ADHD Studies in Saudi Arabia

• Nora Abdulrhman Al-Shewear
• Amen A Bawazir

Background: The health and wellbeing of school students are of essential value to world communities. In Saudi Arabia (SA), a school health program was initiated with the strategic goal of enhancing the health of the students and the early detection of any health problems.

Aims: This study aimed to identify the most common health problems and conditions among school students in SA based on the periodic examination program for school students (PEPSS).

Method: A retrospective secondary data analysis from the Ministry of Health (MOH) was based on the program collected in 2018 across four school grades, namely, 1st primary, 4th primary, 1st intermediate, and 1st secondary grade, from 40 school complexes around SA. The collected data included variables related to sociodemographic, family history, past infec- tious diseases, completion of vaccinations, body mass index (BMI), visual acuity tests, dental examination, scoliosis tests, and attention deficit hyperactivity disorders (ADHD). Data were entered and analyzed using an SPSS program (version 20) where descriptive statistics were calculated, the association between an outcome and some main variables were also calcu- lated, and a p-value of less than 0.05 was considered as significant at a confidence interval of 95%.

Results: From the overall 12,032 students, 46.6% were males, and 53.4% were females. The most common health problems reported were tooth decay (62%), low visual acuity (15.3%), overweight (9.7%), and obesity (8.8%). Although almost all students were fully immunized (99.4%), the health status was calculated as less likely lower among males than females (AOR 1.26; 95% CI: 1.17-1.37).

Conclusion: The results concluded that dental caries and visual acuity were the highest health problems among students. The widespread prevalence of dental caries indicates the need for more research to appraise the public health implications of this developing problem.

• Aalia Akhtar Hayat
• Tabassum Alvi
• Saira Farhan
• Waqas Sami
• Arej Habib Meny

Introduction: Intellectual disability (ID) is a prevalent neurodevelopmental issue globally. People having ID suffer invariably from psychiatric, behavioral, and emotional disturbances. It is reported that a high rate of comorbidity predisposes the patients to a poorer prognosis and quality of life especially if undiagnosed and untreated. We specifically aimed to study the comorbid physical and psychiatric disorders in this vulnerable population group and to find any association with various related variables.

Material: The observational cross-sectional study was conducted on male and female patients admitted with disabilities in Rehabilitation Centre Majmaah. The data was entered and analyzed using IBM SPSS 26.0.

Results: The number of participants (n) was 147. The mean age of the patients was 24.32+2.19 years. Out of all patients, 17 (11.6%) had mild, 33 (22.4%) had moderate, 56 (38.1 %) had severe and 41 (27.9%) had profound ID. About 72% of the sample (n=42) had comorbidity with either a medical or a psychiatric illness whereas 12 participants (8.17%) suffered from both physical and psychiatric disorders. In this study, n= 30/147 (20.40%) had psychiatric comorbidity. There was a preponderance of ADHD (attention deficit hyperactivity disorder) and Behavioural Disorders. Around 87 patients out of 147 (59.2%) had one or more physical comorbidities. The most common medical comorbidities were Epilepsy (26.53%). Overall, significant association was found between severity of and psychiatric diseases (p=0.023).

Conclusion: Physical and psychiatric comorbidities are common in ID patients. ADHD, Behavioural Disorders and Epilepsy were predominant in the research.

• Waleed Ahmed Alghamdi
• Faten N Alzaben
• Hashem H Alhashemi
• Saeed Sami Shaaban
• Khawlah M Fairaq
• Ahmed S Alsulaimani
• Basmah A Mahin
• Radwan A Ghurab
• Mohammad Gamal Sehlo
• Harold G Koenig

Background: Childhood attention deficit hyperactivity disorder (ADHD) is commonly diagnosed in Saudi Arabia, but there is negligible evidence regarding adult ADHD in college students.
Objective: To determine the prevalence and correlates of ADHD among undergraduates at King Abdulaziz University, Jeddah, Saudi Arabia.
Methods: In this cross-sectional study, 2280 undergraduate students from 11 colleges at King Abdulaziz University, one of the largest university in Saudi Arabia, were approached in person with a questionnaire that elicited information regarding demographics, education, psychiatric history, health behaviors, and ADHD. A validated Arabic version of the Adult ADHD Self-Report Scale was used.
Results: A total of 2059 students (90%) completed the questionnaire (mean age: 21.2 years). Almost one-tenth (11.9%) of the sample met the criteria for adult ADHD; only 6.5% had been diagnosed with ADHD in childhood and <1% (0.8%) had taken medication for the same. Multivariate analyses revealed that high family income, low grade in the last semester, parental divorce, diagnosis of childhood ADHD, prior diagnosis of depression, greater severity of current depression and anxiety, and cigarette smoking increased the likelihood of adult ADHD.
Conclusion: A notable proportion of students in this study had suspected adult ADHD. Early evaluation of students with ADHD and identification of those at risk may potentially help in improving their academic performance and quality of life.

• Ammar A Albokhari
• Rajab A Bresaly
• Magdy M Hassan
• Abrar A Khan

Objectives: Mental disorders manifest as social, occupational, or emotional dysfunctions. Many countries struggle to recognize mental disorders and their effects on communities. Mental health awareness in Saudi Arabia has improved in recent years as psychiatric treatment has become more acceptable in Saudi society. The aim of this study was to determine the percentages of mental disorders among a hospital population at Hera General Hospital, Makkah, Saudi Arabia, using the diagnostic criteria of the fourth edition of the Diagnostic and Statistical Manual of Mental Disorders and the tenth revision of the International Classification of Diseases. We aimed to determine sex differences and to identify the five most common disorders.

Material and Methods: We identified clusters of mental disorders seen at Hera General Hospital psychiatric clinic using the diagnostic criteria of the DSM-IV and ICD-10 and it was a cross-sectional study of patients at a psychiatric outpatient department from July 2009 to June 2019 in Hera General Hospital, Makkah, Saudi Arabia.

Results: The most common mental disorders in patients attending the psychiatric clinic of Hera General Hospital were found to be major depressive disorder (41.3%), followed by anxiety disorders (22.1%), substance-induced psychotic disorder (11.4%), schizophrenia (8.9%), and Mental retardation (7.0%). Females were observed to have a higher risk for mood and anxiety disorders, whereas males had a higher risk for substance-induced psychotic disorder and schizophrenia.

Conclusion: Major depressive disorder was the most prevalent mental disorder at Hera General Hospital. Most patients with depressive disorder were female.

• Tagreed Ameen Zagzoog
• Rehab Mohammed Samy Elshazly
• Mohammad Sayed Said Soliman

The study aimed to determine the prevalence of ADHD symptoms in Saudi children aged 6 to 13 years in Jeddah city. The study also explored the effect of variables namely teacher's knowledge, years of experience and teachers' gender on reported ADHD symptoms among primary grade students. A questionnaire survey methodology was adopted for the study. 550 children were included in the teachers' survey. Teachers assessed the ADHD symptoms in children using an 18-item scale based on DSM-V. The results indicated that the prevalence rates of ADHD among school-age differed according to ADHD subtypes. The Inattention type was rated by 35.34%, Hyperactivity/Impulsivity type was rated by 28.60%, and ADHD-C type was rated by 21.3% of the respondents. According to gender, for the Inattention subtype, the ratio between boys and girls was 1.7:1, for the Hyperactivity/Impulsivity subtype, the ratio between boys and girls was 2.03:1, and for combined subtype, the ratio between boys and girls was 2.2:1. According to the grade level, the highest prevalence of ADHD overall was found in grade three and the lowest prevalence was in grade six in all ADHD types. The present findings indicated that teachers' knowledge and gender (female) successfully predicted teacher-rated ADHD status.

• Yasmin A Altwaijri
• Abdulhameed Al-Habeeb
• Abdullah S Al-Subaie
• Lisa Bilal
• Majid Al-Desouki
• Mona K Shahab
• Sanaa Hyder
• Nancy A Sampson
• Andrew J King
• Ronald C Kessler

Objectives: To estimate 12-month prevalence and severity of mental disorders in the Saudi National Mental Health Survey (SNMHS).

Methods: The SNMHS is a face-to-face community epidemiological survey in a nationally representative household sample of citizens aged 15 to 65 in the Kingdom of Saudi Arabia (KSA) (n = 4,004). The World Health Organization (WHO) Composite International Diagnostic Interview (CIDI) was used to estimate 12-month prevalence of common DSM-IV mental disorders.

Results: Twelve-month prevalence of any DSM-IV/CIDI disorder is 20.2%. Most common are anxiety disorders (12.3%) followed by mood (6.8%), disruptive behavior (5.4%), eating (3.2%), and substance use (1.9%) disorders. The proportion of 12-month cases rated serious (39.0% of all cases) is high across virtually all disorders relative to the proportions found in CIDI surveys in other high-income countries. Younger people have significantly elevated odds of mood and disruptive behavior disorders and serious disorders. Women have significantly elevated odds of anxiety and mood disorders and serious disorders. Previously married people have signifi- cantly elevated odds of most disorder classes and serious disorders.

Conclusions: Both 12-month prevalence and severity of DSM-IV/CIDI disorders are high in Saudi Arabia compared to other high-income countries that carried out com- parable surveys.

• Fatima Al-Haidar
• Sara Adnan Habis
• Latifa Fahad Al-Anazi
• Latifa
• Alaa Jassim Al-Harbi

Background: Attention-deficit/hyperactivity disorder (ADHD) is a chronic neurobehavioral disorder with a substantial lifelong impact on the health system in general. It is one of the most frequent childhood-onset psychiatric conditions, with an estimated worldwide-pooled prevalence exceeding 5% in school-age children, and a prevalence of 1.3-16% in Arab countries. We hypothesized that pediatric endocrine clinics are one of the potential places of ADHD. Thus present study aims to investigate the prevalence of ADHD in children attending pediatric endocrine clinic, determine which gender group is affected more, and address the possible associated factors of ADHD. Method: A quantitative, observational cross-sectional approach was used to estimate the prevalence of ADHD. The study population was children attending pediatric endocrine clinic at KKUH in Riyadh, Saudi Arabia, approached during their regular visit in the clinic from November2015 to March2016, and interviewed to fill a questionnaire includes social demographic questions, medical profile, and a valid screening tool for ADHD. Results: Analysis revealed that the prevalence of ADHD in the study sample was 14.9% (46 cases out of 309 children). 67.39% of these cases were males (31 male case out of 309 children). Results provided evidence that ADHD was associated with low social economic status (SES), and other social demographic characteristics. There was no evidence to suggest any association between ADHD and obesity, thyroid dysfunction, and growth deficit. Conclusion: ADHD occurs in males more than females. It has a high prevalence in children with different endocrine pathologies although there was no relation between (growth deficit, thyroid dysfunctions, and Obesity) and ADHD, except diabetes where diabetic child was found to be less likely to develop ADHD. Anyhow, further studies with bigger sample size will help understanding this link.

• Nader Alrahili
• Abdulrahman A Aldakheel
• Abdullah AlUbied
• Abdulaziz Almalki
• Abdullah AlBarrak
• Bandar Al-Dosari
• Weam AlHemaidi
• Abdullah S Alamro
• Asem S Alamro
• Asem A Alageel

Background: Attention deficit/hyperactivity disorder (ADHD) is a neurobehavioral disorder characterized by the inability to sustain attention, hyperactivity, and impulsivity. Recent studies showed that it can persist in adulthood. The modification of the ’Diagnostic and Statistical Manual of Mental Disorders" in its fifth edition has a significant impact on detecting adult ADHD. To the best of our knowledge, there are no studies done on adult ADHD among medical students in the Gulf region. Methodology: A cross-sectional study was conducted on 487 medical students from all academic year from February 1, 2018, until March 31, 2018, in two governmental and one private medical school in Riyadh city. Self-reported English questionnaire paper used for the study was composed of two parts; socio-demographic and adult ADHD screening scale of DSM-5 version. Results: Fifty-three students (10.9%) reported symptoms of ADHD. Concerning the prevalence and percentage, there was no noticeable difference in gender (p value = 0.364), academic year (p value = 0.666), nationality (p value = 0.379), colleges (p value=0.836), and age (p value = 0.992). History of early life ADHD was significantly associated with adult ADHD (p value = 0.012), along with student"s grade point average, mainly from a score of three and above out of five (p value = 0.024). Conclusion: Our study found a higher prevalence of ADHD among medical students compared with worldwide prevalence. This difference could be due to social and cultural factors. Those individuals may have difficulty in communication and learning which can disturb academic efficiency, lengthen their study, and even disturb their development.

