Document Type : Original Article
Authors
- . Azam Hamidzadeh
- . Mehrnaz Kharatha
- . Milad Bazghaleh
- . Hassan Basirinejad 1
- . Nasrin Fadae Aghdam
- . Hossein Ebrahimi 2
1 Department of Epidemiology, School of Epidemiology and Biostatics, Tehran University of Medical Sciences, Tehran, Iran
2 Center for Health Related Social and Behavioral Sciences Research, Shahroud University of Medical Sciences, Shahroud, Iran
Abstract
BACKGROUND: Attention‑deficit hyperactivity disorder (ADHD) is one of the most common reasons
for visiting psychiatrists and psychologists. This study aimed to investigate the prevalence of ADHD
and its related risk factors among children at elementary schools.
MATERIALS AND METHODS: This cross‑sectional study focused on teachers and parents of 779
elementary students who were selected through stratified cluster random sampling; Conners Parent
and Teacher Questionnaires were used to collecting data. The data were analyzed by the use of
descriptive statistics (frequency and percentage), independent samples t‑test, Chi‑square, one‑way
ANOVA, and linear regression. The significant level was set at 0.05.
Results: According to teachers’ responses, the prevalence of ADHD among students in elementary
schools was 4.4%, whereas parents reported a prevalence of 0.5%. There was a significant
relationship between childhood ADHD and marital status of parents, fathers’ smoking habits, previous
experience of living in rural areas, children’s previous history of having diseases and using the
medicine, previous history of ADHD, and psychological problems in the family.
Conclusions: According to the study, teachers and parents suffer from a lack of knowledge about
ADHD. Thus, the educational workshops and programs should be held for teachers, parents, and
counselors to inform them about the procedures for timely diagnosis and treatment of ADHD.
Keywords
1. Dobrosavljevic M, Solares C, Cortese S, Andershed H, Larsson H.
Prevalence of attention‑deficit/hyperactivity disorder in older
adults: A systematic review and meta‑analysis. Neurosci Biobehav
Rev 2020;118:282‑9.
2. Ayano G, Yohannes K, Abraha M. Epidemiology of
attention‑deficit/hyperactivity disorder (ADHD) in children
and adolescents in Africa: A systematic review and meta‑analysis.
Ann Gen Psychiatry 2020;19:21.
3. Hankey JR, Liu YS, Chokka PR. Adult ADHD: Prevalence,
comorbidities, and patient‑reported dysfunction in a tertiary
mental health clinic. Psychiatry Clin Psychopharmacol
2020;30:3‑9.
4. LeGris J, Boylan K, Stead V, Beyfuss K, Chan A. Developmental
risk relationships between ADHD and depressive disorders in
childhood. Curr Dev Dis Rep 2016;3:25‑32.
5. Melegari MG, Bruni O, Sacco R, Barni D, Sette S, Donfrancesco R.
Comorbidity of attention deficit hyperactivity disorder and
generalized anxiety disorder in children and adolescents.
Psychiatry Res 2018;270:780‑5.
6. Vitola E, Bau C, Salum G, Horta B, Quevedo L, Barros F, et al.
Exploring DSM‑5 ADHD criteria beyond young adulthood:
Phenomenology, psychometric properties and prevalence in a
large three‑decade birth cohort. Psychol Med 2017;47:744.
7. Chang Z, Lichtenstein P, D’Onofrio BM, Almqvist C,
Kuja‑Halkola R, Sjölander A, et al. Maternal age at childbirth and
risk for ADHD in offspring: A population‑based cohort study. Int
J Epidemiol 2014;43:1815‑24.
8. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA.
The worldwide prevalence of ADHD: A systematic review and
metaregression analysis. Am J Psychiatry 2007;164:942‑8.
9. Abdollahian A, Shakeri M, Vosogh A. Prevalence of attention
deficit/hyperactivity disorder in pre‑school children in Mashhad
city in school year of 2002‑2003. J Med Sci Univ Mashhad
2004;47:275‑80.
10. Akhavan Karbasi S, Golestan M, Fallah R, Sadr Bafghi M.
Prevalence of attention deficit hyperactivity disorder in 6 year
olds of Yazd city. JSSU 2008;15:29‑34.
11. Bahreynian AA, Bayat MR. Prevalence of ADHD in school‑aged
boys in Tehran. Pejouhandeh 2002;6:555‑8.
12. Moayedi F, Moayedi A, Goli G, Hemedi Y. Prevalence of attention
deficit hyperactivity disorder in Bandarabbas primary school
students in 2010. Bimonthly J Hormoz Univ Med Sci 2013;17:241‑7.
