Sleep Profile in Children With Attention Deficit Hyperactivity Disorder

Background: Attention deficit hyperactivity disorder [ADHD] is a common neurological disorder affecting 5-8% of school- age children and symptoms continue to mature in about 60% of cases, about 4% of adults

Objectives: To identify sleep problems and thier diagnostic characteristics that may help to better understand ADHD and to assess the severity of symptoms and their relationship to ADHD

Methodology: A case- control study was carried out on 60 children divided into: 30 children with ADHD diagnosed according to the DSM of mental disorders [5th ed.], in addition, 30 normal children as controls. the study was conducted at te institute of postgraduate childhood studies and center of psychiatry at Ain shams University in the period from April 2016 to October 2017. Complete psychological history and examination were done for each child who met the inclusion criteria. physical, neurological and psychological examination were performed using: DSM 5, conner scale, child sleep habits questionnaire and sleep laboratory at the center for Psychiatry Ain shams University

Results: The findings revealed that 18 [60%] of cases suffered from insomnia: [27.7%], primary insomnia [22.2%], primary, intermediate and final insomnia [16.6%], primary and late insomnia[11.1%], moderate insomnia and hyper hypnosis [5.5%]. there is increased instability in sleep and latency in children with ADHD. there are statistically significant differences between cases and control groups as regards longer latency, lack of sleep, slightly lower phases 3 and 4duration, longer duration of dreaming sleep [ accompanied by eye movement] and longer respone time, increased vigilance, height of the periodic leg movement

Conclusion: there is a high co- occurrence of sleep problems among children with ADHD that minimally 65.62% of ADHD cases have at least one sleep disturbance type

Psychosocial problems and EEG findings in children with end stage renal failure

Psychosocial disturbances are most commonly encountered problems in children with chronic renal failure and end stage renal disease but little is known about the prevalence in Egypt. The present study aimed to assess the psychosocial functioning level and EEG findings in children with chronic renal failure whether on conservative therapy or undergoing chronic dialysis. Fifty four patients with end-stage renal disease were divided into three groups: Group I: twelve patients on regular hemodialysis three times weekly. Group II: twelve patients on continuous intermittent peritoneal dialysis [CIPD]. Group III: thirty patients with CRF on conservative treatment [CTr]. The patients and controls [13 children] were assessed for psychosocial problems including depression [Children's Depression Inventory], anxiety [Children Manifest Anxiety Scale], phobia [Phobic scale for children], behavioral disturbances, and intelligence [IQ]. Also EEG was done for patients with CNS manifestations. Psychiatric diagnosis on axis I according to DSM-IV showed that HD group had more prevalent major depression compared to other CRF groups. As regard social difficulties, no significant differences were detected statistically between CRF group and control group but HD group was more significantly complaining from social difficulties than CTr and control groups. The depression was more common in HD and PD groups than CTr group with no statistically significant difference. Severe anxiety symptoms were more common among HD patients with high significant difference than CTr and control. Differences between the studied groups as regard phobic scale revealed that phobia was significantly more common among HD, CTr and CRF groups in relation to control group. The patients on HD had more fear of illness than those on PD or CTr with no statistically significant difference but a highly significant difference was found between CRF groups and control. Behavioral disturbances were more common in HD and PD groups than controls with statistically significant difference in between [p=0.05]. Nocturnal enuresis [NE] of primary type was more prevalent in HD and PD groups than CTr group with significant difference in between. Also NE was more prevalent in CRF groups than control with significant difference between HD and PD groups and controls. Statistically significant correlation [border line] was detected between NE and age of onset with higher rate of primary NE among children with early age at onset of the illness [<6y]. The highest mean of IQ was found in the control group with significant difference between it and CRF group [p<0.001]. The IQ was negatively correlated with duration of the disease [p<0.01], and age of onset of CRF [p<0.001]. The school leavers and failure were more common among RD and PD groups than conservative group [p<0.01] and control [p<0.001]. Differences between studied groups as regard global assessment score showed that HD group had lower score than other CRF groups with no significant difference but a significant difference was found between CRF groups and controls [p<0.001]. EEG findings revealed generalized slow wave activity in EEG [generalized low voltage] in all patients whether on hemodialysis [11 patients] or on conservative treatment [14 patients]. Activity of Beta and Alpha waves are mostly poor with generalized Theta and Delta waves. Psychosocial disturbances are commonly encountered problems in children with end stage renal disease. Depression was more common among HD and PD patients. High rates of phobia on phobic scales, phobia of illness, severe anxiety and behavioral disturbances were found among CRF groups. Multiaxial assessment showed significant differences in psychiatric diagnosis, educational difficulties and global function with higher rate in CRF children. Nocturnal enuresis was significantly higher among CRF children and correlated with the age at onset of illness and social difficulties. Thus proper medical support and rehabilitation programs to guard against psychiatric troubles, their causes, and their sequalae are recommended including transporting vehicles, hospital based educational programs, summer camps, peer socialization, and others

