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Abstract ioral problems that start as early as three years and peak at the school entrance. ADHD is classified in the DSM- IV as a disruptive behavior disorder, because of the significant difficulties it creates in social conduct and social adjustment. Three core behaviors contribute to the ADHD pattern; inattention, impulsivity, and hyperactivity. In addition, a cluster of associated characteristics includes: disorganization, poor peer-sibling relations, aggressive behavior, poor self-esteem, memory problems, and inconsistency. (American Psychiatric Association; DSM-IV-TR, 2000 Diagnosis of ADHD may constitute achallenging situation. So in order to meet the criteria for a diagnosis of ADHD, symptoms and behavior must: affect the child in more than one setting and were present before age 7 years. (Ann C. Childress 2012) According to the core symptoms; there are three subtypes of ADHD: ADHD, Combined Type, ADHD Predominantly Inattentive Type and ADHD Predominantly Hyperactive-Impulsive Type (Smucker U. 2001) At the same time there is no evidence that genetic factors alone can create ADHD. But also environmental factors fall in the realm of the etiology. (knopik et al., 2009) Youths with ADHD also have up to a 4 times higher risk of developing depressive disorders than the general adolescent population-(Pliszka SR 1998); most studies indicate prevalence Summary 81 rates of 9 to 38 percent for depressive disorders in children with ADHD. (Turgay A 2001) Major depression (MD) often exacerbates the symptoms and dysfunctions of ADHD. Accordingly, this study tested the hypothesis that children with ADHD had co-morbid depression. Main aim of the study was to search for depression as a symptoms or a disorder in a group of children with ADHD and to compare patients with ADHD with and without co-morbid depression regarding socio-demographic data and clinical profile of ADHD. Subjects and method: Design and site of the study The current study was a cross sectional descriptive study. It was done in Abassia Mental Health hospital in Cairo, Egypt. All patients were recruited from the outpatient clinics of child psychiatry in the period between December 2011 to May 2012. Ethical issues The study’s design and methods were approved by the ethical and scientific committee of Department of Psychiatry; Faculty of Medicine- Ain shams University. All patients and their legal guardians were informed by the details of the study and gave an informed consent. Subjects Summary 82 Patients were selected according to the following inclusion criteria; age range between 6-16 years. Patients should fulfill DSMIV diagnostic criteria for ADHD. Patients were excluded if beyond our age limit; co morbid chronic medical illness that may affect diagnosis; Co morbid mental retardation; Autistic spectrum disorder or Psychotic disorders. Procedures and Tools: 1- History taking including socio-demographic data, data about past psychiatric history and family history. 2- Psychiatric examination using Mini International Neuropsychiatric Interview (M.I.N.I.KID) 3- Conner’s Rating Scale Study proper: After ethical approval and consent, all subjects and their parents underwent separate, detailed semi-structured interviews to determine mental health diagnoses, using the The Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), under supervision of senior child pschiatry. (sheehan et al., 1998) All interviews has done under supervision of senior child psychiatry. CONNER’S scale for assessment of severity and symptoms profile of the patients has done via clinical psychologist with good experience with the scale. Summary 83 Statistical analysis: Data obtained was analyzed by an expert statistician using statistical package for social science SPSS version 15. Results: Our study include 45 males (64.3 %) and 25 females (35.7%). Mean age of the sample was 10.27 years. Most prevalent diagnostic subtype in our sample was combined as it was 51.4% of the sample. 23 (32.9%) patients had depressive symptoms. Depressive symptoms were significantly more among female gender. At the same time 19 (27.1%) patients had depression while 51(72.9%) didn’t have. MD was significantly more common among females. Similarly it was more among combined and inattentive subtype but with no statistical significance. Correlation between depressive symptoms and CONNER’S scale sub items revealed non significance except for negative correlation with hyperactivity symptoms in parent and teacher scale. Similarly with Conner ADHD index score (teacher), Conner global index total (parent and teacher) DSM impulsive (parent and teacher). Lastly with DSMIV impulsive (parent and teacher). While correlation between Conner’s scale sub items and depression disorder revealed significance only with conner ADHD index parent. Furthermore, our result recognized high percentage of ADHD in the first born child in the patient group. Furthermore the results reveled Summary 84 that high percentage of fathers and mothers of the patients group were high graduate. Discussion: Socio-Demographic Data; Analysis of data of 70 patients: 25 (35.7%) females and 45 (64.3 %) males. As we see there was marked significant difference between males and females as P was.000.That was in concordance with Biederman & Faraone, 2004 who reported that boys are about three times more likely than girls to be diagnosed with ADHD. At the same time, mean age of the whole sample was10.27+/-2.1. According to DSM-IV-TR criteria, the onset of ADHD is before age 7, however, many individuals are not diagnosed until a later age due to the prominent expression of ADHD symptoms in the school setting (Faraone et al., 2006). Further more, 70% of our sample had 4 or 5 sibling, in addition 65% of fathers and 61% of mothers were high graduated, This may reflect the increased awareness of the parents of the higher class for the disorder, their over concern with academic problems and scholastic achievement of their children . Depressive symptoms and MDD Over time, children with AD/HD may become frustrated and demoralized because of their symptoms. They may develop feelings of a lack of control over what happens in their environment or become depressed as they experience repeated failures or negative interactions in school, at home, and in other settings. As these Summary 85 negative experiences accumulate, the child with AD/HD may begin to feel discouraged. Typically, in these situations AD/HD symptoms appear first and the depression comes later. These negative reactions are common in individuals with AD/HD and some experts claim that up to 70 percent of those with AD/HD will be treated for depression at some point in their lives (Barkley, 2007). ADHD symptoms profile and depression Children with ADHD and depression display more impairment in social and academic functioning compared to controls. Although social impairment is greater in children with ADHD and depression than in children with only ADHD (gabrielle et al., 2005). Strengths and limitations: We searched not only for major depression but we tried to detect sub-threshold disorder which may be more prevalent and need same concern in management and treatment. The study used valid tools for diagnosis and assessment as Mini International Neuropsychiatric Interview for children and adolescent (M.I.N.I. KID), and CONNER’S scale which previously used in many studies with good validity and reliability. All interviews and scales have done via experts and under supervision of senior child psychiatrist with good inter-rater reliability. Furthermore we tried to detect which ADHD symptoms were more associated with depression in order to predict depression. However we couldn’t generalize our results as our sample was hospital base and not representative to the whole community. In Summary 86 addition small sample size relative to previous studies as it was a single center study. Lastly after diagnosing depression and detecting depressive symptoms with (M.I.N.I. KID) and history we didn’t use any scale for more assessment of depression severity and correlation with ADHD although the primary aim of this study was to detect co-morbidity between depression and ADHD and further studies may be needed to overcome these limitations. Recommendations: 1. Recognition, prevention, and treatment of environmental causes of ADHD may provide more effective management and reduce the reliance on symptom modification with medication 2. Behavioral methods include the modification of aspects of the child’s environment (e.g., classroom, parenting practices, stressors, social support) to prevent or reduce the likelihood of later behavioral problems in adolescence. 3. Educating the child’s teachers about ADHD is an important part of the treatment of the children. 4. There is a need for scales fairly evaluating different types of the prienatal complications and the use of those scales during routine psychiatric history especially in the children. 5. We must put in our mind that the core symptoms of ADHD may be accompanied by other comorbid psychiatric disorder. |