• Hassan Maajeeny

Education in Saudi Arabia, including the education of children with special needs, is developing rapidly. However, children with emotional and behavioral disorders are neither consistently identified nor adequately served in Saudi Arabia although they are recognized as a distinct category of children who require special education services. The goal of this study was to examine the prevalence of emotional and behavioral disorders among children in Saudi Arabia to assess the need for intervention services to help those children reach their potential. The current research identified the types of behaviors that are most evident in the study sample. Also, the relationship between demographics and emotional and behavioral disorders is studied to identify possible predictors of disruptive forms of behavior. Parents of children aged 4-17 years in Saudi Arabia were surveyed using the Strengths and Difficulties Questionnaire. The findings of the study suggest that children with emotional and behavioral disorders in Saudi Arabia may account for 20% of the population of children between the ages of 4 and 17. The findings also revealed that over 20% of children in Saudi Arabia have difficulties in peer relationship and lack the necessary prosocial behaviors. The parent reporting, child gender, child education type, the geographical region, the father"s education level, and the family"s socioeconomic status were found to be statistically significant predictors of children difficulties. However, these predictors were only able to explain a small portion of the difficulty scores.

• Faten N AlZaben
• Mohammad G Sehlo
• Waleed A Alghamdi
• Haythum O Tayeb
• Doaa A Khalifa
• Abdulrahman T Mira
• Abdulaziz M Alshuaibi
• Mosab A Alguthmi
• Ahmad A Alguthmi
• Ahmad A Derham
• Harold G Koenig

Objectives: To determine the prevalence of attention deficit hyperactivity disorder (ADHD), subtypes of ADHD, and psychiatric, academic, and behavioral comorbidity in public primary school students in Jeddah, Saudi Arabia.

Methods: This is a cross-sectional study. A simple random sample of 6 primary government schools in Jeddah, Saudi Arabia, was identified (3 male, 3 female), and a random sample of classes in each of grades 1-6 were selected. Between July and November 2016, teachers in these classes were asked to complete the Vanderbilt ADHD scale on all students in their classes.

Results: A total of 929 students were screened. The overall prevalence of ADHD was 5% (5.3% in girls, 4.7% in boys). The most prevalent subtype of ADHD was combined type (2.7%), followed by hyperactive type (1.2%), and inattentive type (1.1%). The highest prevalence of ADHD overall was in grade 3 (7.1%) and the lowest prevalence in grade 6 (3.4%). Among students with ADHD, prevalence of comorbid psychiatric, academic, and behavioral problems was widespread (56.5% oppositional defiant disorder/conduct disorder, 54.4% impaired academic performance, 44.4% classroom behavioral problems, 41.3% depression/ anxiety). Comorbid problems were especially prevalent in combined ADHD subtype and in boys.

Conclusions: Attention deficit hyperactivity disorder is common in primary school children in Jeddah, and is associated with widespread psychiatric, academic, and behavioral problems, especially in boys. These findings have implications for the diagnosis and treatment of this serious neurobehavioral disorder.

• Turki Homoud Albatti
• Zhour Alhedyan
• Norah Alnaeim
• Anjod Almuhareb
• Jawaher Alabdulkarim
• Rawan Albadia
• Khawla Alshahrani

Objectives: The aim of the study was to 1) determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD) among both governmental and private primary Saudi school children, 2) measure the gender difference of ADHD prevalence, and 3) determine any association between the socio-demographic characteristic of the parents of children with ADHD. Methods: This is an observational cross-sectional study of 1000 primary school children belonging to 1st, 2nd and 3rd grade. The selected students were screened by the ADHD rating scale using multistage sampling technique. The first stage was selection of 20 schools from all Riyadh regions by simple randomization. The second stage was choosing children whom serial numbers were multiples of five in each class. The ADHD rating scale was filled by both parents and teachers along with a socio-demographic questionnaire for the parents. Results: The estimated prevalence of ADHD was 3.4%. ADHD manifestations affect boys more than girls. In addition, ADHD was more frequent among children of illiterate mothers. Finally, ADHD was significantly more prevalent among first grade children. Conclusion: This epidemiological study filled the data gap of ADHD prevalence in Riyadh. The study’s findings go in line with many nearby and global studies.

• Mohammed M.J. Alqahtani

Introduction: Preterm survivors from the neonatal intensive care unit (NICU) are considered as high risk group for some neurobehavioral impairments such as cognitive disabilities, developmental delays, social/ emotional limitations, attention-deficit/hyperactivity disorder (ADHD), and academic difficulties. Objective: The current study aimed to investigate the neurobehavioral outcome of premature infants in Saudi Arabia at the school age. Methods: At the school age, preterm children (range 23-29 weeks or ≤ 1.52 kg) born from April, 2006 through September, 2008, and who were admitted following birth to a NICU, were evaluated with several neurobehavioral tools. Results: This study includes 53 preterm children, who were followed up at the chronological age that ranged from 6.4-8.0 years. The results of the neurobehavioral assessments showed in general normal social adaptive levels and cognitive abilities, with mean total score of about 91.0 and 90.0, respectively. The prevalence of ADHD among preterm children was high, with result of 34.0% for the inattentive type and 11.3% for the hyperactive/ impulsive type. None of the preterm children repeats a grade, but 22.6% utilize a form of special educational supports. Some of the preterm children showed poor school performance in reading skills, writing skills and mathematics skills, with percentages of 26.4%, 28.3% and 15.1%, respectively. Conclusions: The present results emphasize that preterm children are a group of high-risk children who need regular follow-up to track the developmental conditions and to provide the early developmental intervention for optimal outcome.

• Nagah Mohamed Aboel-Fetoh
• Jamilah Faisal Alnathir
• Aminah Abdullah Alhussain
• Hayat Faisal Alnathir

• Ahmed Elhassan Hamid Hassan

• Omar Al-Modayfer
• Yousra Alatiq

Objectives: Studies have shown that mental health problems at an early age can lead to greater impairment in adult life. Epidemiological evidence on the prevalence and incidence of mental health disorders is fundamental for planning mental health services. However, these data are lacking in Saudi Arabia. The current study examined the prevalence of mental health problems in Saudi children and adolescents living in a selected community in Riyadh City.

Methods: This two-stage epidemiological study used the Strengths and Difficulties Questionnaire (SDQ) to screen all eligible participants for the presence of a possible psychiatric disorder. The screening was followed by the use of a structured psychiatric interview (MINI-Kid), which was administered to a subsample to confirm the presence or absence of psychiatric disorders. Results: In the first stage, N= 924 participants were screened with n=226 receiving follow-up interviews. The overall prevalence of any psychiatric disorder was 36.3% (39.2% for children and 34.1% for adolescents). For the overall sample, behavioral disorders were more common than emotional disorders (25.7% vs. 21.7%). The most common specific disorders were oppositional defiant disorder (15.9%), attention-deficit/hyperactivity disorder (8.4%), general anxiety disorder (7.8%) and separation anxiety (7.8%). Only having internet in the house and the mother"s education were predictors of having psychiatric illness among the adolescents, but these were not predictors among the children.

Conclusion: The rate of psychiatric disorders among Saudi children and adolescents is within the wide range reported by international studies, but is associated with specific social predictive factors.

• Raed A.H Abu Taleb
• Aesha Farheen

Introduction: Among childhood mental disorders, attention deficit hyperactivity disorder is a common yet under diagnosed condition. Few studies have addressed this problem in Saudi Arabia. Objectives: To assess proportion of attention deficit hyperactivity disorder (ADHD) positive students among primary school children in Sabia City, Jizan and study their personal characteristics. Subjects and Methods: Four primary schools in Sabia City were randomly selected. A total of 200 pupils (100 boys and 100 girls) were included in this study. Data collection tools included the personal characteristics questionnaire and the Arabic version of the ADHD Rating Scale. Results: A total of 13.5% of students were positive regarding ADHD, with higher percentage of positive results among male than female students (15% vs. 12%, respectively). Younger students had higher percentage of positive results than older students. Highest percentage of positive results were observed among students who were first born (20.7%) followed by those who were last born (14.8%). Students whose fathers were illiterate had the highest proportion of positive results (31.3%), while students whose mothers were illiterate had significantly highest proportion of positive results (40.8%, p10 members had the highest proportion of positive results. Conclusions: ADHD is common among primary school children in Sabia City. Symptoms of ADHD are more among boys than girls. There is higher proportion of ADHD symptoms among school children whose mothers are illiterate.

• Moayyad Homidi
• Yahia Obaidat
• Diala Hamaidi

This study aimed at identifying the spread of attention deficit/hyperactivity disorder (ADHD), as well as its subtypes, in a sample of primary school children in Jeddah, KSA. The implemented tool was the Attention Deficit Hyperactivity Disorder Scale. This instrument was administered to 2770 students with a range of 6-12 years. The findings of the study reveal that the prevalence of ADHD was estimated to be 11.6%. The subtypes results indicate: a prevalence of 6.3% for ADD, a prevalence of 2.2% for HD. The third type that is the combined hyperactive/ impulsive and inattentive type of ADHD has a prevalence of 3.1%. The results show that there is a difference between ADHD prevalence among elementary school children due to the difference in age. Furthermore, the total prevalence percentage of ADHD for female students was (4.2%). The total prevalence percentage of ADHD for male students was (7.4%).

• Elham Jenahi
• Mohamed S Khalil
• Hassan Bella

BACKGROUND AND OBJECTIVES:Attention deficit hyperactivity disorder (ADHD) is the most commonly seen developmental disorder, with significant impacts on the child's social, psychological, and scholastic functioning. The aim of this study was to determine the prevalence and sociodemographic correlates of ADHD in female primary schoolchildren. DESIGN AND SETTING:A cross-sectional study conducted in Al-Khobar Town, Eastern Saudi Arabia. METHODS:A random sample of six primary schools for girls was chosen, from which samples of 1009 students were selected by systematic random sampling, with ages ranging between 6 and 15 years (mean and standard deviation, 9.2 [1.9]). All subjects were screened for different types of ADHD using the Attention Deficit Disorders Evaluation Scale. RESULTS:The overall prevalence of ADHD was 3.5%. The prevalence of children with ADHD/inattentive type was 2.1% and the prevalence of children with ADHD/hyperactive-impulsive type was 5.6%. This rate decreased significantly with increase in age. The prevalence was higher in government school students, among Saudi citizens, later born siblings, higher number of siblings, and lower parental education. CONCLUSIONS:It was concluded that the prevalence of ADHD in female primary schoolchildren is comparable with what has been reported in other studies. Some demographic factors should be taken into consideration when interpreting this result. Implications and recommendations to the concerned authorities are outlined to improve the health and educational care services to help these children.

• A A Al-Habeeb
• Naseem A Qureshi
• T A Al-Maliki

Data about psychiatric problems among young people are scarce in the Gulf countries. This retrospective review of records describes the pattern of child and adolescent psychiatric disorders among patients consulting 3 child psychiatric clinics in Saudi Arabia during the year 2008. Most patients were referred from the public health sector (92.8%). Psychotropic drugs were prescribed for 86.2% of patients and psychotherapy for 55.2%. Maternal perinatal complications and other psychosocial stressors were noted in almost 45.8% of cases. Family history of psychiatric disorder was reported in 31.5% of patients. Psychiatric comorbidity was noted in 40.5% of cases while physical diseases were noted in 29.9%. The outcome was classified as unstable at the last consultation in 17.9% of cases. In a linear regression analysis the only factors significantly associated with unstable outcome were a higher load of symptoms (OR 2.64) and perinatal complications (OR 2.84).

