Attention Deficit / Hyperactivity Disorder in Children ofOrphanages

Abstract

The family is that the small unit which offers the healthiest environment to the child. Survival parents show real concern for their children's behaviour and education and they accord their children greater self-direction in everyday tasks. Residential care institutes are those that receive children who were deprived from a normal nurturing environment. they have been described as a ''breeding ground'' for common psychiatric pathologies of childhood like anxiety, depression, autism, conduct, oppositional defiant disorders and ADHD. ADHD is a neurodevelopmental disorder causing executive dysfunction that leads to significant impairment in social, academic, or occupational functioning. It has three subtypes; inattention, hyperactivity/impulsivity and combined. It can occur by genetic or environmental etiology, with onset before age of 12 years. Diagnosis is mainly clinical, treatment depends on educational accommodations, medications (Psychostimulants), behavior modification, and family counseling. Children in orphanages suffer a substantial number of behavioral, learning, social or emotional problems, stigmatization, exploitation, lack of visits and neglect of support. In addition to lack of medical and health services, orphanages would have a marked negative impact on the normal psychological and even physical development of their children. However, the care for orphans is provided by institutions in order not to be exposed to delinquency and deviation. Institution care provides the basic needs, the primary care and the supervision for those children who are deprived from the familial life. It also provides them with the financial support and the medical care. Moreover, it offers social, educational, vocational, recreational, and spiritual care. This study was taken up to assess ADHD among children living in residential care institutes as well as the risk factors contributing to its development. It was a cross-sectional, comparative clinical trial. Eighty Cases were selected from Benha and Shoubra EL-Khiema orphanages for boys and girls whose ages range from six to twelve years, then they were assessed using Vanderbilt ADHD parent rating scale for orphanages children after translation and back translation by three psychiatric clinicians; two consultants and one specialist, before using them in the study. Exclusion criteria were the ones refusing to give consent, were uncooperative, suffered from a severe physical illness, with history of substance abuse or mentally retarded children. A written informed consent was obtained from the head managers, the children and their care givers in the orphanages. To encourage the children to open up during the period of the study, several social visits on many different occasions preceded. A control group of 80 children was randomly selected from a primary school after taking a permission from Benha educational administration and an oral consent from the students. They were matched as much as possible with the cases group for age and sex. The control group was assessed using Vanderbilt ADHD teacher rating scale after being translated as Vanderbilt ADHD parent rating scale. (K) for both scales' translation was 98.56%. intelligence quotient photographed test was done for both groups. Demographic characteristics of the study revealed that the mean age of orphans was 10.5 years. No statistical difference between sex distribution at either group.