الفهرس 
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Abstract
The study participants were children with attention-deficit hyperactivity disorder (ADHD) (cases) and control: total number of cases was 200 (151 males), while total number of controls was 400 children (302 males). Mean age of cases was about 6.9 years old. There was highly statistically significant difference between percentage of both cases and control in residence as 67.5 % of children with ADHD were urban (P-value <0.0001).
As regards characteristics of the family of the study participants there was highly statistically significant difference between cases and control in family’s income as 65.0 % of cases’ families had monthly income > 2000.0 L. E (P-value < 0.0001) also there was a statistically significant difference between cases and control in the percentage of the order of the child in his family (P-value =0.01) but there was no statistically significant difference between cases and control in percentage of consanguinity between parents.
The educational level of the fathers and mothers of cases was highly significantly higher compared to the educational level of the fathers of the controls also a significantly higher percentage of the mothers of cases (31.0 %) shared in labor force in comparison to the mothers of the controls (17.75 %).
The distribution of possible risk factors of ADHD in both cases and control groups illustrates a highly statistically significant difference between cases and control groups in distribution of each parents’ relationship, child-parent relationship, exposure to punishment from parents, exposure to SHS, presence of toxemia during pregnancy, delivery mode and finally presence of perinatal hypoxia or asphyxia (p- value< 0.0001). but There’s no statistically significant difference between both groups in previous exposure to head injury, duration of electronic use or mother age at delivery if less than or more than 35 years old as risk factors of ADHD.
The results also revealed that the mean score of children with ADHD child self-report (4-12 years old) for all domains of HRQOL except physical health domain were significantly lower than the healthy controls (p value was < 0.0001 for psychological health domain social health domain and was 0.01 for school health domain). The order of mean score in different domains in cases group was as following: school functioning (67.2±21.0) <psychological health domain (76,4±18.2) < physical health domain (81.4±16.2) < social health domain (87,8±16.4). The results also demonstrated that the parents reported significantly lower mean score for all domains of HRQOL and total generic score of their children compared to the children’s self-reported mean score.
Several factors were found to affect the HRQOL in children with ADHD as gender; boys had significantly higher mean score for school health domain compared to females. Also, age affect the HRQOL as older children had a significantly lower mean score for school and psychological functioning domains compared to children in younger age groups but they had higher mean score for physical and social functioning. Children with positive family history of the diseases reported significantly lower mean score for physical and school functioning health domains and total generic score compared to those who hadn’t family history of the disease (P-value = 0.001, <0.0001 and =0.003 consequently). There was also statistically significant difference between child self-report mean score and type of treatment they received in both physical health, social and school functioning health scores (P-value was <0.0001, =0.02 and =0.01 consequently).
As school function domain was the most important domain in QOL in relation to ADHD our study results showed factors affecting the child self-reported school health score for children with ADHD as the following:
Gender, age of the child, his educational level, fathers’ age, mothers’ age, fathers’ education (primary and preparatory school and faculty or institute categories), type of treatment (psychotherapy category), and number of siblings were significant in univariate analysis and were included in multivariate analysis model to find the simultaneous effect of these variables. Multivariate regression analysis revealed that gender, age of the child, consanguinity and number of siblings were significant.
Recommendations
After what we found an independent factor affecting health-related quality of life of children with ADHD, we recommend with:
1- Screening for possible risk factors of development of ADHD among families as in presence of family history of ADHD.
2- The early investment in diagnosis and interventions is decisive, considering the need to create special support groups, avoiding or reducing personal and family suffering, as well as negative influence in adult life.
3- Attention to Psycho-therapy as an important line of treatment of ADHD.
4- Follow up of the used drugs and its impact in their quality of life.
5- There is need for increasing academic performance and its ability, in addition, in order to increase the comprehensive quality of life reported by the patients, treating the accompanying depressive symptoms is critical.
6- Family support which improves HRQOL scores in children with ADHD.