• Mohammed M Alqahtani

The current study was designed to explore the prevalence of attention-deficit hyperactive disorder (ADHD) in primary schools in Saudi Arabia. The study collected data from both teachers and parents for 708 primary school pupils attending grades 1-3 (7-9 years old), using DSM-IV criteria of ADHD. The result showed that the overall rate of ADHD was 2.7%, and in particular, the rate of attention types, 2.0%; hyperactive/impulsivity type, 1.4% and combined type, 0.7%. Teachers reported ADHD in a higher frequency than parents. However, applying a combination of reports from teachers and parents, screening of ADHD is likely to be more accurate. These findings highlight the importance of detecting ADHD in pupils at an early age and to develop a specific set of psychological clinical interventions for helping them.

• Mohammed M Alqahtani

Objective: To investigate comorbidity of oppositional-defiant disorder (ODD), conduct disorder (CD), anxiety, and depression and to investigate the impaired social and academic developments among children with ADHD in primary school settings in Saudi Arabia.

Method: Data for the purpose of this study are obtained from parent and teachers of 652 primary school children attending Grades 1 to 3 (children aged between 7 and 9 years). Vanderbilt ADHD diagnostic rating scale, which has relevance and found to be reliable by previous studies, is used in the study.

Results: ODD and CD are reported to be present in close to two thirds (73%) of children with ADHD, as assessed with DSM-IV-TR criteria. Anxiety and depression disorder are estimated to be present in 36% of children with ADHD. Children with ADHD show high levels of impairment in academic achievements (63%) and social performance (90%), compared with non-ADHD children.

Conclusion: These findings suggest that a significant minority of disruptive children may have their difficulties compounded by the presence of ADHD, which raises the question whether their problems are known and whether they have received appropriate help. It is important to develop a specific set of psychological clinical intervention for helping children with ADHD, ODD, CD, and other related problems. Educating teachers and parents about ADHD and its comorbidity is considered essential in this regard.

• Jamal H Al-Hamed
• Attia Z Taha
• Amr A Sabra
• Hassan Bella

Attention Deficit Hyperactivity Disorder (ADHD) is one of the most common mental disorders that develop in children and becomes apparent in the preschool and early school years. Several family and maternal-related factors were shown to be associated with ADHD. The aim of the present study was to determine the prevalence of ADHD and associated family and psychosocial factors among male primary school children in Dammam city, Saudi Arabia. A sample size of 1287 students aged 6-13 years in 67 government and 10 private primary schools was selected by multistage systematic random sampling. Data was collected using two types of questionnaires: the modified Arabic version of the Attention Deficit Disorders Evaluation Scale (ADDES) school version, and Parents" questionnaire to diagnose the three main subtypes of ADHD namely: inattention, hyperactivity-impulsivity, and combined ADHD. The majority of the boys were from government schools (83.0%), were of age 6-

• Moataz M Abdel-Fattah
• Abdel-Rahman A Asal
• Saeed M Al-Asmary
• Nabil S Al-Helali
• Tawfiq M Al-Jabbar
• Mostafa A Arafa

Background: Young people can have mental, emotional, and behavioral problems that are real, painful, and costly. Objectives: determination of the prevalence rate of emotional and/or behavioral problems among male Saudi school- children and identifying their possible risk factors. Method: All male schoolchildren of Al-Abnae schools specialized for the sons of the employees of the Saudi Ministry of Defense (military and civilians) in Taif Governorate, Saudi Arabia were included. This study was conducted through two phases: A screening phase for all schoolchildren and adolescents included in the study through a cross sectional approach to assess their emotional and behavioral problems. A case-control phase to study risk factors. The screening phase was conducted using the Child Behavior Checklist ’Parents" form". Results: Among 1313 participated in the study, 109 (8.3%) were emotionally and/or behaviorally disturbed students (according to cut-off score for boys estimated at the 90th percentiles). Among studied socio-demographic variables, educational level (intermediate versus primary) and mother occupation (working versus non-working) were associated with a higher risk higher risk of developing emotional and/or behavioral disturbance. Unwanted pregnancy (OR=4.77, CI: 3.68-5.86), history of meningitis (OR=7.50, CI: 5.12-9.88), accidents (OR=4.07, CI: 2.87-5.26) and bronchial asthma (OR=2.96, CI: 2.16-3.76) had an increased risk of emotional and/or behavioral disturbance.

• Fatima A Al-Haidar

To review the experience of a child psychiatric clinic regarding co-morbidity and treatment characteristics of children with attention deficit hyperactivity disorder (ADHD), a retrospective study was done on patients under 19 years who were attending the clinic and were diagnosed with ADHD. Co-morbidity and treatment characteristics were also studied. ADHD was diagnosed in 25.5% of the patients. Of these, 28.3% had coexistent expressive language disorder and 38.7% coexistent mild mental retardation. A psychostimulant (methylphenidate) was prescribed to 23.6% while antidepressants (primarily imipramine) were prescribed to 35.9%. Behavioural therapy was the most commonly offered psychotherapy. Antidepressants were used more than psychostimulants. Psychotropics had a more beneficial effect than psychotherapy.

• Fath El-Aleem Abur Rahim
• Abur-Razzak Al-Hamad
• Kutaiba Chaleby
• Abullah Al-Subaie

This is an epidemiologic study of 199 children and adolescents who were referred for evaluation to a child psychiatry clinic in a teaching hospital in Riyadh,Saudi Arabia during a 6 year period. Objectives: (I) to clarify who utilizes the services of a child psychiatry clinic. (2) what are the psychological problems that triggers the referral, and (3) compare our results with western literature on similar clinical populations of children and adolescents. Methods: All children referred to the childpsychiatry clinic were assessed using a semi-structured interview according to the +AP DSM-III system and a modified global assessment of functioning scale providedfor the fourth axis of the DSM III. Results: Significant findings which differ from literature reports include: a low representation of conduct disorder (5%), highrepresentations of attention deficit hyperactivity disorder (12.6%), mental retardation (20Tc), conversion disorder (8%) and obsessional disorder (4%). First referred to traditional healers were 46% and there was a low rate (0.6%)of referral from pediatricians compared to 22% in western societies. Discussion: The results are discussed with emphasis on socio-cultural perspectives.

• Abdullah Almilaibary

Background: Attention deficit hyperactivity disorder (ADHD) is among the most frequent psychiatric disorder in children, and it has a detrimental impact on the child’s social, familial, and familial functioning. Teachers are frequently the first to suspect attention ADHD in their students since they are with them for the most of the day and are familiar with how normal students behave in the classroom.

Aims & Objective: this study aims to identify and measure the awareness and attitude of primary teachers towards the diagnosis and management of students with ADHD.

Subjects and methods: This cross-sectional study was conducted at a primary school in the AlBaha area of Saudi Arabia from January 18 to April 24, 2022. Data were collected using a written questionnaire in Arabic language and simple vocabulary. Data was statistically analyzed using SPSS (version 25).

Results: Around 361 participants completed the questionnaire; worked in AlBaha. Therefore, they were included in the analysis. Most of the teachers were female (N = 226, 62.6%) and had bachelor’s as their highest qualification (N = 296, 81.9 %). For most of the questions, the teachers had inadequate or poor knowledge, around 66.5% of teachers had more than ten years of work experience.

Conclusions: The study emphasized the lack of understanding of ADHD among primary and kindergarten school teachers in AlBaha city. This information gap raises severe concerns about the screening of ADHD at the school level in Suadia Arabia.

• Nader M Alrahili
• Mansour Abdulaziz Al Harthi
• Sarah Jassim Ababtain
• Salma Saad Al Sharif
• Mohammed Abdulaziz Alnuwaysir
• Roaa Fahad Al Huzaimi

• Fahad Alanazi
• Yousef Al Turki

Objective: The aim of this study was to explore teachers’ knowledge about the ADHD, its origin, causes, and identify the main demographic variables affecting their knowledge.

Methods: The study was conducted among male school teachers of ten government primary schools that are found in different regions of Riyadh city, the Kingdom of Saudi Arabia. We used a stratified random sampling technique to collect our sample with inclusion criteria of being male teachers who currently working in male government primary school and are directly involved on teaching of students. Data analysis was performed using SPSS software statistical program version 21.

Results: We received 400 response for our questionnaire, mostly younger than 40 years old. Most of teachers in this sample had a bachelor’s degree, only 6% had diploma while 8% had a higher degree, while most of them had experience more than 5 years in teaching (74.2%). Only 8%of teachers admitted that they had not heard about ADHD before. 78% of teachers had read about ADHD at least once before. This knowledge was more from reading books (32.8%) followed by reading internet websites (28.7%), TV/Media (14.6%) while magazine and social media represent (23.9%). Most of the teachers showed that they had attended courses/ training about ADHD (76.7%) however only 40.4% of them thought that they had the enough information about the disease. 51.5% of teachers showed that they had already asked before to assess a child who was suspected to have ADHD and 65.3% had taught a child with the disease.

Conclusion: From the results of this study, it is concluded that the knowledge regarding ADHD among elementary school teachers is suboptimal. Some teachers had misunderstanding about ADHD symptoms and general information, which indicated the further needing for courses to enhance this knowledge.

• Ahmed Hamed ALJadani
• Ibrahim Abdullah Alnais
• Turki Ali Alshammari
• Salman Sayah Alonazi
• Abdulrahman Mansour Alshammari
• Abdulilah Saad Aldhmadi
• Meshael Nezzal Alreshidi
• Hasan Ali Alahmed

Aims: Teachers are often the first to recognize that their students have attention-deficit/hyperactivity disorder (ADHD), since students and teachers are in contact most school days, and teachers notice how average students usually perform in the school setting. There were two aims in this study; 1) to assess teachers’ knowledge regarding ADHD and 2) to investigate socio-demographic differences between teachers on their knowledge of ADHD in the city of Ha’il, Saudi Arabia.

Methods: From January to February 2020 we conducted a cross-sectional study using an electronic questionnaire distributed randomly through visits to schools. The study population comprised of 405 teachers working in governmental elementary schools in Ha’il city. The questionnaire contained a total of 44 questions, 39 of them from the Knowledge of Attention Deficit Disorder Scale developed by Sciutto et al and 5 demographic questions. Respondents’ answers were used to evaluate their general knowledge about ADHD and its symptoms, diagnosis, and treatment. We also requested information and classified teachers according to their demographic characteristics.

Results: The age ranges for teachers were between 22 and 60 years. The average percentage of knowledge regarding ADHD symptoms/diagnosis was 45.3%, whereas general knowledge and awareness of treatment measures were 32.3% and 31.2%, respectively. The average percentage score of overall knowledge regarding ADHD was 34.9%.

Conclusions: ADHD knowledge among elementary school teachers in Ha’il city was insufficient considering the primary role of teachers in identifying this disorder.

• Abdullah M Alshehri
• Shehata F Shehata
• Khalid M Almosa
• Nabil J Awadalla

Background: Adequately knowledgeable schoolteachers can play an essential role in early detection and proper treatment of children with attention-deficit/hyperactivity disorder (ADHD) at school.

Objectives: To assess the schoolteachers’ knowledge of ADHD and to evaluate the effectiveness of the ADHD knowledge improvement program.

Methods: A randomized controlled trial study design was followed on 100 primary school teachers from Abha City, Saudi Arabia. Teachers were randomly selected and allocated into trial and control groups. A self-administered questionnaire was used to evaluate teachers’ knowledge about ADHD. After the baseline assessment, participants in the trial group received a two-day ADHD knowledge improvement program. Teachers’ knowledge about ADHD was reassessed using the same questionnaire immediately after finishing the intervention program and after three months in both groups.

Results: Only 16% and 22% of trial and control groups, respectively, showed adequate baseline knowledge about ADHD. Teachers’ main sources of information about ADHD were the internet (67%), friends (47%), TV (34%), and reading books (23%). Knowledge of teachers in the trial group significantly improved immediately after the intervention. After three months, these knowledge benefits slightly declined but remained more adequate than those of teachers in the control group. The logistic regression model revealed that being a participant in the trial group and of higher qualification were associated with significant improvement in teachers’ retained knowledge on ADHD (p < 0.001 and p = 0.050, respectively).

