الفهرس 
Clinical Features of Childhood ADHDOnly 14 pages are availabe for public view
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Abstract
ADHD is one of the most common neurobehavioral disorders of childhood that is associated with varying degrees of disturbances in family functioning, disrupted parent-child relationships, reduced parenting self-efficacy, and increased levels of parenting stress and parental psychopathology. The efficacy of parent training in treating ADHD has been supported in several studies. Considering the enormous burden of ADHD on victims and their families, effective mental health interventions are greatly needed.
The aim of the present study was to study psychological profile of parents of ADHD children and to construct, implement, and evaluate a psychosocial intervention program for parents of ADHD children. Specific objectives included: assessing negative emotions of parents of ADHD children; identifying some correlates of negative emotions of ADHD children’s parents; constructing and implementing a psychosocial intervention program for a group of parents of ADHD children, and evaluating the impact of the intervention program on sampled parents and children.
A study targeting parents of ADHD children was conducted in Smouha Health Insurance Child Mental Health Clinic for School Students affiliated to Health Insurance Organization using a cross-sectional design to study the psychological profile of parents of ADHD children, and a non-experimental pre-post test design to evaluate the impact of an intervention program on sampled parents and their children. All parents of children who received ADHD diagnosis seen at the visits times were willing to participate in the study (n=109). Parents of 50 ADHD children were willing to join the psychosocial intervention program. All participants were subjected to:
1. Structured interview with parents using a predesigned questionnaire to collect both family-related and child-related data.
2. Psychological testing using the Arabic Version of Conners’ Rating Scale, Home Situations Questionnaire, the Arabic Version of Adult ADHD Self-Report Scale,the Arabic Version of Depression Anxiety Stress Scale, and the Parenting Scale.
A psychosocial intervention program was constructed with the following objectives: improving parents knowledge about ADHD; increasing parents understanding of reasons behind deviant child behavior; improving parents positive parenting practices; helping parents practice stress management techniques; helping parents acquire problem-solving skills, and providing social support for parents of ADHD children. Mothers of 50 children with ADHD were assigned to groups, who attended 8 sessions for each group on weekly basis. Evaluation of the impact of the program was carried out using pre-post test design. Post-testing was conducted twice; immediately after program completion and two months later using the Parenting Scale, the Arabic Version of Depression Anxiety Stress Scales, Home Situations Questionnaire, the Arabic Version of Conners’ Rating Scale, and parental ADHD-related knowledge questionnaire.
The study revealed the following important results:
• The majority the sample had moderately satisfactory knowledge level (76.1%), while the minority had highly satisfactory level (5.5%).
• For all items of the knowledge questionnaire, parents reported that they ”do not know” more frequently than those responded by right or wrong answers.
• The prevalence of severe to extremely severe depressive and anxiety symptoms on DASS were 16.5%, for each, and 51.4% for severe to extremely severe stress symptoms.
• The highest percentages of severe/extremely severe depression, anxiety, and stress symptoms were among the youngest parents (33.3% for depression & 25% for anxiety & 62.5% for stress), and children (31.1% for each depression & anxiety & 57.8% for stress). These differences were not statistically significant except for anxiety regarding parents’ and child’s ages (Fisher’s exact= 13.45 for child’s age, p<0.01, Fisher’s exact= 9.89 for parents’ age, p<0.05), and for depression regarding child’s age (Fisher’s exact= 12.38 for depression, p<0.01).
• Rates of severe to extremely severe depression, anxiety, and stress symptoms were higher among parents with low socio-economic level compared to those with high level (20% versus 0% for depression, 26.1% versus 0% for anxiety & 61.5% versus 0% for stress). These differences were statistically significant for both anxiety and stress (X2 = 16.88, p<0.01 for anxiety & Fisher’s exact= 25.23, p<0.001 for stress).
• Rates of severe/extremely severe depression, anxiety and stress symptoms were significantly higher among parents who reported marital conflicts than those without conflicts (40.7% versus 7%, X2 = 27.43, p<0.001 for depression, 37.1% versus 11.3%, X2 = 9.99, p<0.01 for anxiety & 81.5% versus 43.6%, X2 = 11.94, p<0.01 for stress).
• Parents who were highly likely or just likely to have ADHD rated significantly higher than those who were not likely to have ADHD regarding severe/extremely severe depression, anxiety, and stress symptoms (25.5% for depression & 50% for anxiety & 75% for stress, for highly likely & 20 % for depression & 30% for anxiety & 70% for stress, for likely versus 14.8% for depression & 9.9% for anxiety & 44.4% for stress, for not likely, Fisher’s exact= 9.128, p<0.05 for depression, Fisher’s exact= 12.665, p<0.01 for anxiety, Fisher’s exact= 10.833, p<0.05 for stress).