13. Moradi A, Khobazkhob M. Hyperactivity disorder (ADHD)
among school children of Nishaboor ‑ Iran during 2006. J Gorgan
Univ Med Sci 2008;10:37‑42.
14. Ghafari Nejad A. Prevalence of Social phobia disorder and related
factors among high school students in Kerman. Sci J Hamadan
Univ Med Sci Health Serv 1998;8:1‑9.
15. Fallahzadeh M. P*revalence of Attention Deficit Hyperactivity
Disorder among School‑Children in Karaj. The Abstract Book of
the 5th Congress on Hygienic and Mental Health in Children and
Youth, Zanjan, Iran; 2000. p. 24.
16. Mostafaee MR, Shokati M, Sarchami R, Rafiei H. Prevalence of
attention deficit hyperactivity disorder in elementary school
students in Hamadan. Int J Epidemiol Res 2016;3:63‑8.
17. Shabani M, Yadeghari A. Prevalence of attention deficit
hyperactivity disorder (ADHD) in elementary school children in
Zanjan, 2004‑05. J Zanjan Univ Med Sci Health Serv 2005;51:48‑2.
18. Starck M, Grünwald J, Schlarb AA. Occurrence of ADHD in
parents of ADHD children in a clinical sample. Neuropsychiatr
Dis Treat 2016;12:581‑8.
19. Mulraney M, Schilpzand EJ, Hazell P, Nicholson JM, Anderson V,
Efron D, et al. Comorbidity and correlates of disruptive mood
dysregulation disorder in 6‑8‑year‑old children with ADHD. Eur Child Adolesc Psychiatry 2016;25:321‑30.
20. Cadman T, Findon J, Eklund H, Hayward H, Howley D,
Cheung C, et al. Six‑year follow‑up study of combined
type ADHD from childhood to young adulthood: Predictors of
functional impairment and comorbid symptoms. Eur Psychiatry
2016;35:47‑54.
21. Russell AE, Ford T, WilliamsR, Russell G. The association between
socioeconomic disadvantage and attention deficit/hyperactivity
disorder (ADHD): A systematic review. Child Psychiatry Hum
Dev 2016;47:440‑58.
22. Wymbs BT, Pelham WE Jr., Molina BS, Gnagy EM, Wilson TK,
Greenhouse JB. Rate and predictors of divorce among parents of
youths with ADHD. J Consult Clin Psychol 2008;76:735‑44.
23. Al Hamed JH, Taha AZ, Sabra AA, Bella H. Attention deficit
hyperactivity disorder (ADHD) among male primary school
children in Dammam, Saudi Arabia: Prevalence and associated
factors. J Egypt Public Health Assoc 2008;83:165‑82.
24. Bayati A, Faghihzadeh S, Rahgavi A. Aiding factors of
attention‑deficit disorder/hyperactivity among school age
children in arak state primary schools. J Rahavard Danesh
2000;3:9‑14.
25. Khoushabi K, Setareh‑Forouzan A, Moradi S, Mohammadkhani P.
Risk factors of attention deficit hyperactivity disorder in children.
J Rehabil 2006;7:6.
26. de Zwaan M, Gruss B, Muller A, Graap H, Martin A, Glaesmer H,
et al. The estimated prevalence and correlates of adult ADHD in a
German community sample. Eur Arch Psychiatry Clin Neurosci
2012;262:79‑86.
27. Paraskevopoulou M, van Rooij D, Schene AH, Scheres AP,
Buitelaar JK, Schellekens AF. Effects of substance misuse and
family history of substance use disorder on delay discounting in
adolescents and young adults with attention‑deficit/hyperactivity
disorder. Eur Addict Res 2020;26:295‑305.
28. Minatoya M, Araki A, Itoh S, Yamazaki K, Kobayashi S,
Miyashita C, et al. Prenatal tobacco exposure and ADHD
symptoms at pre‑school age: The Hokkaido study on environment
and children’s health. Environ Health Prevent Med 2019;24:74.
29. Kouchakzadeh Talami S, Namazi A, Zarkesh M. Symptoms
related to attention deficit hyperactivity disorder among
preschool children based on parents report. Holistic Nurs Midwif
J 2015;25:35‑44.
30. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E,
et al. Family‑environment risk factors for attention‑deficit
hyperactivity disorder: A test of Rutter’s indicators of adversity.
Arch Gen Psychiatry 1995;52:464‑70.
31. Muñoz‑Silva A, Lago‑UrbanoR, Sanchez‑Garcia M. Family impact
and parenting styles in families of children with ADHD. J Child
Fam Stud 2017;26:2810‑23.
