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Prevalence and correlates of Attention Deficit Hyperactive Disorder (ADHD) risk factors among school children in a rural area of North India
Pawan sharma.
1 Department of Community Medicine, GMC, Jammu, Jammu and Kashmir, India
Rajiv K. Gupta
Rakesh banal.
2 Department of Psychiatry, GMC, Jammu, Jammu and Kashmir, India
Mudasir Majeed
Rashmi kumari, bhavna langer, najma akhter, chandini gupta.
3 Department of Community Medicine, ASCOMS, Sidhra, Jammu, Jammu and Kashmir, India
Sunil K. Raina
4 Department of Community Medicine, Dr. RP Govt. Medical College, Tanda, Himachal Pradesh, India
Background:
Attention-deficit hyperactive disorder (ADHD) is one of the most common neurodevelopmental disorders of childhood and has the potential for continuity into adolescence and adulthood. Its presence increases difficulties in academic performance and social interactions besides leading to low self-esteem. The present study aimed to determine the prevalence of ADHD among children of age 6–12 years in Government schools of a rural area in Jammu district of J and K.
The present study was conducted in R.S. Pura block of Jammu district. Miran Sahib zone of R.S Pura block was chosen randomly and all the government primary schools in this zone were included in the survey. The presence of ADHD was assessed using Vanderbilt ADHD diagnostic teacher rating scale. The children positive for ADHD were visited at their residential places and a personal information questionnaire (PIQ) was administered to their parents—preferably the mother. The data thus collected was presented as proportions.
ADHD prevalence was found to be 6.34% (13/205). Majority (69.3%) of the ADHD-positive children were living in a joint family and belonged to lower/lower middle class. Family history of ADHD was absent in all the ADHD-positive children.
Conclusion:
The current study conducted in a rural area among 6- to 12-year-old children of Government schools has shown a reasonably high ADHD prevalence of 6.34%.
Introduction
Mental illness is the leading cause of disability adjusted life years (DALYs) among all major diseases and conditions in the world.[ 1 ] Mental and neurological disorders account for 14% of global burden of disease in the world and have profound impact on communities worldwide from social, cultural, and economic perspectives.[ 2 ]
An average of 3–4% of India's population suffers from major mental disorders.[ 3 ] Data from the National Mental Health Survey (2015–2016) reveals that, in India, common mental disorders like depression, anxiety disorders, and substance use disorders are a huge burden affecting nearly 10.0% of the population. 1.9% of the populations were affected with severe mental disorders in their lifetime and 0.8% was identified to be currently affected with a severe mental disorders. Nearly 150 million Indians are in need of active interventions.
ADHD (attention-deficit hyperactive disorder) is responsible for 0.06% of total years lost to disability (YLDs) and 0.02% of total DALYs. Majority of the burden due to ADHD occur in childhood; the magnitude of the burden attributable to ADHD needs the attention of policy makers in terms of early intervention and treatment.
ADHD is defined as by age inappropriate attention deficit, hyperactivity and impulsive behaviors usually seen in children of the same age or developmental level. ADHD becomes apparent in the preschool and early school years. Three major clinical subtypes of ADHD are recognized: predominantly inattentive (ADHD-IA), predominantly hyperactive/impulsive (ADHD-H/I), or a combination of these two subtypes (ADHD-C).[ 4 ]
The prevalence of ADHD is highly variable worldwide, ranging from as low as 1% to as high as nearly 20%[ 5 ] depending on the diagnostic criteria and the assessment tools used.[ 6 ] With an estimated worldwide-pooled prevalence of 5.3%, ADHD is the most prevalent mental disorder in children. In India, the prevalence of ADHD has been reported to be 1.6–17.9%.[ 7 ]
Extensive search on Pubmed revealed a paucity of data on ADHD from this part of India.
Materials and Methods
The present cross-sectional study was conducted in R.S Pura block of Jammu district of J&K state. The study was duly approved by the Institutional Ethical Committee (IEC) through letter no: IEC/T4c/2016/294 dated 7/10/2016.
R.S Pura block consists of eight health zones for the delivery of health services. Out of these eight health zones, Miran Sahib Health zone was selected randomly using the simple random sampling technique. The study was conducted for a period of one year extending from Nov 1, 2016 to Oct 31, 2017. All children aged 6–12 yrs and studying in the Govt. Primary Schools of Miran Sahib Health zone and were known for to the teachers for the past 6 months were included in the study. Children suffering from any other neurological disorder were excluded from the study.
Permission was sought from the Chief Education Officer, Jammu for the conduct of study in the Govt. Primary Schools of Miran Sahib Zone in R.S. Pura block. The list of Govt. primary schools was procured and all the schools were covered in the study zone. The school teachers were interviewed using Vanderbilt ADHD diagnostic teacher rating Scale. Children positive for ADHD were singled out and their residential addresses were collected from the school. Then, their parents were contacted and administered personal information questionnaire (PIQ). The data thus collected was tabulated and analyzed. Chi-square test was used as the test of significance and P value < 0.05 were considered significant.
During the course of the survey, 205 children (6–12 years) were registered, out of which 117 were males. ADHD prevalence was found to be 6.34% (13/205). There was higher prevalence of ADHD in males (76.9%) as compared to their female counterparts (23.1%) [ Table 1 ].
Distribution of the various neurological disorders among the studied population after the administration of Vanderbilt scale ( n =205)
The results have revealed that 69.3% (9/13) of the children suffering from ADHD were residing in joint families and were from lower middle class families. 53.8% (7/13) of the respondents had up to two siblings. Eleven out of the 13 children were living with both the parents and family history of ADHD was absent in all the 13 children [ Table 2 ].
Distribution of patients with ADHD with regards to sociodemographic factor ( n =13)
92.3% (12/13) of children had full-term duration of pregnancy and a normal vaginal delivery. Eleven of the respondents had institutional delivery and seven of them belonged to the first order by birth. Ten of these children had birth weight ≥2.5 kgs, 11 were breastfed, six were weaned at 3–6 months and 11 had normal milestones [ Table 3 ]. Seven of these 13 respondents had ≥8 hours of sleep and a TV watching time of 1–2 hours.