Conclusions: The majority of male primary school teachers in Abha City, Saudi Arabia, have inadequate knowledge about ADHD. Applying a knowledge improvement program can substantially improve their knowledge of ADHD. Consideration should be given to the integration of ADHD knowledge improvement program into teachers’ educational programs.

• Nawaf Abbas Alshammari

School counselors play a critical role in the identification and management of students with attention deficit hyperactivity disorder (ADHD). In order for the counselors to effectively help students with this condition, it is important that they have knowledge about this disorder. Therefore, the aim of this study was to assess the level of knowledge that elementary school counselors in the Northern Border of Saudi Arabia have with (ADHD). The Knowledge of Attention Deficit Disorder Scale (KADDS) was used to evaluate the counselors. The KADDS scale has three sub-scales that test general knowledge, diagnosis and symptoms, and treatment of ADHD. The study sampled 89 of approximate 200 school counselors working at elementary schools across the Region. The study data was analyzed using Statistical Packages for Social Sciences. The counselors got 31% of the questions in the general knowledge sub-scale correct while 43% were answered incorrectly, and 26% answered, “don’t know.” In the diagnosis/symptoms sub-scale 63% of the questions were answered correctly, 21% were answered incorrectly, while 16% answered “don’t know.” In the treatment sub-scale 38% of questions were answered correctly, 26% were answered incorrectly while 36% answered “don’t know.” Overall, 41% of the questions were answered correctly, 32% were answered incorrectly, while 27% answered “don’t know.” Based on these findings, the researcher concluded that the school counselors in the Northern Border Region of Saudi Arabia do not have sufficient knowledge of ADHD. This lack of knowledge invariably inhibits their ability to help children with ADHD.

• Mohammed Alsuhaibani
• Omar Alsaawi
• Khalid Alsuwayti
• Ibrahim Alahmed

Background: Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder that affects multiple aspects of an individual’s life. It is characterized by attention deficit, hyperactivity, and impulsivity. As it is linked to various comorbidities, individuals and families often find it difficult to cope with it. Therefore, early diagnosis and intervention are vital.

Aim: This study examined the ADHD awareness and knowledge of medical students and interns at Qassim University, Saudi Arabia.

Method: For this cross-sectional study, the convenience sample consisted of male and female, fourth- to fifth-year medical students and interns. Descriptive and inferential statistics were computed, and the results were tested against a significance threshold of 0.05.

Results: The majority of students demonstrated good awareness (83.9%) and fair levels of knowledge (48.2%) of ADHD. Age, academic year, and noncompletion of pediatric and psychiatric classes were associated with poor awareness. Odds ratios (ORs) for poor awareness were lower for the older (>23 years) and fifth-year students as compared with the younger and fourth-year students. Students who had not completed pediatric and psychiatric rotations demonstrated poor awareness.

Conclusion: Medical students had a good awareness of ADHD; however, they had insufficient knowledge. As such, their knowledge must be improved, which can be achieved through the promotion of continuous education of students and primary health care physicians. The inclusion of the topic of ADHD in pediatric and psychiatric courses is necessary for advancing the knowledge of medical students on ADHD.

• Ahlam Jried Al-Bluwe
• Reem Najran ALShammary
• Reem Zaal Aldogeman
• Halah Mohammad Alrasheedi
• Almahaa Mukhlid Alshammari
• Mona Madbouly Shahin
• Fayez Saud Alreshidi

Background: The prevalence of attention deficit hyperactivity disorder in Saudi Arabian children aged 6–12 years is approximately 4–12%. The current study assessed beliefs and awareness regarding ADHD among Hail population.

Methods: This cross-sectional study was conducted in Hail region, via online questionnaire for 422 participants aged 15 years or greater and residing in Hail.

Results: 94.1% had heard of ADHD, 5.9% had not. Of the former, 20.1% obtained their information from previous experience with a patient, 19.9% knew about the disorder through a medical website, 13.1% from books and journals, 37.0% through social media, and 9.9% did not mention the source. 54.3% believed ADHD to be a mixed disorder, that has behavioral, neurological, and psychiatric aspects while 26.8% believed it to be a behavioral disorder, 6.6% with neurological, 6.4% considered it a psychiatric disorder and 5.9% of respondents didn’t know. Regarding the cause, 11.4% believed it is genetic, 5.5% attributed the causes to nutritional habits, 5.6% attributed causes to food preservatives, 0.2 % believed it's caused by smoking, and 77.3%thought it's a multi-cause disorder.

Conclusion: This study reveals that the level of knowledge appears to be good among the population of Hail compered to Madina region.

• Zainab J Al-Mohsin
• Heba A Al-Saffar
• Shaher Z Al-Shehri
• Marwa M Shafey

Background: Mothers' perceptions about attention-deficit hyperactivity disorder (ADHD) are central to the management of the disorder. The aim of the study was to assess the knowledge, experiences, and attitudes of mothers with ADHD children toward ADHD and identify their common sources of information and service barriers from the perspectives of these mothers in the Dammam, AI-Khobar, and Al-Qatif areas.

Materials and Methods: This cross-sectional study comprised mothers of 132 children with ADHD who attended private and government sector special education schools and day-care centers in the Al-Khobar, Dammam, and Al-Qatif cities of Saudi Arabia. All the mothers completed self-administered structured questionnaires.

Results: About 47% mothers of children with ADHD had poor knowledge of ADHD, 74.2% had a positive attitude toward the condition, and 51.5% had a neutral perception of their children. Most of the children received combined therapy, with 69.5% exhibiting improved behavior. The most common concern of mothers was fear of the side effects of medication (39.4%). The mothers were the first family members to seek advice; the most common reason for first visit to clinic were poor social skills (45.5%), and attention hyperactive aggressive behavior (45.5%). The most common reason for the delay in diagnosis was failure to recognize the child's aberrant behavior (67.4%), whereas the most common source of information was internet (63.6%).

Conclusion: It is important for clinicians to address the mothers' perceptions of ADHD as part of the treatment for ADHD to improve the children's quality of life. It is also important to develop educational materials and awareness campaigns that target mothers and facilitate good communication between the services through the social media.

• Tariq Melhem

The study aimed to assess the effectiveness of a training programme in increasing teachers’ knowledge of Attention Deficit Hyperactivity Disorder (ADHD) in the Eastern Region of Saudi Arabia. The sample comprised 124 teachers from schools in the said region, and these teachers were divided into two groups: (1) experimental group with 62 teachers and (2) control group with 62 teachers. The quasi-experimental approach was employed for collecting data; the Cognitive Awareness Scale of ADHD (Melhem, 2020) was also employed. It consists of 37 items distributed into three domains, namely, general knowledge, characteristics and diagnosis and treatment. Results revealed that the effectiveness of the training programme in increasing teachers’ ADHD knowledge was in favour of the experimental group. Moreover, no statistically significant differences were observed in the increase of the levels of ADHD knowledge amongst the teachers in the experimental group due to the variable of teaching experience. That is, the levels of ADHD knowledge of teachers from the experimental group are the same according to their teaching experience. In sum, the training programme significantly increased the levels of ADHD knowledge of teachers from the experimental group. Moreover, educational institutions in Saudi Arabia should include ADHD training programmes in teacher-training curricula in Saudi Arabia.

• Mohammed Al-Hwaiti

• Manal Basudan
• Naeema Akbar
• Waled El-Ghamdi
• Adel Ibrahim

• Manal Basudan
• Naeema Akbar
• Waled El-Ghamdi
• Adel Ibrahim

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatry disorders in children, it has negative impact on the academic, familial and social functioning of the child. The recent advances in its treatment calls for social intervention including school-based activities, which necessitates knowledgeable teachers. Aim: The main aim of this study is to explore the level of knowledge and attitude of the school teachers of female primary schools in Jeddah about ADHD. Subjects and methods: Through a cross sectional design, 376 school teachers were selected by multistage sampling from female primary schools in Jeddah, they were invited to fill a predesigned valid questionnaire reflecting their knowledge and attitude towards ADHD. SPSS ver 21 was used for data entry and statistical analysis which included descriptive as well as analytic analysis using Chi square test. P value<0.05 was considered an indication for significance. Results: Almost one half of the teachers (47.6%) aged between 40-49 years, who were mostly married (81.1%) and having children (84.3%). Out of them, 8.2% reported that they have ADHD child. Although that more than one half of the teachers (54.3%) thought that they had knowledge about ADHD, the true knowledge test questions revealed a much lower percentage (24.5%) who showed good knowledge about ADHD. Only older teachers had significant better knowledge. More than one half of the teachers (57.2%) perceive that the first step in the management policy when suspecting ADHD is the referral of the child to advisor and asking for attendance of the parents. Conclusion and recommendations: Most of the teachers have insufficient level of knowledge about ADHD. There is a tangible need for training programs provided to the teachers about early recognition and policy of care of ADHD children.

• Asma Mohammed Ali Alabd
• Soha Kamel Mesbah
• Mohammad Alboliteeh

Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children. Teachers play an important role in the diagnosis of ADHD because of their daily contact with students in a range of pertinent situations. Aim of the study: Evaluate the effect of educational program on knowledge, attitude and classroom management technique among elementary school teachers in Hail City towards attention deficit hyperactivity disorder. A quasi-experimental design was used to conduct the current study in four Saudi elementary school in Hail City (2 females & 2 males elementary school) during the period from March 2018 to May 2018. Subjects: A sample of convenience of 95 teachers working in the previously elementary school. Tools: One tool were utilized for data collection, Self-administrated Questionnaire: The tool was divided into four parts, I) personal characteristics of studied sample, II) the knowledge of Attention Deficit Disorders Scale (KADDS), III) Teachers" beliefs about and attitudes toward ADHD, and IV) Perception of classroom management techniques. Results: Findings showed that mean score regarding ADHD knowledge, attitude, and classroom management technique were significantly higher after than before program with highly significant association between knowledge, attitude, and classroom management technique. Conclusion: ADHD educational program was effective in improving teachers" knowledge, attitude, and classroom management technique. Recommendation: The results indicated the need to increase awareness about ADHD and importance of adopting classroom management technique in order to deal with ADHD children through health education programs to teachers were needed.

• Esra'a Yahya Al-Moghamsi
• Abdulaziz Aljohani

Background: Teachers are often the first ones to suspect attention deficit/hyperactivity disorder (ADHD) in their students, because they are with them for most of the day and they know how normal students typically behave in classroom situations. The aim of this study is to assess the teachers" level of knowledge of ADHD and identify some factors affecting that knowledge. Methods: It is a cross-sectional study conducted among male and female elementary governmental schools in Madina city during the year 2017/1438. A pre-validated and translated self-administered questionnaire is used in data collection. It includes demographical questionnaire and the Knowledge of Attention Deficit Disorder Scale. Results: The study included 416 teachers. Their age ranged between 22 and 66 years. The average percentage of knowledge regarding ADHD general information, symptoms/diagnosis, and treatment were 41.6 ± 15.1, 41.7 ± 15, and 30.7 ± 16.6, respectively. The average percentage of overall knowledge score regarding ADHD was 38 ± 11.3. Only experience in teaching (P = 0.042) and previous experience with a child with ADHD (P < 0.001) were significantly associated with teachers" knowledge regarding ADHD general information. Special need teachers had the highest score of knowledge regarding ADHD symptoms (mean rank was 283.7), P = 0.013, and they had the highest score of knowledge regarding ADHD treatment (mean rank was 261.9), P = 0.032. Teachers who reported previous experience with a child with ADHD expressed higher level of overall knowledge regarding ADHD, P < 0.001. Conclusions: The knowledge regarding ADHD among elementary school teachers in Madina is suboptimal, particularly regarding treatment.

