Prevalence of Attention Deficit Hyperactivity Disorder among school children at selected schools, Eluru, Andhra Pradesh

Attention-Deficit/Hyperactivity Disorder (ADHD) is a significant community health problem worrying a considerable quantity of children and grown persons. It is single utmost familiar neurobehavioural problems of juvenile and has the possibility for continuousness into youth and adult. 1) To determine the prevalence of ADHD among school children aged between 6–12 years in schools at Eluru District 2) To co-relate the prevalence of ADHD with parent report and teacher report. 3) To associate the prevalence of Attention Deficit Hyperactive Disorder among school children with their demographic variables. Research approach was quantitative, and design was a cross-sectional research design. The study captivated on parents and teachers of school children in four schools at Eluru District recognized by the Board of Secondary Education, Government of Andhra Pradesh. The samples were chosen using convenient sampling technique and consisted of 509 school children studying in selected schools aged between 6 – 12 years after getting informed consent from their parents & teachers. The prevalence of ADHD was measured using Conner’s Abbreviated Rating Scale for parents & teachers. The data were analyzed using descriptive and inferential statistics. Result shows that 19 (3.7%) school children were categorized as ADHD based on parents report and 10 (2.0%) school children were categorized as ADHD based on teachers report. The analysis depicts that there was a positive correlation between the parents report and teachers report where r = 0.589. This study concludes that ADHD is found to be prevalent in school children and may be continued in the adolescent period if left uncared.

ADHD, prevalence, school children, Conner's Abbreviated Rating Scale A Attention-De icit/Hyperactivity Disorder (ADHD) is a signi icant community health problem worrying a considerable quantity of children and grown persons. It is single utmost familiar neurobehavioural problems of juvenile and has the possibility for continuousness into youth and adult. 1) To determine the prevalence of ADHD among school children aged between 6-12 years in schools at Eluru District 2) To co-relate the prevalence of ADHD with parent report and teacher report. 3) To associate the prevalence of Attention De icit Hyperactive Disorder among school children with their demographic variables. Research approach was quantitative, and design was a cross-sectional research design. The study captivated on parents and teachers of school children in four schools at Eluru District recognized by the Board of Secondary Education, Government of Andhra Pradesh. The samples were chosen using convenient sampling technique and consisted of 509 school children studying in selected schools aged between 6 -12 years after getting informed consent from their parents & teachers. The prevalence of ADHD was measured using Conner's Abbreviated Rating Scale for parents & teachers. The data were analyzed using descriptive and inferential statistics. Result shows that 19 (3.7%) school children were categorized as ADHD based on parents report and 10 (2.0%) school children were categorized as ADHD based on teachers report. The analysis depicts that there was a positive correlation between the parents report and teachers report where r = 0.589. This study concludes that ADHD is found to be prevalent in school children and may be continued in the adolescent period if left uncared.

INTRODUCTION
Mental and neurological ailments contribute to fourteen per cent of the global problem of illnesses in the world and have a profound in luence on societies globally from societal, cultural, and iscal standpoints. (WHO, 2008) ADHD is one of the utmost familiar neurodevelopmental problems of a juvenile. It is generally primarily detected in childhood and often continues into adulthood. Children with ADHD may experience substantial functional dif iculties such as poor academic performance, low selfcon idence, bothersome interactive relations with family members and friends. Children with ADHD may have a problem in paying attention, impulsive regulatory behaviours, or be excessively active (CDC, 2020). The children who have ADHD usually display hyperactivity, inattention and/or impulsivity and are very disturbed. ADHD and impulsivity can burden in the school life, reaching goals, varying abilities of the student. Studies have discovered contributory documentation of genetic in luences in the aetiology of ADHD. (Townsend, 2015) Attention De icit Hyperactive Disorder is demarcated as by age inapt attention shortfall, overactivity, and imprudent attitude typically understood in children of a similar stage or growing age. ADHD turn out to be ostensible in the children. Three main clinical subsets of Attention De icit Hyperactive Disorder are known: mainly inattentive (ADHD-IA), mostly hyperactive/impulsive (ADHD-H/I), or an amalgamation of these two subsets (ADHD-C). (Guze, 1994).
Attention De icit Hyperactive Disorder was principally measured to be a disease distressing the children, but current studies have demonstrated that the signs of ADHD present among adolescents and adults. Majority of the researches have revealed that hyperactivity gets reduced from childhood to adolescence. Still, the signs of ADHD such as inattentiveness and impulsivity remain to be apparent in adolescents and even to adulthood, producing problems in family and interpersonal relationships. (Zhang and Jin, 2007) Around 30% of children with Attention De icit Hyperactive Disorder has a learning incapacity, and a signi icant majority underperform academically. (Dupaul et al., 2001) According to recent studies, it may persist into adolescent and adult life, although the majority of Attention De icit Hyperactive Disorder referral is for children between 4-18 years, primary assessment is critical. (Michielsen et al., 2012;Spira and Fischel, 2005) METHODOLOGY Quantitative approach and cross-sectional descriptive study design was used for the study. The variables are study variable, demographic variables and clinical variables. Study variable was prevalence of Attention De icit Hyperactive Disorder. In contrast, the demographic variables comprise age in years, gender, standard, type of family, birth order of the child, number of children in the family, education of the father and mother, the job of the father and mother, domicile, monthly income of the family and clinical variables were Family history of children with ADHD, Duration of history with ADHD.
The study was done among school children aged between 6-12 years in schools at Eluru District recognized by the Board of Secondary Education, Government of Andhra Pradesh. The sample comprised of school children who satis ied the inclusion criteria. The sample size was 509. Non-probability convenient sampling method was assumed to pick the samples. The tool encompasses of 3 sectionssection A -Structured questionnaire to evoke the demographic data. Section B -A standardized Conner's Abbreviated Rating Scale was used that parents and teachers illed consist of 10 items which are used to screen the Attention De icit Hyperactive Disorder of the child and these items. The minimum score was '0', and the Maximum score was '30'. The content of the instrument was recognized based on the views of Nursing experts. Recommendations were included in the demographic and clinical variable tool. Tool reliability was recognized by test-retest technique and the 'r' value was 0.89. The data were analyzed using descriptive and inferential statistics.