Pre- (maternal) and postnatal (maternal and child’s) factors associated with ADHD ( n =13)
Prevalence of ADHD in the present study in rural primary school children was found to be 6.3% which is in agreement with the other studies conducted across different parts of India.[ 8 , 9 , 10 , 11 ] Similar results have been obtained by some other authors from other parts of the world.[ 12 , 13 ] Importantly, however, there is no uniform opinion on the prevalence rates and huge difference in prevalence reported by various studies have been found across the world. While El-Gendy SD et al .[ 14 ] reported a higher prevalence of 21.8% and 16.2% of ADHD based on the teacher and parent scales, respectively, in primary school children aged 6–12 years, EL-Nemr FM et al .[ 15 ] and SafaviP et al .[ 16 ] reported higher prevalence rates of 19.7% and 17.3% in their respective studies. Similarly, Suvarna BS et al .[ 17 ] reported a higher prevalence of 12.2% of ADHD in children aged 4–6 years in Southwest Mumbai, India, Ramya HS et al .[ 18 ] and Mannapur R et al .[ 19 ] have reported a lower prevalence of 1.3% and 2.3% of ADHD in their respective studies.
What exactly accounts for difference in the results? Is there really a pattern to this differential distribution or are these varied results merely an exaggeration due to the use of different diagnostic criterion and assessment tools. Identifying the true prevalence will require uniform application of data collection and interpretation tools after following standardized methodologies.
Sex-wise prevalence of ADHD was found to be high in male children and the ration was 3:1 in the present study. These results are consistent with the results reported by others.[ 9 , 19 , 20 ] Generally speaking, ADHD is more commonly diagnosed in boys than girls, but research into ADHD in adulthood suggests an almost equal prevalence between men and women. A few theories have been advanced to provide a reason for this. One possibility is that girls are in some way “protected” from developing ADHD and so it takes a higher burden of risk factors than in boys for girls to develop problems. Another possibility is that ADHD symptoms are missed in girls or that mental health problems in girls develop into problems other than ADHD.
Some of the common risk factors attributed to occurrence of ADHD include: Blood relatives, such as a parent or sibling, with ADHD or another mental health disorder, exposure to environmental toxins—such as lead, found mainly in paint and pipes in older buildings, maternal drug use, alcohol use, or smoking during pregnancy, and premature birth. When we analyzed the outcomes in our study for possible correlates of ADHD, we found 69.3% of the ADHD-positive children were living in a joint family. These results are in contrast to the findings of Venkatesh C et al .[ 21 ] who reported that ADHD was more common in children belonging to nuclear families. Therefore, family type (joint or nuclear) may not be one of the correlates for ADHD. Interestingly, however, none of the ADHD-positive children in our study had ADHD-positive family history, which was also in contrary to the results reported by Venkatesh C et al .[ 22 ] Family did not seem to be a contributing factor as more than half of the ADHD-positive children in the current study were having a 1–2 siblings, with 84.6% of ADHD-positive respondents living with both the parents.
Again, interestingly majority (92.3%) of ADHD positives in the current study had full-term duration of pregnancy with more than half of the ADHD positives belonging to the first birth, 76.9% of ADHD positive children had a birth weight >20.5 kg. Therefore, prematurity does not appear to be a cause as per our study.
Establishing the cause for ADHD may be difficult, given in the diversity in the results reported by studies. Using a standardized nationally representative sample may help answer the query. Importantly, family physicians are often the first point of contact for families of children and youth with conditions like ADHD. A large majority of patients with these conditions are diagnosed and treated in community clinics. Residency training programs for family physicians must incorporate behavioral, developmental, and mental health training including ADHD diagnosis and treatment among its explicit learning objectives and take measures to ensure this objective is being met.[ 23 ]
Limitations
The current cross-sectional study with a small, homogeneous sample with a possibility of recall bias may lack generalization.
Financial support and sponsorship
Conflicts of interest.
There are no conflicts of interest.
Burden of Attention Deficit Hyperactivity Disorder (ADHD) in Indian Children: A Systematic Review and Meta-Analysis
- Original Article
- Published: 16 January 2022
- Volume 89 , pages 570–578, ( 2022 )
Cite this article
- Anil Chauhan 1 na1 ,
- Jitendra Kumar Sahu 2 na1 ,
- Manvi Singh 3 ,
- Nishant Jaiswal 1 ,
- Amit Agarwal 1 ,
- Singanamalla Bhanudeep 2 ,
- Pranita Pradhan 3 &
- Meenu Singh ORCID: orcid.org/0000-0002-2224-2743 1 , 3 , 4
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To determine the pooled prevalence of attention deficit hyperactivity disorder (ADHD) in Indian children.
The searching of published literature was conducted in different databases (PubMed, Ovid SP, and EMBASE). The authors also tried to acquire information from the unpublished literature about the prevalence of ADHD. A screening was done to include eligible original studies, community or school-based, cross-sectional or cohort, reporting the prevalence of ADHD in children aged ≤ 18 y in India. Retrieved data were analyzed using STATA MP12 (Texas College station).
Of 729 studies retrieved by searching different databases, 183 studies were removed as duplicates, and 546 titles and abstracts were screened. After screening, 19 studies were included for quantitative analysis. Subgroup analysis was conducted with respect to their setting (school-based/community-based). Fifteen studies performed in a school-based setting showed 75.1 (95% CI 56.0–94.1) pooled prevalence of ADHD per 1000 children of 4–19 y of age. In community-based settings, the pooled prevalence per 1000 children surveyed was 18.6 (95% CI 8.8–28.4). The overall pooled prevalence of ADHD was observed as 63.2 (95% CI 49.2–77.1) in 1000 children surveyed. Significant heterogeneity was observed in the systemic review.