Summary
Attention deficit hyperactivity disorder (ADHD) is the most common neuropsychiatric disorder during childhood. ADHD has claimed a place among the important problems of the fields of psychiatry and education for years as a lifelong disorder. Children with ADHD exhibit developmentally inappropriate levels of inattention, hyperactivity and/or impulsivity which result in a range of impairments in social, educational, and family functioning. Those with ADHD have serious impairment in cognitive, emotional, social, interpersonal, and academic performance in life. It affects about 5–7% of children worldwide when diagnosed via the DSM-5 criteria.
In Egypt, studies showed a wide range of variation of prevalence of ADHD; for example, in Assuit city, 6% of elementary school children but in Cairo, the prevalence of ADHD was reported to be 9.4%. On the other hand, prevalence reported to be 20.9% among 8-12 children admitted to Sayed Galal hospital outpatient pediatric clinic (Al-Azhar University Hospitals) and 20.5% in Fayoum city among 4-6 years old children. The great difference in the prevalence of ADHD reflects variations in methodology such as diagnostic practices, sources of information and studied population rather than real differences behavior. This is the case whether ADHD is diagnosed through parent ratings on questionnaires, teacher ratings, or a diagnostic procedure as DSM or ICD diagnostic criteria were applied. The precise causes of ADHD are unknown in the majority of cases, it is a disorder with multiple etiologies. Combinations of genetic, neurological, and environmental factors contribute to pathogenesis and its heterogeneous phenotype.
According to the DSM-5, ADHD symptoms can be hyperactivity, impulsivity or maladaptive levels of inattention symptoms.
A multimodal approach combining non-pharmacological (behavioral) management and pharmacological interventions is often needed to effectively treat children and adolescents impaired by ADHD. Quality of life (QOL) describes an individual’s subjective perception of their position in life as evidenced by their physical, psychological, social and school functioning. QOL has become an increasingly important measure of outcome in child mental health clinical work and research.
Here this study was conducted aiming to assess health-related quality of life of children having attention deficit hyperactivity disorder (ADHD) attending neuro-psychiatry and pediatric outpatient clinics at Sohag University Hospital. Furthermore, potential differences between self-report and parent/proxy reports and the risk factors influencing them will be assessed and to compare QOL of those children with QOL of control group. A case-control hospital-based study was carried out among targeted patients. 600 children were included, distributed into two groups: 200 children with ADHD and 400 control children. We use the Pediatric Quality of Life Inventory (Peds QOL, Mapi Research Institute, Lyon, France) obtained from mapi-trust.org after their approval and it’s a 23-item generic health status instrument that assesses 5 domains of health (8 items for physical functioning, 5 items for emotional and psychological functioning, 5 items for social functioning, and 5 items for school functioning) for children age 4-12 years old self-report and their patient proxy-report. The study carried out in the period from 1st June 2021 till 30th May 2022. Results revealed that the mean score of children with ADHD child self-report (5-12 years old) for all domains of HRQOL except physical health domain were significantly lower than the healthy controls (p value was < 0.0001 for psychological health domain social health domain and was 0.01 for school health domain).
The order of mean score in different domains in cases group was as following: school functioning (67.2±21.0) <psychological health domain (76,4±18.2) < physical health domain (81.4±16.2) < social health domain (87,8±16.4). Children with ADHD; boys had significantly higher mean score for school health domain compared to females. Older children had a significantly lower mean score for school and psychological functioning compared to children in younger age groups but they had higher mean score for physical and social functioning.
The parents of the cases group reported statistically significant lower mean scores in all domains of HRQOL compared to the parents of the control group (P-value < 0.0001).
There was a highly statistically significant difference between cases and control groups in distribution of each parents’ relationship, child-parent relationship, exposure to punishment from parents, exposure to SHS, presence of toxemia during pregnancy, delivery mode and finally presence of perinatal hypoxia or asphyxia (p- value< 0.0001) on the other hand there was no statistically significant difference between both groups in previous exposure to head injury, duration of electronic use as risk factors of ADHD or mother age at delivery if less than or more than 35 years old. So, we recommend with develop effective programs to help avoid risk factors that may lead to ADHD and early detection of ADHD in children as this will decrease the burden of the disease as poor school or work performance in the future, relationship difficulties and improve their HRQOL. We also recommend with Family support which improves HRQOL scores in children with ADHD.