Letters to the Editor
Attention-Deficit Hyperactivity Disorder in a Sample of Omani Schoolboys
Dear Editor:
Attention-deficit hyperactivity disorder (ADHD) is a common disorder affecting schoolchildren and adolescents (1,2). Studies conducted elsewhere (especially in the West) suggest a prevalence rate ranging from 3% to 15% among schoolchildren, although even higher figures have been reported. ADHD affects boys 3 to 10 times more than girls and is characterized by high comorbidity. Delayed diagnosis and inadequate treatment of ADHD can lead to repeated school failure, antisocial behaviour, road traffic accidents, family problems, and delinquencies. Research on ADHD from developing countries is scarce, despite the preponderance of youth in their communities. Conners’ Rating Scale is a screening tool that is widely used in both community and hospital studies to detect hyperactivity, inattention, and behaviours related to ADHD (3,4). It has been translated into Arabic and validated (5,6).
We report on a study, the objective of which was to quantify the rate of hyperactivity and to examine its psychosocial and academic correlates in schoolboys in the Sultanate of Oman, a country with a youth-based population of 2 million, situated in the southeastern part of the Arab Peninsula. This is the first such study among Omani schoolboys.
During 2002, we obtained informed consent and studied 1502 schoolboys, aged 6 to 14 years, from 8 randomly selected public elementary schools in Muscat. Their teachers completed the short form of Conners’ Teacher Rating Scale (CTRS) and also gave their subjective view of the pupil’s behaviour regarding aggression, stealing, and lying. Pupils with a CTRS score > 15 were considered probable cases of ADHD. Social workers assisted in providing the children’s demographic and school achievement variables. School performance was determined by results in both mathematics and Arabic, as well as by school failure(s) in previous years. Pupils whose grades were under 50% in one or both subjects were considered to be the poorly achieving group. SPSS software (7) was used for the data analysis, and the results of the chi-square test were considered significant if P < 0.05.
Of the 1502 schoolboys, 117 (7.8%) had a CTRS score > 15 and were considered to represent the hyperactive group. This group exhibited aggressive, stealing, and lying behaviour more than their counter group (P < 0.001). Also, they had poor school achievement in both the first term of the current school year, as well as failure(s) in the previous year (P < 0.001). The birth order of the group exhibiting hyperactivity and the total number of their siblings did not differ significantly from the rest of the sample (P > 0.10 and P > 0.05, respectively). The paternal education of the boys showing hyperactivity was lower than that of the normoactive group (P = 0.05), while the maternal education was more or less similarly distributed in both groups (P = 0.25). This study confirms the presence of hyperactivity in Omani boys and is consistent with results of other studies in different countries. This finding is of high importance with regard to planning for primary, secondary, and tertiary prevention of this disorder in Oman. The poor school performance among the group with hyperactivity may be attributable to the disturbed cognitive functions that characterize such children (8,9). Because ADHD is a neurobiological (within-child) disorder, environmental factors do not play a role in its causation; however, the nature of that environment could influence its outcome, positively or negatively.
Acknowledgement
We are grateful to Ms Zena Al-Sharbati, University of Toronto, for helping in the preparation and the statistical analysis of this letter.
References
1. Al-Sharbati M, Al-Hussaini A, Sajjeev A. Profile of child and adolescent psychiatry in Oman. Saudi Med J 2003;24: 391–5.
2. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 4th ed. Washington (DC): American Psychiatric Association; 1994.
3. Conners CK, Sitarenios G, Parker JD, Epstein JN. Revision and restandardization of the Conners Teacher Rating Scale (CTRS-R): factor structure, reliability, and criterion validity. J Abnorm Child Psychol 1998;26:279–91.
4. Farre-Riba A, Narbona J. Conners’ rating scales in the assessment of attention deficit disorder with hyperactivity (ADHD). A new validation and factor analysis in Spanish children. Rev Neurol 1997;25:200–4.
5. Al-Sharbati MM, Younan A, Sudani O. Behavioral problems among pupils. Saudi Med J 1998;19:776–80.
6. Al-Sharbati MM, Al-Lawatiya S, Al-Adawi S, Martin R, Al-Hussaini A. Urbanization, culture and hyperactivity: an exploratory study of Omani schoolgirls. Women’s Health and Urban Life: An International and Interdisciplinary Journal 2003;2(2):43–60.
7. SPSS Inc. SPSS version 9. Chicago (IL): SPSS Inc; 2004.
8. Al-Sharbati M. Learning disabilities in children: diagnosis, treatment and prognosis [dissertation]. Louvain (Belgium): Louvain Catholic University; 1987. p 36–7.
9. Willems G, Bert-Depuydt R, de leval N, Boukaert A, Noel A, Al-Sharbati M, and others. Models of neuropediatric prediction of learning disability: neuropediatric and neuropsychological prospective study of learning disorders. In: Inge Flehmig, Leo Stern, editors. Child development and learning behavior. Stuttgart–New York: Gustav Fischer Verlag; 1986. p 191–201.
Marwan M Al-Sharbati MBChB, MSc, PhD
Salwa Al-Lawatiya BSc
Faissal KH Al-Msherfi BSc
Ala’a A Al-Hussaini MBChB, DPM, FRCPsych
Al-Khoud, Sultanate of Oman
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