Iron deficiency in South African children and adolescents with attention deficit hyperactivity disorder

Objective: Iron deficiency may play a role in the pathophysiology of attention deficit hyperactivity disorder (ADHD) by causing dopamine dysfunction, but there is conflicting evidence in the literature regarding this relationship. This study investigates the possible correlation between iron deficiency and ADHD in children and adolescents attending a South African child and adolescent psychiatry outpatient service.Method: In this retrospective study, we gathered data from 245 outpatient children and adolescents who had their serum ferritin and/or iron levels tested between February 2011 and January 2016. Relevant statistical methods were used to test for correlations between ADHD and various demographic and clinical factors, including iron deficiency.Results: Out of 245 patients, 88 (35.9%) had iron deficiency, 156 (63.7%) had ADHD and 55 (22.4%) had both iron deficiency and ADHD. Variables found to be significantly correlated with ADHD included gender, age, and methylphenidate treatment, but there was no significant correlation between ADHD and iron deficiency.Conclusions: Our study emphasizes the great complexity involved in understanding ADHD. Comparisons between mentally-ill paediatric patients and matched healthy controls from the same communities are required to further explore the possible association between iron deficiency and ADHD

Role of electroencephalogram in diagnosis of attention deficit hyper activity disorder

Introduction: Attention deficit hyper activity disorder (ADHD), is the most prevalent neurodevelopmental disorder of childhood, which is characterized by the presence of inattention, hyperactivity, and/or impulsivity, EEG is the substrate of brain activity underlying cognition and behavior.Objective: To detect the abnormalities in the electroencephalogram (EEG) in patients with ADHD also to find the relation between attention deficit hyperactivity disorder symptom severity and results of EEG. Method: sixty patients of ADHD and 60 age and sex matched control were evaluated with EEG to detect abnormal waves. Results: Patients with ADHD show abnormal EEG results in the form of background slowing in3 patients (5%) and epileptiform discharge in 19 patients (32%) frontal slowing in 13 patients(22%) normal EEG in 25 patients (42%).Conclusion: There is increased low frequency activity and decreased high frequency activity in children with ADHD, this may aid as an indicator in the diagnosis of ADHD

Attention deficit hyperactivity disorder in Ilorin: screening with the conner's teachers' rating scale

Background: The prevalence of Attention Deficit Hyperactivity Disorder (ADHD) or its risk in North Central Nigeria has not been adequately reported. The consequences of missing the disorder and its co-morbidities are usually costly to the society. Method: Using a multi-stage sampling technique, nine primary schools from where a total of 1,480 pupils were selected across the three local government areas within Ilorin metropolis (two public and one private school from each LGA) we selected. An ADHD assessment tool - the short version of Conner's Teacher Rating Scale was administered on the pupils through their respective class teachers after training the teachers on how to administer the tool. They were classified into Inattention ADHD and Hyperactive/impulsive ADHD. Results: Of the 1480 (741 males and 739 female) pupils recruited, public schools contributed 1033 (69.8%) pupils while 447(30.2%) were from the private schools. A prevalence of 15.8% was found for ADHD risk. Statistically significant differences were present in the male to the female distribution of the Inattention ADHD, Hyperactivity ADHD (each with p< 0.05) but not in the overall ADHD index(p> 0.05). The ADHD Index was higher in the public schools. Conclusion: Prevalence of primary pupils aged 6-12 years in Ilorin at risk of ADHD is 15.8%, no significant gender variation was found. It is hereby recommended that Pre-primary school entry screening for ADHD should be instituted considered to enhance early recognition and prompt intervention so as to save the country from bad childhood that develops into bad adulthood with its myriads of anti-social and behavioural consequences

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among Rural Primary School Children in Southeastern Nigeria: Comparison of School and Home Settings