32. Malek A, Amiri S, Abdi S. Previous medical history of diseases
in children with attention deficit hyperactivity disorder and their
parents. J Anal Res Clin Med 2014;2:42‑6.
33. Yazdi, S.A.H., Mashhadi, A., Kimiaee, S.A. and Asemi,
Z., Effectiveness of Children of Divorce Intervention
Program (CODIP) on externalized and internalized problems in
children of divorce. Fam Psychol 2015;2:3‑14.
34. FayyadJ, SampsonNA, HwangI, AdamowskiT, Aguilar‑GaxiolaS,
Al‑Hamzawi A, et al. The descriptive epidemiology of DSM‑IV
Adult ADHD in the World Health Organization World Mental
Health Surveys. Atten Defic Hyperact Disord 2017;9:47‑65.
35. Russell G, Ford T, Rosenberg R, Kelly S. The association of
attention deficit hyperactivity disorder with socioeconomic
disadvantage: Alternative explanations and evidence. J Child
Psychol Psychiatry 2016;55:436‑45.
36. Joelsson P, Chudal R, Talati A, Suominen A, Brown AS,
Sourander A. Prenatal smoking exposure and neuropsychiatric
comorbidity of ADHD: A Finnish nationwide population‑based
cohort study. BMC Psychiatry 2016;16:306.
37. Shahim, Sima, Leila Mehrangiz, and Farideh Yousefi. “Prevalence
of attention deficit hyperactivity disorder in a group of elementary
school children.” Iranian Journal of Pediatrics 17.s2 (2007): 211‑216
38. Shooshtary MH, Chimeh N, Najafi M, Mohamadi MR,
Yousefi‑Nouraie R, Rahimi‑Mvaghar A. The prevalence of
attention deficit hyperactivity disorder in Iran: A systematic
review. Iran J Psychiatry 2010;5:88‑92.
39. Venkata JA, Panicker AS. Prevalence of attention deficit
hyperactivity disorder in primary school children. Indian J
Psychiatry 2013;55:338‑42.
40. EL‑Gendy SD, El‑Bitar EA, El‑Awady MA, Bayomy HE,
Agwa EM. Attention‑deficit/hyperactivity disorder: Prevalence
and risk factors in Egyptian primary school children. Egypt J
Commun Med 2017;35:1‑16.
41. Willcutt EG, Pennington BF. Comorbidity of reading disability and
attention‑deficit/hyperactivity disorder: Differences by gender
and subtype. J Learn Disabil 2000;33:179‑91.
42. Pierrehumbert B, Bader M, Thévoz S, Kinal A, Halfon O.
Hyperactivity and attention problems in a Swiss sample of
school‑aged children: Effects of school achievement, child gender,
and informants. J Atten Disord 2006;10:65‑76.
43. Soma Y, Nakamura K, Oyama M, Tsuchiya Y, Yamamoto M.
Prevalence of attention‑deficit/hyperactivity disorder (ADHD)
symptoms in preschool children: Discrepancy between parent
and teacher evaluations. Environ Health Prev Med 2009;14:150‑4.
44. Meysamie A, Fard MD, Mohammadi MR. Prevalence of
attention‑deficit/hyperactivity disorder symptoms in
preschool‑aged Iranian children. Iran J Pediatr 2011;21:467‑72.
45. Arfaie A, Mohammadi A, Sohrabi R. Relationship between
marital conflict and child affective‑behavioral psychopathological
symptoms. Procedia Soc Behav Sci 2013;84:1776‑8.
46. Taghaza M, Abolmaali K, Saberi H. Comparsion of familys
emotional setting in hyperactive versus normal children. J Behav
Sci 2012;4:9‑26.
47. DuPaulGJ, McGoeyKE, EckertTL, VanBrakle J. Preschool children
with attention‑deficit/hyperactivity disorder: Impairments in
behavioral, social, and school functioning. J Am Acad Child
Adolesc Psychiatry 2001;40:508‑15.
48. Counts CA, Nigg JT, Stawicki JA, Rappley MD, von Eye A. Family
adversity in DSM‑IV ADHD combined and inattentive subtypes
and associated disruptive behavior problems. J Am Acad Child
Adolesc Psychiatry 2005;44:690‑8.
49. Hurtig T, Ebeling H, Taanila A, Miettunen J, Smalley S,
McGough J, et al. ADHD and comorbid disorders in relation to
family environment and symptom severity. Eur Child Adolesc
Psychiatry 2007;16:362‑9.
50. Gustavson K, Ystrom E, Stoltenberg C, Susser E, Surén P,
Magnus P, Knudsen GP, Smith GD, Langley K, Rutter M,
Aase H. Smoking in pregnancy and child ADHD. Pediatrics.
