Academic journal article East Asian Archives of Psychiatry

Co-Morbidity in Attention-Deficit Hyperactivity Disorder: A Clinical Study from India

Academic journal article East Asian Archives of Psychiatry

Co-Morbidity in Attention-Deficit Hyperactivity Disorder: A Clinical Study from India

Article excerpt

Introduction

Attention-deficit hyperactivity disorder (ADHD) is a common but complex neurodevelopmental disorder with onset in childhood or adolescence.1,2 Co-morbidity with psychiatric and other neurodevelopmental disorders seems to be a distinct clinical characteristic, although the reasons and mechanisms for the same have not been fully elucidated.3,4 Why is co-morbidity in ADHD so important? Psychiatric and other neurodevelopmental co-morbidities seen with ADHD have been shown to have assessment, diagnostic, management-related, and prognostic implications.5,6 Barkley7 even argues for ADHD with co-morbidities to be thought of as a discrete clinical subtype with its own course and outcome profile, separate from pure ADHD. Although community-based studies may be ideal to identify the prevalence of co-morbidities,8 given the limitations in terms of trained manpower, funding and the magnitude and diversity of the Indian population, good clinic-based naturalistic, observational studies are a viable alternative and an adjunct to community-based studies. There are very few prospective Indian studies of co-morbidity in children with ADHD.9-11 This study was undertaken to assess the prevalence of co-morbidity in children diagnosed with ADHD at a tertiary care child and adolescent psychiatry centre.

Methods

Sample and Setting

This was an observational, prospective study drawn from the clinical sample attending the outpatient services of the Department of Child and Adolescent Psychiatry at the National Institute of Mental Health And Neuro Sciences (NIMHANS), Bangalore, India. The methodology and results presented and discussed in this paper are part of a larger follow-up study. Children and adolescents between 4 and 16 years, who were newly diagnosed by consultant psychiatrists in the department to have ADHD as per the DSM-IV criteria and who were drug-naïve, were included in the study. Data were collected over a period from 1 December 2011 to 30 November 2012. In order to maintain the reliability of the observations, we attempted to include only those families who had a parent / guardian constantly staying with the child. Children who had moderate, severe or profound intellectual disability, any progressive neurological disorder and / or sensory impairment were excluded from the study. This was done as there was considerable diagnostic masking and overshadowing in this population thus it might be difficult to diagnose ADHD and other psychiatric co-morbidities reliably with the tools used in the study.

All tests were administered by the first author to the same parent / guardian throughout the study period. The socio-demographic and clinical profiles were recorded as per a pre-specified format followed by Department of Child and Adolescent Psychiatry, NIMHANS. This included, in addition to history of present illness, physical and psychiatric examinations, a detailed birth history (pre- / peri- / post-natal history), developmental milestones and current developmental level (motor, social, language and adaptive), temperamental characteristics as per Chess and Thomas12 classification, family history of psychiatric illness and / or substance use, parenting style, psychosocial history (marital discord, domestic violence, disciplining practices, family environment), schooling history including academic problems, if any, and attendance at school. These details were obtained from the primary caregiver.

The school teacher was also interviewed by telephone after obtaining the parent and the child's consent with regard to the child's problems in school if any, their academic performance in all subjects, and their capacity for interpersonal relationships both with authority figures and peers. The teacher also rated the Attention Deficit Hyperactivity Disorder Rating Scale IV (ADHD-RS) [School version].13 This was administered to the teacher by telephone by the first author.

All children and adolescents included in the study with a history of speech and language problems were evaluated independently by the speech and language pathologist at the Department of Speech Pathology and Audiology, NIMHANS. …

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