• Hamzah Hassan Alfageer
• Mohamed Dhafer Aldawodi
• Sulaiman A Al Queflie
• Nazish Masud
• Nesrin A Al Harthy
• Nawaf Alogayyel
• Mohammed Alrabah
• Shoeb Qureshi
• Qureshi

Objective: We assessed the level and source of knowledge and attitude of male primary school teachers about attention_deficit and hyperactivity disorder (ADHD). Methods: A cross_sectional study was conducted from January to November 2016 involving Saudi male teachers currently working at 17 primary schools in Khashm_Alaan district, Saudi Arabia. A prevalidated, self_administered, structured questionnaire was used for data collection. Teachers" mean knowledge score was measured in the following three categories: insufficient, good, and very good. Results: Only 141 out of 182 teachers completed the questionnaire. Mean age of participants was 36.16 ± 6.6 years with teaching experience of 12 ± 6.2 years. Bachelor"s degree was the highest qualification reported by 86% of participants. Seventy_two percent of the teachers had either very good (13%) or good (59%) knowledge about ADHD. Almost half of them reported multiple sources such as internet, social media, and television for obtaining information about ADHD. However, internet and social media alone were reported as a source of information by 13% and 11.4%, respectively. Those who attended any course on ADHD had significantly (P = 0.006) more knowledge about the disorder. Furthermore, those teachers having taught a child with ADHD had more knowledge about the disorder. A significant correlation between mean knowledge and attitude scores was observed. Conclusion: Two_third of the teachers had knowledge about ADHD. Those who had either attended a course or taught a child with the ADHD had significantly more knowledge about the disorder. Most of the teachers learned about the disorder from multiple sources.

• Asma Mohammed Ali Alabd
• Soha Kamel Mesbah
• Mohammad Alboliteeh

Background: Attention deficit hyperactivity disorder (ADHD) is the most common neurobehavioral disorder of childhood and can profoundly affect the academic achievement, well-being, and social interactions of children. Teachers play an important role in the diagnosis of ADHD because of their daily contact with students in a range of pertinent situations.

Aim of the study: Evaluate the effect of educational program on knowledge, attitude and classroom management technique among elementary school teachers in Hail City towards attention deficit hyperactivity disorder. A quasi-experimental design was used to conduct the current study in four Saudi elementary school in Hail City (2 females & 2 males elementary school) during the period from March 2018 to May 2018.

Subjects: A sample of convenience of 95 teachers working in the previously elementary school.

Tools: One tool were utilized for data collection, Self-administrated Questionnaire: The tool was divided into four parts, I) personal characteristics of studied sample, II) the knowledge of Attention Deficit Disorders Scale (KADDS), III) Teachers’ beliefs about and attitudes toward ADHD, and IV) Perception of classroom management techniques.

Results: Findings showed that mean score regarding ADHD knowledge, attitude, and classroom management technique were significantly higher after than before program with highly significant association between knowledge, attitude, and classroom management technique.

Conclusion: ADHD educational program was effective in improving teachers’ knowledge, attitude, and classroom management technique.

Recommendation: The results indicated the need to increase awareness about ADHD and importance of adopting classroom management technique in order to deal with ADHD children through health education programs to teachers were needed.

• Ayedh A Al-Ahmari
• Rishi K Bharti
• Mohammad S Al-Shahrani
• Muffarah H Alharthi
• Hassan M Alqarni
• Hassan M Alshehri

Background: Attention_deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders. This study aimed to assess the knowledge, attitude, and practice of primary health_care (PHC) physicians on diagnosis and management of ADHD. Materials and Methods: This was a cross-sectional study included 340 PHC physicians in Aseer Region, Saudi Arabia. A self_administered questionnaire was used to collect data on personal characteristics, knowledge, attitude, and practice of the diagnosis and management of ADHD. Results: Nearly 47.6% of the PHC physicians were aged <30 years, 60.3% were male, 79.1% were Saudi nationals, and 84.1% had completed MBBS. Only 13.2% had attended continuing medical education courses on ADHD, 63.2% had read about ADHD; Internet was the main source of information (30.7%). Participants" attitude toward ADHD was mainly positive, while 32.1% had poor knowledge and 17.6% had diagnosed ADHD cases in the last year, but 73.3% had referred the diagnosed cases to specialists. Participants" knowledge differed significantly according to their age, gender, and nationality.
Conclusions: PHC physicians" knowledge about ADHD was suboptimal, but they had a positive attitude toward their role with regard to ADHD. PHC physicians should focus on the clinical and diagnostic aspects of ADHD. Awareness and interest of undergraduate medical students and newly graduated physicians in ADHD should be raised. The Ministry of Health should encourage attendance at extracurricular courses and workshops.

• Abeer Al Nowaiser
• Heba Elkhodary
• Omar El Meligy
• Lana Shinawy
• Elham Asiri
• Shuroog Aldosari

Aim: The aim was to measure the level of perception and knowledge of dental care providers to Attention Deficit Hyperactivity Disorder (ADHD) at King Abdulaziz University faculty of dentistry (KAUFD), Jeddah, Saudi Arabia. Materials and Methods: Three-part questionnaire with an explanatory method were mailed to 50 specialist pediatric faculty members and residents (Master, Doctorate degrees and Saudi Board) and 140 dental interns and externs. The first part of the questionnaire includes the participants" demographic information. The second part related to the participants previous clinical and educational experiences with ADHD and the third part included questions related to the participants" knowledge and management of ADHD. The respondents were asked to choose only one choice from 3 choices (agree, disagree, I do not know). Results: Working experience was found to be a significant factor (P ≤ 0.05) in relation to the background knowledge of the participants when comparing those with 10+ years of work experience to those with 1-3 years and 4-9 years work experience. Additionally, female participants had better knowledge than their male counterpart (p<0.001), as did married participants (p=0.007) and those who have children especially with regards to the adverse effects of drugs, oral health and dental management for ADHD patients (p=0.001, p=0.011, p=0.011). Interns also reported significant differences than consultants (P ≤ 0.05) in their knowledge and general information about oral health and dental management for ADHD. Conclusion: The background knowledge among a sample of oral health care providers in KAUFD was found to be statistically and positively related to the work experience in terms of years of practice as well as the social and demographic status of the participants.

• Hebah F Qashqari
• Abdulaziz O Alsulami
• Eman K Kamal
• Mohammed MS Jan

Background: Early recognition of attention deficit hyperactivity disorder (ADHD) is needed to prevent its psychosocial and educational consequences. We aimed to study ADHD awareness among medical students and identify correlating and contributing factors to their lack of knowledge. Methods: A cross sectional study included 5th year medical students attending their pediatric rotation from September 15, 2012 until June 15, 2013 at King Abdulaziz University hospital, Jeddah, Kingdom of Saudi Arabia. A structured 25-item questionnaire was designed to examine their demographics , educational experience, and awareness questions about ADHD. Results: Of 120 approached students, 111 were included with ages ranging from 20-29 years (mean 22) and 69% being females. Most students 69 (62%) were enrolled during their pediatric rotation and 97 (87%) already completed their psychiatry course. Although most students (67%) recognized ADHD, only 13 (12%) categorized their level of knowledge as very good or excellent. Only 24% correctly recognized ADHD subtypes and 58% did not know what is the initial required management step. Only 19 students (17%) correctly recognized all ADHD features based on the DSM IV criteria with a mean correct score of 69% (standard deviation 14). No correlations were found with their age, gender, completing their pediatric/ psychiatry rotation, or specialty interests. Conclusions: Medical student"s level of knowledge about ADHD needs improvement. This has to be corrected in order to improve early recognition and intervention. Increased ADHD education and exposure during pediatric/neuroscience modules are needed in our region.

• Khaled Alghamdi
• Abrar Alharbi
• Abdul-Qader Susi
• Tafani Thani

Introduction: Attention Deficit Hyper-Active Disorder (ADHD) is one of the most common neurobehavioral developmental disorders among children. The prevalence of ADHD in all Arabic countries in general was ranging from 1.3% to 16% compared to 4-8% in US. While in Korea it was between 7.6% to 9.5%. However, the prevalence was reached 20 % in India. Methodology: A cross sectional study has been set in Saudi Arabia, Madina Region. The study population included both genders from 15 years and above, people living outside Madina and those whom are in the medical field have been excluded. Data were analyzed by the SPSS version 20. Results: 25.1 % knew the disease through their experience with an ADHD patient known to them. 14.7% read about ADHD through medical websites, 7,3% and 7.6% knew about it from newspapers and social media, respectively. 71.3%, believed that ADHD is a real disease, 22 % believe that it is a behavioral disorder, 16 % consider it as a neurological disease while 18 % considered it as a psychiatric disorder. On the other hand, 31 .8 % believe that ADHD is a mixed disorder and only 11 % did not know anything about the nature of the disease. , 32.2 % believe that it is a genetic disease, 23.1% blame nutritional habits, 19.3% believe that preservatives and dye contents of certain types of the food are the main cause, 4.9 % considered insecticides the main cause ,1.1% connected it to smoking and the rest believe that it is multi-cause disease.5.6% of respondents believe that medical management is the main modality of treatment, 27.1% think that behavioral therapy is main treatment option and 59.8% suggested both modalities and the rest considered it as not a treatable disease. Conclusion and Recommendations: Madina society is in a tremendous need to increase their awareness about ADHD in a simple layman language.

• Manal Omar Kamal

Attention Deficit Hyperactivity Disorder (ADHD) is prevalent in schools around the world today. Over 1.6 million Saudi children suffer from ADD/ADHD today, which is comparable with other nations. Roughly 11% of US students are effected by ADHD and 15% of Saudi students. The Saudi Arabian Ministry of Education has approved the implementation of ADD/ADHD programs in schools. However, teachers in Saudi Arabia are not well prepared to work with the issues that they are facing in their classrooms with these students. Both teachers and parents can benefit from learning new strategies to work with their ADD/ADHD students. The lack of proper instructional strategies employed and understanding of the disorder cause students to fall behind and struggle academically. There are many simple resources that teachers can tap into for help; however, many are not prepared to teach students with ADHD. This study seeks to gather information through survey questionnaires and research regarding teacher's as well as student advisor's understanding and perspectives of ADD/ADHD and to provide information in order to bring awareness of different types of strategies for Saudi teachers, student advisors and parents to implement with elementary, middle, and high school students in their academic achievements. This project also seeks to develop a program and Guidebook for teachers and parents to use providing information and instructional strategies to help them with students with ADD/ADHD.

• Mohammed MJ Alqahtani

The purpose of this study is to provide quantitative data on parental experiences with their children with attention-deficit hyperactivity disorder (ADHD) and to focus more on their opinion about medication and the role of psychological assessment and interventions. The study sample included 211 parents of children with ADHD. More than half of the parents think that ADHD could be treated without medication and that their child is too young to have psychotropic medication with its side effects. There were concerns about misdiagnosis and being too quick to prescribe medications. Psychometric assessment and psychological intervention were infrequently used and their experience with combined interventions is almost rare. Pressure from schools to prescribe medication was one of the parents" concerns. Parental satisfaction with medication occurred when an improvement in school performance was noted. It is essential for health professionals to be aware of parents" experiences and to develop a proper evidence-based intervention for ADHD which includes psychological counselling or combined interventions and not to rely on medication intervention alone.

