Attention deficit hyperactivity disorder in a referred sample of school-aged children in Kuwait: sociodemographics, frequency, clinical presentations and impairments

Abstract

Background Although attention deficit hyperactivity disorder (ADHD) is one of the best-researched disorders in medicine, to our knowledge, there are no existing clinical studies on ADHD in Kuwait. This is the first study on ADHD in the state of Kuwait. Aim of the work The main aim of this study was to describe the clinical profile, frequency, sociodemographics, and impairments seen in patients with ADHD subtypes in a clinic-referred sample of school-aged children with ADHD in Kuwait. Patients and methods The sample consisted of 70 patients recruited from the child psychiatric outpatient clinic of the Kuwait Centre of Mental Health. The included patients had to fulfill the Diagnostic and Statistical Manual of Mental Disorders , 4th ed. - text revision criteria - for ADHD and were between the ages of 6 and 15 years; patients of both sexes, Kuwaitis or expats, from all socioeconomic and educational backgrounds were included. All participants were initially screened using the Vanderbilt ADHD parent and teacher diagnostic rating scale and then subjected to a semistructured interview to verify the diagnosis of ADHD and apply the exclusion criteria. Wechsler Intelligence scale III was applied to rule out cases of intellectual disability (IQ score ≤70). The Mini International Neuropsychiatric Interview (MINI-KID) was performed to rule out cases with autism spectrum disorders and psychosis. Results This study showed that 71.4% of patients were male and 28.6% were female. The mean age of the patients was 10.2 (΁2.6) years. The most prevalent ADHD subtype was the ADHD-combined subtype (65.7%), followed by the ADHD-predominantly inattentive subtype (20%) and the ADHD-hyperactive impulsive subtype (14.3%). The ADHD-inattentive subtype was significantly more common among female patients and adolescents. The ADHD-hyperactive impulsive subtype was significantly more common among male patients and younger children. The ADHD-inattentive subtype showed a significantly older age of onset and presentation compared with the other two subtypes. In all, 51.4% of patients had a history of perinatal problems and 70% had a family history of ADHD. Patients in the sample were highly impaired functioning at both home and school; 90% failed to complete their homework, 68.6% disrupted classrooms, 12.9% were on probation or had been dismissed from school, 25.7% repeated a school grade, and 72.9% of patients had problematic relations with family members or peers. Conclusion The ADHD-combined type is the most prevalent subtype. The older mean age at presentation to the clinic compared with the mean age in similar studies may point to the critical lack of public awareness regarding ADHD or reluctance to refer children to the only psychiatric hospital in Kuwait. They suffer from impairments in many aspects of their lives that warrant attention in screening, management, and planning for service delivery as well.