ETHICAL CONSIDERATIONS
The dissertation committee of SRM College of Nursing (SRMCON), SRMIST approved the proposal. Permission was from the Correspondent/ Principals of selected schools and informed consent was attained from parents and school teachers before collecting the data. Guarantee was speci ied to the samples that anonymity of every participant would be kept con idential. They are allowed to withdraw from the study at any time. The investigators explained the aims and methods of data collection and particulars about the study was described to the samples. Data collection was done for four weeks. The con identiality about the data and inding was assured to the participants. Table 1 shows that (21.6%) of children were in the age of 11 and 12 years, 54.2% of children were males, 22.4% of children were studying in the ifth standard, 71.1% of children were in the nuclear family, 56.4% of children were irstborn child, 76.8% of the family had two children, 34.0% of Fathers completed graduation or post-graduation, 30.5% of the mothers completed graduation or post-graduation, 29.3% of the father's occupation was professional, 65.8% of the mothers were housewife, 81.1% of them were from a rural area. 23.8% of the children's family monthly income were more than 29.766/-; considering the clinical variables, none of them has a history of previous illness & duration of illness.   identi ied to have ADHD. Table 3 Analysis depicts a positive correlation between parents report and teacher report where r = 0.589 with a p-value of 0.01 level, which is statistically signi icant.

RESULTS
The analysis depicts that there was a signi icant association with the demographic variable, such as the number of children. There was no signi icant association found with other demographic variables such as age, sex, standard, type of family, birth order, father's and mother's education, father's and mother's occupation, domicile, monthly family income in parents report. The analysis depicts that there was a signi icant association with the demographic variables and teachers report such as age, standard, type of family and number of children. There was no signi icant association found with other demographic variables such as sex, birth order, father's and mother's education, occupation of father and mother, domicile and family income in teacher's report.

DISCUSSION
ADHD is a vastly predominant disorder among children. This study speci ies the importance of early identi ication of this neurobehavioural problem disorder. To determine the prevalence of ADHD among school children aged between 6-12 years analysis shows that prevalence of ADHD among school children in Parent report 405(79.6%) were normal, 85(16.7%) were under risk for ADHD, 19(3.7%) were identi ied to have ADHD. Considering Teacher report the prevalence of ADHD among school children was 401(78.8%) were normal, 98(19.3%) were under risk for ADHD, 10(2.0%) were identi-ied to have ADHD. The results of the current study is reliable with a cross-sectional study to assess the prevalence of ADHD in school-aged children in Coimbatore district. Children aged between 6 and 11 years were selected and screened with Conners' Abbreviated Rating Scale. The prevalence of ADHD was found to be 11.32%. (Venkata and Panicker, 2013) The study is also consistent with the other study to assess the prevalence of ADHD among primary school children. The sample consisted of 865 children with the age group of 4-10 years from ive different primary schools using Modi ied Conners' Teacher Rating Scale. Results showed that out of 865 children, the total number of males was 407 and females was 458. The study concluded with the prevalence of ADHD from 3% to 12%, and the worldwide prevalence of ADHD was approximately 3%. The study reported that 6.3% of primary school children were with symptoms of ADHD. (Srignanasoundari et al., 2016) To correlate the prevalence of ADHD with parent report and teacher report, analysis depicts that there was a positive correlation (r = 0.589) between the parent report and teacher report.
The analysis depicts that there was a signi icant association with the demographic variable such as number of children. There was no signi icant association found with other demographic variables such as age, sex, standard, type of family, birth order, father's and mother's education, father's and mother's occupation, domicile, monthly family income in parents report. The analysis depicts that there was a signi icant association with the demographic variables and teachers report such as age, standard, type of family and number of children. There was no signi icant association found with other demographic variables such as sex, birth order, father's and mother's education, occupation of father and mother, domicile and family income in teacher's report.
The parents and teachers were explained on ADHD through pamphlets and PowerPoint presentation. Parents and teachers were sensitized about identifying and initiating the care and treatment of ADHD.

CONCLUSION
The occurrence of ADHD among children in India is commonly constant with epidemiological facts throughout the world with few exemptions. There is a lack of awareness of ADHD among parents, teachers and educationists. There is a need for continued work to gather data on the prevalence of Attention De icit Hyperactivity Disorder in our community, thereby sensitizing the parents, teachers and primary care physicians. It is understood that ADHD grounds the most critical disease burden on children, and it changes the upcoming life of some children.