Conclusions
ADHD accounts for a significant health burden, and understanding its burden is crucial for effective health policy-making for educational intervention and rehabilitation.
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Acknowledgements
The authors thank Indian Council of Medical Research (ICMR) Advanced Center of Evidence Based Child Health, PGIMER, Chandigarh for supporting this systematic review .
ICMR Advanced Centre for Evidence Based Child Health Phase 2, PGIMER, Chandigarh (Grant reference No 5/7/1668/CH/CAR/2019-RBMCH).
Author information
Anil Chauhan and Jitendra Kumar Sahu have equal contribution to this manuscript and share the first authorship.
Authors and Affiliations
Department of Telemedicine, Postgraduate Institute of Medical Education and Research (PGIMER), Evidence Based Health Informatics Unit, Regional Resource Centre, Chandigarh, India
Anil Chauhan, Nishant Jaiswal, Amit Agarwal & Meenu Singh
Pediatric Neurology Unit, Department of Pediatrics, PGIMER, Chandigarh, India
Jitendra Kumar Sahu & Singanamalla Bhanudeep
ICMR Advanced Center for Evidence Based Child Health, Department of Pediatrics, PGIMER, Chandigarh, 160012, India
Manvi Singh, Pranita Pradhan & Meenu Singh
Department of Pediatrics, PGIMER, Chandigarh, India
Meenu Singh
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Contributions
The studies searched through different databases were independently screened for their titles and abstracts by AC, SB, and JKS. The full texts of eligible studies so identified were further analyzed or screened by AC and MaS for their inclusion. PP contributed in searching the literature for this systematic review. Any discrepancies were resolved by consulting MS. AA, AC, JKS, and MaS extracted data independently from eligible studies. AC and JKS independently assessed the quality of the included studies by using a validated quality assessment tool. The data were analyzed by NJ, AC, and AA using “STATA MP12 (Texas, College Station).” MS is the guarantor for this paper.
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Correspondence to Meenu Singh .
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Chauhan, A., Sahu, J.K., Singh, M. et al. Burden of Attention Deficit Hyperactivity Disorder (ADHD) in Indian Children: A Systematic Review and Meta-Analysis. Indian J Pediatr 89 , 570–578 (2022). https://doi.org/10.1007/s12098-021-03999-9
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Received : 18 March 2021
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DOI : https://doi.org/10.1007/s12098-021-03999-9
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Burden of Attention Deficit Hyperactivity Disorder (ADHD) in Indian Children: A Systematic Review and Meta-Analysis.
Author information, affiliations.
- Chauhan A 1
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- Agarwal A 1
- Singh M 1, 3
- Bhanudeep S 2
- Pradhan P 3
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Indian Journal of Pediatrics , 16 Jan 2022 , 89(6): 570-578 https://doi.org/10.1007/s12098-021-03999-9 PMID: 35034274
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ADHD research in India: A narrative review
Affiliations.
- 1 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India. Electronic address: [email protected].
- 2 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry 605006, India. Electronic address: [email protected].
- 3 Room No. 4091, Department of Psychiatry, 4th Floor Academic Block, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India. Electronic address: [email protected].
- 4 Department of Psychiatry, 4th Floor Academic Block, All India Institute of Medical Sciences (AIIMS), Ansari Nagar, New Delhi 110029, India. Electronic address: [email protected].
- 5 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India. Electronic address: [email protected].
- 6 Department of Psychiatry, Jawaharlal Institute of Postgraduate Medical Education & Research (JIPMER), Puducherry, India. Electronic address: [email protected].
- PMID: 28709018
- DOI: 10.1016/j.ajp.2017.07.022
Introduction: Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder with no clear etiopathogenesis. Owing to unique socio cultural milieu of India, it is worthwhile reviewing research on ADHD from India and comparing findings with global research. Thereby, we attempted to provide a comprehensive overview of research on ADHD from India.
Methods: A boolean search of articles published in English from September 1966 to January 2017 on electronic search engines Google Scholar, PubMed, IndMED, MedIND, using the search terms "ADHD", "Attention Deficit and Hyperactivity Disorder", "Hyperactivity" ,"Child psychiatry", "Hyperkinetic disorder", "Attention Deficit Disorder", "India"was carried out and peer - reviewed studies conducted among human subjects in India were included for review. Case reports, animal studies, previous reviews were excluded from the current review.
Results: Results of 73 studies found eligible for the review were organized into broad themes such as epidemiology, etiology, course and follow up, clinical profile and comorbidity, assessment /biomarkers, intervention/treatment parameters, pathways to care and knowledge and attitude towards ADHD.
Discussion: There was a gap noted in research from India in the domains of biomarkers, course and follow up and non-pharmacological intervention. The prevalence of ADHD as well as comorbidity of Bipolar Disorder was comparatively lower compared to western studies. The studies found unique to India include comparing the effect of allopathic intervention with Ayurvedic intervention, yoga as a non pharmacological intervention. There is a need for studies from India on biomarkers, studies with prospective research design, larger sample size and with matched controls.
Keywords: ADHD; Attention Deficit Hyperactivity Disorder; India; Research; Trends.
Copyright © 2017 Elsevier B.V. All rights reserved.
Publication types
- Attention Deficit Disorder with Hyperactivity* / diagnosis
- Attention Deficit Disorder with Hyperactivity* / epidemiology
- Attention Deficit Disorder with Hyperactivity* / therapy
- Biomedical Research* / trends
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They Denied Her ADHD Because She Was Disciplined, Studious… and Indian
“the accommodations coordinator was basically assuming my parents forced me to take advanced courses. he was valuing my teacher’s observations more than my doctor’s opinion and my personal struggles. i knew if i was a white kid, he would not have made those comments to me.”.
During lessons, Eeshani doodled rainbows and flowers on her notebook, using funky-colored gel pens to take the dryness out of note-taking. Her brain wandered during lectures even though she looked at the board; no hint of her inner struggle for the outside world to see.
