Evidence-based Medicine: Time for a change? - Journal of Medical ...

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ORIGINAL ARTICLE Attention deficit hyperactivity disorder (ADHD) in a school sample in Manipur 1 R.K. Lenin Singh, 2 S. Gojendra Singh, 3 L. Roshan Singh, 4 N. Heramani singh, 5 M. Akshyakumar Singh Abstract Objective: To find out the prevalence of ADHD among the school children in a city school, Imphal, Manipur. Methods: A total of 312 students within the age range of 5-12 years were evaluated by using Vanderbilt ADHD Diagnostic Teacher Rating Scale and Vanderbilt ADHD Diagnostic Parents Rating Scale. Results: The prevalence of ADHD was estimated to be 4.17% and the rate was higher among boys than girls with a percentage of 2.9% and 1.8% respectively. Conclusion: ADHD is common among the school children in Manipur. Keywords: Prevalence, attention deficit hyperactivity disorder, school children Introduction: Attention-deficit/hyperactivity disorder (ADHD) has defining features of inattention, over activity, and impulsivity 1 . It is the most frequently encountered childhoodonset neurodevelopment disorder in primary care settings. Symptoms frequently co-occur with other emotional, behavioral, and learning problems, including oppositional defiant disorder, conduct disorder, depression, anxiety, and learning disabilities. 1. Associate professor, 2. Registrar, Dept. of psychiatry, 3. Assistant Professor, Dept. of Clinical Psychology, 4. Professor & Head, Dept. of Psychiatry 5. Professor, Dept. of Clinical Psychology Correspondence: Dr. R.K.Lenin Singh, Associate Professor, Department of Psychiatry, RIMS, Imphal Email Address: leninrk@yahoo.com Introduction: Attention-deficit/hyperactivity disorder (ADHD) has defining features of inattention, over activity, and impulsivity 1 . It is the most frequently encountered childhoodonset neurodevelopment disorder in primary care settings. Symptoms frequently co-occur with other emotional, behavioral, and learning problems, including oppositional defiant disorder, conduct disorder, depression, anxiety, and learning disabilities. The National Institute of Mental Health (NIMH), estimates that between 3% and 5% of preschool and school-age children have ADHD or approximately two million children in the United States. This means in a class of 25 to 30 students, it is likely that at least one student will have this common condition 2 . The cause of ADHD is unknown, and multiple pathways may lead to the phenotypic expression of the disorder 3 . Some studies suggest that genes play a large role. Like many other illnesses, ADHD probably results from a combination of factors. In addition to genetics, researchers are looking at possible environmental factors, and are studying how brain injuries, nutrition, and the social environment might contribute to ADHD. Results from several international studies of twins show that ADHD often runs in families. Researchers are looking at several genes that may make people more likely to develop the disorder 4,5 . Children with ADHD who carry a particular version of a certain gene have thinner brain tissue in the areas of the brain associated with attention. This National Institute of Mental Health (NIMH) research showed that the difference was not 46 JMS * JMS Vol 25 * Vol * No. 25 3 * No. * September, 1 * June, 2010 2011
ORIGINAL ARTICLE permanent, however, and as children with this gene grew up, the brain developed to a normal level of thickness. Their ADHD symptoms also improved. 6 Other studies suggest a potential link between cigarette smoking and alcohol use during pregnancy and ADHD in children. 7,8 In addition, preschoolers who are exposed to high levels of lead, which can sometimes be found in plumbing fixtures or paint in old buildings, may have a higher risk of developing ADHD. 9 Children who have suffered a brain injury may show some behaviors similar to those of ADHD. However, only a small percentage of children with ADHD have suffered a traumatic brain injury. Recent British research indicates a possible link between consumption of certain food additives like artificial colors or preservatives, and an increase in activity. 10 Research is under way to confirm the findings and to learn more about how food additives may affect hyperactivity. Treatments can relieve many of the disorder’s symptoms, but there is no cure. With treatment, most people with ADHD can be successful in school and lead productive lives. Researchers are developing more effective treatments and interventions, and using new tools such as brain imaging, to better understand ADHD and to find more effective ways to treat and prevent it. Methods: A cross-sectional study design was used. Primary data was collected through personal interview method from both the teachers of the City Montessori Higher Secondary School, Imphal and parents of the children studying in the school. The interviewer read out a prepared script that provided an overview of the study aims and objectives and also benefits for participation were explained. All the students belonging to classes between I to VII with an age range of 5-12 years who were studying in the school were recruited. Based on purposive sampling technique, a sample of 312 children was selected. All the children were screened for ADHD by using Vanderbilt ADHD Diagnostic Teacher Rating Scale 11 and Vanderbilt ADHD Diagnostic Parents Rating Scale. 11 Sociodemographic data were collected using a semi-structured proforma and the diagnosis of ADHD was made using DSM-IV-TR criteria. Procedure: To proceed with the study, necessary permission was sought from the school authority. The teachers of the school were educated and trained about ADHD. One day training programme for the teachers on ADHD screening tool were conducted by a specialist in the field. In the programme, all the 18 criteria for ADHD in Vanderbilt Teacher rating Scale was discussed and explained one by one. After the training, teachers were asked to screen the school children belonging to class I to VII using the particular scale. The parents of the students were also educated about ADHD by organizing one day awareness programme for parents at schools. Parents were explained about the Vanderbilt Parents Rating Scale. The scale is the parents’ version of teachers rating scale which has all the 18 DSM-IV criteria for ADHD. The scale was further simplified and translated into Manipuri and back translated, so that parents could understand at ease. After that, parents were also asked to screen and rate the severity of each behavior on a 4 point Scale. Result: The present study was based on a primary sample of study subjects. For the particular school 312 students, both boys and girls were screened. Table 1. Students screened for ADHD by Teachers Class students students with positive positive screened ADHD boys girls I 28 4 2 2 II 55 11 6 5 III 53 1 1 0 IV 47 0 0 0 V 47 0 0 0 VI 43 0 0 0 VII 39 1 1 0 TOTAL 312 17 (5.45%) 10 (3.23%) 7 (2.22%) Table 2. Student screened for ADHD by Parents Class student No. of No. of Negative Miss out Total No. of screened boys girls students positive by positive of teachers ADHD I 4 1 2 1 0 3 II 11 6 3 2 0 9 III 1 1 0 0 0 1 IV 0 0 0 0 0 0 V 0 0 0 0 0 0 VI 0 0 0 0 0 0 VII 1 0 0 0 1 0 TOTAL 17 8 5 3 1 13 JMS * Vol 25 * No. 13 * June, September, 2010 2011 47
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