Background: Diagnosis of ADHD depends on manifestation of symptoms in at least two different settings. This therefore emphasizes the importance of multiple informants; parents and teachers. However perception could differ because of differences and inconsistencies across different settings. This is particularly important in rural settings in Africa where the educational attainment and outlook of teachers are very different from those of the parents. The study is aimed at comparing the presentations of children with ADHD in the rural area; across two different settings: home and school. Methods: The teachers of 181 rural primary school children in Ogberuru in Imo state; south eastern; Nigeria completed the school version of ADHD rating scale-IV; and their parents completed a Socio demographic questionnaire and the home versions of the ADHD rating scale IV. Results: Of the 18 symptoms of the condition; there were significant differences in the rate of identification in eight symptoms. These symptoms include 'being easily distracted' (p=0.0427); 'difficulty following through on instruction' (p=0.0026); 'fails to give close attention to details (p=0.0001); 'avoids tasks necessary for tasks' (p=0.0013); 'difficulty playing quietly (p=0.0059 ) ; 'talks excessively' (p=0.0023); 'intrudes on others' (p=0.0004); and 'seems not to listen when spoken to directly' (p=0.0002). They were all consistently more manifest in school settings than in their homes. Conclusion: Teachers identified ADHD symptoms more commonly than parents. They could therefore play critical roles in programs aimed at improving early identification and management of children with ADHD especially in rural Africa where healthcare facilities are scarce

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) among Rural Primary School Children in Southeastern Nigeria: Comparison of School and Home Settings

Background: Diagnosis of ADHD depends on manifestation of symptoms in at least two different settings. This therefore emphasizes the importance of multiple informants; parents and teachers. However perception could differ because of differences and inconsistencies across different settings. This is particularly important in rural settings in Africa where the educational attainment and outlook of teachers are very different from those of the parents. The study is aimed at comparing the presentations of children with ADHD in the rural area; across two different settings: home and school.Methods: The teachers of 181 rural primary school children in Ogberuru in Imo state; south eastern; Nigeria completed the school version of ADHD rating scale-IV; and their parents completed a Socio demographic questionnaire and the home versions of the ADHD rating scale IV. Results: Of the 18 symptoms of the condition; there were significant differences in the rate of identification in eight symptoms. These symptoms include 'being easily distracted' (p=0.0427); 'difficulty following through on instruction' (p=0.0026); 'fails to give close attention to details (p=0.0001); 'avoids tasks necessary for tasks' (p=0.0013); 'difficulty playing quietly (p=0.0059 ) ; 'talks excessively' (p=0.0023); 'intrudes on others' (p=0.0004); and 'seems not to listen when spoken to directly' (p=0.0002). They were all consistently more manifest in school settings than in their homes. Conclusion: Teachers identified ADHD symptoms more commonly than parents. They could therefore play critical roles in programs aimed at improving early identification and management of children with ADHD especially in rural Africa where healthcare facilities are scarce

HIV-associated neurocognitive disorders

HIV infection is associated with disturbances in brain function referred to as HIV-associated neurocognitive disorders (HAND). This literature review outlines the recently revised diagnostic criteria for the range of HAND from the earliest to the more advanced stages: (i) asymptomatic neurocognitive impairment; (ii) mild neurocognitive disorder; and (iii) HIVassociated dementia. Relevant literature is also reviewed regarding the differential impact upon component cognitive domains known to be affected in HAND; which in turn should ideally be targeted during clinical and neuropsychological assessments: psychomotor and information processing speed; learning and memory; attention and working memory; speech and language; executive functioning and visuospatial functioning. A discussion outlining the neuropsychological tools used in the diagnostic screening of HAND is also included. The central mechanisms of HAND appear to revolve primarily around psychomotor slowing and cognitive control over mental operations; possibly reflecting the influence of disrupted fronto-striatal circuits on distributed neural networks critical to cognitive functions. The accurate assessment and diagnosis of HAND depends on meeting the need for statistically sound neuropsychological assessment techniques that may be used confidently in assessing South African populations; as well as the development of relevant norms for comparison of test performance data