2017 Feb 1;139(2).
51. Kabir Z, Connolly GN, Alpert HR. Secondhand smoke exposure
and neurobehavioral disorders among children in the United
States. Pediatrics 2011;128:263‑70.
52. Mohamed F, Syed H, Salah M. Prevalence of attention
deficit hyperactivity disorder in children. Sci J Public Health
2015;3:274‑80.
53. Khushabi K. Study of Prevalence of ADHD and Comorbid
Disorders in Primary School Students of Tehran. Iran, Tehran:
University of Welfare and Rehabilitation; 2002.
Prevalence of attention‑deficit/hyperactivity disorder in older
adults: A systematic review and meta‑analysis. Neurosci Biobehav
Rev 2020;118:282‑9.
2. Ayano G, Yohannes K, Abraha M. Epidemiology of
attention‑deficit/hyperactivity disorder (ADHD) in children
and adolescents in Africa: A systematic review and meta‑analysis.
Ann Gen Psychiatry 2020;19:21.
3. Hankey JR, Liu YS, Chokka PR. Adult ADHD: Prevalence,
comorbidities, and patient‑reported dysfunction in a tertiary
mental health clinic. Psychiatry Clin Psychopharmacol
2020;30:3‑9.
4. LeGris J, Boylan K, Stead V, Beyfuss K, Chan A. Developmental
risk relationships between ADHD and depressive disorders in
childhood. Curr Dev Dis Rep 2016;3:25‑32.
5. Melegari MG, Bruni O, Sacco R, Barni D, Sette S, Donfrancesco R.
Comorbidity of attention deficit hyperactivity disorder and
generalized anxiety disorder in children and adolescents.
Psychiatry Res 2018;270:780‑5.
6. Vitola E, Bau C, Salum G, Horta B, Quevedo L, Barros F, et al.
Exploring DSM‑5 ADHD criteria beyond young adulthood:
Phenomenology, psychometric properties and prevalence in a
large three‑decade birth cohort. Psychol Med 2017;47:744.
7. Chang Z, Lichtenstein P, D’Onofrio BM, Almqvist C,
Kuja‑Halkola R, Sjölander A, et al. Maternal age at childbirth and
risk for ADHD in offspring: A population‑based cohort study. Int
J Epidemiol 2014;43:1815‑24.
8. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA.
The worldwide prevalence of ADHD: A systematic review and
metaregression analysis. Am J Psychiatry 2007;164:942‑8.
9. Abdollahian A, Shakeri M, Vosogh A. Prevalence of attention
deficit/hyperactivity disorder in pre‑school children in Mashhad
city in school year of 2002‑2003. J Med Sci Univ Mashhad
2004;47:275‑80.
10. Akhavan Karbasi S, Golestan M, Fallah R, Sadr Bafghi M.
Prevalence of attention deficit hyperactivity disorder in 6 year
olds of Yazd city. JSSU 2008;15:29‑34.
11. Bahreynian AA, Bayat MR. Prevalence of ADHD in school‑aged
boys in Tehran. Pejouhandeh 2002;6:555‑8.
12. Moayedi F, Moayedi A, Goli G, Hemedi Y. Prevalence of attention
deficit hyperactivity disorder in Bandarabbas primary school
students in 2010. Bimonthly J Hormoz Univ Med Sci 2013;17:241‑7.
13. Moradi A, Khobazkhob M. Hyperactivity disorder (ADHD)
among school children of Nishaboor ‑ Iran during 2006. J Gorgan
Univ Med Sci 2008;10:37‑42.
14. Ghafari Nejad A. Prevalence of Social phobia disorder and related
factors among high school students in Kerman. Sci J Hamadan
Univ Med Sci Health Serv 1998;8:1‑9.
15. Fallahzadeh M. P*revalence of Attention Deficit Hyperactivity
Disorder among School‑Children in Karaj. The Abstract Book of
the 5th Congress on Hygienic and Mental Health in Children and
Youth, Zanjan, Iran; 2000. p. 24.
16. Mostafaee MR, Shokati M, Sarchami R, Rafiei H. Prevalence of
attention deficit hyperactivity disorder in elementary school
students in Hamadan. Int J Epidemiol Res 2016;3:63‑8.
17. Shabani M, Yadeghari A. Prevalence of attention deficit
hyperactivity disorder (ADHD) in elementary school children in
Zanjan, 2004‑05. J Zanjan Univ Med Sci Health Serv 2005;51:48‑2.
18. Starck M, Grünwald J, Schlarb AA. Occurrence of ADHD in
parents of ADHD children in a clinical sample. Neuropsychiatr
Dis Treat 2016;12:581‑8.