• Mark J Sciutto
• Mark D Terjesen
• Alena
• Zdena Michalova_
• Sandra Schmiedeler
• Katerina Antonopoulou
• Norhan Z Shaker
• Ji-yeon Lee
• Keetam Lee
• Keetam Alkahtani
• Bradley Drake
• Jaco Rossouw

Attention-Deficit/Hyperactivity Disorder (ADHD) is among the most prevalent disorders of childhood and adolescence worldwide. Teachers are likely to play an important role in multiple stages of the help-seeking process (e.g., problem recognition) for children with ADHD. This study examined the relationship of prior exposure and ADHD training with teachers" knowledge and misconceptions of the disorder in a multinational sample. Teachers (N = 2,307) from nine countries (Czech Republic, Germany, Greece, Iraq, the Republic of Korea, Saudi Arabia, South Africa, United States, and Vietnam) completed measures of ADHD knowledge, prior exposure, and education/training related to ADHD. There was considerable variability in overall levels of knowledge and specific misconceptions across the countries sampled. Although the predictors of ADHD knowledge varied considerably across countries, some form of professional training and prior exposure to ADHD was associated with greater knowledge in the majority of countries. Implications for teacher training and the role teachers can play in the help-seeking process are discussed. Note: Saudi data published previously in 2013 (PDF: Teachers’ Knowledge and Misconceptions of Attention Deficit/Hyperactivity Disorder)

• Mohammed M.J. Alqahtani

Adherence behaviour to medication for attention deficit hyperactivity disorder (ADHD) is frequently suboptimal. Parents have several beliefs and experiences about ADHD medication and they going to make their decisions based on that background. This study aims to investigate qualitatively the parental experiences regarding using medication of ADHD for their children with ADHD. A qualitative approach was chosen to gain an in-depth insight into the experiences and beliefs. The investigations approached more than 60 parents during their follow-up. And the final sample included 44 parents. Parents generally were reluctant to medicate their children. Some parents revealed positive experiences about ADHD’s medication, mainly when that medication associated with positive performance at their schools. Parents described their hesitancy to continue the medication as a result of having uncertain assessments, side-effects of that medication and stigma. It was rare to hear from parents that behavioural or educational intervention could be used to manage ADHD, mainly when they decide to discontinue medication. There is a need to develop intervention program that educate, encourage, and support parents in following behaviour and pharmacological recommendations.

• Mohamed S Khalil
• Elham Jenahi

Objective: The teacher’s knowledge plays a key role in the process of assessing, screening, and diagnosing attention deficit hyperactivity disorder. This was a cross-sectional study aimed at surveying teachers’ knowledge about attention-deficit hyperactivity disorder, one of the most prevailing neurodevelopmental disorders. Materials and Methods: One hundred and thirteen female elementary school teachers were randomly chosen from six regular female public and private schools in Al-Khobar in the Eastern Province of Saudi Arabia. They completed a self-reported questionnaire on their general "factual" knowledge of the nature of attention-deficit hyperactivity disorder, and the management "action knowledge" of the condition. Factors which might affect their knowledge were also examined. Results: About 48.7% of the total sample had adequate factual knowledge, but only 27 (23.9%) showed adequate action knowledge about how to deal with attention-deficit hyperactivity disorder. Teachers’ knowledge of attention-deficit hyperactivity disorder (factual and action) was not significantly correlated with their years of experience, level of education (qualification) and duration of training in educational methodology. Conclusion: It was concluded that teachers in female primary schools had inadequate knowledge about attention-deficit hyperactivity disorder. Implications and recommendation for health and educational professional are outlined.

• Mohaned Abed
• Susan Pearson
• Paula Clarke
• Mary Chambers

Attention Deficit Hyperactivity Disorder (ADHD) is considered one of the most frequently diagnosed psychiatric childhood disorders. It has an effect on 3-5% of school-aged children, and brings about difficulties in academic and social interaction. This study explored the knowledge and beliefs of parents in Saudi Arabia about children with ADHD. The Knowledge about Attention Deficit Disorder Questionnaire (KADD-Q) was administered to a sample of parents, followed by interviews with a subset of the total respondents. The results indicated that the parents knew more about the characteristics of ADHD than they knew about its related causes and treatment. Overall, the findings indicated that these parents had some knowledge about general characteristics of ADHD, but they had little understanding of causes and possible interventions. These results suggest an important need for more formal parents training regarding all aspects of ADHD in school age children. View on ResearchGate

• Abdulrahman Abdullah Abaoud
• Nabil Sharaf Almalki

This study was aimed at measuring the differences of elementary school teachers" perceptions of behavioral problems that appear in pupils with attention deficit hyperactivity disorder (ADHD). The study focused on measuring any statistically significance differences of some variables and their relationship to the extent of realization of teachers. These variables included gender, level of education, years of experience, teacher’s current position, previous experience in teaching pupils with ADHD, and training. This research applied the descriptive approach, using a questionnaire. The study sample included 304 male elementary school teachers and 301 female elementary school teachers. The study found several results; no statistically significant differences at the 0.05 level or less regarding teachers" perceptions of behavioral problems in pupils with ADHD and level of education. The study also showed statistically significant differences between the perceptions of teachers and gender, years of experience, teacher’s current position, previous experience in teaching pupils with ADHD, and training. [Full study is in Arabic]

• Mohaned Abed
• Susan Pearson
• Paula Clarke
• Mary Chambers

Attention Deficit Hyperactivity Disorder (ADHD) is considered one of the most frequently diagnosed psychiatric childhood disorders. It has an effect on 3-5% of school-aged children, and brings about difficulties in academic and social interaction with both parents and teachers. The rationale behind this study is the exploration of the knowledge and beliefs of children regarding ADHD. The results of the survey based on the responses of 58 children to the ADHD Knowledge and Opinions Questionnaires and subsequent interviews showed positive choices of evidence-based medication and psychosocial treatment, and an understanding of the range of effects of ADHD, and the possible handling strategies. Children were able to determine environments in which ADHD made it difficult for them to be, and also identify adults who they considered capable of assisting them with their condition. Overall, the findings reveal that, whilst children have some knowledge regarding ADHD, demystification workshops are required.

• Areej M. Ali Munshi

Background: Attention deficit hyperactivity disorder (ADHD) is a disorder of childhood and adolescence and it is one of the most common psychiatric disorders that cause distress in the lives of both children and adult. If ADHD remains undetected the child may experience academic failure, rejection by peers, and develop low self-esteem. Teachers are seen as one of the most valuable sources of information with regard to referral and diagnosis of ADHD. They also have the responsibility for creating an environment conductive to academic, social and emotional success for children with ADHD. Aims & Objective: To assess the knowledge of primary school and kindergarten female teachers in Al-Rusaifah district, Makkah city, towards the diagnosis and the management of ADHD as well as factors associated with ADHD knowledge among them. Materials and Methods: A cross sectional study among primary school and kindergarten female teachers working in Al-Rusaifah district, Makkah, Saudi Arabia, 2011. An interview questionnaire for diagnosis and management of ADHD in children was implemented. The questionnaire was designed in Arabic language. It consists of 38 questions covering 3 parts; regarding socio demographic features, general knowledge of ADHD with its coexisting conditions, and management of ADHD utilizing a questionnaire based on the Diagnostic and Statistical Manual of Mental Disorders (4th Ed) (DSM-IVR) diagnostic criteria. Results: The study included 130 teachers with a response rate of 100%. Their age ranged between 22 and 58 years with a mean of 33.32 ± 7.77 years. More than half of the participants (72; 55.4%), responded that they had insufficient information regarding ADHD during their undergraduate stage. The majority (114; 87.7%) did not attend any conference regarding ADHD while (78; 60%) reported history of reading about ADHD. Relatively highest level of knowledge was observed for the items dealing with symptoms and facts related to diagnosis of ADHD (71.75%) while the lowest level of knowledge was revealed for the items reflecting general knowledge about ADHD (37%). The overall mean percentage of correct answers was 58.9%. The mean percentage of score reflecting knowledge of the teachers about diagnosis of ADHD was significantly higher among teachers aged 25 years or below as compared to older teachers. The majority of teachers (84.6%) agreed that they have an active role in the management of ADHD and that teachers should play an active role in ADHD management if combined with drugs (83.8%). Conclusion: In conclusion, an inadequacy of knowledge regarding ADHD among a sample of female teachers in Al-Rusaifah district, Makkah, was observed. This inadequacy of knowledge raises serious questions about the screening of ADHD at the level of schools in Makkah.

• Mohaned Abed
• Susan Pearson
• Paula Clarke
• Mary Chambers

Attention Deficit Hyperactivity Disorder (ADHD) is considered one of the most frequently diagnosed psychiatric childhood disorders. It affects 3-7% of school-aged children, interfering with their academic performance and social interactions. This study explored the knowledge and beliefs of teachers in Saudi Arabia about children with ADHD. The Knowledge about Attention Deficit Disorder Questionnaire (KADD-Q) was administered to a sample of teachers, followed by interviews with a subset of the total respondents. The results indicated that the teachers knew more about the characteristics of ADHD than they knew about its related causes and treatment. Overall, the findings indicated that these teachers had some knowledge about general characteristics of ADHD, but they had little understanding of causes and possible interventions. These results suggest an important need for more formal teacher training regarding all aspects of ADHD in school-age children.

• Sharat Chandra Pani
• Hannan Hillis
• Tasneem Chaballout
• Wedad Al Enazi
• Youmna AlAttar
• Mona Aboramadan

Background and Aim: Attention-deficit hyperactivity disorder (ADHD) is one of the most common childhood mental disorders that manifest with difficulties in staying focused and hyperactivity. Such children have been reported to have a higher incidence of traumatic dental injuries. The aim of this article was to study the knowledge and attitude of Saudi teachers of children with ADHD towards the management of traumatic dental injuries and compare them to their counterparts in mainstream schools. Material and Methods: A four-part structured Arabic questionnaire was administered to 281 teachers of children with ADHD and 384 teachers in mainstream schools. The questionnaire recorded the demographic data, type of children taught, experience of the teacher in dealing with traumatic dental injuries, the teachers’ perceived importance of managing traumatic dental injuries and their knowledge of emergency management of these injuries. The difference in knowledge and attitude between teachers of mainstream schools and schools for children with ADHD was assessed. Results and Conclusions: The results of the study indicate that teachers of children with ADHD have a greater experience of witnessing traumatic dental injuries and place significantly more importance towards the management of these injuries than their counterparts in mainstream schools. The influence of demographic variables on knowledge seen in teachers from mainstream schools is absent in those teaching children with ADHD.

• Keetam D.F. Alkahtani

Teachers can play a key role in identifying and supporting students with Attention Deficit/Hyperactivity Disorder (ADHD). In order to fulfill this important role, it is imperative for teachers to have explicit knowledge about ADHD. The overall aim of this study is to investigate teachers" knowledge and misconceptions of ADHD. Four hundred and twenty-nine (429) teachers participated. The Knowledge of Attention Deficit Disorder Scale (KADDS) along with a demographic questionnaire was used as the survey instruments to collect data. Descriptive statistics and correlation test were used to analyze the data. Results indicated that teachers" knowledge of ADHD was insufficient. Teachers" level of knowledge of ADHD was positively related to their prior training and experience with ADHD (i.e., the number of ADHD courses taken in college or graduate level, and the number of workshops pertaining to ADHD). Teachers" level of knowledge of ADHD also correlated positively with their level of confidence in teaching a student with ADHD. In spite of a few limitations, the results of this study are valuable for identifying areas where there is a misperception or lack of knowledge among teachers.

• Rania A Zaki

ADHD is the most common neurobehavioral disorder that affects large number of children world-wide. It characterized by three main symptoms; inattentiveness, hyperactivity and impulsivity. Caring of children with ADHD can be challenging for the whole family, Parents may be hurt by their children’s behavior as well as by the way other people respond to it. The purpose of this study was to enhance the awareness of parent caregivers about caring of their ADHD children’s through the Implementation of the research Program, quasi-experimental design was selected for this study. Subjects were consists of (30) mothers caregivers of ADHD children’s. The study was conducted in the General Administration of Intellectual Education Centers in the city of Abha. Data were collected by using two tools, the first was an interview questionnaire used to assess the family care givers Knowledge, attitude & practice toward their ADHD children behaviors in daily living activities, and the second was concerned with Attention deficit hyperactivity disorders scale. The results denoted that there was highly statistical significant relation between pre and post program implementation regarding family caregivers positive attitude and practice. So the study recommended that further studies should be done on large group of family caregivers to improve the parenting skills in managing their ADHD children behaviors.

