Study of changes in rs2283265 polymorphisms in dopamine receptor D2 and rs27072 in dopamine transporter gene (SLC6A3) in patients with attention-deficit hyperactivity disorder.

Objectives: Attention-deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children that lead to numerous complications. This study examined the changes in rs2283265 polymorphisms in the dopamine receptor D2 (DRD2) and rs27072 in the dopamine transporter gene (SLC6A3) in ADHD patients. Materials & Methods: This descriptive-analytical study was performed on children aged 4-12 years with ADHD. In this study, 100 patients in the ADHD group (according to DSM-IV-TR criteria and diagnosed by interview by a child and adolescent psychiatrist) and 100 children in the control group (including patients referring to the pediatrician without hyperactivity) were enrolled. Two polymorphisms rs2283265 and rs27072 in two groups were comparatively investigated using PCR-RFLP method and restriction enzymes. Data were analyzed using SPSS 17. Results: There was a significant correlation between gender and ADHD, and the disease was more common in boys (P=0.021). In this study, there was no significant relationship between ADHD types and frequency distribution of rs2283265 (DRD2) and rs27072 (SLC6A3) polymorphism genotypes (P<0.05). However, there was a significant correlation between distribution of rs2283265 (DRD2) and rs27072 (SLC6A3) polymorphisms and ADHD (P<0.05). Conclusion: It seems that the changes in DRD2 and SLC6A3 genes are associated with ADHD, and study of these genes can be helpful in diagnosis and genetic screening.

The Relationship Between Body Mass Index and Depression, Anxiety, Body Image, and Eating Attitudes in Adolescents in Iran.

Background: The aim of this study was to investigate the relationship between body mass index (BMI) and depression, anxiety, body image, and eating attitudes in 12- to 16-year-old adolescents. Materials and Methods: In this descriptive-analytical study on 437 students in Shahrekord, Iran, selected by two-step random sampling (selection of schools and students), participants were divided into normal weight (BMI: 5-85th), overweight (BMI: 85-95th), and obese (BMI >95th) groups and completed the questionnaires and data were analyzed by SPSS version 23. Results: BMI had a positive correlation with anxiety, depression, and dysfunctional eating attitudes, and negative correlation with body image in adolescents. Mean scores of depression and anxiety in both overweight and obese groups were significantly higher than those in normal weight adolescents but scores of body image and eating attitudes were not different between overweight and normal weight groups. Conclusion: Obesity and overweight may have adverse effects on mental health of adolescents and more attention to psychological aspect of obesity can help us to provide better health services to overweight and obese adolescents.

Mental disorders and their comorbidities among children and adolescents aged 6 to 18 years in Lorestan Province.

OBJECTIVES: The profile of mental disorders has been changing over time. The aim of this study was to investigate the prevalence of mental disorders in children and adolescents in the Lorestan province of Iran. MATERIALS & METHODS: This community-based cross-sectional study was done on 1001 children and adolescents aged 6-18 years from Lorestan province randomly selected by multistage cluster sampling method. Children and their parents were interviewed using the Kiddie-Sads-Present and Lifetime Version (K-SADS-PL). Also, the comorbidities of psychiatric disorders were evaluated. RESULTS: According to obtained results, 25.1% of participants were diagnosed to have at least one psychiatric disorder. The prevalence of psychiatric disorders was not significantly different between the two sexes (OR=0.876, P=0.378) and three age groups (P>0.05). this prevalence was significantly higher in rural areas than in urban areas (OR= 1.997, P=0) and was significantly lower in children of fathers with a high school diploma or higher education compared to children of less-educated fathers (P<0.05). On contrary, it was significantly more prevalent in children of mothers with high school and bachelor's degrees compared to illiterate mothers. (p<0.05). The most prevalent psychiatric disorders were oppositional defiant disorder (ODD) (5.9%), separation anxiety disorder (5.3%), and depressive disorders (5%). The most prevalent groups of psychiatric disorders included anxiety disorders (11.2%), behavioral disorders (9.4%), and mood disorders (5%). Behavioral disorders were highly comorbid with anxiety disorders (20.7%). CONCLUSION: Mental disorders affect a high proportion of children and adolescents in Lorestan province. There is a need for psychiatric facilities to provide for the needs of families to child mental health services.

Prevalence of elimination disorders and comorbid psychiatric disorders in Iranian children and adolescents.

