الفهرس 
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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
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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
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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.
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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
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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
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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
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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.