ABSTRACT
Background: Attention-deficit/hyperactivity disorder (ADHD) is generally accepted as having a strong genetic basis but environmental influences have also been reported as contributing factors. Among the environmental influences, maternal smoking, pregnancy, labour/delivery and neonatal complications (PLDNC) and disturbed family situations have been implicated most. Aims: To study the pattern and extent of familial and environmental risk factors in children with ADHD attending a tertiary general hospital in India. Methods: The study was conducted in the child guidance clinic (CGC) of Kolkata, India from January 2012 to August 2013. The sample was screened by applying child symptom inventory -4-parent version to all the children of age five to twelve years attending the CGC. Children with IQ< 50 were excluded by Binet Kamat test. The final sample was selected by DSM-IVTR criteria. The parents of the final sample were finally interviewed with a semi-structured proforma to find out the familial and environmental risk factors among them. Results: The final sample was 84 ADHD cases out of total 339 children attending the CGC. Of them, 5.95% had diagnosed cases of ADHD among their siblings and cousins, while nearly 20% had alcohol dependence and bipolarity among parents. There was no maternal substance abuse, but disturbed family situations were found in 32.14% of children with ADHD, mostly contributed by parental mental illnesses. PLDNC were also quite common (nearly 30%) among these children, but no regular exposure to food additives. Conclusions: The extent of ADHD in our CGC (25%) though similar with other studies, the pattern of risk factors are different. There is complex interaction of familial (parental externalizing disorders) and other environmental factors (family situations, antenatal care). The role of inadequate maternal and child health care delivery system is also evident.