At night, she had to study the material taught in class for hours. During a home study session, she could focus… but on the wrong tasks. If she had assignments due on Wednesday and Friday, she’d start Friday’s first. She observed that her peers spent less time studying than she did and earned higher marks. This hurt her self-esteem . Her inner critic told her that she was stupid.
“I would have felt fine getting average grades if I knew I did not put in effort, but I was doing just that,” she said. “When my friends studied for an hour or so, they would get a high A-grade; I would study for four or five hours and receive a low B. It didn’t make sense to me why these things seemed easier for others.”
This Is What ADHD Looks Like?
To many people, a “struggling” student is the class clown or an emotionally unstable child, usually a male — and typically not of Asian descent . A loud, boisterous student who has side conversations during lectures, blurts out answers, doesn’t raise their hand, cannot sit still, talks back to teachers, gets into fights, and has an extensive incident file — this is the stereotypical ADHD poster child .
Eeshani doesn’t fit that profile at all. Those who best know her say she’s reserved and quiet around people she doesn’t know well but becomes a chatterbox once comfortable. When communicating, she does “zone out fast” and miss what people say to her. She prefers not to work in groups for class projects because she doesn’t like to speak up when other students don’t pitch in.
[ Read: “I’m Not Supposed to Have ADHD” ]
Eeshani often skipped exams and napped at home, but she wasn’t playing hooky. She experienced anxiety when taking in-person tests with other students.
“I hated taking tests with students around me in complete silence,” she said. “I’d be so distracted by the noises of pencil taps or feet tapping, so I’d stay home on test days so I could be alone in a room to make up the test.”
Teachers didn’t mind her making up tests at first, but later observed that it was a pattern for her, which raised some suspicion. It’s not that Eeshani neglected to study, either.
“I’d be up until about 4 or 5 a.m., studying,” she said. “I would wake up so tired, but not feel ready for the test, so I’d ask my parents if I could skip that day. Friends would text me asking where I was, and I would say, ‘I can’t take the test.’ I didn’t care if they talked about me, because I did this for me.”
[ Read: “What It Feels Like Living with Undiagnosed ADHD” ]
To her family, Eeshani was independent and mature. While she may have appeared to be just another studious Indian child on the surface, she struggled hard.
“When I would read, I’d read all the words on the page but have truly no idea what I just read, and I’d have to keep re-reading until I could pay proper attention,” she said.
The Moment Her Struggles Became Undeniable
One night, Eeshani burst into her parent’s room crying at 3 a.m. because she couldn’t focus on her study material. Shortly thereafter, her mother called the pediatrician as she requested. The doctor instructed her parents to fill out a form with a checklist, and have Eeshani’s teachers each do so, too.
When she visited her doctor, Eeshani did not imagine that she’d be diagnosed with attention deficit hyperactive disorder ( ADHD ) or obsessive compulsive personality disorder (OCPD). She simply thought she would receive more “studying tips.”
During the appointment, the doctor asked Eeshani about her family health history. When she mentioned that she had an aunt who dealt with anxiety, the doctor suggested that Eeshani may have anxiety as well.
The usually-reserved Eeshani was not afraid to speak up. She told the doctor that she did not think she had an anxiety disorder, but rather extreme focusing difficulties, particularly with tasks that she felt others her age could complete more easily. After reading the teachers’ completed forms, the doctor felt that their observations of Eeshani were “normal.”
“The pediatrician gave me a differential diagnosis of anxiety and instructed me to visit a neurologist to rule out the possibility of ADHD,” Eeshani said.
She Spoke a Truth Everyone Refused to Hear
Eeshani began to advocate for herself at school. She informed a school counselor and accommodation coordinator about the pediatrician’s findings, which led to a grueling ordeal which included a counselor, coordinator, her parents, and all her teachers.
Eeshani’s parents explained her struggles as well the neurologist’s and doctor’s opinions. The teachers shared their opinions about her work ethic and academic performance. One teacher concluded that calculus is a difficult subject, so it’s natural that a student would struggle a bit. Another suggested that she attend early morning help sessions.
“What teachers did not understand was that it wouldn’t matter if I attended the help sessions,” she said. “I knew the course content; I just couldn’t focus, and that was something they could not change unless they understood.”
Eeshani’s accommodations coordinator said that she needed to attend the help sessions. He stated that everyone has anxiety, and he agreed with the teacher that calculus is a tough subject. Eeshani was disappointed to leave the meeting without an Individualized Educational Plan ( IEP ), which gives specialized instruction to students with disabilities, or a 504 Plan that helps provide accommodations to students with disabilities.
“The accommodations coordinator told me that my poor academic performance is nothing out of the ordinary and could result from my choice of taking higher-level courses due to academic pressure,” she said. “I knew right away what he meant. He was basically assuming my parents forced me to take advanced courses. He was valuing my teacher’s observations more than my doctor’s opinion and my personal struggles. I knew if I was a white kid, he would not have made those comments to me.”
What’s more, Eeshani struggled in both AP and regular classes.
“The regular classes were easier, but my grades remained the same as in the AP, and I was expecting them to go up,” she said.
The ADHD Validation She Was Nearly Denied Due to Stereotypes
At a neurologist’s office, Eeshani took a computer simulation test. Her results showed “clear signs of inattentiveness ” compared to a control group that also took that test. She performed well at the start of the test, but her focus level started dropping off later. This was the validation she so badly needed, and then she was sent to a psychiatrist.
“I used to think that I just was not smart, but I noticed that I knew so much course content, but when assessed with simple multiple-choice questions, I couldn’t convey that,” she said.
Eeshani visited a psychiatrist as the neurologist recommended. The psychiatrist diagnosed her with ADHD and OCPD, which is marked by preoccupation with orderliness, perfectionism, and mental and interpersonal control, at the expense of flexibility, openness, and efficiency.
