الفهرس 
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Abstract
A DHD is a common childhood neurobehavioural disorder defined by symptoms of developmentally inappropriate inattention, impulsivity and hyperactivity. A recent meta-analysis estimated the worldwide prevalence of ADHD to be 5.29%, making it the most prevalent psychiatric disorder of childhood. The social and economic costs of childhood ADHD are considerable, and difficulties often persist into adulthood. Children with ADHD are at high risk for developing adjustment problems, antisocial behaviour, substance abuse, other psychiatric disorders, and difficulties in education and work.
Until relatively recently, the causal relation between ADHD and inflammation has remained unclear. The higher co-occurrence of ADHD with inflammatory and autoimmune disorders may suggest a range of underlying mechanisms, including an altered immune response, common genetics, and environmental links. It has also been suggested that increased cytokine release due to an inflammatory process may affect the prefrontal cortex functioning.
ADHD patients were more likely to have asthma, allergic rhinitis, atopic dermatitis, and allergic conjunctivitis in comparison to the non-ADHD subjects from the population.
There have been a limited number of studies reporting altered levels of inflammatory biomarkers in children and adolescents with ADHD. Some studies used cytokines as inflammatory markers in ADHD. The cytokines costs as inflammatory markers are too much expensive so researchers start to use another inflammatory marker that are less expensive and less invasive.
NLR, PLR and MPV are new, simple and inexpensive marker of the systemic inflammatory response. Few studies have examined NLR, PLR and MPV in population with mental disorders although it is inexpensive.
The relation between NLR, PLR and MPV as inflammatory markers and pathogenesis of ADHD has been evident in only few studies. Our study aimed to investigate this relation and further verification of its value. Increasing evidence suggests that immunological and inflammatory dysfunctions may play an essential role on predisposition, onset, and progression of psychiatric disorders like ADHD
The study included 2 parts:
Theoretical part
Included 2 chapters:
Chapter 1: Review of literature about ADHD including epidemiology, etiology, clinical picture, diagnostic criteria, comorbidities, impact on patient family and management of ADHD.
Chapter 2: Review of literature about inflammation and ADHD including theories about that, inflammation as a-part of pathogenesis of ADHD, NLR PLR and MPV as inflammatory markers in different psychiatric disorders and NLR, PLR and MPV as inflammatory markers in ADHD.
Clinical part
Methodology:
This is an observational cross sectional case control –etiological study was done in El-Matarya teaching hospital.
Subjects
50 patients with ADHD diagnosed according to DSM -V criteria using MINI-KID.
Recruited from child psychiatry outpatient clinic of EL-Matarya teaching hospital
Inclusion criteria
IQ> 70
Both sexes.
Age: 6-12 years old.
Exclusion criteria
IQ below 70
Patients having any other psychiatric disorders comorbid with ADHD
Patients with chronic medical illness.
Patients receiving medications including medication to treat ADHD
Patients showing thrombocytosis, thrombocytopenia, lymphocytosis, lymphopenia, neutrophilia, neutropenia
Control group
50 Control cases matched in age and sex with cases.
The controls group is healthy children with no medical or psychiatric disease. The control group was selected from the relatives of patients group.
Tools and method:
Patients were subjected to:
1. Written informed consent before enrollment in the study.
2. Diagnostic interview using Mini-kid for establishment of diagnosis and exclude comorbid condition.
3. IQ assessment: the Wechsler intelligence scale for children.
4. Conners’ Parent Rating Scale, establishing severity of ADHD in patient group.
5. Complete blood count analysis with calculation of NLR, PLR and MPV.
Controls were subjected to:
1. Written informed consent before enrollment in the study.
2. Diagnostic interview using Mini-kid to confirm that control has no any psychiatric disorders.
3. Complete blood count analysis with calculation of NLR, PLR and MPV.
Results
ADHD patients showed higher NLR, PLR and MPV values than control.
The severity of ADHD (measured by Conners’ parent rating scale) had no significant relation with NLR, PLR and MPV.
The subtypes of ADHD had no statistically significant relation with NLR, PLR and MPV.
Neutrophil count was significantly high in patients group as compared with control group, while the reverse for the lymphocyte count.
Platelet count didn’t show a statistically significant difference between patients group and control group.
The sociodemographic features of age and sex didn’t have statistically significant relation with inflammatory markers NLR and PLR.
Sex had a statistically significant relation with MPV.
There were statistically significant correlations between NLR and all of VIQ, PIQ and TIQ while the PLR had a statistically significant correlation only with VIQ and TIQ. MPV had no a statistically significant correlation with any type of I.Q.
Discussion
The study compared the obtained results with the results found in other studies and reported possible causes of similarity or differences.
Recommendations
The study recommends:
There is a need for further studies with larger number investigating the role of NLR, PLR and MPV as inflammatory markers in ADHD.
There is need for Using NLR, PLR and MPV as initial laboratory test for ADHD patients before starting medication as studies showed that ADHD patients receive stimulants with elevated MPV have an increased risk of cardiac disease more than patients with normal MPV.