ADHD Research in Arab Countries: A Systematic Review of Literature

Psychometric Properties of the Arabic Vanderbilt Children's ADHD Diagnostic Rating Scale (VADRS-A) in a Saudi Population Sample

Objective

This study aimed to utilize Principal Component Analysis (PCA) and Confirmatory Factor Analysis (CFA) to investigate the constructive validity of the Arabic translation of the Vanderbilt Attention Deficit/Hyperactive Disorder (ADHD) Diagnostic Scale (VADRS-A) using its two versions, the Arabic Vanderbilt ADHD Diagnostic Parent Rating Scale (VADPRS-A) and the Arabic Vanderbilt ADHD Diagnostic Teacher Rating Scale (VADTRS-A).

Method

A descriptive research design was employed. Children were assessed by their parents and teachers, and a cluster sample of 1812 participants was chosen from many schools in Saudi Arabia, divided into two groups: parents (504) and teachers (1308) of children whose ages ranged between 5 to 12 years old. The VADPRS-A and VADTRS-A were administered to parents and teachers under the supervision of the Saudi ADHD Society.

Results

The results of the PCA of VADPRS-A found that the six factors saturate one general factor that explained (59%) of the total variance of the factor matrix with eigenvalues (3.540). Similarly, the PCA of VADTRS-A demonstrated that the five factors were saturated on a general factor that explained (69.20%) of the total variance of the factor matrix with eigenvalues (3.460). Also, the results indicate the high internal consistency of VADPRS-A and VADTRS-A, all factors correlated together and the total scores positively and significantly statistically (p>.001) correlation coefficients ranged between (0.296 to 0.843) for VADPRS-A, and ranges between (0.432 to 0.939) for VADTRS-A. Also, the Cronbach's α coefficient values for the six factors and total score of VADPRS-A were (.906, .925, .900, .896, .853, .872, .959) respectively, and these values are close to the values of the McDonald's ω for the factors and the total score were (.908, .923, .901, .871, .850, .877, .925) respectively. In the same way, Cronbach's α coefficients were (.967, .921, .914, .858, .948, .971) for all factors and the total score of VADTRS-A respectively, and these values are close to the values of the McDonald's ω (.968, .921, .919, .856, .943, .965) for all factors and the total score of VADTRS-A. In addition CFA for VADPRS-A and VADTRS-A models showed acceptable factor loading and good values of goodness-of-fit indices; CFI, TLI, RMSEA, IFI, and GFI (0.956, 0.942, 0.049, 0.956, 0.952) respectively for VADPRS-A model, and were (0.958, 0.932, 0.051, 0.963, 0.964) for VADTRS-A model, all of these were at an acceptable range. These results suggest a fit with the previous theoretical literature about VADPRS and VADTRS and DSM-5 and ICD-11 criteria of ADHD.

Conclusion

These findings highlighted the good psychometric properties of VADRS-A in both its versions VADPRS-A and VADTRS-A in the Saudi environment. Due to these findings, we suggest utilizing VADPRS-A and VADTRS-A during ADHD diagnosis in children 5-12 years old in Saudi Arabia, to facilitate early diagnosis and intervention, and to help mitigate the risks of ADHD during subsequent developmental phases in children's lives.

COGMED working memory training in children with Attention Deficit/Hyperactivity Disorder (ADHD): A feasibility study in Saudi Arabia

Working memory training has been proven effective for improving cognitive functioning in patients with Attention Deficit/Hyperactivity Disorder (ADHD). However, the feasibility of this type of training for children in Saudi Arabia has not been previously explored. We investigated the feasibility of implementing Cogmed Working Memory Training (CWMT) in a sample of 29 Saudi children with ADHD. We found no significant demographic or clinical differences between compliant and noncompliant children. Although compliant children were initially better at following instructions and reported better improvements in working memory and math skills compared to those who did not complete the CWMT, all children who participated in the program showed improvements in performing the CWMT tasks. Most parents found the Cogmed training feasible for their children, were satisfied and keen to continue with the program, and felt the training helped them to address their problems. Most children did not encounter any difficulties in using the software, and many families were, therefore, likely to continue using the techniques from the program. We conclude that CWMT for children with ADHD is feasible in Saudi Arabia. Larger case-controlled studies are needed to thoroughly investigate the effects of CWMT compared to other interventions in Saudi children with ADHD.

The Prevalence and Associated Factors of Attention Deficit Hyperactivity Disorder Among Primary School Children in Amman, Jordan

Objective Attention deficit hyperactivity disorder (ADHD) is a common neurodevelopmental disorder characterized by impaired levels of inattention, disorganization and/or hyperactivity-impulsivity. The aim of this study was to estimate the prevalence of ADHD among primary school children in Jordan and assess the potential risk factors. Method A cross-sectional study was conducted in 2022-2023 on 1563 school children aged six to 12 years. ADHD was assessed using parent and teacher versions of the Conners Rating scale. Risk factors were evaluated through a sociodemographic questionnaire. A p-value set at <.05 was considered statistically significant. Results ADHD prevalence based on parents' and teachers' perspectives was 27.7% and 22.5%, respectively. Males, smoking during pregnancy, low birth weight, low parental education and unemployment, and public schools had increased ADHD rates.  Conclusion ADHD presents a major problem among primary school children in Jordan. Early detection, prevention, and management of this disease require parents' and teachers' awareness and risk factor control.