Prevalence of behaviour disorders in a sample of Egyptian urban and rural primary school children

The object of the study was to investigate the prevalence of behavior disorders in children of both rural and urban areas, and the risk factors associated with disorder in the sample. A clinical survey was done in elementary urban and rural schools in scholar year 1993-94. 1706 pupils; 892 from rural area, 814 from urban area were studied. The total number of cases elicited in this study was 132 and another 132 children were non cases served as control. Complete physical and neurological examination, psychiatric interviewing based on DSM III R, an Arabic version of Eysenck personality questionnaire; one for adult and the other for children and IQ assessment. It was found that the prevalence rate of behavior disorder among children was 7.74%, 5.16% among children of rural area, 10.57% among that of urban one with a ratio of 1: 2. The prevalence among boys was 11.41% and 4.01% for girls with sex ratio 2.31: 1. A prevalence among private school was 10.1%, while among public school was 11.5% without any statistically significance. As regard the risk factors using logestic regression analysis and odds ratio. Only 12 factors from 22 appeared as independent risk factors

Conversion disorder in adolescence

As the researches regarding this topic in Egypt are actually few, hence, it was thought of utmost necessary to undertake a work to study conversation disorder in adolescence in Egypt. Structured psychiatric sheet was applied to all the students registered in Qalyoub Preparatory School during the year 1988 - 1989 [730 students]. 34 students were found with histories of conversion disorder. These cases were thoroughly studied by comparing with 34 controls selected from the same school and matched for age, sex and social class. The female: male ratio was 1: 0.7, the mean age was 14.29 +0.99. 73.5% were from low social classes, 71.6% came from large families but the disorder was insignificant. The cases showed scholastic retardation while conversion disorder could occur in students with low, average or high intelligence. All the cases complained of family communication problems with significant difference. 41.7% had an aggressive father and 47.1% had an aggressive mother, while 26.4% had an overprotective father and 38.23% had an overprotective mother but with no significant difference with the controls. The predominant conversion symptom was seizure, all the cases had psychological stresses before the onset of conversion disorder. The cases scored high neuroticism, psychoticism and low extroversion

Academic achievement in postmeningitic postencephalitic children

Thirty children who were admitted to Dearb Negm Hospital, fever unit and were diagnosed as meningitis and/or encephalitis were the subjects of the study. All evaluations were initiated at least three years following the acute episode. The age of evaluation was from 6 to 12 years. Each child was matched by age, sex, social class and classroom membership with a nonmeningitic nonencephalitic peer. Academic achievement was assessed using review of school's marks, teacher questionnaire and parent interview. Deviant behavioural assessment and psychometric testing for intelligence and personality were done, with physical, neurological and psychiatric evaluations. Our results revealed that children who have recovered from meningitis and / or encephalitis with low average intelligence [81.2], high neuroticism [13.1 +/- 4.07] males and 15.1 +/- 4.19 females] and with residual defects of mild to moderate neurological sequelae [6.6% hearing troubles, 3.3% epilepsy and 3.3% six nerve affection] can succeed in the primary school but with grades lower than nonmeningitic noncephalitic peer. We suggest that good academic success need more school and family support to compensate for the differences in intelligence quotient and residual neurological defects