Prevalence of ADHD in Preschool Children: A community-based Study from Turkey

Abstract

Objective:

This study aims to determine the prevalence of Attention Deficit Hyperactivity Disorder (ADHD), considering both parents’ and teachers’ reports and clinical diagnosis, and to examine the relationship between ADHD prevalence and measurement tools, sex, age, and clinical presentations.

Method:

This two-phase epidemiological study was conducted on 689 preschoolers aged 3 to 6 years in Kocaeli, Turkey. In the first phase, the Conners Rating Scale-Revised Long Form and the ADHD Rating Scale-IV Preschool Version were administered to teachers after parents. In the second phase, diagnostic evaluation was performed using DSM-5 ADHD criteria for children scoring above the 93rd percentile on any scale, according to either parent or teacher reports.

Results:

The prevalence of ADHD was estimated to range from 2% to 12.6%, depending on the measurement method. The prevalence of ADHD diagnosis was 3.3%, with a male-to-female ratio of 1.9:1. The hyperactive-impulsive presentation (1.62%) was more common than the combined presentation (1.32%) and the inattentive presentation (0.44%).

Conclusion:

Our findings are consistent with the literature, emphasizing the importance of ADHD screening in preschool children for early diagnosis. Measurement tools used in ADHD screening and parent-teacher responses should be evaluated carefully.

Keywords

ADHD preschooler screening prevalence epidemiology Turkey

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References

Acar

Karagoz

Meydan

M. C.

Cinoglu

D. S.

Isık

(2022). Socio-economic development ranking of districts SEGE-2022 (Vol. 35, No. 8, pp. 29–60). Republic of Turkey Ministry of Industry and Technology.

Aktepe

Demirci

Calıskan

A. M.

Sonmez

(2010). Symptoms and diagnoses of patients referring to a child and adolescent psychiatry polyclinic. Dusunen Adam The Journal of Psychiatry and Neurological Sciences, 23(2), 100–108.

American Psychiatric Association. (2000). Diagnostic and statistical manual of mental disorders, fourth edition, text revision (DSM-IV-TR).

American Psychiatric Association. (2013). Diagnostic and statistical manual of mental disorders fifth edition-DSM-V.

Bianchini

Postorino

Grasso

Santoro

Migliore

Burlo

Tata

Mazzone

(2013). Prevalence of ADHD in a sample of Italian students: A population-based study. Research In Developmental Disabilities, 34(9), 2543–2550.

Canals

Morales-Hidalgo

Jané

M. C.

Domènech

(2018). ADHD prevalence in Spanish preschoolers: Comorbidity, socio-demographic factors, and functional consequences. Journal of Attention Disorders, 22(2), 143–153.

Cao

Yan

Wang

Tao

Shao

Tao

(2018). Prevalence of attention-deficit/hyperactivity disorder symptoms and their associations with sleep schedules and sleep-related problems among preschoolers in mainland China. BMC Pediatrics, 18, 70.

Chan

H. K.

Rowe

Carroll

(2024). Factors associated with parent-teacher hyperactivity/inattention screening discrepancy: Findings from a UK national sample. PLoS ONE, 19(5), Article 0299980.

Conners

C. K.

Sitarenios

Parker

J. D.

Epstein

J. N.

(1998a). The revised conners’ parent rating scale (CPRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26(4), 257–268.

10.

Conners

C. K.

Sitarenios

Parker

J. D.

Epstein

J. N.

(1998b). Revision and restandardization of the conners teacher rating scale (CTRS-R): Factor structure, reliability, and criterion validity. Journal of Abnormal Child Psychology, 26(4), 279–291.

11.

Connor

D. F.

(2002). Preschool attention deficit hyperactivity disorder: A review of prevalence, diagnosis, neurobiology, and stimulant treatment. Journal of Developmental & Behavioral Pediatrics, 23(1), 1–9.

12.

Danielson

M. L.

Visser

S. N.

Gleason

M. M.

Peacock

Claussen

A. H.

Blumberg

S. J.

(2017). A national profile of attention-deficit hyperactivity disorder diagnosis and treatment among US children aged 2 to 5 years. Journal of Developmental & Behavioral Pediatrics, 38(7), 455–464.

