Previous findings in Turkish samples of children have suggested higher prevalence of ADHD than those detected in Western cultures. Methodological problems might explain these findings. Here, we aimed to re-check the prevalence rate of Attention-Deficit/Hyperactivity Disorder (ADHD) along with other childhood psychiatric disorders in a representative school sample of elementary school children in İzmir, Turkey.
The sample consisted of 419 randomly selected primary school children aged 6–14-year-old. We were able to interview 417 cases (99.5 % of the sample). Psychiatric diagnoses in children were assessed using the K-SADS-PL (Schedule for Affective Disorders and Schizophrenia for School-Age Children- Present and Lifetime Version) and an impairment criterion scale.
The prevalence rates of ADHD were 21.8 and 12.7 % in children without and with impairment, respectively. The following major mental disorders were significantly more prevalent in ADHD cases than controls: oppositional defiant disorder (ODD) (9.4 versus 0 %), conduct disorder (15.1 versus 0 %), anxiety (17 versus 0.5 %), and mood (5.7 versus 0.8 %).
Our results confirmed a substantially higher ADHD prevalence rate (more than double) than the suggested pooled worldwide prevalence, although similar to the one recently detected in a representative populational sample of children in the US (11 %). These findings, consistent with previous developmental epidemiology studies from Turkey, confirm that ADHD is highly prevalent in Turkish elementary school children.
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Steiner H, Remsing L (2007) Work Group on Quality Issues (2007) Practice parameter for the assessment and treatment of children and adolescents with oppositional defiant disorder. J Am Acad Child Adolesc Psychiatry 46:126–141. doi:10.1097/01.chi.0000246060.62706.af
Polanczyk G, Jensen P (2008) Epidemiologic considerations in attention deficit hyperactivity disorder: a review and update. Child Adolesc Psychiatric Clin N Am 17:245–260. doi:10.1016/j.chc.2007.11.006
Goldman LS, Genel M, Bezman RJ, Slantetz PJ (1998) Diagnosis and treatment of attention-deficit/hyperactivity disorder in children and adolescents. JAMA 279:1100–1107. doi:10.1001/jama.279.14.1100
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Washington, DC
Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA (2007) The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 164:942–948. doi:10.1176/appi.ajp.164.6.942
Willcutt EG (2012) The prevalence of DSM-IV attention-deficit/hyperactivity disorder : a meta-analytic review. Neurotherapeutics 9:490–499. doi:10.1007/s13311-012-0135-8
Bird HR (2002) The diagnostic classification, epidemiology and cross-cultural validity of ADHD. In: Jensen PS, Cooper JR (eds) Attention deficit hyperactivity disorder: state of the science Best practices. Civic Research Institute, New Jersey, pp 2-1–2-12
Faraone SV, Sergeant J, Gillberg C, Biederman J (2003) The worldwide prevalence of ADHD: is it a American condition? World Psychiatry 2:104–113
Skounti M, Philalithis A, Galanakis E (2007) Variations in prevalence of attention deficit hyperactivity disorder worldwide. Eur J Pediatr 166:117–123. doi:10.1007/s00431-006-0299-5
Taylor E (2009) Developing ADHD. J Child Psychol Psychiatry 50:126–132. doi:10.1111/j.1469-7610.2008.01999.x
Thomas R, Mitchell GK, Batstra L (2013) Attention-deficit/hyperactivity disorder: are we helping or harming? BMJ 347:f6172. doi:10.1136/bmj.f6172
Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA (2013) ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. doi:10.1093/ije/dyt261 (in press)
Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ (2014) Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003–2011. J Am Acad Child Adolesc Psychiatry 53(34–46):e2. doi:10.1016/j.jaac.2013.09.001