Community survey of attention-deficit/hyperactivity disorder among primary school pupils in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) is a common childhood neuro-developmental condition with early onset. ADHD affects children worldwide. However, there is a variation in the prevalence across different countries. In Nigeria, there is paucity of information on the prevalence. To provide the relevant information, a cross-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6-12 years selected systematically among pupils in Egor Local Government Area of Edo State. Materials and Methods: All the 1473 pupils were screened with the Disruptive Behavior Disorder (DBD) Rating Scale to identify children who had ADHD symptoms as contained in the DSM -IV. Such children were compared with randomly selected controls. The academic records of both the groups were also compared. Results: The prevalence of ADHD was 7.6%. The prevalence was higher in boys (9.4%) when compared to girls (5.5%) (P = 0.003). Of the three different subtypes of ADHD, the predominantly inattentive subtype (ADHD-I) was the most prevalent (47.3% of the ADHD population) followed by the combined type (ADHD-C; 31.3%), while the least prevalent was the hyperactive/impulsive subtype (ADHD-HI; 21.4%). There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. Conclusion: The prevalence of ADHD was relatively high when compared to the figures available for other countries. For this reason, there is a need to pay increased attention to this condition in Nigeria. Community screening under the umbrella of the School Health Program could be of assistance

Socio-demographic determinants and impact on academic performance of attention deficit/hyperactivity disorder in school children in Benin City, Nigeria

Background: Attention-deficit/hyperactivity disorder (ADHD) affects children worldwide. In Nigeria, there is paucity of information on the socio-demographic associates of this important childhood condition. Methods: Across-sectional study was conducted between February and August 2006 among 1473 public primary school pupils aged 6 to 12 years, selected randomly among pupils drawn from Egor Local Government Area of Edo State. The subjects were screened using Disruptive Behaviour Disorder (DBD) Rating Scale to identify children with ADHD symptoms. Identified subjects were further evaluated with questionnaires to ensure that they met the other explicit non-symptom criteria contained in the DSM-IV manual, such as functional impairments. Children who were confirmed to have ADHD were compared with randomly selected controls to determine the association, if any, between the prevalence of the condition and some sociodemographic characteristics. Results: The prevalence of ADHD was 7.6%. There was no statistically significant difference in the prevalence of ADHD amongst the different age cohorts. No significant association was found between the prevalence of ADHD and socioeconomic background, size of family, age of parents and characteristics of the child's primary caregiver. The children with ADHD had significantly lower school aggregate than that of selected control (Mean aggregate score of 51.7+16.1% versus 63.7+ 16.5%,p<0.001). Conclusion: The prevalence of ADHD in this study is relatively high. Community screening under the umbrella of the School Health Programme is required. Appropriate medications, educational support and psychotherapy when incorporated in the national health system will go a long way in redirecting affected children's developmental lives

The Effect of Sympathomimetic Medication on Cardiovascular Functioning of Children with Attention-Deficit / Hyperactivity Disorder : Cardiovascular Topic

Objective : The aim of this study was to investigate the effects of sympathomimetic medication on the cardiovascular system of children with attention-deficit / hyperactivity disorder (ADHD). Methods : Cardiovascular functioning of children with ADHD (n = 19) was tested while the children were stimulant free and during a period in which they were on stimulant medication. Electrocardiograms (ECGs) were obtained by means of a Schiller CardioLaptop AT-110 ECG recorder using the standard 12-lead cable positioning for a resting ECG. Blood pressure was measured by means of a stethoscope and mercury sphygmomanometer. Results : The main findings of this study were that methylphenidate usage is associated with increases in heart rate (HR) and blood pressure (BP); and that it does not adversely affect HR-corrected QT and JT intervals or cardiac dispersion values. Conclusion : Methylphenidate causes an increase in HR as well as increases in both systolic and diastolic BP; but no change in cardiac depolarisation and repolarisation duration or homogeneity

General Practitioners' Familiarity; Attitudes and Practices with Regard to Attention Deficit Hyperactivity Disorder in Children and Adults