13.

DuPaul

G. J.

Anastopoulos

A. D.

Power

T. J.

Reid

Ikeda

M. J.

McGoey

K. E.

(1998a). Parent ratings of attention-deficit/hyperactivity disorder symptoms: Factor structure and normative data. Journal of Psychopathology and Behavioral Assessment, 20(1), 83–102.

14.

DuPaul

G. J.

Power

T. J.

Anastopoulos

A. D.

Reid

(1998b). ADHD rating scale-ıv: Checklists, norms, and clinical ınterpretation. Guilford Press.

15.

Egger

Kondo

D. G.

Angold

(2006). The epidemiology and diagnostic issues in preschool attention-deficit/hyperactivity disorder: A review. Infants and Young Children 19(2), 109–122.

16.

Ercan

E. S.

Bilac

Ozaslan

T. U.

Rohde

L. A.

(2015). Is the prevalence of ADHD in Turkish elementary school children really high? Social Psychiatry and Psychiatric Epidemiology, 50(7), 1145–1152.

17.

Eskil

E. O.

(2020). Attention deficiency hyperactivity disorders rating scale-IV preschool Turkish version: Validity and reliability study [Master Thesis]. Cag Univercity Department of Psychology.

18.

Espinet

S. D.

Graziosi

G. M.

Toplak

M. E.

Hesson

Minhas

(2022). A review of Canadian diagnosed ADHD prevalence and incidence estimates published in the past decade. Brain Science, 12(8), 1051.

19.

Guler

A. S.

Scahill

Jeon

Taskin

Dedeoglu

Unal

Yazgan

(2017). Use of multiple informants to identify children at high risk for ADHD in Turkish school-age children. Journal of Attention Disorders, 21(9), 764–775.

20.

Halperin

J. M.

Marks

D. J.

(2019). Practitioner review: Assessment and treatment of preschool children with attention-deficit/hyperactivity disorder. Journal of Child Psychology and Psychiatry, 60(9), 930–943.

21.

Hebrani

Abdolahian

Behdani

Vosoogh

Javanbakht

(2007). The prevalence of attention deficit hyperactivity disorder in preschool-age children in Mashhad, north-East of Iran. Archives of Iranian Medicine, 10(2), 147–151.

22.

Kaçamak Öğüt

Ozbaran

N. B.

Kose

Kesikci

(2020). Executive functions in preschool children with attention deficit hyperactivity disorder. Alpha Psyciatry, 21, 423–428.

23.

Kaner

Buyukozturk

Iseri

Ozaydin

(2011a). Conners’ parent rating scale long form-revised: Factor structure, reliability and validity studies. Turkish Journal of Child and Adolescent Mental Health, 18(1), 45–58.

24.

Kaner

Buyukozturk

Iseri

Ozaydin

(2011b). Conner’s teachers rating scale/ revised long: Assessing the psychometric characteristics of Turkish children. Turkish Journal of Clinical Psychiatry, 14(3), 150–163.

25.

Kazda

Bell

Thomas

McGeechan

Sims

Barratt

(2021). Overdiagnosis of attention-deficit/hyperactivity disorder in children and adolescents: A systematic scoping review. JAMA Network Open, 4(4), e215335.

26.

Kutlu

Cevher Binici

(2017). The prevalance of attention deficit hyperactivity disorder and the frequency of medication use among preschool children in a district children hospital. Journal of Dr Behcet Uz Children’s Hospital, 7(1), 15–21.

27.

McGoey

K. E.

DuPaul

G. J.

Haley

Shelton

T. L.

(2007). Parent and teacher ratings of attention-deficit/hyperactivity disorder in preschool: The ADHD rating scale-IV preschool version. Journal of Psychopathology and Behavioral Assessment, 29(4), 269–276.

28.

Morales-Hidalgo

Hernández-Martínez

Vera

Voltas

Canals

(2017). Psychometric properties of the conners-3 and conners early childhood indexes in a Spanish school population. International Journal of Clinical and Health Psychology, 17(1), 85–96.

29.

