الفهرس 
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Abstract
SUMMARY
A
ttention deficit hyperactivity disorder (ADHD) one of the most studied mental health disorders which expresses itself in childhood. The principal signs of inattention, impulsivity, and hyperactivity are based on a detailed history of a child’s early developmental patterns along with direct observation of the child, especially in situations that require sustained attention.
ADHD is characterized by pervasive and impairing symptoms of inattention, hyperactivity and impulsivity. ADHD has a complex etiology consisting of multiple genetic and environmental factors acting together to create a spectrum of neurobiological liability.
Brain derived neurotrophic factor is one of the well-known neurotrophins, It is the most abundant and widely distributed one in the mammalian central nervous system (CNS). It plays a key role in the growth and maintenance of several neuronal systems, serves as a neurotransmitter modulator, and participates in mechanisms of neuronalplasticity, such as long-term potentiation and learning.
Some reports and several lines of evidence suggest that BDNF plays a role in the pathophysiology of ADHD.
Accordingly, the present study was aiming to investigate the plasma level of BDNF in ADHD children and its correlates to severity of symptoms and cognitive functions in these children.
We hypothesized in this study that BDNF level in children with ADHD is decreased in comparison to same aged normal children and correlates with severity of its symptoms suggesting that BDNF plays a role in the etiopathogenesis of ADHD affecting cognitive functions as well.
Children who were matching the inclusion criteria were subjected to several tests starting with the K-SADS for diagnosis of ADHD and exclusion of other psychiatric co-morbidities. Then I.Q. measured using WISC to include only those with average I.Q. or above. A sample of blood was obtained from Children. After that trail making tests (A,B) were applied to the subjects. The Conner’s parent rating scale was applied with the ADHD children’s parents
The mean age of the control group in the current study was 8.37 years, while the mean age of ADHD group was 8.18 years of the sample that was referred to the outpatient clinic. Boys represented 66.7% of the control group and girls represented 33.3%, while in ADHD group boys were 75.0% and girls were 25.0% Most of children in both groups belonged to middle socioeconomic class.
Assessment of ADHD symptoms in the case group using Conner’s parent rating scale revealed that there were significant oppositional, inattentive and hyperactivity. Meanwhile there was no significant anxiety, social problem, perfectionism or psychosomatic symptoms.
The distribution of the subtypes of ADHD in our study was found to be as following: 5(8.3%) cases with attention deficit predominant type, 15 (25%) cases with hyperactivity predominant type and 40 (66.7%) cases with combined type.
Results of this study revealed that:
The main findings in the study were significant difference between the two studied groups regarding plasma BDNF level being higher in the ADHD group.
There was no significant difference between the three subtypes of ADHD regarding BDNF level. Still BDNF level was lowest in the inattentive subtype and highest in the hyperactivity predominant subtype.
There was statistically significant difference in BDNF level between both the hyperactive and combined subtypes of ADHD and the control group but there was no significant difference between the inattentive subgroup of children and the control group.
As regard sociodemographic data, there were no significant correlation between age or gender and BDNF level.
As regard severity of symptoms in the ADHD group as assessed by Conner’s parent rating scale there was no significant correlation between plasma BDNF level and the score of any of the domains except for a weak negative correlation with emotional lability domain.
As regards the correlation between the control group and the ADHD IQ scores and BDNF level, there was no significant correlation between any of the IQ scores and BDNF level in the control group while there was a significant positive correlation between both performance IQ and total IQ and BDNF level in the ADHD group.
As regards scores of trail making A test scores and the correlation to BDNF level, there was no significant correlation whether in the control nor in the case groups.
Meanwhile regarding the correlation between scores of trail making test B and BDNF level, there was a moderately positive correlation in the control group and a weak negative correlation in the ADHD group.
We concluded that children with ADHD exhibit higher levels of plasma BDNF in comparison to age and sex-matched healthy controls. In addition there is no obvious correlation between severity of symptoms in children with ADHD and their plasma BDNF levels. These findings provide preliminary evidence that BDNF may actually play a role in the pathophysiology of ADHD.
At the end of our study, we recommended for further research using more sensitive and accurate tools for cognitive functions assessment in children.
Finally, we recommended that management would benefit from integrating a biopsychosocial model in treating ADHD