الفهرس 
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Abstract
Previous research has suggested that ADHD-related symptoms are potentially important biobehavioral risk factors for CSV. The association between trauma and ADHD is not independent of other psychological comorbidities. Both ADHD and CSV have a major impact on children’s adaptability, self-image and self-esteem, resulting in childhood internalizing and externalizing behavior problems.
The current study sought to examine SE level variations in ADHD children based on the existence of internalizing and/or externalizing problems and SVE, to assess the relation between SVE and internalizing and/or externalizing problems as well as to identify factors associated with decreased SE among ADHD children.
After obtaining the approval from the Ethical Committee of Faculty of Postgraduate Childhood Studies and informed consents from caregivers and their children, the study was conducted on 372 children, with age range from 8-14 years, of both genders and diagnosed with ADHD all variants. They were divided into 2 groups: the case group, which included 186 ADHD children with scores in the clinical and subclinical ranges of internalizing and externalizing scales of CBCL Parent form; and control group, which included 186 ADHD children with scores lying in the normal range of internalizing and externalizing scales of CBCL Parent form. Children with any chronic medical health problem, those with physical disabilities and IQ below 80 and those with comorbid ASD were all excluded from the study.
All participating children were subjected to physical health assessment, psychiatric assessment, psychometric assessment in the form of Stanford-Binet Intelligence Scale 5th Edition Arabic version, ADHD-SC4 Arabic version, behavioral and emotional assessment by CBCL School age Parent form, SE assessment by CSEI-School form and SVE by CSAQ-Arabic.
Statistical analysis was performed through SPSS Program. The results revealed that ADHD children with internalization and/or externalization or with SVE expressed statistically significant less total and domain specific CSEI scores means than ADHD children without internalization and/or externalization and without SVE respectively. Also, children with internalization and/or externalization showed statistically significant higher frequency of SVE. Moreover, ADHD children with internalizing problems showed statistically significant lower CSEI scores means and higher SVE frequency than ADHD children with comorbid internalization and externalization or with externalization. In addition, significant lower total CSEI scores mean was associated with increasing age and related to second birth order, single parent families, ADHD-I type, severe ADHD, treatment incompliance, one modality therapy and academic failures.
In conclusion, internalization and/or externalization as well as SVE have a negative effect on ADHD children’s SE level. The effect is more significant in ADHD with comorbidity of internalization and internalization & externalization than with externalization. Factors found to be related to lower SE level are older age, second birth order, families with single parent (died, abroad, separated parent), ADHD-I presentation, severe ADHD presentation, unimodal treatment, treatment incompliance and poor academic performance with academic failures