S., Levine, M.D., Walker, D.K. and Sullivan, M. (1985): The emergence of attention deficit in early childhood: a prospective study. Dev. Behav. Pediatr., 6:339-348.

29.    Arnold, L. and Jensen, P.S. (1995): Attention Deficit disorders.  In Kaplan, H.I. and Sadock, B.J. (Eds) Comprehensive textbook of Psychiatry 6th. Edition, Baltimore, Philadelphia, Hong Kong, London, Munich, Sydney, Tokyo: Williams and Wilkins, 2245-2311.

30.    Rutter, M. (1977): Psychiatric disorders: Ecological factors and concepts of causation.  In Mc Gurk H., ed Ecological factors in human development.  Amsterdam, the Netherlands: North-Holland publishing co; 173-187.

31.    Gill, M., Daly, G., Heron, S., Hawi, Z. and Fitzgerald, M. (1997): Confirmation of association between attention deficit hyperactivity disorder and a dopamine transports polymosphism. Mol-psychiatry, Jul. 2(4):311-313.

32.    Taylor, E.A., Everitt, B., Thorle, G., Schachar, R., Rutter, M. and Wieselberg, M. (1986): Conduct disorder and hyperactivity: a cluster analytical approach to the identification of a behavioral syndrome.  British Journal of child psychiatry and psychology, 149:768-77.

33.    Faraone, S.V., Biederman, J., Krifches, Lehma, B. and Keenan, K. (1993): Evidence for the independent familial transmission of ADHD and learning disabilities results from a family genetic study of ADHD. Am.J. Psychiatry, 150:891-895.

34.    Faraone, S.V. and Biederman, J. (1994): Genetics of ADHD. Child and Adolescent psychiatr.  Clinics of North America, 3: 285-829.

35.    Biederman. J., Faraone, S.V., Milberger, S., Marrs, A., Quellette, C., Moore, P., Spencer, T., Norman, D., Wilens, T., Kraus, L., and Perrin, J. (1996): A Prospective 4-years follow.- Study of Attention- Deficit Hyperactivity and Related Disorders; Arch. Gen. Psychiatry, Vol.53, May, 437-446.

36.    Okasha, A. (1997): Behaviuor sciences, medical psychology. The Anglo-Egyptian Bookshop, Cairo.

37.    Nijiokiktjien, C. and Verschoor, CA. (1998): Attention deficit in children with low performance IQ: Arguments for right hemisphere dysfunction.  Phsiology, vol. 24(2): 145-151.

38.    Nijiokiktjien, C. and Verschoor C.A. (1997): Attention and the Right hemisphere I.N.S. Symp, veldhoven, the Netherlands, and symp 067 Int. Congr. Of Physiological sciences, st. Petersburg.


 

 



2008 � Copyright The Egyptian Journal of Neurology,
Psychiatry and Neurosurgery. All rights reserved.

Powered By DOT IT