PREVALENCE, CORRELATES AND COMMON COMORBIDITIES OF ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) IN PRIMARY SCHOOL CHILDREN IN FREETOWN

Abstract

Background: Attention deficit hyperactivity disorder (ADHD) is one of the most common neuro-developmental condition seen in children. Symptoms generally interfere with academic and behavioral functioning at school, and may also disrupt family and peer relationships. There is increasing interest and evidence supporting early identification and early intervention in children with ADHD. This is to ameliorate the burden on child and family as early as possible and thereby diminish the later development of social and academic impairments that are often associated with untreated cases of ADHD. However, there is lack of research opportunities and data evaluating the prevalence of common mental health problems especially among school children in Sierra Leone. This study therefore, aimed to determine the prevalence and correlates of ADHD and co-morbid conditions in a sample of primary school children in Freetown, Sierra Leone. Methodology: Stratified random sampling was done to select eight schools, both private and public, from a total of 526 primary schools representing the eight administrative zones in Freetown municipality. Balloting was then carried out at the level of the school to select participants (N=300) by proportional sampling. Students were assessed using the KSADS-PL to screen for Attention Deficit Hyperactivity Disorder (ADHD). Students who screened positive where then further assessed using the KSADS supplements 1 and 4 to make a definitive diagnose of ADHD and other comorbid conditions. Data collected was entered and analyzed using SPSS Version 23. Categorical data was computed in frequencies and percentages and continuous data was summarized as mean and standard deviation. Associations were tested using Chi-square and significant associations were established using logistic regression model. Significant level was set at 0.05. Results: The overall prevalence of ADHD was 3%. The prevalence of the predominantly inattentive sub-types was 1.7%, while the other sub-types; predominantly hyperactive/impulsive and combined had prevalence of 1% and 0.3% respectively. Females were more likely to be diagnosed with the predominantly inattentive sub-type than the males giving a ratio of 3.2:0.6 while males had higher representation on the predominantly hyperactive and combined sub-types with male to female ratio of 1.1:0.8 and 1:0 respectively. The co-morbid conditions include oppositional defiant disorder (ODD – 33.3%) and conduct disorder (CD –11.1%). Maternal educational level and maternal use of psychoactive substance was found to be independently associated with ADHD. Quality of handwriting, repeating a class and poor academic performance were found to be significantly associated with the diagnosis of ADHD. Conclusion: Our findings support the notion that ADHD occurs across cultures. Given the prevalence rate, efforts should be made to map out strategies for early identification and referral of these children for proper evaluation and treatment. In addition, the school health system should be strengthened to be able to support these affected children. This study can serve as a platform for future studies in Sierra Leone as well as for planning interventions for children with ADHD in Sierra Leone.