PURPOSE: Currently, there is a paucity of studies on the prevalence of Elimination Disorders among Iranian children and adolescents. Due to the ongoing need to monitor the health status of these children and adolescents, the present study aims to investigate the prevalence of Elimination Disorders and comorbid disorders in Iranian children and adolescents. METHODS: In this cross-sectional study, 29,781 children and adolescents age 6 to 18 years old were selected and studied from all the provinces in Iran. The sampling was carried out by employing a multistage cluster sampling method, and several clinical psychologists using semi-structured interviews collected the data. Furthermore, clinical psychologists collected demographic information (including information about gender, age, place of residence, education level, and parental education level). The collected data were analyzed using SPSS version 20. RESULTS: Generally, the prevalence of Elimination Disorders was found to be 5.4% covering both enuresis (p= 5.4, 95% CI = 5.1-5.7) and encopresis (p= 0.13, 95% CI = 0.09-0.2). The total prevalence of comorbid disorders was 38%, and among the comorbid disorders, Attention Deficit Hyperactivity Disorder (ADHD) (p= 11, 95% CI = 9.5-12.7) and Separation Anxiety (p= 10.6, 95% CI = 9.1-12.2) were the most prevalent. CONCLUSION: The prevalence of Elimination Disorders in Iranian children and adolescents is moderate compared to similar studies elsewhere. As for comorbid disorders, ADHD and Separation Anxiety were found to be the most prevalent disorders. Since Elimination Disorders coexist with psychiatric disorders in children, further studies of these comorbidities may give better insight into the treatment and prognosis of Elimination Disorders.

Prevalence, comorbidity and predictors of anxiety disorders among children and adolescents.

Childhood anxiety may lead to serious health consequences in later life. The present study provides the prevalence, comorbidity, and predictors of anxiety disorders among children and adolescents. This was a cross-sectional national project that was implemented on 28,698 children and adolescents in Iran. Participants entered the study by multistage cluster sampling with an equal number of each gender and three age groups (6-9, 10-14, and 15-18 years) within each cluster. The tools used in this research were the demographic questionnaire and K-SADS-PL. To analyze the data logistic regression and chi-square tests were used in SPSS (ver. 16). The prevalence of anxiety disorder in children and adolescents was 13.2 in boys and 15.1 in girls. Furthermore, gender, age, place of residence and history of psychiatric hospitalization of parents could predict anxiety disorders. Anxiety disorders had comorbidity with behavioral disorders, neurodevelopmental disorders, mood disorders, psychotic disorders, substance abuse disorders, and elimination disorders. According to our findings in this study, anxiety disorders affect the performance, health and life of children and adolescents, identifying the childhood anxiety, as well as finding diseases that are associated with anxiety disorders, can help in the prevention of the disorder.

Social anxiety disorder among children and adolescents: A nationwide survey of prevalence, socio-demographic characteristics, risk factors and co-morbidities.

BACKGROUND: Social anxiety disorder is a frequent psychiatric disorder. We aimed to estimate the life-time prevalence, socio-demographic characteristics, risk factors and co-morbidities of this condition among children and adolescents. METHODS: This was a cross sectional national survey conducted in Iranian individuals aged 6 to 18 years. Face-to-face household interviews were performed by trained clinical psychologists. The Farsi version of the kiddie schedule for affective disorders and schizophrenia for school-age children/present and lifetime version (K-SADS-PL) was administered to estimate the SAD prevalence. Parental personality traits and their psychopathologies were also obtained using Millon clinical multiaxial inventory, third edition (MCMI-III) to find the possible risk factors. RESULTS: From 29,878 participants, 585 individuals were diagnosed with SAD and weighted lifetime prevalence of 1.8% was observed. The odds of this condition was significantly higher among older adolescents (odds ratio (OR):1.47; 95% confidence interval(CI): 1.11-1.95) and individuals with paternal history of psychiatric hospitalization (OR: 2.96; 95%CI: 1.29-6.79). Higher means of persistent depression disorder (OR: 1.009; 95%CI: 1.000-1.018) and melancholic personality trait (OR: 1.007; 95%CI: 1.001-1.014) in mothers as well as schizophrenia spectrum (OR: 1.014; 95%CI: 1.001-1.027) and anxiety (OR: 1.010; 95%CI: 1.010-1.021) in fathers were statistically associated with higher odds of SAD in their children. Other anxiety disorders and behavioral disorders were the most prevalent co-morbidities. LIMITATIONS: The cross-sectional analysis does not enable analyses of possible causal associations. Lacking control group and follow-up periods were other major limitations that should be resolved in future studies. CONCLUSION: Clinicians and researchers need to continue studying this condition at all levels and in all developmental periods.

