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首页> 外文期刊>Child and Adolescent Psychiatry and Mental Health >Cross-sectional survey on prevalence of attention deficit hyperactivity disorder symptoms at a tertiary care health facility in Nairobi
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Cross-sectional survey on prevalence of attention deficit hyperactivity disorder symptoms at a tertiary care health facility in Nairobi

机译：内罗毕一家三级医疗卫生机构的注意缺陷多动障碍症状患病率横断面调查

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Background Attention deficit hyperactivity disorder is the most common childhood neurobehavioral disorder with well documented adverse consequences in adolescence and adulthood, yet 60-80% of cases go undiagnosed. Routine screening is not practiced in most pediatric outpatient services and little information exists on factors associated with the condition in developing countries. Methods This was a questionnaire based cross-sectional survey whose primary objective was to determine prevalence of attention deficit hyperactivity disorder (ADHD) symptoms in children aged 6-12 years attending a tertiary care hospital Accidents and Emergency unit. Secondary objectives were to: (i) ascertain if physical injury and poor academic performance were associated with ADHD, (ii) compare diagnostic utility of parent-filled Vanderbilt Assessment Scale (VAS) against Statistical Manual of Mental Disorders-IV (DSM-IV) as the gold reference and (iii) establish if there exists an association between ADHD symptoms cluster and co-morbid conditions. Results Prevalence of cluster of symptoms consistent with ADHD was 6.3% (95% CI; 3.72-10.33) in 240 children studied. Those affected were more likely to repeat classes than the asymptomatic (OR 20.2; 95% CI 4.02-100.43). Additionally, 67% of the symptomatic had previously experienced burns and 37% post-traumatic open wounds. The odds of having an injury in the symptomatic was 2.9 (95% CI; 1.01-8.42) compared to the asymptomatic. Using DSM-IV as reference, VAS had a sensitivity of 66.7% (95%; CI 39.03-87.12) and specificity of 99.0% (95% CI; 96.1-99.2). Positive predictive value was 83.0% (95% CI; 50.4-97.3) and negative predictive value 98.0% (CI 95.1-99.1). Oppositional defiant disorder symptoms, anxiety, depression and conduct problems were not significantly associated with ADHD cluster of symptoms. Conclusion The study found a relatively high prevalence of symptoms associated with ADHD. Symptomatic children experienced poor school performance. These findings support introduction of a policy on routine screening for ADHD in pediatric outpatient service. Positive history of injury and poor academic performance should trigger further evaluation for ADHD. Vanderbilt assessment scale is easier to administer than DSM-IV but has low sensitivity and high specificity that make it inappropriate for screening. It however provides a suitable alternative confirmatory test to determine who among clinically symptomatic patients requires referral to a psychiatrist.
机译：背景技术注意缺陷多动障碍是最常见的儿童神经行为障碍，在青春期和成年期都有充分的不良后果记录，但仍有60-80％的病例未被诊断。大多数儿科门诊均未进行例行筛查，在发展中国家与病情相关的因素信息很少。方法这是一项基于问卷调查的横断面调查，其主要目的是确定就诊于三级医院急诊室的6-12岁儿童的注意缺陷多动障碍（ADHD）症状的患病率。次要目标是：（i）确定人格障碍是否与身体伤害和学习成绩差有关;（ii）将父母填写的范德比尔特量表（VAS）与《 IV型精神疾病统计手册》（DSM-IV）的诊断效用进行比较作为黄金参考，并且（iii）确定ADHD症状群与合并症之间是否存在关联。结果在240名接受研究的儿童中，与ADHD相符的症状簇患病率为6.3％（95％CI; 3.72-10.33）。那些受影响的人比无症状的人更可能重复上课（OR 20.2; 95％CI 4.02-100.43）。此外，有症状的67％的人先前曾经历过烧伤，而创伤后的开放性伤口为37％。与无症状者相比，有症状者受伤的几率是2.9（95％CI; 1.01-8.42）。使用DSM-IV作为参考，VAS的敏感性为66.7％（95％; CI为39.03-87.12），特异性为99.0％（95％CI为96.1-99.2）。阳性预测值为83.0％（95％CI; 50.4-97.3），阴性预测值为98.0％（CI 95.1-99.1）。对抗性反抗障碍的症状，焦虑，抑郁和行为问题与多动症症状群没有显着相关。结论研究发现与多动症相关的症状患病率较高。有症状的儿童的学习成绩差。这些发现支持对儿科门诊ADHD进行常规筛查的政策的引入。积极的损伤史和不良的学习成绩应触发对多动症的进一步评估。与DSM-IV相比，Vanderbilt评估量表更易于管理，但灵敏度低，特异性高，因此不适用于筛查。但是，它提供了一种合适的替代性验证测试，可以确定临床症状患者中谁需要转诊至精神病医生。

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