“He told me that OCPD includes behaviors such as wanting to be in a certain environment or wanting to be ambitious and high-achieving to set goals made for myself, but while remaining independent,” she said.
She began taking stimulant medications — first Vyvanse , and then switched to Adderall XR for insurance reasons. Her psychiatrist, who is also Indian American, applauded her parents for bringing her in. He said many South Asian families don’t take their kids to psychiatrists, which inhibits proper diagnosis.
“I told my psych how my school would treat me,” she said. “He didn’t look shocked; he just understood and was non-judgmental. I see him every three months. He taught me that, because my ADHD is severe, I cannot take a break with medicine as it is also helpful for completing chores and tasks in daily life, rather than just school.”
Before her diagnosis and ever imagining she had ADHD, Eeshani once heard kids at school make jokes about Adderall. When she was first prescribed Adderall, she was nervous about potential side effects and what other people may think of her if they knew she was using it. She feared that her accomplishments may be viewed differently.
“My mom and dad were happy that there was a solution once I got diagnosed and received medicine, but they had to remind me that my medicines don’t drive my success,” she said. “I do.”
This article was excerpted from the forthcoming book by Mrinal Gokhale titled, Saaya Unveiled: South Asian Mental Health Spotlighted , available on Kindle now and in paperback in May 2021.
Model Minority Myth: Next Steps
- Blog: “How a Culture of Impossibly High Standards Denied My Mental Health Struggles”
- Read: “You Couldn’t Possibly Have ADHD!”
- Read: “I Have a Voice, Too: On Being an Asian American with ADHD.”
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Millions of Indian Children (and Parents) Struggle with ADHD
Attention Deficit Hyperactivity Disorder or ADHD is a cognitive disorder that afflicts approximately 2-7% of children globally. ADHD prevalence in India, however, is much higher than the global average. As the disorder can affect a person’s everyday functioning even until adulthood, children suffering from ADHD in India stand the risk of long-term negative outcomes such as lower educational and employment attainment. In terms of social impact, a child with ADHD can cause a lot of anxiety to the people around him, putting strains on parent/sibling-child relationships. As children with ADHD become adults, they could manifest imbalances in emotion (trouble controlling anger, depression and mood swings, relationships and problems at work) and behavior (getting into addictions and substance abuse, experiencing chronic boredom).
ADHD in India
In India, a study entitled Prevalence of Attention Deficit Hyperactivity Disorder in Primary School Children that was conducted in Coimbatore found ADHD prevalence in children to be higher than the global estimate, at 11.32% . The highest prevalence is found in ages 9 (at 26.4%) and 10 (at 25%). Further, the study showed that more males (66.7%) were found to have ADHD. Children who have ADHD were also observed to not only have poor academic performance and behavioural difficulty but also had problems with reading and writing.
Another ADHD study conducted in different parts of India also suggested a prevalence between 2% to as high as 17%. In numbers, an article published in India Today mentioned that it is estimated that 10 million Indian children are diagnosed with ADHD annually.
What is ADHD?
In the early days, ADHD was also referred to as ‘Attention Deficit Disorder’(ADD). ADD is a milder representation of the symptoms of ADHD - that is without hyperactivity - and is more often seen in girls. Currently, ADD is no longer considered a medical diagnosis and doctors have been using the term ADHD to describe both the hyperactive and inattentive types.
There are 3 types of ADHD.
- Primarily Inattentive
- Primarily hyperactive-impulsive
Coping with ADHD
Medications.
Medicines used to manage ADHD symptoms help to balance and enhance neurotransmitters thereby improving symptoms. Stimulant medicines work for about 70-80% of people. They can be used to treat both moderate and severe symptoms of ADHD. Some stimulants are approved for children over the age of 3 and children over the age of 6, respectively. These medicines help children, teens, and adults who have a hard time at work, home or school.
Types of medications available for ADHD are:
- If stimulants and non-stimulants don’t work
- If they cause side effects that you can’t live without
- If you have other medical conditions
ADHD Pharmacophobia in Some Indian Communities
Non-pharmacological solutions | adhd india.
In India, there are alternative solutions being advocated:
- Psychosocial interventions – involve behavioral intervention, parent training, peer and social skills training, and school/classroom‑based intervention/training.
- Body focused - body‑oriented activities such as yoga‑based, physical exercises, sleep and mindfulness‑based interventions such as using breathing exercises with music therapy or attention training.
- Cognitive-behavioral training (such as play therapy).
- Neuro cognitive training - computer-based attention and EEG biofeedback training like the Cogo game launched by Singapore-based Neeuro Pte. Ltd. alongside researchers from the Institute of Mental Health (IMH), the medical school Duke-NUS, and Singapore’s Agency for Science, Technology and Research (A*STAR).
A decade’s worth of work by the researchers suggested that EEG-based attention training is a promising solution. In fact, brain scans done on the children with ADHD in their latest clinical trial, exhibited reorganized brain network activity, meaning having less inattentive symptoms.
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- TIMESOFINDIA.COM Updated: Dec 12, 2021, 18:13 IST IST
Attention disorders are primarily associated with children but as awareness increases, more grown-ups are being diagnosed with it
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What is ADHD? Know symptoms, causes and more about the chronic brain condition
It is essential to create awareness and understanding around adhd to reduce stigma and provide support for those living with this condition. with proper management and support, individuals with adhd can lead fulfilling lives and reach their full potential..
What is ADHD?
ADHD is a neurodevelopmental disorder that affects the brain's executive function. This means that individuals with ADHD have difficulties with controlling their impulses, paying attention, and organising tasks. It is a chronic condition that requires ongoing management and can significantly impact an individual's daily life.
Symptoms of ADHD
The symptoms of ADHD can vary from person to person and can also change over time. However, there are three main types of ADHD: predominantly inattentive, predominantly hyperactive-impulsive, and combined type.
