inattention and impulsivity persists more than overt
physical hyperactivity [1,2]. This study aimed to estimate the
proportion of ADHD in adolescents from a school, and study the
applicability of a Diagnostic and Statistical Manual-IV (DSM-IV)-based
questionnaire for detecting ADHD [3].
A private English medium school in Delhi was chosen
and permissions were taken from school authorities. The study protocol
was approved by the Institutional Ethical Committee. Five hundred
students, 100 each (50 boys and 50 girls) from classes 6th to 10th, were
selected randomly. At the beginning, several sessions were taken with
the teachers and parents explaining the purpose and importance of the
study. Each student was given a sealed envelope addressed to their
parents containing a letter providing background of the study, consent
form, Conners’ parents rating scale-revised: short form (CPRS-R:S) and
DSM-IV based ADHD questionnaire. Both parents were requested to complete
the scales together and return them in a sealed envelope. A reminder was
sent after two weeks in non-responders and class teacher was requested
to reinforce the same in subsequent parent-teacher meetings.
The class teacher was asked to rate the Conners’
teachers rating scale-revised:short form (CTRS-R:S) for each selected
student of his/her class and the DSM-IV based questionnaire for every 5
65
on ADHD Index subscale and inattention and/or Hyperactivity subscale
were taken as positive. Children positive on both CTRS-R:S and CPRS-R:S
were labeled as ADHD. They were classified as predominantly hyperactive,
predominantly inattentive or combined type, based on subscale scores
[4]. Their intelligence quotient was assessed in school premises using
Standard progressive matrices [5]. Intervention services were offered to
diagnosed cases.
The DSM-IV based questionnaire had 18 questions. The
students fulfilling DSM-IV criteria (i.e. presence of symptoms in 6 out
of 9 questions on inattention or 6 out of 9 questions in
hyperactivity-impulsivity domain, or both) were taken as positive for
ADHD. Statistical analysis was carried out using SPSS version 11.
Besides descriptive statistics, agreement studies were done to compare
the results of DSM-IV based questionnaire with Conners’ Rating Scales.
The median age of study population was 13 years
(range 10-15 years). Fifty one (10%) students were positive for ADHD on
CPRS-R:S and 52 (10%) were positive on CTRS-R:S; 36 (7.2%) were positive
for both. These children had average intelligence. Twenty nine (80%)
were males, 28 (75%) had predominantly inattentive type of ADHD and rest
had combined type. The results of DSM-IV based questionnaire are shown
in Table I.
Table I: Performance of the Study Questionnaire Against Conners’ Rating Scales
|
|
Conners’ rating scales |
|
|
positive |
negative |
|
*Parents’ Questionnaire |
+
|
28 |
16 |
|
– |
8 |
448 |
|
#Teachers’ Questionnaire
|
+
|
10 |
5 |
|
– |
2 |
83 |
|
+: positive or –: negative for ADHD; Cohen’s Kappa 0.67* and
0.77#
|
The prevalence of ADHD among primary school children
is estimated to vary from 2% to 17% [6]. There are fewer studies in
adolescents. In a school-based study from Colombia, 7.3% adolescents
were diagnosed as ADHD using DSM-IV based ADHD checklist, with
Inattentive subtype being predominant [7]. In a two-stage study from
Brazil, 9.7% of 1013 students were positive using sent checklist [8].
The major limitation of this study was that we could
not perform a detailed assessment in a clinical setting to confirm our
diagnosis. However, the diagnosis was based on the agreement between
parents and teachers rating, which is in line with DSM-IV criterion of
presence of symptoms in two settings.
To conclude, ADHD is an important behavior problem in
adolescents. DSM-IV based questionnaire, which is simple to administer
and score, can be a useful screening tool in resource-limited settings.
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Williamson S, Fine C. Diagnostic continuity between child and adolescent
ADHD: findings from a longitudinal clinical sample. J Am Acad Child
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APA Press; 2000.
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Toman-nanda, New York: Multi health system; 1989.
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7. Pineda D, Ardilla A, Rosselli M, Arias BE, Henao
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