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      Prevalence and correlates of Attention Deficit Hyperactive Disorder (ADHD) risk factors among school children in a rural area of North India

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          Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6–12 years in Government schools of a rural area in Jammu district of J and K.


          The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents—preferably the mother. The data thus collected was presented as proportions.


          ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children.


          The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.

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          Most cited references 18

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          The worldwide prevalence of ADHD: a systematic review and metaregression analysis.

          The worldwide prevalence estimates of attention deficit hyperactivity disorder (ADHD)/hyperkinetic disorder (HD) are highly heterogeneous. Presently, the reasons for this discrepancy remain poorly understood. The purpose of this study was to determine the possible causes of the varied worldwide estimates of the disorder and to compute its worldwide-pooled prevalence. The authors searched MEDLINE and PsycINFO databases from January 1978 to December 2005 and reviewed textbooks and reference lists of the studies selected. Authors of relevant articles from North America, South America, Europe, Africa, Asia, Oceania, and the Middle East and ADHD/HD experts were contacted. Surveys were included if they reported point prevalence of ADHD/HD for subjects 18 years of age or younger from the general population or schools according to DSM or ICD criteria. The literature search generated 9,105 records, and 303 full-text articles were reviewed. One hundred and two studies comprising 171,756 subjects from all world regions were included. The ADHD/HD worldwide-pooled prevalence was 5.29%. This estimate was associated with significant variability. In the multivariate metaregression model, diagnostic criteria, source of information, requirement of impairment for diagnosis, and geographic origin of the studies were significantly associated with ADHD/HD prevalence rates. Geographic location was associated with significant variability only between estimates from North America and both Africa and the Middle East. No significant differences were found between Europe and North America. Our findings suggest that geographic location plays a limited role in the reasons for the large variability of ADHD/HD prevalence estimates worldwide. Instead, this variability seems to be explained primarily by the methodological characteristics of studies.
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            Depression: The Disorder and the Burden