Overgaard

K. R.

Oerbeck

Friis

Pripp

A. H.

Aase

Biele

Ingeborgrud

C. B.

Polanczyk

G. V.

Zeiner

(2023a). Attention-deficit/hyperactivity disorder from preschool to school age: Change and stability of parent and teacher reports. European Child & Adolescent Psychiatry, 32, 1947–1955.

30.

Overgaard

K. R.

Oerbeck

Friis

Pripp

A. H.

Aase

Biele

Ingeborgrud

C. B.

Polanczyk

G. V.

Zeiner

(2023b). Early and repeated screening detects children with persistent attention-deficit/hyperactivity disorder. European Child & Adolescent Psychiatry, 1, 9.

31.

Overgaard

K. R.

Oerbeck

Friis

Pripp

A. H.

Aase

Zeiner

(2022). Predictive validity of attention deficit/hyperactivity disorder from ages 3 to 5 years. European Child & Adolescent Psychiatry, 31, 1093–1102.

32.

Oztop

D. B.

Efendi

G. Y.

Uytun

M. C.

Yurumez

Konsuk Unlu

Ayidaga Akman

Cakiroglu

Gunaydın

Alkan

Aktas Altunay

(2024). The validity and reliability of preschool age psychiatric assessment (PAPA) in Turkish population. Asian Journal of Psychiatry, 91, Article 103837.

33.

Sans

C. J.

Morales Hidalgo

Roigé Castellví

Voltas Moreso

Hernández Martínez

(2021). Prevalence and epidemiological characteristics of ADHD in pre-school and school age children in the province of Tarragona, Spain. Journal of Attention Disorders, 25(13), 1818–1833.

34.

Sollie

Larsson

Mørch

W. T.

(2013). Comparison of mother, father, and teacher reports of ADHD core symptoms in a sample of child psychiatric outpatients. Journal of Attention Disorders, 17(8), 699–710.

35.

Soma

Nakamura

Oyama

Tsuchiya

Yamamoto

(2009). Prevalence of attention-deficit/hyperactivity disorder (ADHD) symptoms in preschool children: Discrepancy between parent and teacher evaluations. Environmental Health and Preventive Medicine, 14(2), 150–154.

36.

Thapar

Cooper

(2016). Attention deficit hyperactivity disorder. The Lancet, 387(10024), 1240–1250.

37.

Turkish Statistical Institute. (2022). 2000-2022 population of provinces by years. https://data.tuik.gov.tr/Kategori/GetKategori?p=nufus-ve-demografi-109&dil=1

38.

Tong

Kawachi

(2021). Factors moderating the link between early childhood non-parental care and ADHD symptoms. Heliyon, 7(12), e08562.

39.

The WHO World Mental Health Survey Consortium. (2004). Prevalence, severity and unmet need for treatment of mental disorders in the World Health Organization World Mental Health Surveys. JAMA, 291(21), 2581–2590.

40.

Wichstrøm

Suzanne Berg-Nielsen

Angold

Link Egger

Solheim

Hamre Sveen

(2012). Prevalence of psychiatric disorders in preschoolers. The Journal of Child Psychology and Psychiatry, 53(6), 695–705.

41.

Wigal

Chappell

Palumbo

Lubaczewski

Ramaker

Abbas

(2020). Diagnosis and treatment options for preschoolers with attention-deficit/hyperactivity disorder. Journal of Child and Adolescent Psychopharmacology, 30(2), 104–118.

42.

Wolraich

Brown

R. T.

Dupaul

Earls

Feldman

H. M.

Ganiats

T. G.

Kaplanek

Meyer

Perrin

Pierce

Reiff

Stein

M. T.

Visser

(2011). ADHD: Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 128(5), 1007–1022.

43.

Younis

E. A.

Shalaby

S. E. S.

Abdo

S. A. E.

(2023). Screening of attention deficit hyperactivity disorder among preschool children Gharbia Governorate, Egypt. BMC Psychiatry, 23, 285.

44.

Zorlu

Unlu

Cakaloz

Zencir

Buber

Isildar

(2020). The prevalence and comorbidity rates of ADHD among school-age children in Turkey. Journal of Attention Disorders, 24(9), 1237–1245.