Evaluating how occupational exposure to organophosphates and pyrethroids impacts ADHD severity in Egyptian male adolescents

BACKGROUND

Attention Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by deficits in attention and hyperactivity/impulsivity that cause impairments to daily living. An area of long-standing concern is understanding links between environmental toxicants, including pesticides, and the development or worsening of ADHD.

OBJECTIVES

The present study evaluated associations between occupational pesticide exposure, specifically organophosphate (OP) pesticides, chlorpyrifos (CPF) and the pyrethroids (PYR) alpha-cypermethrin (αCM) and lambda-cyhalothrin (λCH), and symptoms of ADHD in a longitudinal study among Egyptian adolescent males.

METHODS

Participants (N = 226, mean age = 17) were Egyptian adolescent males who either applied pesticides or were non-applicators. Urinary trichloro-2-pyridinol (TCPy) was measured as a specific metabolite biomarker of exposure to chlorpyrifos. Urinary 3-phenoxybenzoic acid (3-PBA) was measured as a general metabolite biomarker of exposure to pyrethroids, while urinary cis-3-(2,2- dichlorovinyl)-2,2-dimethylcyclopropane carboxylic acid (cis-DCCA) was measured as a specific biomarker of exposure to αCM and lambda cyhalothric acid (λCH acid) measured as a specific biomarker of exposure to λCH. Ordinal logistic regression models controlling for age were used to determine the likelihood of ADHD development (measured via parent-reported ADHD symptoms) as the level of biomarkers of pesticide exposure increased.

RESULTS

Cis-DCCA was the only biomarker associated with higher likelihood ADHD symptoms (> 0.60 vs. 0-0.17 μg/g creatinine; OR = 2.82, 95% CI: 1.29-6.14). All participants reported clinical levels of ADHD symptoms when compared to national norms used in the United States. TCPy, trans-DCCA and λCH acid were not associated with risk of ADHD symptoms after controlling for levels of cis-DCCA. No other metabolites were associated with the number of ADHD symptoms. There were no interaction effects found for exposure to both OPs and Pyrethroids.

DISCUSSION

The results suggest that exposure to the pyrethroid αCM is associated with more ADHD symptoms. Methodological and cultural considerations in need of further study are discussed.

The Impact of Autism Spectrum Disorder on Parents in Arab Countries: A Systematic Literature Review

Background

Having a child with autism spectrum disorder can have significant psychological effects on parents. This systematic review summarizes the current state of literature underscoring the impact of autism spectrum disorder (ASD) on parents in Arab countries.

Methods

A systematic search of seven databases (PubMed, Scopus, ProQuest, Google Scholar, ERIC, Academic Search Complete, and PsycINFO) was performed, which identified 24 studies (20 quantitative studies and four qualitative studies) that included 3,299 parents or caregivers of children with ASD. These studies were conducted in 10 Arab countries (Saudi Arabia, Jordan, Egypt, Kuwait, Bahrain, Oman, Emirates, Palestine, Qatar, and Lebanon).

Results

The majority of the included studies found that ASD has a significant negative impact on the mental health and wellbeing of Arab parents. It was found that parents of children with ASD have a poor quality of life (QoL) and an increased risk of psychological disorders. These findings were in contrast to findings of parents of typically developing children and children with other developmental disorders. Challenges faced by parents of children with ASD were associated with several child- and parent-related factors. The most common coping strategy used by parents was religious coping.

Conclusion

The impact of ASD on parents has only recently gained traction among researchers in Arab countries. Despite several knowledge gaps, published studies have provided useful information outlining the impact of ASD on parents in some of these countries. Further research comprising larger random samples and using varied research and data-collection methods is required to understand the multifaceted challenges experienced by parents raising children with ASD in Arab countries.

Psychometric Properties of ADHD Rating Scale-5 for Children and Adolescents in Sudan-School Version

The ADHD Rating Scale-5 for Children and Adolescents, School Version, has been adopted and validated to be used in assessing ADHD among school children within Western contexts. However, there are few assessment tools in use for identifying ADHD characteristics in children in Sudan. Therefore, this study aimed to investigate the psychometric properties of this rating scale in the context of Sudan. To accomplish this, data were collected on a sample of 3,742 school-aged children and adolescents as reported by their teachers. Psychometric properties can be classified as very good, with very high reliability (>0.90), and high construct validity tested by exploratory and confirmatory factor analysis. Thus, the ADHD Rating Scale-5 for Children and Adolescents, School Version, is valid, reliable, and suitable to use for assessing ADHD symptoms among children and adolescents in the Sudanese context.

