Prevalence of ADHD in Saudi Arabia

• 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.

• 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.

• 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.

• 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.

• 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.

• 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.

• 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%).

• 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.

• 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.