ADULT ATTENTION DEFICIT HYPERACTIVITY DISORDER (ADHD) AMONG ATTENDANTS OF HEALTH INSURANCE GENERAL PRACTITIONER CLINICS IN ALEXANDRIA

Abstract

Recently, adult ADHD has become the focus of many researches. It has become apparent that this disorder is a common and frequently undiagnosed psychiatric problem, yet treatable. The impact of ADHD on individuals, families, and society is profound and requires immediate attention. It causes significant functional impairment including problems with employment, marriage, parenting, economic, and social functioning. Moreover, the impairment caused by it may be compounded by comorbid psychiatric conditions. The aim of the present study was to study adult ADHD among attendants of Health Insurance general practitioner clinics in Alexandria. Specific objectives included: developing and validating an Arabic Version of the Adult ADHD Self- Report Scale (ASRS); determining the prevalence rate of adult ADHD and its subtypes among attendants of Health Insurance G.P clinics in Alexandria; determining sociodemographic, individual and familial psychiatric history correlates, and identifYing psychosocial difficulties experienced by patients with ADHD. A cross-sectional study was conducted in the G.P clinics of Health Insurance Organization in Alexandria targeting adult patients aged 18-45 years attending these clinics. The sample size was determined to be at least 620 based on a prevalence estimate of 4%. The G.P clinics were distributed on six districts. Each district was represented by a G.P clinic with the highest attendance rate/month. The previously determined sample was proportionally allocated on the six G.P clinics based on daily clinic attendance. In each clinic, the predetermined sample was selected by systematic random sample technique. Participants were subjected to: 1. Structured interview using a predesigned questionnaire to collect socio­ demographic, academic, medical, psychiatric, and familial data, as well as data about psychosocial difficulties experienced by ADHD patients in daily life. 2. Psychological testing using the Arabic Version of the ASRS. The study revealed the following important results: • Reliability and validity of the Arabic Version of the ASRS: Satisfactory test-retest reliability (r = 0.76 for the total scale, 0.80 for the inattentive subscale & 0.69 for the hyperactive/impulsive subscale) and internal consistency (0.86 for the total scale, 0.89 for the inattentive subscale & 0.81 for the hyperactive/impulsive subscale). Factor analysis revealed that, three factors were extracted; reflecting: inattention (factor 1), hyperactivity (factor 2), and impulsivity (factor3). Satisfactory sensetivity (92%) and specificity (97.5%) as well as significant positive correlation between individuals' total scores on the ASRS and functional impairment in different life aspects (r= 0.38, p<0.01). The prevalence of adult ADHD in the present study was 4.8%. The hyperactive/impulsive subtype was the commonest subtype (43.3%), followed by the inattentive subtype (33.3%), while the combined subtype rated 23.3%. • The age group less than 25 years old was at a significantly higher risk to have ADHD than those who were 35 to 45 years old (OR= 2.91). • Among all occupations, semi-skilled participants were at a significantly higher risk for persistence of ADHD than professionals (OR= 4.03). • History of frequent school absenteeism and school expulsion were significant risk factors for adult ADHD (OR= 3.57 & 2.80, respectively).