The predominantly inattentive type is characterised by difficulty paying attention and staying focused on tasks. People with this type of ADHD may have trouble organising their thoughts and may easily get distracted.
The predominantly hyperactive-impulsive type is marked by excessive energy and impulsivity. Individuals with this type of ADHD may constantly fidget or squirm, have difficulty sitting still, and often act without thinking.
Combined type is the most common form of ADHD and presents a combination of inattentive and hyperactive-impulsive symptoms.
Some common symptoms of ADHD include:
- Difficulty paying attention to details and following through on tasks
- Easily distracted or forgetful
- Excessive talking or interrupting others
- Difficulty waiting for turns or taking turns
- Impulsive behaviour or acting without thinking
- Restlessness or fidgeting
- Trouble following instructions
- Forgetfulness or losing things frequently
It is essential to remember that everyone can experience some of these symptoms at times, but for individuals with ADHD, these symptoms are persistent and significantly impact their daily lives.
Causes of ADHD
The exact cause of ADHD is still not fully understood. However, research suggests that there may be a combination of genetic and environmental factors that contribute to its development.
Treatments for ADHD
While there is no cure for ADHD, there are effective treatments available that can help manage the symptoms and improve an individual's quality of life. Treatment plans for ADHD typically include a combination of medication, therapy, and lifestyle changes.
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Approximately one in nine U.S. children diagnosed with ADHD, as new national study highlights an 'ever-expanding' public health concern
One million more children in the u.s. are diagnosed with adhd in 2022 than in 2016.
An exploration into the national U.S. dataset on children ever diagnosed with ADHD has revealed an "ongoing and ever-expanding" public health issue.
Findings published in the peer-reviewed Journal of Clinical Child & Adolescent Psychology uncover that approximately one million more children, aged 3-17, had received an ADHD diagnosis in 2022 than in 2016.
The paper reveals around one in nine children have ever received an ADHD diagnosis -- 11.4%, or 7.1 million children. Some 6.5 million children (10.5%) currently live with ADHD.
Among children currently living with ADHD, 58.1% have moderate or severe ADHD. 77.9% have at least one co-occurring disorder, approximately half of children with current ADHD (53.6%) received ADHD medication, and 44.4% had received behavioral treatment for ADHD in the past year. Nearly one third (30.1%) did not receive any ADHD-specific treatment.
The results follow an analysis of the 2022 National Survey of Children's Health (NSCH) dataset. They demonstrate that the estimated prevalence of ADHD (based on a parent report) is higher in the United States than comparable estimates from other countries.
The expert team of authors come from institutions including the Centers for Disease Control and Prevention, the Oak Ridge Institute for Science and Education, and the Health Resources and Services Administration.
In the paper, the team explains the increase of ADHD prevalence can partially be explained by "sociodemographic and child characteristics," whilst they state societal context can also "contribute to the overall trends in the diagnosis of ADHD." These include the context around children's mental health before and during the COVID-19 pandemic.
"Public awareness of ADHD has changed over time. ADHD was historically described as an externalizing disorder with a focus on easily observable hyperactive-impulsive symptoms, and was thought to primarily affect boys," the authors say.
"With increased awareness of symptoms related to attention regulation, ADHD has been increasingly recognized in girls, adolescents, and adults.
"Moreover, ADHD has previously been diagnosed at lower rates among children in some racial and ethnic minority groups. With increased awareness, such gaps in diagnoses have been narrowing or closing.
"Circumstances related to the pandemic may also have increased the likelihood that a child's ADHD symptoms could cause impairment. For example, in families where children needed to engage in virtual classroom learning while parents were also working from home, previously manageable ADHD symptoms may have become more impairing or symptoms that were previously unobserved by parents may have become recognizable."
The aim of this new paper was to provide updated U.S. prevalence estimates of diagnosed ADHD; ADHD severity; co-occurring disorders; and receipt of ADHD medication and behavioral treatment.
The team assessed 45,483 completed interviews, monitoring, as well, differences in demographic and clinical subgroups. Questions asked parents for details such as the severity of the condition.
Findings highlight how socioeconomic and geographic factors play a part in diagnosis/prevalence of ADHD.
For example:
- Asian and Hispanic/Latino children had a lower prevalence of diagnosed ADHD than White children.
- Children living in households with high school as the highest level of education and lower-income households had a higher prevalence than children living in households with more education and with income ≥200% of the federal poverty level, respectively.
- Children with public insurance (with or without private insurance) had a higher prevalence than children with private insurance alone.
- Prevalence was also higher for children living in the Northeast, Midwest, or South compared to those living in the West and for children living in rural or suburban areas compared to children living in urban areas.
The results also demonstrated how such factors impacted upon medicated treatment:
- Hispanic children and children living in non-English-speaking households had a lower prevalence of taking ADHD medication than non-Hispanic children and children living in primarily English-speaking homes, respectively.
- A higher prevalence of children with both public and private insurance were taking ADHD medication than children with private insurance only.
- A higher prevalence of children living in the Midwest and South were taking ADHD medication compared to children in the West.
Other behavioral treatments, such as mental health counseling, also followed similar patterns. Explaining the findings further, the authors state: "Shifts in patterns of treatments may also be affected by changes in the demographic distribution of who receives ADHD diagnoses.
"There is evidence that the sex difference for diagnosis of ADHD may be narrowing; in prior years, the ratio of boys to girls diagnosed with ADHD was more than 2:1."
Concluding, the team state that they hope their findings can be used by clinicians to understand diagnosis and treatment patterns to better inform clinical practice. As well, they hope it could be used by policymakers, government agencies, health care systems, public health practitioners, and other partners to plan for the needs of children with ADHD, such as by ensuring access to care and services for ADHD.
Future research, the team states, could investigate patterns of service delivery during and after the pandemic; as well as modes of ADHD service delivery; uptake and discontinuation of ADHD medication; and receipt of evidence-based behavioral treatment and other recommended services such as school services.