Background: Attention-Deficit Hyperactivity Disorder (ADHD) is a common disorder; affecting 4 to 5 of South African children. Recent studies reveal that 30to 70of children continue to experience problems related to ADHD in adulthood. Adults are becoming increasingly aware of adult ADHD as a result of public awareness campaigns in the media. Their first line of action is to visit their family physician (GP); but the question that arises is whether these practitioners are ready to take on patients with ADHD. The aims of this study were to determine the familiarity; attitudes and practices of general practitioners (GPs) in South Africa with regard to ADHD in both children and adults; and whether there are differences in children and adults with regard to depression and generalised anxiety disorders as comorbid disorders. The study also briefly explored the training models of GPs in South Africa. Methods: The research questions were addressed by means of a survey approach; using quantitative measures. An e-mail message with a covering letter; explaining the purpose of the research project; provided a link to a web-based questionnaire. It was relayed to 6 704 GPs on the database of the company MEDpages; which managed the distribution. A questionnaire attached to an e-mail message was sent to all departments of Family Health at universities in the countryto obtain information with regard to the training models of GPs. The questionnaire was completed by 229 respondents. The data were statistically analysed using Statistica Version 7.0. Results: The most significant outcome of the study revealed a considerable need among GPs to increase their knowledge base with regard to ADHD (87with regard to children and 89with regard to adults). As they were of the opinion that they should be able to diagnose and manage ADHD in both children (90) and adults (85) a significant need for a screening tool (83) was also found. The GPs' knowledge and training with regard to depression and generalised anxiety disorders were significantly more extensive with regard to adults than to children. Training with regard to ADHD in adults was almost non-existent. With regard to children the most important barriers were uninformed parents (70); limited funds (61); uninformed teachers (58); and with regard to adults these barriers were uninformed patients (64); lack of knowledge on ADHD in adults on the part of the GPs (63); and consultation time (58). Although GPs did seem to have an awareness of the important role of the psychologist in the diagnosis and effective management of patients with ADHD; their referral practices generally involved a limited interdisciplinary approach. Conclusion: It is recommended that the limited knowledge base of GPs with regard to ADHD should be addressed by adapting the curriculum of undergraduate medical students and providing opportunities for continued medical education that focuses on the diagnosis and management of ADHD; in both children and adults. GPs should acknowledge the educational psychologist as an equal partner within a multidisciplinary team

A Case of Effective Single-Session Treatment for Attention Deficit and Learning Problems in A Routine Clinical Practice:The Value of a Tran diagnostic Approach to Case Formulation

This article reports a systematic clinical case study of the psychological assessment and treatment of Daniel (9); a coloured South African boy with a diagnosis of attention deficit hyperactivity disorder (ADHD) (inattentive type). The case is of scientific interest because: (1) there was only a single treatment session; in which contingency management training was delivered to Daniel's parents and teacher; (2) there was evidence for the effectiveness of the intervention immediately and at two-year follow-up; (3) it documents the transportability to a South African context of an intervention developed by overseas research; (4) it documents the central role of case formulation in the delivery of effective psychological interventions; and (5) although Daniel met the criteria for ADHD; he also displayed symptoms of depression and social anxiety and the case supports the use of a transdiagnostic approach to case formulation. The conscientiousness with which his parents and teachers applied the programme was a major factor in the effectiveness of the intervention; and such rapid impact would not be possible where parents and teachers are unavailable or not co-operative. The publication of systematic case studies such as this one is important for the development of a local evidence-based practice in South Africa

Prescribing Patterns of Methylphenidate in a South African Patient Population who are Members of a Private Medical Aid

Methylphenidate is primarily used for attention deficit hyperactivity disorder (ADHD) in children. The primary aim of the study was to investigate the prescribing patterns of methylphenidate of a medical aid patient population in a private sector and to compare the results with previous studies. An exposure cohort drug utilisation study was conducted. Data were obtained from a South African medical aid administrator. Prescription records for 115 patients who received methylphenidate during 2002 were retrospectively analysed. Nearly three-quarters (73.0) of the patients were males and 79.1of patients were 18 years or younger. The average age of patients was 15.6 (SD=10.8) years. Seventeen patients were 30 years or older. Two-thirds of prescriptions (67.3) were for methylphenidate 10 mg (the innovator product); 20.7were for the 20 mg slow-release innovator product and the rest were prescriptions for the recently introduced 10 mg generic equivalent tablet. Patients received on average 4.0 (SD=3.3) prescriptions for methylphenidate during the year. The average Prescribed Daily Dose (PDD) for methylphenidate was 15.4 (SD=7.6) mg. Further studies are recommended; especially into the quality of life of patients before and after receiving methylphenidate. The impact of methylphenidate on the academic performance of patients should also be quantified