Diosmetin Mitigates Cognitive and Memory Impairment Provoked by Chronic Unpredictable Mild Stress in Mice.

MATERIALS AND METHODS: In the present experimental study, male NMRI mice were exposed to chronic unpredictable mild stress (CUMS) paradigm for 35 days. Diosmetin (at doses of 10, 20, and 40 mg/kg. i.p.) or diosmetin solvent (normal saline + DMSO, 1 ml/kg; i.p.) was administered 30 min before stress induction. After 28 days, memory and cognitive performance were assessed by shuttle box and novel object recognition tests. Finally, antioxidant capacity (FRAP) and malondialdehyde (MDA) level of serum and brain, and serum corticosterone level were evaluated. RESULTS: Behavioral tests showed that CUMS significantly reduced the secondary latency in passive avoidance memory test and diagnosis index in novel object recognition test compared to the control group (P < 0.001), whereas treatment with diosmetin (20 and 40 mg/kg) significantly improved memory performance in the two tests (P < 0.001). In addition, diosmetin (40 mg/kg) could pronouncedly suppress increase in serum corticosterone levels, reduction in antioxidant capacity, and production of excess MDA caused by CUMS compared to the control group (P < 0.01, P < 0.001, and P < 0.001, respectively). CONCLUSION: Chronic stress can impair memory and cognition and treatment with diosmetin can partly improve this disorder in male mice by increasing the antioxidant capacity of brain tissue and serum and improving serum corticosterone levels.

Prevalence, comorbidities, and sociodemographic predictors of conduct disorder: the national epidemiology of Iranian children and adolescents psychiatric disorders (IRCAP).

The aim was to evaluate the lifetime prevalence of conduct disorder according to sociodemographic characteristics, determine the sociodemographic predictors of conduct disorder, and estimate the rates of comorbidities of psychiatric disorders in children and adolescents with conduct disorder by age and gender. The National Epidemiology of Iranian Children and Adolescents Psychiatric Disorders was a cross-sectional, general population-based study on 30,532 children and adolescents aged 6-18 years from all provinces of Iran, which was done using multistage cluster sampling. Iranian citizens aged 6-18 years who resided at least 1 year in each province were included, and children and adolescents with severe physical illnesses that prevented them to participate in the study were excluded. The sample weighting adjustment was used, since we had randomly selected the equal number of 1000 participants of each province from the urban and rural areas. Trained psychologists conducted diagnostic interviews with the adolescents and the children's parents using the Persian version of the Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version (K-SADS-PL). In this study, 54 children aged 6-9 years (0.58%, CI 0.47-0.77), 64 adolescents aged 10-14 years (0.57%, CI 0.47-0.77), and 117 adolescents aged 15-18 years (1.22%, CI 0.96-1.44) met the criteria of the lifetime conduct disorder. Conduct disorder was significantly more common in boys than in girls, and was significantly less prevalent among those participants whose fathers had no history of psychiatric hospitalization. Of the participants with conduct disorder, 83.4% met the criteria for at least one other psychiatric disorder. Conduct disorder had a high rate of comorbidity with oppositional defiant disorder (54.89%, CI 48.50-61.12), attention-deficit/hyperactivity disorder (32.34%, CI 26.68-38.56), tobacco use (20.43%, CI 15.77-26.04), and depressive disorders (18.30%, CI 13.88-23.74). Because of using the diagnostic instrument, we found a low total rate of prevalence for conduct disorder; however, higher rates of it were observed among boys and adolescents. Further studies are needed to explore the nature of comorbidities of conduct disorder and to consider them in a large clinical population.

Prevalence, correlates and comorbidities of feeding and eating disorders in a nationally representative sample of Iranian children and adolescents.