This study is subject to a number of limitations, including it being based on a survey of parent recall and reporting decisions and have not been validated against medical records or clinical judgment.
- Attention Deficit Disorder
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Materials provided by Taylor & Francis Group . Note: Content may be edited for style and length.
Journal Reference :
- Melissa L. Danielson, Angelika H. Claussen, Rebecca H. Bitsko, Samuel M. Katz, Kimberly Newsome, Stephen J. Blumberg, Michael D. Kogan, Reem Ghandour. ADHD Prevalence Among U.S. Children and Adolescents in 2022: Diagnosis, Severity, Co-Occurring Disorders, and Treatment . Journal of Clinical Child & Adolescent Psychology , 2024; 1 DOI: 10.1080/15374416.2024.2335625
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Biodiversity in sustainable agriculture: A case study on Indian Sarus crane
The world’s ecosystem is facing threats due to human activities, resulting in significant biodiversity loss and the decline of ecosystem services. Recognising the pivotal role of ecosystem services in urban development, there is an opportunity to address these challenges through strategic ecological restoration efforts.
Given that agriculture’s expanding footprint is causing habitat loss, preventing wild lands from being converted into farmland is critical to maintaining biodiversity. By embracing both traditional knowledge and new research, farmers and scientists are producing food in a way that harnesses biodiversity to make the most of what nature provides. This approach is called agroecology, and is a core component of regenerative agriculture, which builds up natural resources like healthy soil and water rather than using them up.
While embracing agroecology is a revolutionary shift away from industrial farming, it’s nothing new: these practices are often adapted from the practices of indigenous people worldwide, who have created complex agroecological systems that exist in balance with nature. Preserving and reviving these indigenous traditions can make agriculture around the world more sustainable and help preserve biodiversity. The fact that 80 per cent of the world’s biodiversity is preserved on lands that are managed by indigenous people is a testament to agroecology’s potential.
Playing vital role
Agricultural biodiversity not only sustains the food-based bio-resources, but it plays a vital role in maintaining a viable population of various dependent flora and fauna, that play an important role in providing nutrients, pest management and propagation of the agricultural diversity. In this, one of such important faunal species is the Sarus Crane, directly associated with agriculture.
Sarus Cranes (Grus Antigone) in India have benefited from long-standing cultural and traditional values of farmers. There are 15 crane species in the world out of which the Sarus crane is the only resident species found in India. The major population of Sarus cranes are found in Uttar Pradesh, Gujarat and Rajasthan. They are classified as “Vulnerable” in the IUCN Red List. The prominent growing conservation challenges for Sarus cranes are local threats like egg mortality and land use change, and broader threats like industrialisation, land use change, and changing climate. Challenges to Sarus crane conservation are enormous, but persisting traditional agriculture and positive farmer attitudes offer considerable advantages. Framing and developing initiatives around these advantages will be critical to executing efficient and long-term conservation interventions.
But for farmers to take steps to boost biodiversity, we must sensitise them first and make them aware of how it can in turn benefit them. One effective initiative in this regard is the Sarus Crane Conservation Programme in Gujarat’s Kheda and Anand districts. This serves as a compelling case study of how farmers can actively contribute and play a crucial role. Due to the reduced availability of natural habitats, the Sarus crane has adopted the sub-optimal habitat of paddy fields for its survival. Out of the three population stronghold States in India, Kheda district in Gujarat is the only place where maximum number of nests are found in the paddy fields. The Sarus crane uproots the paddy saplings for building its nest because of which the farmers considered the bird as a pest for paddy, and they remove the nests and eggs in their agriculture fields.
The program is focused on conserving the Sarus crane population, building partnerships with the forest department and the community, educating farmers and local communities and building capacity to sustain the conservation efforts. The status of the species is documented, while important roosting, breeding and congregation sites are identified. Threats to the birds and their habitat are investigate. Armed with this information, a mammoth awareness campaign was conducted with 521 sensitisation programmes involving 58,665 community members including farmers, teachers and students across 40 villages. This led to the formation of 88 Rural Sarus Protection Group volunteers in these villages. The results speak for themselves as Sarus numbers went from 500 in 2015 to 1254 in 2023.
Farmers were a pivotal part of this effort and played a key role once they were sensitised about the benefits of Sarus conservation for the agrarian ecosystem, especially when it comes to pest management. Thus, as is evident, farms and biodiversity need not be at odds with each other. In today’s world, with the challenge of global warming, we need to conserve biodiversity, our strongest natural defence against climate change. By practicing sustainable, modern, informed methods of agriculture, we can have the best of farms and biodiversity.
The author is Vice President – CSR, UPL Ltd
Published on June 2, 2024
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1.1. Evaluation of ADHD. The current diagnostic criteria for ADHD can be found in the DSM-5 [] and in the International Statistical Classification of Diseases and Related Health Problems, eleventh revision, from the World Health Organization [].Various evaluation instruments are used to identify ADHD, from general assessments via broad scales such as the Wechsler scale, to more specific tests ...
goals, different abilities, and competitions of the student. There is ample literature reporting the prevalence of ADHD in the most part of the world. However, the prevalence of ADHD is not clearly understood in India. Many studies have been conducted in India to estimate the prevalence of ADHD in different parts of the country, but no attempt has yet been done to draw a conclusion on the ...
Prevalence of ADHD in the present study in rural primary school children was found to be 6.3% which is in agreement with the other studies conducted across different parts of India.[8,9,10,11] Similar results have been obtained by some other authors from other parts of the world.[12,13] Importantly, however, there is no uniform opinion on the ...
The subtypes of ADHD were categorized as 124 (43.3%) for inattentive type, 124 (43.3%) for hyperactive type, and 38 (13.2%) for combined type of ADHD. Conclusion The present study shows a high ...
Objective To determine the pooled prevalence of attention deficit hyperactivity disorder (ADHD) in Indian children. Methods The searching of published literature was conducted in different databases (PubMed, Ovid SP, and EMBASE). The authors also tried to acquire information from the unpublished literature about the prevalence of ADHD. A screening was done to include eligible original studies ...