Ercan ES, Kandulu R, Uslu E, Ardic UA, Yazici KU, Basay BK, Aydın C, Rohde RA (2013) Prevalence and diagnostic stability of ADHD and ODD in Turkish children: a 4-year longitudinal study. Child Adolesc Psychiatry Ment Health 7:30. doi:10.1186/1753-2000-7-30
Canino G, Polanczyk G, Bauermeister JJ, Rohde LA, Rick PJ (2010) Does the prevalence of CD and ODD vary across cultures? Soc Psychiatry Psychiatr Epidemiol 45:695–704. doi:10.1007/s00127-010-0242-y
Erşan EE, Doğan O, Doğan S, Sümer H (2004) The distribution of symptoms of attention-deficit/hyperactivity disorder and oppositional defiant disorder in school age children in Turkey. Eur Child Adolesc Psychiatry 13:354–361. doi:10.1007/s00787-004-0410-2
Gul N, Tiryaki A, Cengel Kultur SE, Topbas M, Ak I (2010) Prevalence of attention deficit hyperactivity disorder and comorbid disruptive behavior disorders among school age children in Trabzon. BCP 50:56
Chen C, Burton M, Greenberger E, Dmitrieva J (1999) Population migration and the variation of dopamine D4 receptor (DRD4) allele frequencies around the globe. Evol Hum Behav 20:309–324
Cartwright-Hatton S, McNicol K, Doubleday E (2006) Anxiety in a neglected population: prevalence of anxiety disorders in pre-adolescent children. Clin Psychol Rev 26:817–833. doi:10.1016/j.cpr.2005.12.002
Kaufman J, Birmaher B, Brent D, Rao U, Flynn C, Moreci P, Williamson D, Ryan N (1997) Schedule for affective disorders and schizophrenia for school-age children-present and lifetime version (K-SADS-PL): initial reliability and validity data. J Am Acad Child Adolesc Psychiatry 36:980–988. doi:10.1097/00004583-199707000-00021
Gökler B, Ünal F, Pehlivantürk B, Kültür EÇ, Akdemir D, Taner Y (2004) Reliability and validity of Schedule for Affective Disorders and Schizophrenia for School-Age Children-Present and Lifetime Version- Turkish Version (K-SADS-PL-T) [in Turkish]. Turk J Child Adolesc Ment Health 11:109–116
DuPaul GJ, Power TJ, McGoey KE, Ikeda MJ, Anastopoulos AD (1998) Reliability and validity of parent and teacher ratings of attention-deficit/hyperactivity disorder symptoms. J Psychoeduc Assess 16:55–68. doi:10.1177/073428299801600104
American Psychiatric Association (1994) Diagnostic and Statistical Manual of Mental Disorders, 4th edn. Washington, DC
Magnússon P, Smári J, Grétarsdóttir H, Prándardóttir H (1999) Attention deficit/hyperactivity symptoms in icelandic schoolchildren: assessment with the attention deficit/hyperactivity rating scale-IV. Scand J Psychol 40:301–306
Ercan ES, Amado S, Somer O, Çıkoğlu S (2001) Development of a test battery for the assessment of attention deficit hyperactivity disorder. Turk J Child Adolesc Ment Health 8:132–144
Achenbach TM (1991) Manual for the Child Behavior Checklist/4–18 and 1991 Profile. University of Vermont Department of Psychiatry, Burlington
Erol N, Arslan BL, Akçakin M (1995) The adaptation and standardization of the Child Behavior Checklist among 6–18 year-old Turkish children. In: Sergeant J (ed) Eunethydis: European approaches to hyperkinetic disorder. Fotoratar, Zürih, pp 97–113
Achenbach TM (1991) Manual for the TRF and 1991 Profile. University of Vermont Department of Psychiatry, Burlington
Erol N, ŞimŞek ZT (2000) Mental health of Turkish children: behavioral and emotional problems reported by parents, teachers, and adolescents. In: International perspectives on child and adolescent mental health, chap 13, vol 1. Elsevier, pp 223–247
Leckman JF, Sholomskas D, Thompson WD, Belanger A, Weissman MM (1982) Best estimate of lifetime psychiatric diagnosis: a methodological study. Arch Gen Psychiatry 39:879–883. doi:10.1001/archpsyc.1982.04290080001001
Brotman MA, Schmajuk M, Rich BA, Dickstein DP, Guyer AE, Costello EJ, Egger HL, Angold A, Pine DS, Leibenluft E (2006) Prevalence, clinical correlates, and longitudinal course of severe mood dysregulation in children. Biol Psychiatry 60:991–997. doi:10.1016/j.biopsych.2006.08.042
