Prevalence of Attention-Deficit/Hyperactivity Disorder and Its Associated Factors Among Schoolchildren: A Cross-Sectional Study Using The Conners' Teacher Rating Scale

Abstract

Background:

Attention Deficit Hyperactivity Disorder (ADHD) is considered to be one of the most common neurodevelopmental disorders in children and can continue into adulthood, and its incidence is seemed to have been on rise in the recent times. However, the frequency of ADHD differs significantly across countries. The current study aims to determine the prevalence rates of positive symptoms of ADHD, among children (5-15 years old) in Visakhapatnam, Andhra Pradesh, India as well as to raise awareness about ADHD among the teachers and the school. Thes study also aims to examine the association of ADHD with demographic, family, perinatal, academic, lifestyle and anthropometric factors.

Methods:

A descriptive cross-sectional study was conducted among 511 boys and girls aged 5–15 years enrolled in Classes 1–9 in selected schools in Visakhapatnam district, Andhra Pradesh, after obtaining the necessary permissions. Teachers completed the Conner’s Teacher-Rating Scale Short (CTRS)-28 version questionnaire to screen ADHD symptom positivity. A structured demographic questionnaire was administered to collect participant characteristics and assess potential factors associated with ADHD symptom positivity. Associations between ADHD symptom positivity and potential correlates were examined using bivariate analyses and multivariable logistic regression.

Results:

The overall prevalence of ADHD was 7.6% (39 of 511; 95% CI 5.6 to 10.3). Significant associations were found with age (11.4% at 12 to 16 years versus 3.2% at 9 to 11 years; p = 0.007), rural residence (10.3% versus 4.2% in urban areas; p = 0.008) and father's education (18.9% when intermediate; p = 0.001). Type of delivery was borderline in unadjusted analysis (caesarean 10.3% versus 5.7%; p = 0.056). In the multivariable model, age of 12 years or older (adjusted OR 3.06, 95% CI 1.41 to 6.66), rural residence (2.45, 1.12 to 5.36), intermediate paternal education (2.94, 1.38 to 6.24) and caesarean delivery (2.18, 1.08 to 4.40) were independently associated with ADHD. No significant association was observed with gender, family type, mother's education, birth weight, grade in exams, television or phone use, sleep duration or BMI category.

Conclusion:

About one in thirteen schoolchildren screened positive for ADHD, with higher risk in early adolescence, rural areas and children of fathers with intermediate education. Screening in schools, followed by clinical confirmation, is recommended.