             M. Reddy (2010)
            Depression, the common psychological disorder, affects about 121 million people worldwide. World Health Organization (WHO) states that depression is the leading cause of disability as measured by Years Lived with Disability (YLDs) and the fourth leading contributor to the global burden of disease. By the year 2020, depression is projected to reach second place in the ranking of Disability Adjusted Life Years (DALY) calculated for all ages. Today, depression already is the second cause of DALYs in the age category 15-44 years. BURDEN OF DISEASE An estimated 3-4% of India's 100 crore plus population suffers from major mental disorders and about 7-10% of the population suffers from minor depressive disorders. In the southeast Asian region, 11% of DALYs and 27% of YLDs are attributed to neuropsychiatric disease. A review of eight epidemiological studies on depression in South Asia shows that the prevalence in primary care was 26.3%. In the Goa study, the rate of depressive disorders was 46.5% in adult primary care attendees. The above table 1 shows that disability due to depression exceeds disability due to all forms of cancer and diabetes mellitus combined, as well as exceeding the disability due to strokes and hypertensive heart diseases. Table 1 Age-standardized DALYs per 100,000 population 2004 WHO figures for India The Global Burden of Disease (GBD) study (GBD 1990 Study) launched by the WHO in the 1990s showed that Depressive disorders account for 3.7% of total DALYs and 10.7% of total YLDs. GBD 2000 study (WHO 2001) showed that depression accounts for 4.46% of total DALYs and 12.1% of total YLDs. This clearly highlights a trend of increasing burden of disability secondary to depression. SUICIDALITY Depression is associated with high suicidality. About 50% of individuals who have committed suicide carried a primary diagnosis of depression. Because mood disorders underlie 50-70% of all suicides, effective treatment of these disorders on a national level should, in principle, drastically reduce this major complication of mood disorders. Indian union health ministry estimates state that 120,000 people commit suicide every year in India. Also over 400,000 people attempt suicide. A significant percentage of people who commit suicide in India (37.8%) are below 30 years of age. Ministry officials state that majority of those committing suicide suffer from depression or mental disorders. MORBIDITY Exactly 23% of depressed patients report health difficulties severe enough to keep them bedridden. A community sample of patients with MDD demonstrated increased health care utilization in comparison to patients in the general medical setting. Depression is associated with more impairment in occupational and interpersonal functioning in comparison to several common medical illnesses. The cost of depression, particularly the cost in lost work days, is as great as or greater than the cost of many other common medical illnesses. MATERNAL AND CHILD HEALTH Depression also has a large impact on maternal and child well being. A series of studies from South Asia have demonstrated that early childhood failure to thrive, as indicated by undernutrition and stunting of growth in babies under 1 year, is independently associated with depression in mothers. A study from Pakistan shows that babies of mothers who were depressed during pregnancy and in the postnatal period were more than five times at greater risk for being underweight and stunted at 6 months than babies of non-depressed mothers, even after adjustment for other confounding factors like socioeconomic status. Childhood failure to thrive is a major risk factor for child mortality. Depressed mothers are more likely to cease breastfeeding. Depression during pregnancy is strongly associated with low birth weight. TREATMENT The outcome of depression can be significantly improved by early detection. A wide range of highly effective treatments including antidepressant medications (at a cheaper cost), somatic therapies and psychotherapeutic interventions is available for the treatment of depression. Antidepressant medications and supportive psychological interventions are effective in about 80% of patients. But the number of trained professionals (Psychiatrists, Psychologists, Psychiatric nurses) in our country is very limited and spread out only in urban/semiurban areas. THE PROBLEM OF AWARENESS Less than 25% of those affected (in some estimates less than 10%) by depression receive treatment. Barriers to effective care include the lack of resources, lack of trained providers, and the stigma. Nearly half of the patients with depression, as in diabetes, remain undiagnosed for years or inadequately treated. Large numbers of patients from rural areas remain under care of religious healers and may never receive correct treatment. Special diets, tonics, appetite stimulants and energy pills dominate the prescriptions. Stigma still is a significant barrier. The majority of patients do not receive evidence-based treatments. NEED FOR PRIMARY CARE INVOLVEMENT Despite the fact that many patients with depressive disorders seek help in primary care, general practitioners have difficulties in diagnosing and treating depression. The point prevalence of major depressive disorder in general hospital setting care is higher than 10%. Concomitant depression increases the morbidity and mortality from concurrent medical illness. Depression increases the risk for cardiac illness, diabetes, hypertension, etc. Depressed patients have three times higher risk of developing MI compared to people not having depression. Mood disorders, as highly prevalent and lethal disorders, must command a greater share in the clinical curriculum. Depressive disorders can be easily diagnosed at the primary care level and do not require any special investigations or hi-tech equipment. They can be detected early and managed very effectively by a primary care doctor, with a wide array of effective and safe medications available at reasonable cost. The challenge is to provide all primary care physicians with the requisite hands-on experience in this prevalent group of disorders. Emphasis on training in psychiatry during undergraduate medical training remains an issue of immediate attention. It is highly imperative that Depressive Disorder be considered an issue of public health importance to provide effective treatment to the patients and to reduce the burden of disease on the nation.
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              Prevalence and assessment of attention-deficit/hyperactivity disorder in primary care settings.

              Research literature relating to the prevalence of attention-deficit/hyperactivity disorder (ADHD) and co-occurring conditions in children from primary care settings and the general population is reviewed as the basis of the American Academy of Pediatrics clinical practice guideline for the assessment and diagnosis of ADHD. Epidemiologic studies revealed prevalence rates generally ranging from 4% to 12% in the general population of 6 to 12 year olds. Similar or slightly lower rates of ADHD were revealed in pediatric primary care settings. Other behavioral, emotional, and learning problems significantly co-occurred with ADHD. Also reviewed were rating scales and medical tests that could be employed in evaluating ADHD. The utility of using both parent- and teacher-completed rating scales that specifically assess symptoms of ADHD in the diagnostic process was supported. Recommendations were made regarding the assessment of children with suspected ADHD in the pediatric primary care setting.

                Author and article information

                J Family Med Prim Care
                J Family Med Prim Care
                Journal of Family Medicine and Primary Care
                Wolters Kluwer - Medknow (India )
                January 2020
                28 January 2020
                : 9
                : 1
                : 115-118
                [1 ] Department of Community Medicine, GMC, Jammu, Jammu and Kashmir, India
                [2 ] Department of Psychiatry, GMC, Jammu, Jammu and Kashmir, India
                [3 ] Department of Community Medicine, ASCOMS, Sidhra, Jammu, Jammu and Kashmir, India
                [4 ] Department of Community Medicine, Dr. RP Govt. Medical College, Tanda, Himachal Pradesh, India
                Author notes
                Address for correspondence: Dr. Rajiv K. Gupta, Department of Community Medicine, GMC, Jammu, Jammu and Kashmir, India. E-mail: rajivguptagmc@
                Copyright: © 2020 Journal of Family Medicine and Primary Care

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                Original Article

                adhd, prevalence, rural area, school children


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