الفهرس 
Attention deficit hyperactivity disorderOnly 14 pages are availabe for public view
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Abstract
Attention deficit/hyperactivity disorder (ADHD) is a childhood-onset neurodevelopmental condition characterized by inattention, hyperactivity, and/or impulsivity that can persist into adulthood with deleterious effects on social, academic, and behavioral outcomes.
ADHD is diagnosed by an assessment of a person’s childhood behavioral and mental development, including ruling out the effects of drugs, medications and other medical or psychiatric problems as explanations for the symptoms. Three ADHD types of presentations can be distinguished: the predominantly hyperactive-impulsive type (ADHD-HI), the predominantly inattentive type (ADHD-I) and the combined type (ADHD-C).
The treatment of ADHD is vital, and if left untreated, the severity of the disorder alongside the rate of comorbid disorders will increase. Medication alone is not as effective as when the medication is combined with non-pharmacologic treatment measures. Patients with ADHD managed on both medication and non-pharmacologic treatments have been shown to have higher self-esteem and social functioning skills versus those untreated.
Vitamin D is actually a fat-soluble steroid prohormone that has endocrine, paracrine and autocrine functions. The paracrine and autocrine effects of vitamin D depend on genetic transcription, unique to the type of cell expressing nuclear vitamin D receptors. These potential effects include inhibition of cell proliferation, promotion of cell differentiation, and apoptosis which may in turn have roles in cancer, immunity, and many organ systems. Vitamin D decreases symptoms in ADHD through modulation of neurotransmitters such as dopamine, norepinephrine, and acetylcholine.
The current study tried to investigate the level of vitamin D in ADHD children and the impact of vitamin D supplementation on the symptoms of those children. The study was conducted in two phases, first phase was a case control study and second phase was interventional study. The study included 30 children with ADHD diagnosed according to the diagnostic and statistical manual of psychiatric disease (DSM5). Patients was recruited from the attendants of the Center of Care of Special Needs, Faculity of Postgraduate Childhood Studies, Ain shams University.
Cases were 21 males (70%) and 9 females (30%). Their ages ranged from 5 to 10 years olf (60-120 months) with a mean age of 90.27±19.42 months. Another 30 healthy children taken as a control group. The mean age group was 89.10±19.95 months, 19 controls out of 30 (63.3%) were male and 11 controls (36.6%) were females.
All cases and controls were within the normal IQ range. The two groups were matched as regard age, sex and IQ with no statistically significant difference.
All ADHD children were subjected to full psychiatric clinical assessment to identify psychiatric symptoms/disorders, Conner’s Parent Rating Scale Revised Long version (CPRS-RL), estimation of the serum level of human 25 hydroxyvitamin D by ELISA technique, serum calcium, serum phosphorous, and serum alkaline phosphatase. All of them took Devarol IM as single dose and re-evaluated after 8 weeks by repetition of CPRS-RL, serum 25 hydroxyvitamin D by ELISA technique, serum calcium, serum phosphorous, and serum alkaline phosphatase. Only laboratory investigations done for control group.
In the present study, there was a highly significant difference between serum vitamin D level in cases and controls with p value 0.001 as vitamin D was deficient in cases (mean 14.42) and sufficient in controls (mean 26.58). This deficiency matchs results of two studies evaluating vitamin D among Egyptian children with ADHD.
Data in current showed that the severity of deficiency of vitamin D in children with ADHD was significantly higher than that in healthy children. There was improvement of vitamin D and this was associated with improvement of cognitive problem , somatization, inattention and mixed psarameters of CPRS-RL. Using ROC curve, vitamin D sensitivity was 70% and its specificity was 73.3%.
Comparison between cases before and 8 weeks after injection of single dose of vitamin D IM shows highly significant improvement of serum vitamin D level. Pre-injection vitamin D serum level was (14.42±9.39) which raised after injection of vitamin D to became (44.45± 16.82) with p value < 0.001. This was associated with significant changes of CPRS-RL parameter. Highly significant difference noticed in cognitive problem parameter with a p value 0.009. There was significant difference as regard both inattentive DSM parameter with a p value 0.019 and mixed parameter with a p value 0.050.
There was a statistically significant negative correlation between post vitamin D with post-cognitive problem (p value 0.024), post-somatization (p value 0.038), and post-inattentive DSM (p value 0.025). Highly significant negative correlation between post vitamin D and post-mixed was noticed with a p value 0.004. As increase vitamin D associated with decrease score of these parameters- decrease in score parameters means improvement- so, improvement of vitamin D level associated with improvement of cognition, cognetive problems DSM and mixed parameters of CPRS-RL.
There was a statistically highly significant negative correlation between difference congnitive problems and difference mixed parameter.
Conclusion
1- This study suggests an association between vitamin D level and ADHD in childhood.
2- Serum vitamin D level was lower in children with ADHD than in controls.
3- The low levels of serum vitamin D among the ADHD children suggest the need for regularly monitoring of serum vitamin D levels and treatment of patients with vitamin D deficiencies. In addition, life style and diet should be modified and directed towards eliminating the nutritional deficiencies in the society.
4- Vitamin D could be a valid biomarker in ADHD.
Recommendations
1- More studies should be done to include large samples of patients and wide demographic distribution to ensure that vitamin D is deficient in Egyptian children with ADHD.
2- Farther studies with wider scope on large number of patients entailing vitamin D administration as an adjuvant treatment are needed to clarify the therapeutic effects of vitamin D supplementation.
3- Relationship between serum vitamin D level and ADHD warrants farther investigation to define the exact role of vitamin D in the pathogenesis of ADHD.
4- Large scale prospective studies needed to approve that vitamin D deficiency is a cause of ADHD.
5- Routine checkup of vitamin D level is recommeded in ADHD and more attention for nutritional history of children with ADHD.
6- Prevention and early recognition of vitamin D deficiency particularly in ADHD children is so important, since its treatment is an easy, available, cheap, and safe approach.
7- This study provides preliminary evidence to suggest that vitamin D supplementation may improve aspects of cognitive functioning related to an ADHD diagnosis.
8- The results of current study highlight the importance of evaluation and supplementation of vitamin D in Egytian children with ADHD, although the small sample size focus the need for farther studies.