OBJECTIVE: This study investigated the prevalence of feeding and eating disorders, and identified their correlates and comorbidities among children and adolescents. METHOD: We used the nationally representative sample of the Iranian Children and Adolescents' Psychiatric disorders (IRCAP) survey, with 30,532 participants randomly selected by a multistage cluster sampling method. We employed the kiddie schedule for affective disorders and schizophrenia-present and lifetime version (K-SADS-PL) semi-structured face-to-face interview to screen for any psychiatric disorders, including feeding and eating disorders, and associated factors. We used multivariate binary logistic regression to analyze the data. RESULTS: Valid data from 27,111 participants were analyzed. The total prevalence of feeding and eating disorders among children and adolescents was 0.89 (0.81-1.10). In all types of feeding and eating disorders, the adjusted odds ratio was higher among girls (except binge-eating disorder) and older adolescents but was lower among rural residents. The most common psychiatric comorbidities observed in children and adolescents with feeding and eating disorders were obsessive-compulsive disorder (20.2%), agoraphobia (20.2%), depressive disorder (16.4%), social phobia (10.1%), oppositional defiant disorder (10.1%), generalized anxiety disorder (9.4%), attention deficit hyperactivity disorder (7.5%), and conduct disorder (5.7%), which were significantly more common compared to their peers without feeding and eating disorders. DISCUSSION: Older age, female gender and living in an urban area are predisposing factors in feeding and eating disorders (in binge-eating disorder, the male gender is a positive correlate). We suggest that future works pay attention to the role of gender, comorbidities and predisposing factors.

Epidemiology of Psychiatric Disorders in Children and Adolescents in Chaharmahal and Bakhtiari Province, Iran, 2017.

BACKGROUND: This study aimed to investigate the epidemiology of psychiatric disorders in children and adolescents in Chaharmahal and Bakhtiari Province of Iran. METHODS: This community-based cross-sectional study included 1038 children and adolescents aged 6-18 years from Chaharmahal and Bakhtiari province selected by the multistage cluster sampling method. Samples were interviewed using the Schedule for Affective Disorders and Schizophrenia for School-Age Children. Also, demographic data (gender, age, child education, parent education, and economic situation) were obtained. Binary logistic regression was used to analyze the data. RESULTS: A total of 16.1% of participants were diagnosed to have psychiatric disorders. Total psychiatric disorders were significantly more prevalent in boys than in girls (P=0.025). Unemployment of fathers was significantly related to increased prevalence of psychiatric disorders in children (P=0.016). Other demographic variables had no significant correlation with prevalence of psychiatric disorders in children. Anxiety disorders were highly comorbid with behavioral problems (16.4%). Behavioral disorders also had high comorbidity with elimination disorders (16.7%) and substance use disorders (10%). Enuresis was the most frequent psychiatric disorder (5.8%), followed by epilepsy (3.5%), tobacco use (3.4%), and attention deficit hyperactivity disorder (3%). Total anxiety disorders were the most prevalent group of psychiatric disorders in the sample (21.9%), followed by behavioral disorders (16.3%), elimination disorders (8.2%), and neurodevelopmental disorders (4.5%). CONCLUSION: Our findings suggest that psychiatric disorders affect a significant number of children and adolescents. Prevalence estimates and identification of sources of heterogeneity have important implications to service providers and modifications are needed in mental health services in the community.

Prevalence and Correlates of Psychiatric Disorders in a National Survey of Iranian Children and Adolescents.

Objective: Considering the impact of rapid sociocultural, political, and economical changes on societies and families, population-based surveys of mental disorders in different communities are needed to describe the magnitude of mental health problems and their disabling effects at the individual, familial, and societal levels. Method : A population-based cross sectional survey (IRCAP project) of 30 532 children and adolescents between 6 and 18 years was conducted in all provinces of Iran using a multistage cluster sampling method. Data were collected by 250 clinical psychologists trained to use the validated Persian version of the semi-structured diagnostic interview Kiddie-Schedule for Affective Disorders and Schizophrenia-PL (K-SADS-PL). Results: In this national epidemiological survey, 6209 out of 30 532 (22.31%) were diagnosed with at least one psychiatric disorder. The anxiety disorders (14.13%) and behavioral disorders (8.3%) had the highest prevalence, while eating disorders (0.13%) and psychotic symptoms (0.26%) had the lowest. The prevalence of psychiatric disorders was significantly lower in girls (OR = 0.85; 95% CI: 0.80-0.90), in those living in the rural area (OR = 0.80; 95% CI: 0.73-0.87), in those aged 15-18 years (OR = 0.92; 95% CI: 0.86-0.99), as well as that was significantly higher in those who had a parent suffering from mental disorders (OR = 1.96; 95% CI: 1.63-2.36 for mother and OR = 1.33; 95% CI: 1.07-1.66 for father) or physical illness (OR = 1.26; 95% CI: 1.17-1.35 for mother and OR = 1.19; 95% CI: 1.10-1.28 for father). Conclusion: About one fifth of Iranian children and adolescents suffer from at least one psychiatric disorder. Therefore, we should give a greater priority to promoting mental health and public health, provide more accessible services and trainings, and reduce barriers to accessing existing services.