• Sana Al-Mahmoud

Attention Deficit Hyperactivity Disorder (ADHD) is considered the most common psychiatric disorder that. (ADHD) is a developmental condition that involves problems with inattention and hyperactivity- impulsivity inconsistent with the age of the child. The affected child often has difficulty learning, giving rise to special educational needs that, combined with poor peer and family relationship, can lead to lack of self-esteem. Because the nature of illness is unknown, parents are usually not aware of how the illness will be managed. So the present study aimed to identify the effectiveness of health educational program on parents’ coping strategies and their children with Attention Deficit Hyperactivity Disorder. A quasi-experimental design was utilized in this study. The study has been carried out in the Psychiatric Out-patient Clinic in Al-Amal Complex for Mental Health in Dammam. A total sample of (30) parents and their children with ADHD has been selected. Pre-post assessment were carried out using the following tools: Socio demographic data sheet for both: parents and children. Knowledge assessment was measured by Psychosocial Problems of Parents Scale. developed by Pruyn, 1983 . The last one is The Parental Coping Strategy Inventory (PCSI)Yeh. The result of the current study revealed a statistically significant difference in level of parents knowledge and coping strategies between pre-post assessment. Therefore, researchers recommended the necessity to increase the awareness of illness by health care professionals through counseling, family therapy, free work shops for parents because they really in need.

• Faisal Alamiri
• Michael Faulkner

This study overviews the circumstances surrounding gifted children who manifest challenging behaviours at school, and where the explanatory use of the diagnostic descriptor, AD/HD, is invoked. Specifically, this qualitative research study in Saudi Arabia investigated the phenomenological and diagnostic confusion between giftedness and AD/HD. Three mainstream regular classroom teachers, one specialist teacher of gifted children, and the parents of three gifted children were interviewed. All participants’ perceptions focused on the behavioural dimensions of teacher-nominated gifted children at school and at home. In general, the results indicate that diagnostic confusions between giftedness and AD/HD were manifest, and teachers’ and parents’ perspectives differed. Some unanticipated and interesting data also emerged from the research. In discussion of the results, a number of themes relating to the misidentification of gifted children are discussed. Some educational implications for future research directions are offered.

• Fahad D Al-Osaimi
• Fatima A Al-Haider

Background: Psychosocial problems are common health concerns in children. Therefore, it is essential for pediatricians to be able to identify psychiatric disorders. This depends on the knowledge, practice and attitudes towards psychiatric disorders in childhood. Methods: A constructed questionnaire of items about knowledge, practice and attitudes of pediatricians toward psychiatric disorders in childhood was used. Four hundred and fifty questionnaires were distributed and collected from pediatricians in seven main governmental hospitals in Riyadh over a period of three months (between March 1 and May 30 2005). Findings were analyzed statistically. Results: About 88.8% of the samples had not had any training in child psychiatry during their residency. Forty-eight percent were hesitant in diagnosing psychiatric disorders in children, 76.5% were not confident enough to treat these children, 48.5% were not confident enough to follow them up after being managed by a child psychiatrist and 49.9% were not confident to treat common side effects of psychotropic medications. About 88.8% of the pediatricians thought that pediatricians needed training in child psychiatry during pediatric residency programs. Conclusion: A significant number of pediatricians reported a lack of training in child psychiatry during residency programs. This has an adverse impact on their knowledge, attitudes and possibly practices in dealing with childhood psychiatric disorders.

• Fahad A Bashiri
• Turki H Albatti
• Muddathir H Hamad
• Haya F Al-Joudi
• Hadeel F Daghash
• Saleh M Al-Salehi
• Jeremy L Varnham
• Fatima Alhaidar
• Omar Almodayfer
• Abdulkarim Alhossein
• Hesham Aldhalaan
• Yasser A Ad-Dab'bagh
• Nouf Al Backer
• Waleed Altwaijri
• Khalid Alburikan
• Maysaa W Buraik
• Mohammad Ghaziuddin
• Michael J Nester
• Hayfaa A Wahabi
• Samia Alhabib
• Amr A Jamal
• Yasser S Amer

Background: We recently adapted the published National Institute for Health and Care Excellence (NICE) Attention deficit hyperactivity disorder (ADHD) diagnosis and management guideline to the Saudi Arabian context. It has been postulated that adaptation of evidence-based clinical practice guidelines to the local healthcare context rather than de-novo development will improve their adoption and implementation without imposing a significant burden on resources. The objective of this paper is to describe the adaptation process methodology utilized for the generation of the first national guideline for management of people with ADHD in Saudi Arabia.

Methods: We used the KSU-Modified-ADAPTE methodology for the guideline adaptation process. We describe the full process in detail including the three phases of set-up, adaptation, and finalization. The process was conducted by a multidisciplinary guideline adaptation group in addition to an external review for the clinical content and methodology.

Results: The group adapted ten main categories of recommendations from one source CPG (NICE). The recommendations include: (i) service organisation and training, (ii) recognition, identification and referral, (iii) diagnosis, (iv) support, (v) managing ADHD, (vi) dietary advice, (vii) medication, (viii) maintenance and monitoring, (ix) adherence to treatment, and (x) review of medication and discontinuation. Several implementation tools were compiled and developed to enhance implementability including a clinical algorithm, quality measures, coding system, medication tables, translations, patient information, and online resources.

Conclusions: The finalized clinical practice guideline provides healthcare providers with applicable evidence-based guidance for the management of people with ADHD in Saudi Arabia. The project also demonstrated the effectiveness of KSU-Modified-ADAPTE, and emphasized the value of a collaborative clinical and methodological expert group for adaptation of national guidelines.

Note: This study was conducted as part of the Saudi ADHD Society’s unified ADHD Clinical Practice Guidelines Project, strategic project #7.2 for the period 2017-2019. The project received approval from the Ministry of Labor and Social Development (No. 52476) on 5/8/1438. The project is entirely funded by the Saudi ADHD Society. No funding was received from any pharmaceutical or industrial company.

• Yasser Sami Amer
• Haya Faisal Al-Joudi
• Jeremy L Varnham
• Fahad A Bashiri
• Muddathir Hamad Hamad
• Saleh M Al-Salehi
• Hadeel Fakhri Daghash
• Turki Homod Albatti

Background and objective:  High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD.

Methods: A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.

Results: Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs.

Conclusions: Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended.

Note: This study was conducted as part of the Saudi ADHD Society’s unified ADHD Clinical Practice Guidelines Project, strategic project #7.2 for the period 2017-2019. The project received approval from the Ministry of Labor and Social Development (No. 52476) on 5/8/1438. The project is entirely funded by the Saudi ADHD Society. No funding was received from any pharmaceutical or industrial company.

• Adil Alshammary

The diagnosis of communication and behavioral difficulties in Saudi Arabia is currently still an emerging field and there are few governmental schools in the field of speech therapy in Saudi Arabia. These schools offer a bachelor degree in speech hearing rehabilitation, which started only a few years ago. For this reason, the number of Saudis certified as speech and language therapists is very limited, which has led to several issues regarding diagnosis, therapy and speech services in the kingdom being raised. First hand reports from trained speech and language practitioners suggest that it is common for children with a range of communication difficulties to receive a diagnosis of Autism Spectrum Disorder, with other internationally recognized diagnostic labels (e.g. Attention Deficit Hyperactivity Disorder; ADHD) being far less commonly used.

Due to limitation of number of certified professional speech language therapists in Saudi Arabia, a number of teachers, psychologists and even some religious individuals claim to be speech therapists. They provide unauthorized speech therapy sessions without any experience or permission, in non-authorized centres such as private schools, private centers and even in their homes. This study is aimed at highlighting the importance of accurate diagnosis and the impact of unauthorized workers on children with ADHD and autism inside Saudi Arabia.

• Ahmad M Hassan
• Fatima Al-Haidar
• Fateh Al-Alim
• Othman Al-Hag

Background and Objectives: A clinically validated attention deficit hyperactivity disorder (ADHD) scale in Arabic for evaluating children in Saudi Arabia who might be suspected of having ADHD is lacking. Thus, we studied the validity of an Arabic version of the ADHD Rating Scale in discriminating children with an ADHD diagnosis from normal children or from those with non-ADHD psychiatric diagnoses, including mental retardation. Methods: The guardians of 119 children provided demographic data and completed the standardized Arabic version of the ADHD Rating Scale on their children, who were either normal, had a diagnosis of ADHD, or had a non-ADHD psychiatric diagnosis. The mean rating scores of the groups were compared, and the cutoff points were calculated for both sexes. Results: The scores discriminated children with ADHD diagnosis (mean and [SD], 28 [6.288]) from normal children (10.93 [8.009]), and those with a non-ADHD psychiatric diagnosis (16.63 [8.865]). ADHD cutoff points were obtained for male (23.5) and female (22.5) children. Psychosocial characteristics associated with children having ADHD were not associated with the diagnosis of ADHD. Conclusion: The ADHD Rating Scale (Arabic version), in terms of either the grand total score or the total score of each of its two subscales, demonstrated concurrent and discriminant validity by discriminating children with ADHD from other clinical and non-clinical children groups. The study obtained cutoff points for both sexes based only on the grand total score of the scale because of the relatively small sample size. Replication of the study, utilizing a larger sample and eliciting ratings from both parents and teachers, is recommended.

• Fahad D Al-Osaimi
• Fatima A Al-Haider

Background: Psychosocial problems are common health concerns in children. Therefore, it is essential for pediatricians to be able to identify psychiatric disorders. This depends on the knowledge, practice and attitudes towards psychiatric disorders in childhood. Methods: A constructed questionnaire of items about knowledge, practice and attitudes of pediatricians toward psychiatric disorders in childhood was used. Four hundred and fifty questionnaires were distributed and collected from pediatricians in seven main governmental hospitals in Riyadh over a period of three months (between March 1 and May 30 2005). Findings were analyzed statistically. Results: About 88.8% of the samples had not had any training in child psychiatry during their residency. Forty-eight percent were hesitant in diagnosing psychiatric disorders in children, 76.5% were not confident enough to treat these children, 48.5% were not confident enough to follow them up after being managed by a child psychiatrist and 49.9% were not confident to treat common side effects of psychotropic medications. About 88.8% of the pediatricians thought that pediatricians needed training in child psychiatry during pediatric residency programs. Conclusion: A significant number of pediatricians reported a lack of training in child psychiatry during residency programs. This has an adverse impact on their knowledge, attitudes and possibly practices in dealing with childhood psychiatric disorders.

• Adil Alshammary

The diagnosis of communication and behavioral difficulties in Saudi Arabia is currently still an emerging field and there are few governmental schools in the field of speech therapy in Saudi Arabia. These schools offer a bachelor degree in speech hearing rehabilitation, which started only a few years ago. For this reason, the number of Saudis certified as speech and language therapists is very limited, which has led to several issues regarding diagnosis, therapy and speech services in the kingdom being raised. First hand reports from trained speech and language practitioners suggest that it is common for children with a range of communication difficulties to receive a diagnosis of Autism Spectrum Disorder, with other internationally recognized diagnostic labels (e.g. Attention Deficit Hyperactivity Disorder; ADHD) being far less commonly used.

Due to limitation of number of certified professional speech language therapists in Saudi Arabia, a number of teachers, psychologists and even some religious individuals claim to be speech therapists. They provide unauthorized speech therapy sessions without any experience or permission, in non-authorized centres such as private schools, private centers and even in their homes. This study is aimed at highlighting the importance of accurate diagnosis and the impact of unauthorized workers on children with ADHD and autism inside Saudi Arabia.

• Wael Al-Dakroury
• Hilary Gardner

Communicative differences are a feature of ADHD and measuring differences in verbal behavior can elucidate critical features of the disorder. This study focuses on quantity of verbal output through investigating the verbal productivity and length of turns in children with ADHD compared to age-matched typically developing (TD) children. The participants were twenty Saudi 4-5 year old boys. Ten were typically developing and ten had a diagnosis of ADHD. A 30 minute sample of speech during free play was collected from each child in conversation with an unfamiliar adult interlocutor (UI). All sessions were filmed and audio-recorded, the interactions transcribed then number of turns and whole words per turn counted. The results were statistically analyzed and showed that children with ADHD had a reduced verbal output with respect to total number of words, total number of verbal turns and average number of words per turn compared to typically developing children of similar age. It is argued that the differences are evidence of the negative effect of the core behavioral characteristics of ADHD on verbal pragmatic skills.

