الفهرس 
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Abstract
Attention deficit/hyperactivity disorder (ADHD) is one of the most frequent psychiatric disorders of childhood.
ADHD, which is a multifactorial and clinically
heterogeneous disease, leads to socioeconomic burden and
undesirable academic and occupational results. Worldwide
prevalence of ADHD has been reported to be 4%–7% in
children.
ADHD is most frequent among school-age children,
more common in boys, and its frequency decreases in
further ages. Furthermore, most of the recent studies
assume that ADHD is a life-long disorder. The symptoms
of this disorder include a considerable degree of
inattentiveness, distractibility, impulsivity, and often
hyperactivity that result in numerous problems at home,
school, and social conditions leading to dysfunction in
individual and family life of the patients.
There are three different subtypes of ADHD.
Combined ADHD is the most common subtype, which
involves symptoms of both inattentiveness and
hyperactivity/impulsivity. Inattentive ADHD is marked by
impaired attention and concentration. Hyperactive
impulsive ADHD is marked by hyperactivity without
inattentiveness.
For a diagnosis of ADHD, some symptoms that cause
impairment must be present before age seven. Also, some
impairment from the symptoms must be present in more
than one setting. Also, there must be clear evidence the
symptoms interfere with the person’s ability to function at
home, in social environments, or at work.
Other psychiatric disorders and social problems are
likely to accompany a substantial proportion of children
admitted to a clinic with a diagnosis of ADHD, and this
enhances the severity of the clinical picture. Psychiatric
disorders that accompany ADHD vary widely among
different countries and cultures.
It is reported that more than 50 % of ADHD patients
have at least one psychiatric comorbidity and that this rate
increases with age. Oppositional defiant disorder has been
reported to be one of the most frequent comorbidities in
ADHD with a rate reported between 20% and 80%.
Conduct disorder is also one of the comorbidities of
ADHD. Other reported comorbidities include, depression,
anxiety disorder, bipolar disorder, developmental disorders
of learning, autism, tic disorder and disorders of
elimination.
There is compelling evidence that ADHD
comorbidities would affect the presentation and clinical
severity, long-term prognosis, and therapeutic response of
disease. For example, in presence of communicative
disorder concomitant with ADHD, this comorbidity would
deteriorate the ADHD symptoms and increase aggressive
behaviors and anxiety that result in lack of intimate
relationships. Also, anxiety comorbidity in ADHD patients
is reported to be a cause of poor therapeutic response to
psycho- stimulant medications. Therefore, evaluation and
proper diagnosis of comorbid psychiatric disorders are of
great importance.
The aim of this work was to determine frequency of
psychiatric comorbidities in children diagnosed with
ADHD and to assess the association between ADHD
subtype and the distribution of comorbid psychiatric
disorders.
The present study included 60 children aged between
6 and 12 years, who were admitted to the pediatric
psychiatry outpatient clinic in El-Dakahlia hospital of
mental health and were diagnosed with ADHD DSM –IV R
criteria. An informed written consent was obtained from
the children’s guardians before participation, it included
data about aim of the work, study design, site, time,
subject, tool and confidentiality. Parents were informed by
the results and recommendations, and it was explained that
they could leave the study with no objections.
All selected children diagnosed with ADHD were
subjected to a semi-structured interview to their parents or
caregivers including the demographic data, family history
of consanguinity between parents and presence of similar
condition in family. Full psychiatric clinical assessment
was done to identify psychiatric symptoms/ disorders.
Suitable scales that help in diagnosis of ADHD and
comorbid psychiatric disorders were applied including
Conner’s Parent Rating Scale-revised; L and K-SADS-PL.
Wechsler Intelligence Scale for Children were used to
assess intelligence quotient of selected children.
Our results showed that 90% of ADHD children
included in the study had at least one psychiatric
comorbidity according to K-SADS-PL results. Oppositional
defiant disorder was found to be the most frequent
comorbidity in ADHD children with a rate of 55%,
followed by comorbid nocturnal enuresis (33.3%),
generalized anxiety disorder (33.3%), depressive disorders
(16.7%) and separation anxiety disorder (15%). Other
reported comorbidities included motor tics (11.7%), social
phobia (13.3%), specific phobia (10%), conduct disorder
(8.3%), Tourette disorder (6.7%), panic disorder (5%) and
vocal tics (1.7%).
The present study showed that no statistical significant
difference was found in the distribution of psychiatric
comorbidities according to sex. There was no significant
difference in distribution of psychiatric comorbidities in
cases of ADHD according to its subtype, except for specific
phobia and oppositional defiant disorder. The frequency of
specific phobia was significantly higher in ADHD
inattentive type while oppositional defiant disorder was
more frequent in ADHD combined type with highly
statistical significant difference.
Results of Conner’s Parent Rating Scale, proved the
association between ADHD and oppositional problems,
social problems, emotional lability, cognitive problem,
restless impulsivity and psychosomatic disturbance. No
significant differences between males and females in
distribution of subclasses of Conner’s parent rating scalerevised
In the present study, the mean of IQ of ADHD children
was 96.56± 3.18 that was within the average, and no
significant difference between male children and females.
No statistically significant correlation between IQ and the
different subtypes of ADHD. No statistically significant
relation was found between IQ and ODD, conduct disorder
and depression in children of ADHD.