Cho SC, Kim BN, Kim JW, Rohde LA, Hwang JW, Chungh DS, Shin MS, Lyoo IK, Go BJ, Lee SE, Kim HW (2009) Full syndrome and subthreshold attention-deficit/hyperactivity disorder in a Korean community sample: comorbidity and temperament findings. Eur Child Adolesc Psychiatry 18:447–457. doi:10.1007/s00787-009-0755-7
Güler AS, Scahill L, Jeon S, Taşkın B, Dedeoğlu C, Ünal S, Yazgan Y (2014) Use of Multiple Informants to Identify Children at High Risk for ADHD in Turkish School-Age Children. J Atten Disord [Epub ahead of print]
Costello E, Mustillo S, Erkanli A, Keeler G, Angold A (2003) Prevalence and development of psychiatric disorders in childhood and adolescence. Arch Gen Psychiatry 60:837–844. doi:10.1001/archpsyc.60.8.837
Canino G, Shrout PE, Rubio-Stipec M, Bird HR, Bravo M, Ramirez R, Chavez L, Alegria M, Bauermeister JJ, Hohmann A, Ribera J, Garcia P, Martinez-Taboas A (2004) The DSM-IV rates of child and adolescent disorders in Puerto Rico: prevalence, correlates, service use, and the effects of impairment. Arch Gen Psychiatry 61:85–93. doi:10.1001/archpsyc.61.1.85
Merikangas KR, He JP, Brody D, Fisher PW, Bourdon K, Koretz DS (2010) Prevalence and treatment of mental disorders among US children in the 2001–2004 NHANES. Pediatrics 125:75–81. doi:10.1542/peds.2008-2598
Vicente B, Saldivia S, de la Flora B, Kohn R, Pihan R, Valdivia M, Rioseco P, Melipillan R (2012) Prevalence of child and adolescent mental disorders in Chile: a community epidemiological study. J Child Psychol Psychiatry 53:1026–1035. doi:10.1111/j.1469-7610.2012.02566.x
Merikangas KR, Nakamura EF, Kessler RC (2009) Epidemiology of mental disorders in children and adolescents. Dialogues Clin Neurosci 11:7–20
Froehlich TE, Lanphear BP, Epstein JN, Barbaresi WJ, Katusic SK, Kahn RS (2007) Prevalence, recognition, and treatment of attention-deficit/hyperactivity disorder in a national sample of US children. Arch Pediatr Adolesc Med 161:857–864. doi:10.1001/archpedi.161.9.857
Larsson H, Sariaslan A, Langstrom N, D’Onofrio B, Lichtenstein P (2013) Family income in early childhood and subsequent attention deficit/hyperactivity disorder: a quasi-experimental study. J Child Psychol Psychiatry. doi:10.1111/jcpp.12140 [Epub ahead of print]
Roberts RE, Roberts CR, Xing Y (2007) Rates of DSM-IV psychiatric disorders among adolescents in a large metropolitan area. J Psychiatr Res 41:959–967. doi:10.1016/j.jpsychires.2006.09.006
Souza I, Pinheiro MA, Denardin D, Mattos P, Rohde LA (2004) Attention-deficit/hyperactivity disorder and comorbidity in Brazil comparisons between two referred samples. Eur Child Adolesc Psychiatry 13:243–248. doi:10.1007/s00787-004-0402-2
Biederman J (2005) Attention-deficit/hyperactivity disorder: a selective overview. Biol Psychiatry 57:1215–1220. doi:10.1016/j.biopsych.2004.10.020
Takeda T, Ambrosini PJ, deBerardinis R, Elia J (2012) What can ADHD without comorbidity teach us about comorbidity? Res Dev Disabil 33:419–425. doi:10.1016/j.ridd.2011.09.024
Conflict of interest
No financial or material support was taken for the study. Dr. Luis Augusto Rohde was on the speakers’ bureau/advisory board and/or acted as consultant for Eli Lilly, Janssen-Cilag, Novartis, and Shire in the last three years. The ADHD and Juvenile Bipolar Disorder Outpatient Programs chaired by him received unrestricted educational and research support from the following pharmaceutical companies in the last three years: Eli Lilly, Janssen-Cilag, Novartis, and Shire. Dr Ercan is on advisory boards for Eli Lilly, Turkey and Janssen, Turkey. The other authors have no biomedical financial interests or potential conflicts of interest to report.
Parents provided written informed consents for the participation of their children, and the necessary legal approvals and Ege University Ethical Committee approval were obtained.
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Ercan, E.S., Bilaç, Ö., Uysal Özaslan, T. et al. Is the prevalence of ADHD in Turkish elementary school children really high?. Soc Psychiatry Psychiatr Epidemiol 50, 1145–1152 (2015). https://doi.org/10.1007/s00127-015-1071-9