• Wael Al-Dakroury

Previous research studies have suggested that interlocutor differences have both a quantitative and qualitative impact on Typically Developing (TD) children"s verbal interaction. At the same time the research literature was not so clear when it comes to the influence of interlocutor differences on the verbal interaction of children with Attention Deficit Hyperactivity Disorder (ADHD). The current research study investigated the impact of the interlocutor familiarity on both the TD and ADHD Subgroups using quantitative approach. This was achieved by testing whether or not there was a statistically significant difference in the total number of words during the session, total number of verbal turns, average number of words per turn, and the average number of words per minute during the FI-child (Familiar Interlocutor-child) interaction compared to the UI-child (Unfamiliar Interlocutor-child) interaction. It was expected that interlocutor familiarity would have a greater impact on the ADHD group. The participants were twenty 4-5 year old boys. The were TD and ten had diagnosis of ADHD. A speech sample during free play was collected from each child in conversation with UI and FI in two separate sessions. All sessions were audio-visual recorded using two video cameras. Transcriptions and coding systems were used to analyse the data. Comparisons were made between the TD children and the children with ADHD using quantitative techniques. The results of the quantitative study for the interlocutor impact showed no significant effect of interlocutor was found. Between-group comparison showed no significant difference between the UI and the FI sessions in either the ADHD group or the TD group at the level of the total number of words, the total number of verbal turns, the average number of words per turn, or the average number of words per minute. It was predicted that children with ADHD would be more sensitive than TD to the interlocutor factor but the results of the current study showed that the children with ADHD are not different from TD children in terms of the difference between UI and FI sessions. On the other hand, the TD children were obviously more verbal quantitatively in terms of number of words and turns produced during the UI and the FI sessions. It was observed that during the UI and FI sessions with the children with ADHD, some interlocutors, especially mothers, were sitting quietly watching the children with ADHD playing, without trying again to communicate after a communication failure. The ADHD mothers in the current study may have expected less out of them at the verbal level. Presented during the 30th World Congress of the International Association of Logopedics and Phoniatrics, Dublin, Ireland, 21-25 August 2016.

Author Affiliation:

Queen Margaret University, Edinburgh, UK King Saud University, Riyadh, Saudi Arabia Psych Care Clinics, Riyadh, Saudi Arabia

• Ahmed Elhassan Hamid Hassan

• Ruaa Osama Hariri

Children with Attention-Deficiency/Hyperactive Disorder (ADHD) often have co-existing learning disabilities and developmental weaknesses or delays in some areas including speech (Rief, 2005). Seeing that phonological disorders include articulation errors and other forms of speech disorders, studies pertaining to children with ADHD symptoms who demonstrate signs of phonological disorders in their native Arabic language are lacking. The purpose of this study is to provide a description of Arabic language deficits and to present a theoretical model of potential associations between phonological language deficits and ADHD. Dodd and McCormack"s (1995) four subgroups classification of speech disorder and the phonological disorders pertaining to the Arabic language provided by a Saudi Institute for Speech and Hearing are examined within the theoretical framework. Since intervention may improve articulation and focuses a child"s attention on the sound structure of words, findings in this study are based on the assumption that children with ADHD may acquire phonology for their Arabic language in the same way, and following the same developmental stages as intelligible children. Both quantitative and qualitative analyses have proven that the ADHD group analyzed in this study had indeed failed to acquire most of their Arabic consonants as they should have.

• Mona Alahmadi
• Hashim Noor

The present study investigated the acquisition of discourse markers as being part of complex structures by an Arab monolingual ADHD child, who is also a late talker. The selected child is the offspring of one of the researchers. The child had been observed since the age of five and four months to the age of seven (20 months); his conversations with his mother and family members were tape- recorded, and phonetically transcribed for analysis. The study has three main concerns: first, to examine and analyze systematically the acquisition of discourse markers in Arabic in ADHD children; secondly, trace the type of deviance and the number of deviant structures uttered by the child. Thus, we can see how long it takes the child to overcome the gap and acquire these structures as part of his language inventory. Results indicated that the verbal production of the child significantly exhibits fewer discourse markers which result in loosely connected utterances and less organized structures, i.e. ADHD children are more likely than other children to produce ungrammatical structures and less cohesive utterances. Moreover, the order of the acquisition of some connectives is in line with the literature of typical language development, nonetheless, the child was found late in his acquisition of these discourse markers. In addition, the analysis of the redundant deviant constructions indicated that the child"s employed a number of systematic strategies (omission and/or substitution) in the formation of ungrammatical structures. It is hoped that the obtained results will contribute to the literature of first language acquisition as well as the comorbidity of ADHD and delayed language development in the affected children by providing insights into (i) how first language acquisition proceeds in an ADHD child, and (ii) how speech delay, the most common co-morbid disorder, affects normative language development of an ADHD child, by specifying and analyzing the type as well as the redundancy of deviant structures in his speech.

• Yasser Sami Amer
• Haya Faisal Al-Joudi
• Jeremy L Varnham
• Fahad A Bashiri
• Muddathir Hamad Hamad
• Saleh M Al-Salehi
• Hadeel Fakhri Daghash
• Turki Homod Albatti

Background and objective:  High quality evidence-based clinical practice guidelines (CPGs) have a major impact on the appropriate diagnosis and management and positive outcomes. The evidence-based healthcare for patients with attention deficit hyperactive disorder (ADHD) is challenging. The objective of this study was to appraise the quality of published CPGs for ADHD.

Methods: A systematic review was conducted for ADHD CPGs using CPG databases, DynaMed, PubMed, and Google Scholar. The quality of each included CPG was appraised by three independent appraisers using the Appraisal of Guidelines for Research & Evaluation II (AGREE II) instrument.

Results: Six CPGs were critically reviewed. The AGREE II standardized domain scores revealed variation between the quality of these CPGs with the National Institute of Health and Care Excellence (NICE), University of Michigan Health System, and American Academy of Pediatrics CPGs as the top three. Overall, the recommendations for management of ADHD were similar in these CPGs.

Conclusions: Reporting of CPG development is often poorly documented. Guideline development groups should aim to follow the AGREE II criteria to improve the standards and quality of CPGs. The NICE CPG showed the best quality. Embedding the AGREE II appraisal of CPGs in the training and education of healthcare providers is recommended.

Note: This study was conducted as part of the Saudi ADHD Society’s unified ADHD Clinical Practice Guidelines Project, strategic project #7.2 for the period 2017-2019. The project received approval from the Ministry of Labor and Social Development (No. 52476) on 5/8/1438. The project is entirely funded by the Saudi ADHD Society. No funding was received from any pharmaceutical or industrial company.

• Jamal M Alkhateeb
• Muna S Alhadidi

Objective: No systematic reviews could be identified in the literature that address ADHD research in Arab countries. In an attempt to help fill this gap, this systematic review was undertaken. Method: An electronic literature search of ADHD studies carried out in Arab countries was done by using Google Scholar, PsycINFO, PubMed, Education Resources Information Center (ERIC), and Arabpsynet. Results: The search yielded 58 studies (10 studies on psychoeducational and social aspects of ADHD, 26 prevalence studies and two reviews of epidemiology of ADHD, and 22 studies on risk factors and comorbidities in ADHD). Conclusion: Although there has been an increase in ADHD research in Arab countries in recent years, this research remains relatively sparse and used methods and procedures that limit the generalizability of the findings.

• Najla J Alhraiwil
• Anna Ali
• Mowafa S Househ
• Ali M Al-Shehri
• Ashraf A El-Metwally

Objectives: To assess the epidemiology of attention deficit hyperactivity disorder (ADHD) in Arab countries, and identify gaps for future research. Methods: We searched PubMed from July 1978 to July 2014 and reviewed local journals with cross- referencing. The keywords we used were ADHD, diagnosis, prevalence, incidence, factor, diagnosis, rate, risk, and each of the names of the 22 Arab countries (Jordan, Egypt, Lebanon, Saudi Arabia, and so on). Studies were eligible for inclusion if they investigated the epidemiology of ADHD in any Arab country, and were published in English. The search was conducted from 2nd to 5th August 2014 in King Saud Bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia. Results: A total of 22 articles were included in the review. Twenty studies were cross-sectional and found the prevalence of ADHD ranged between 1.3-16%, prevalence of hyperactive type ADHD between 1.4-7.8%, and the prevalence of inattention type between 2.1-2.7%. Only 2 case-control studies investigated potential risk factors. Evidence extracted from these studies shows a significant association between ADHD and male gender, previous psychiatric illness in the family, vitamin D deficiency, poor school performance, sleep problems, and nocturnal enuresis. Conclusions: The prevalence of ADHD in Arab countries is comparable to reports in North America, Africa, and other countries of the Middle East. Longitudinal studies are needed to investigate the prognosis and determinants of this condition in the Arab world.

• Rashed A Aldabas

The purpose of this paper is to examine and conduct a historical overview of special education in Saudi Arabia. Special education has existed in Saudi Arabia since 1958 and has made considerable progress in providing services to students with disabilities. However, there is still a need for improvement in educating students with disabilities and in the movement toward inclusive education. Providing free and appropriate public education for such students should be the purpose guiding special education in the country. This paper discusses the areas that need to be improved in order to ensure that students receive the best possible education within inclusive learning environments.

• Harold G Koenig
• Faten Al-Zaben
• Mohammad Gamal Sehlo
• Doaa Ahmed Khalifa
• Mahmoud Shaheen Al-Ahwal

Background: In 1983, an article and accompanying editorial was published on the state of psychiatry in the Kingdom of Saudi Arabia (KSA), which was described as ’a mental health system in statu nascendi." Methods: We provide a 30-year update on advances in mental health care in KSA. Data are reported from a wide range of sources, including the 2007 Saudi Arabian Mental and Social Health Atlas, which compares services in KSA with the rest of the world. Results: We examine how the current mental health system operates in KSA, including recent changes in mental healthcare policy and development of a national mental healthcare plan. Discussed are current needs based on the prevalence and recognition of mental disorders; availability of services and providers (psychiatrists, psychiatric nurses, psychologists, and social workers); education and training in psychiatry; developments in consultation-liaison, addictions, child-adolescent, and geriatric psychiatry; and progress in mental health research. Conclusions: Mental healthcare in Saudi Arabia has come a long way in a very short time, despite cultural, religious, social, and political challenges, although there still remain areas where improvement is needed. The development of psychiatry in KSA serves as a model for countries in the Middle East and around the world.

• Lynn G Farah
• John A Fayyad
• Valsamma Eapen
• Youmna Cassir
• Mariana M Salamoun
• Caroline C Tabet
• Zeina N Mneimneh
• Elie G Karam
• G Karam

Objective: Epidemiological studies on psychiatric disorders are quite rare in the Arab World. This article reviews epidemiological studies on ADHD in all the Arab countries. Method: All epidemiological studies on ADHD conducted from 1966 through the present were reviewed. Samples were drawn from the general community, primary care clinical set- tings, and populations of traumatized children. Data on prevalence, gender differences, risk factors, comorbidity, and burden of ADHD were reviewed Results: ADHD rates in Arab populations were similar to those in other cultures. Comparisons within Arab studies were difficult given the variability of methodology and instruments used. Conclusion: There is an important need for research on ADHD in the Arab World, not only to assess the national prevalence in children and adolescents, but also to look at the differential burden and treatment of this disorder, which has high levels of mental comorbidities and high impact across the life span.

• Yasser S Al-Ghamdy
• Naseem A Qureshi

Although attention deficit hyperactivity disorder is a common child psychiatric disorder, the epidemiology and pathophysiology of attention deficit hyperactivity disorder is variable in different studies. Attention deficit hyperactivity disorder and comorbid disorders in children aided both by attention deficit hyperactivity disorder diagnostic criteria and assessment scales entails a comprehensive neuropsychiatric interview plus collection of information from different sources. Although psychosocial and behavioral therapies are of great therapeutic values, the psychopharmacological drugs are often used in the treatment of patients with attention deficit hyperactivity disorder. With a combined approach, a substantial proportion of patients with attention deficit hyperactivity disorder (90%) show good recovery. The patients with attention deficit hyperactivity disorder need careful evaluation and appropriate long-term treatment in order to prevent subsequent negative consequences. In rapidly developing countries, the researchers should carry out studies, which explore different aspects of attention deficit hyperactivity disorder in children, adolescents and adults.