Factors Associated with Treatment Adherence in Children with Attention Deficit Hyperactivity Disorder.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is a common psychiatric disorder in children. The aim of this study was to investigate factors related to treatment adherence in children with ADHD. METHODS: This cross-sectional study was done in 118 children (aged 6-12 years) with ADHD who have been on medications for at least 6 months. The patients were selected based on the convenience sampling method from those who were referred to child psychiatry clinic. Medication Adherence Report Scale, Belief about Medicines Questionnaire specific version, and Children Symptom Inventory-4 were completed by parents and teachers. FINDINGS: Medication adherence had significant negative correlation with inattention scores on teacher-report forms (r = -0.27, P= 0.003) and poor economic status (P = 0.03). There was a positive correlation between medication adherence and history of psychopharmacological treatment in the family (P = 0.01), and father's education level (P = 0.001). Treatment adherence had no significant correlation with age, gender, comorbid disorders, mother's education, family history of ADHD, medication side effects, or parental concerns and beliefs about the necessity of drug use. CONCLUSION: The factors found to have a correlation with adherence should be taken in to account by clinicians so that adherence can be improved in their patients.

The effect of adding ferrous sulfate to methylphenidate on attention-deficit/hyperactivity disorder in children.

Attention deficit/hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children with several complications. This study was conducted to investigate the effect of adding ferrous sulfate to methylphenidate in decreasing ADHD symptoms. This study was a double-blind, randomized clinical trial. In this study, 42 nonanemic children with ADHD and serum ferritin below 30 mg/ml were enrolled according to convenience sampling and randomly assigned to two groups of 21 each, cases and controls. The two groups were matched for age and sex. The case group was administered with ferrous sulfate 5 mg/kg in addition to methylphenidate up to 1 mg/kg and the control group with methylphenidate alone. The scores on child symptoms inventory-4 (CSI-4) were recorded at baseline and after 2 months of treatment. Data were analyzed by t-test, Pearson's correlation coefficient, and repeated measures ANOVA in SPSS 16. The scores on CSI-4 decreased significantly at month 2 in both groups (P < 0.001). The scores on attention deficit and hyperactivity subscales of the CSI-4 were significantly lower in the case group than the control group (P < 0.05). The total score on CSI-4 decreased more markedly in the case group (P < 0.04). Use of ferrous sulfate plus methylphenidate can be effective in reducing ADHD symptoms in nonanemic children with low serum ferritin.

The effectiveness of cognitive-function stress management training in glycemic control in children and in mental health of mother caring for child with type 1 diabetes mellitus.

AIM: The study was aimed to evaluate the effectiveness of a training course of cognitive-behavioral stress management in glycaemia regulation in children with type 1 diabetes mellitus as well as in mental health status of their mothers. MATERIALS AND METHODS: Fifty children with type 1 diabetes mellitus and their mothers were selected and randomly assigned into two groups. A group of mothers (n=25; as experimental one besides their children) passed a course, eight 2-h sessions, on the cognitive-behavioral and stress management, and the control group received the usual care. To evaluate the effectiveness of the intervention, before and after holding the course, glycosylated hemoglobin (HbA1C) test was done on both groups of children, and also some information was collected from the mothers through interview and the DASS (depression, anxiety, stress scale) and PSI (parenting stress index) questionnaires. RESULTS: After the intervention, HbA1c level decreased in the experimental group. Feeling of depression, anxiety and stress was significantly lower than the control group. Furthermore, training for parenting stress management positively affected on the sense of demanding, reinforcement, and adaptability in child domain and also on attachment, competence, depression, relationship with spouse and family health in parent domain. CONCLUSION: The intervention program was significantly effective in reducing the amount of HbA1c in diabetic children, and also reduced the intensity of psychosocial problems such as depression, anxiety and stress in the mothers caring for children with type 1 diabetes.

Comparison of the effects of methylphenidate and the combination of methylphenidate and risperidone in preschool children with attention-deficit hyperactivity disorder.

