Prevalence And Socio-Demographic Profile Of Attention-Deficit/Hyperactivity Disorder (ADHD) Children In Southern Tamil Nadu: A Three-Stage, Multi-Informant Screening Study

Abstract

Despite being one of the most common childhood neurodevelopmental disorders, ADHD prevalence remains poorly documented in semi-urban and rural school settings across Tamil Nadu. This study aimed to determine the prevalence and socio-demographic profile of doctor-diagnosed ADHD among Grade III children in English-medium primary schools of Southern districts of Tamil Nadu. A cross-sectional, three-stage sequential screening design was used with 438 Grade III children from 12 English-medium State Board primary schools. In Stage 1, classroom teachers completed the Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS) for all children. Children who screened positive proceeded to Stage 2, in which parents completed the Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS). Children who screened positive on both informant ratings (n = 92) were referred to Stage 3 for psychiatric evaluation using the DSM-5 checklist. Of the 92 children referred for doctor's diagnosis, 71 children (16.2% of the total population; 77.2% of the referred sample) were confirmed as children with ADHD, comprising of Predominantly Inattentive (n = 30, 42.3% of confirmed cases), Predominantly Hyperactive/Impulsive (n = 20, 28.2%), and Combined (n = 21, 29.6%) presentations. Males accounted for approximately 73% of confirmed cases across all three presentations, a marked increase from the near-even gender split (50.2% male) in the total population. Referred and confirmed cases also showed a consistent, modest over-representation of higher-income, employed-mother, and more highly educated households relative to the total population, while representation by birth order and locality remained broadly proportional. The observed prevalence is consistent with the wide range reported across Indian school-based studies and underscores the value of multi-informant, sequential screening for early identification of ADHD in resource-limited primary school settings, while also highlighting the need to guard against participation-related bias at the parent- and clinician-screening stages.