• Significant positive correlation was found between ineffective parenting practices as indicated by Parenting Scale scores and severity of negative emotions among parents as indicated by DASS scores [r(depression)= 0.232, r(anxiety)= 0.292, r(stress)= 0.219, p<0.05].
• Significant positive correlation was found between parental overreactivity and severity of negative emotions [r(depression)= 0.223, r(anxiety)= 0.277, r(stress)= 0.295, p<0.05].
• Significant positive correlation was found between children’s scores on Conners’ scale and parents’ scores on depression and stress subscales of DASS [r(depression)= 0.371, r(stress)= 0.447, p<0.01].
• Significant positive correlation was found between children’s scores on HSQ and severity of negative emotions among parents as indicated by DASS [r(depression)= 0.346, r(anxiety)= 0.217, r(stress)= 0.436, p<0.01].
• Total scores of Conners’ rating scale decreased significantly immediately after the program (1) compared to the scores reported by parents before the intiation of the program (X ± SD= 24.62 ± 3.76 before, 16.66 ± 5.92 after 1). Although the mean scores increased significantly two months after termination of the program (2) compared to scores followed termination of program immediately (1), yet they were still significantly lower than scores reported before intiation of the program (X ± SD= 24.62 ± 3.76 before, 16.66 ± 5.92 after 1, 19.78 ± 7.18 after 2).
• The mean total scores of HSQ decreased significantly immediately after the program (1) compared to the mean scores reported before program intiation. The mean total scores increased significantly two months after program termination (2) compared to that scores immediately after program termination. However, mean scores reported two months after program termination remained significantly lower than those reported before initiation of the program (X±SD=29.98±8.21 before, 19.50±9.0 after 1, 23.76±11.70 after 2).
• Total scores of ADHD-related knowledge questionnaire increased significantly immediately after the program (1) and two months later (2) compared to the scores of parents before the intiation of the program (X ± SD= 10.78 ± 3.33 before, 17.32 ± 2.37 after 1, 17.24 ± 2.33 after 2).
• Percentages of right answers for each item of knowledge questionnaire increased significantly immediately after the program (1) and two months later (2) compared to those before the intiation of the program. The percentages of right answers remained the same two months after program termination as those reported immediately after program.
• There were significant decrease in mean total scores of Parenting Scale, laxness, overreactivity, and verbosity subscales’ scores immediately after the program compared to the scores of parents before the intiation of the program. Although, mean total scores as well as mean subscales’ scores of Parenting scale increased significantly two months after termination of the program compared to mean scores followed termination of program immediately, yet, these scores were still significantly lower than those reported before intiation of the program.
• There were significant decrease in mean scores of three subscales immediately after the program compared to the scores of parents before the intiation of the program. For the three subscales, parents’ mean scores reported two months after termination of the program showed significant increase compared to their mean scores followed termination of program immediately. However, scores reported two months after program termination remained significantly lower than those reported before initiation of the program.
Accordingly, the following recommendations are suggested:
• Effective multi-modal intervention programs should include psychosocial intervention programs for parents as an integral component of patient management plan that address the multiple needs of children and parents.
• Providing booster sessions to consolidate the beneficial effects of parents’ psychosocial intervention programs, as well as to help and find solutions to problems that emerge during practice and in different stages of child development.
• Establishing parental services unit as a subdivision of mental health clinics, aiming at delivering specialized services for parents of ADHD children.
• Dissemination of information regarding ADHD nature, causes, and different treatment modalities should be an integral component of any intervention program.
• Assessing psychological functioning of parents using appropriate screening tools should be a basic part of managing ADHD in children.
• Parents with psychological dysfunction should be supported and helped through support groups, stress management programs, and medications in severe cases.
• Provision of training programs for school personnel (teachers and school psychologist) in mental health care of children with ADHD are greatly needed. Raising awareness about nature of the problem, needs of ADHD children, effective behavior modification strategies in classroom, and appropriate educational accommodations to help children coping with their deficits should be targeted.
• Training school health personel in parent psychoeducation to ensure continuity of service.
• Continous communication and collaboration between involved school personnel and primary care providers is mandatory.
• Provision of early identification and intervention plans that enable “at risk” children and their carers to be given support aimed at prevention.
• Establishing a center in the High Institute of Public Health in Alexandria for training parents of ADHD children, teachers, and health personnel in behavioral management of ADHD.
• Further research with longitudinal designs is needed to cover gaps in our knowledge regarding longitudinal effects of behavioral parent training programs.