Attention-deficit hyperactivity disorder (ADHD) is a common psychiatric disorder among preschool children but the number of controlled clinical trials regarding psychopharmacological treatment in this age group is limited. The aim of this study was to compare methylphenidate with the combination of methylphenidate and risperidone in preschool children with ADHD. Forty-two preschool children, aged 3-6 years, diagnosed with ADHD by a child and adolescent psychiatrist according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition-Text Revision criteria, were enrolled in a 6-week, single-blind clinical trial and administered with methylphenidate (5-30 mg/dl) or the combination of methylphenidate and risperidone (0.25-2 mg/dl) in Iran. Treatment outcomes were assessed using the Conners' Rating Scale and Clinical Global Impression (CGI) Scale at baseline and 3 and 6 weeks after starting the drugs administration. Side effects were rated by a checklist and body weight was measured at each visit. There were no significant differences between the two protocols in Parent Conners' Rating Scale scores (P > 0.05) and CGI scores (P > 0.05). Both groups showed a significant improvement in ADHD symptoms over the 6 weeks of treatment for Parent Conners' Rating Scale (P < 0.001). The combination group used significantly lower doses of methylphenidate compared to the other group (P = 0.002). The most common adverse effects were anorexia (21.7%) and daytime drowsiness (17.4%) in combination treatment group and insomnia (33.3%) and anorexia (25%) in methylphenidate group. Risperidone and methylphenidate may be effective and well tolerated in preschool children with ADHD, and adding risperidone to methylphenidate may decrease the occurrence of some side effects of methylphenidate such as insomnia and anorexia and lower the dose of methylphenidate may be needed to control symptoms.

Comparison of risperidone and aripiprazole in the treatment of preschool children with disruptive behavior disorder and attention deficit-hyperactivity disorder: A randomized clinical trial.

Although pharmacotherapy with atypical antipsychotics is common in child psychiatry, there has been little research on this issue. To compare the efficacy and safety of risperidone and aripiprazole in the treatment of preschool children with disruptive behavior disorders comorbid with attention deficit-hyperactivity disorder (ADHD). Randomized clinical trial conducted in a university-affiliated child psychiatry clinic in southwest Iran. Forty 3-6-year-old children, diagnosed with oppositional defiant disorder comorbid with ADHD, were randomized to an 8-week trial of treatment with risperidone or aripiprazole (20 patients in each group). Assessment was performed by Conners' rating scale-revised and clinical global impressions scale, before treatment, and at weeks 2, 4, and 8 of treatment. The data were analyzed by SPSS version 16. Mean scores between the two groups were compared by analysis of variance and independent and paired t-test. Mean scores of Conners rating scales were not different between two groups in any steps of evaluation. Both groups had significantly reduced scores in week 2 of treatment (P = 0.00), with no significant change in subsequent measurements. Rates of improvement, mean increase in weight (P = 0.894), and mean change in fasting blood sugar (P = 0.671) were not significantly different between two groups. Mean serum prolactin showed a significant increase in risperidone group (P = 0.00). Both risperidone and aripiprazole were equally effective in reducing symptoms of ADHD and oppositional defiant disorder, and relatively safe, but high rates of side effects suggest the cautious use of these drugs in children.

Prevalence of Attention-Deficit Hyperactivity Disorder in Students and Needs Modification of Mental Health Services in Shahrekord, Iran in 2013.

INTRODUCTION AND OBJECTIVES: In view of the complications of Attention-Deficit Hyperactivity Disorder (ADHD) and significance of its treatment, the present study was aimed to investigate the prevalence of ADHD among elementary school students of Shahrekord and to assess the obstacles preventing patients from accessing mental health services. MATERIALS AND METHODS: In this cross-sectional study, 631 eligible students were selected from elementary school students in Shahrekord County, Iran. Multi-stage stratified random sampling was adopted. Demographic data were gathered and Child Symptom Inventory-4 for parents and teachers was filled out for each student. The students with suspected ADHD were identified, and examined for the association among mental health help-seeking steps. Obstacles to mental health help-seeking were assessed. RESULTS: ADHD prevalence was derived 17.3% and higher among male students (p=0.025). ADHD prevalence was associated with parents' education and occupation. The evaluation and diagnosis rates were significantly associated with gender (p=0.002 and 0.005, respectively). The most prevalent obstacles facing access to mental health services were those relevant to feeling no need (86%), negative expectations of treatment (78%) and mental health system (64%). CONCLUSION: ADHD was highly prevalent among elementary school students. Identifying the patients and examining the existing obstacles of access to mental health system seems necessary.