Out of 3 studies, 2 studies were on children with ADHD and one study on adult ADHD. One study found that about 74.5% retained diagnosis of ADHD at the end of 3 years (Garg et al., 2013). To the contrary, the other study noted that only 40% retained diagnosis (Srinivasaraghavan et al., 2013). Inattentive type was the most persistent diagnosis noted.
A total of 38 studies from India were included in the current meta-analysis, yielding an estimated ADHD prevalence rate of 58.8 cases per 1000 (95% CI: 44.8-74.5), based on a sample size of 39064 (Table 2 and Fig. 2). Conversely, limited data from three studies in Pakistan indicate the highest reported ADHD prevalence in the region, at 178.2 ...
and management of ADHD; but, in India, few studies are done, and it is in the growing stage.[10] In the past ... setting of ADHD; (3) case reports, Editorials, and Reviews; and (4) Studies with ...
The authors also tried to acquire information from the unpublished literature about the prevalence of ADHD. A screening was done to include eligible original studies, community or school-based, cross-sectional or cohort, reporting the prevalence of ADHD in children aged ≤ 18 y in India.
Introduction. Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by persistent pattern of inattention and/or hyperactivity-impulsivity, interfering with functioning and development (APA, 2013). The worldwide- pooled prevalence of ADHD was estimated to be 5.29% in 2007 (Polanczyk et al., 2007).
The subtypes of ADHD were categorized as 124 (43.3%) for inattentive type, 124 (43.3%) for hyperactive type, and 38 (13.2%) for combined type of ADHD. Conclusion The present study shows a high ...
The studies found unique to India include compa … There was a gap noted in research from India in the domains of biomarkers, course and follow up and non-pharmacological intervention. The prevalence of ADHD as well as comorbidity of Bipolar Disorder was comparatively lower compared to western studies.
Lastly, the results make a case for professionals and school personnel to invest in children with ADHD to ensure that Indian schools will be truly inclusive. ... ADHD in Indian schools : a study of students with ADHD and their teachers in twenty primary schools in New Delhi and Bangalore. Files. b25698254_Sethi_ Nandini.pdf (21.89 MB) Date. 2010.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder that affects both children and adults. It is characterized by difficulties in sustaining attention, impulsivity ...
Research Paper The International Journal of Indian Psychology ISSN 2348-5396 (e) | ISSN: 2349- 3429 (p) Volume 6, Issue 2, DIP: 18.01.030/20180602
During a home study session, she could focus… but on the wrong tasks. If she had assignments due on Wednesday and Friday, she'd start Friday's first. She observed that her peers spent less time studying than she did and earned higher marks. This hurt her self-esteem. Her inner critic told her that she was stupid.
ADHD in India . In India, a study entitled Prevalence of Attention Deficit Hyperactivity Disorder in Primary School Children that was conducted in Coimbatore found ADHD prevalence in children to be higher than the global estimate, at 11.32%. The highest prevalence is found in ages 9 (at 26.4%) and 10 (at 25%). ...
ADHD can result in profound impairments in cognitive and social functioning. For example, impaired short-term memory was higher in college students with ADHD (Dudukovic, Gottshall, Cavanaugh, & Moody, 2014); adults with ADHD are more likely to procrastinate in ... Attention deficit/hyperactivity disorder in adults: A case study ...
Further, the authors observed the negligible reporting of India's ADHD scenario in the reviewed literature. Thus, this study aims to explore the status of ADHD in India's urban setting through ...
ADHD - A Case Study" Published in International Journal of Trend in Scientific Research and Development (ijtsrd), ISSN: 2456-6470, Volume-7 | Issue-6, ... countries, but there is no data available from India 2. It is 3 times commoner in boys 3. Risk factors in children with untreated ADHD as they
Mamidala et al conducted a retrospective case-cohort study in India. This study was the first in India to examine the factors that contribute to ASD. The researchers analyzed children under the age of 10 with ASD and compared them to an equal number of control subjects. They looked at various pre-, peri-, and neonatal factors and evaluated a ...
ADHD is often associated solely with kids, the picture that comes to mind for many is a young child, most often, a boy, with far too much energy. Aided by growing awareness about mental health and ...
Fig. 1 summarizes suggested steps in caring for adults with ADHD and can guide providers with limited experience in treating the disorder. With improved science and longer life spans, many disorders once seen only during childhood are now continuing into adulthood. ADHD is one of many disorders once thought to only occur in children and resolve as
Some common symptoms of ADHD include: Difficulty paying attention to details and following through on tasks. Easily distracted or forgetful. Excessive talking or interrupting others. Difficulty ...
This abstract has measured the technical efficiency of government-aided lower primary schools in Hailakandi district, a disadvantaged and remote region of southern Assam in North-eastern India based on a robust sample of 95 schools covering 718 children.
Approximately one in nine U.S. children diagnosed with ADHD, as new national study highlights an 'ever-expanding' public health concern. ScienceDaily . Retrieved May 27, 2024 from www.sciencedaily ...
Biodiversity in sustainable agriculture: A case study on Indian Sarus crane. June 2, 2024 by Barbara Harbor. ... This serves as a compelling case study of how farmers can actively contribute and play a crucial role. Due to the reduced availability of natural habitats, the Sarus crane has adopted the sub-optimal habitat of paddy fields for its ...
The Sarus crane uproots the paddy saplings for building its nest because of which the farmers considered the bird as a pest for paddy, and they remove the nests and eggs in their agriculture ...
The current research objective is to evaluate the appropriateness of groundwater for irrigation use and identify the sources of nitrate (NO 3 − ) contamination in groundwater using stable isotopic signatures (N 15 and O 18 ). Groundwater samples (n = 50) from Southwest Delhi were analyzed pre- and post-monsoon for irrigation quality.