Exploring Elementary Schoolteachers' Perceptions of Attention Deficit Hyperactivity Disorder (ADHD) in Northern Jordan

The purpose of this study was to ascertain elementary schoolteachers' perceptions of attention deficit hyperactivity disorder (ADHD) in northern Jordan. This study utilized a descriptive cross-sectional research design using a self-reporting questionnaire to gather data from elementary schoolteachers in northern Jordan from February to June 2019. The results indicate that elementary schoolteachers in northern Jordan have negative perceptions regarding ADHD and its causes, treatment, and diagnosis. The lack of professional pre-service training and education about children's behavioral problems overall, but especially regarding ADHD knowledge and management of children with ADHD was found to be deficient among our sample of elementary schoolteachers. The pronounced lack of research on teacher management of ADHD in children in Jordan may have contributed to these findings. Structured educational and training programs addressing children with ADHD should be implemented to enhance teachers' knowledge about ADHD and to improve their role in helping the affected children and their families.

Parental Barriers in Seeking Mental Health Services for Attention Deficit Hyperactivity Disorder in Children: Systematic Review

OBJECTIVE

Many children at risk for negative outcomes related to untreated attention deficit hyperactivity disorder (ADHD) do not receive necessary mental healthcare. Parents' mental health-seeking behavior is important in the early identification of ADHD and preventing comorbidities with ADHD. Parents may experience some barriers that may delay or stop parents from seeking mental healthcare for their children.

METHOD

This systematic review summarized existing evidence of parents' barriers to seeking mental healthcare for their children at risk of ADHD.

RESULTS

This review included 21 studies that address different parental barriers under the three levels of the social-ecological model, including individual, interpersonal, and community levels.

CONCLUSION

Raising parents' awareness of the process of seeking mental healthcare has the potential to help identify children at risk for ADHD earlier. Developing psychoeducational intervention that improves parents' seeking behavior and reduces barriers toward seeking mental healthcare is needed.

Prevalence and correlates of attention deficit hyperactivity disorder among college students in Jeddah, Saudi Arabia

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.

Shorter rapid eye movement sleep duration in children with attention-deficit /hyperactivity disorder: the impact on quality of life

OBJECTIVES

The relationship of sleep with attention deficit hyperactivity disorder (ADHD) remains complex and unclear. The current study aimed to compare the subjective and objective sleep parameters among children with and without ADHD. Moreover, to address the effect of sleep parameters on the quality of life (QoL).

METHODS

We assessed 42 participants who were children with ADHD (aged 6-12 years), with predominant combined presentation (23), compared to 42 healthy children, who underwent a sleep study assessment subjectively (the Children's Sleep Habits Questionnaire), and objectively (one-night Polysomnographic recording). Also, parents completed the pediatric quality of life inventory (PedsQL-P).

RESULTS

Children with ADHD had more subjective sleep problems. ADHD patients also had a significant decrease in total sleep time and sleep efficiency, spending more time in wake and N1 sleep stages. Moreover, they had significantly lower rapid eye movement (REM)sleep duration and less duration of deep sleep stages. Multivariate regression analysis showed that REM sleep duration was the most contributing and predictive factor to QoL and school function impairment.

CONCLUSION

Children with ADHD have a significantly lower sleep quantity and poor sleep quality. In addition, short REM sleep duration independently contributes to further deterioration in different areas of QoL.

Impact of attention deficit hyperactivity disorder and gender differences on academic and social difficulties among adolescents in Qatari Schools

Background: To evaluate the social and academic impact of adolescents with Attention Deficit Hyperactivity Disorder (ADHD) and gender differences compared with their non-ADHD peers.

Methods: A cross-sectional descriptive study using a standardized rating scale of teacher observations was conducted in the schools of Qatar from 7^th to 12^th grades. Teachers completed Swanson, Nolan, and Pelham (SNAP-IV) rating scale questionnaires for the ADHD core symptoms together with nine questions to evaluate the academic and social difficulties in all participants.

Results: A total of 1775 students (mean age: 15 ± 1.5 years; boys/girls: 717/1058) were included in this study. Based on the SNAP-IV rating scale, 150 students were showing core symptoms of ADHD and classified as having ADHD (8.5%; boys/girls; 93/57) and 1625 students as non-ADHD peers (91.5%; boys/girls; 624/1001). Prevalence of ADHD among adolescent students is 8.5%, and it varied significantly between genders with 13% of boys and 5.4% of girls affected by this disorder. Adolescents with ADHD had more academic and social difficulties than their non-ADHD peers, the boys more so than the girls. Boys with inattentive subtype of ADHD had more academic difficulties than girls, while girls had more social difficulties than boys.

Conclusion: The results of this study revealed that ADHD among adolescents is substantially associated with academic and social difficulties in the school environment. Gender differences among students with ADHD should be considered in the school and clinical environment.

Prevalence of attention deficit hyperactivity disorder and comorbid psychiatric and behavioral problems among primary school students in western Saudi Arabia

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.