19. Mulraney M, Schilpzand EJ, Hazell P, Nicholson JM, Anderson V,
Efron D, et al. Comorbidity and correlates of disruptive mood
dysregulation disorder in 6‑8‑year‑old children with ADHD. Eur Child Adolesc Psychiatry 2016;25:321‑30.
20. Cadman T, Findon J, Eklund H, Hayward H, Howley D,
Cheung C, et al. Six‑year follow‑up study of combined
type ADHD from childhood to young adulthood: Predictors of
functional impairment and comorbid symptoms. Eur Psychiatry
2016;35:47‑54.
21. Russell AE, Ford T, WilliamsR, Russell G. The association between
socioeconomic disadvantage and attention deficit/hyperactivity
disorder (ADHD): A systematic review. Child Psychiatry Hum
Dev 2016;47:440‑58.
22. Wymbs BT, Pelham WE Jr., Molina BS, Gnagy EM, Wilson TK,
Greenhouse JB. Rate and predictors of divorce among parents of
youths with ADHD. J Consult Clin Psychol 2008;76:735‑44.
23. Al Hamed JH, Taha AZ, Sabra AA, Bella H. Attention deficit
hyperactivity disorder (ADHD) among male primary school
children in Dammam, Saudi Arabia: Prevalence and associated
factors. J Egypt Public Health Assoc 2008;83:165‑82.
24. Bayati A, Faghihzadeh S, Rahgavi A. Aiding factors of
attention‑deficit disorder/hyperactivity among school age
children in arak state primary schools. J Rahavard Danesh
2000;3:9‑14.
25. Khoushabi K, Setareh‑Forouzan A, Moradi S, Mohammadkhani P.
Risk factors of attention deficit hyperactivity disorder in children.
J Rehabil 2006;7:6.
26. de Zwaan M, Gruss B, Muller A, Graap H, Martin A, Glaesmer H,
et al. The estimated prevalence and correlates of adult ADHD in a
German community sample. Eur Arch Psychiatry Clin Neurosci
2012;262:79‑86.
27. Paraskevopoulou M, van Rooij D, Schene AH, Scheres AP,
Buitelaar JK, Schellekens AF. Effects of substance misuse and
family history of substance use disorder on delay discounting in
adolescents and young adults with attention‑deficit/hyperactivity
disorder. Eur Addict Res 2020;26:295‑305.
28. Minatoya M, Araki A, Itoh S, Yamazaki K, Kobayashi S,
Miyashita C, et al. Prenatal tobacco exposure and ADHD
symptoms at pre‑school age: The Hokkaido study on environment
and children’s health. Environ Health Prevent Med 2019;24:74.
29. Kouchakzadeh Talami S, Namazi A, Zarkesh M. Symptoms
related to attention deficit hyperactivity disorder among
preschool children based on parents report. Holistic Nurs Midwif
J 2015;25:35‑44.
30. Biederman J, Milberger S, Faraone SV, Kiely K, Guite J, Mick E,
et al. Family‑environment risk factors for attention‑deficit
hyperactivity disorder: A test of Rutter’s indicators of adversity.
Arch Gen Psychiatry 1995;52:464‑70.
31. Muñoz‑Silva A, Lago‑UrbanoR, Sanchez‑Garcia M. Family impact
and parenting styles in families of children with ADHD. J Child
Fam Stud 2017;26:2810‑23.
32. Malek A, Amiri S, Abdi S. Previous medical history of diseases
in children with attention deficit hyperactivity disorder and their
parents. J Anal Res Clin Med 2014;2:42‑6.
33. Yazdi, S.A.H., Mashhadi, A., Kimiaee, S.A. and Asemi,
Z., Effectiveness of Children of Divorce Intervention
Program (CODIP) on externalized and internalized problems in
children of divorce. Fam Psychol 2015;2:3‑14.
34. FayyadJ, SampsonNA, HwangI, AdamowskiT, Aguilar‑GaxiolaS,
Al‑Hamzawi A, et al. The descriptive epidemiology of DSM‑IV
Adult ADHD in the World Health Organization World Mental
Health Surveys. Atten Defic Hyperact Disord 2017;9:47‑65.
35. Russell G, Ford T, Rosenberg R, Kelly S. The association of
attention deficit hyperactivity disorder with socioeconomic
disadvantage: Alternative explanations and evidence. J Child
Psychol Psychiatry 2016;55:436‑45.
36. Joelsson P, Chudal R, Talati A, Suominen A, Brown AS,
Sourander A. Prenatal smoking exposure and neuropsychiatric
comorbidity of ADHD: A Finnish nationwide population‑based
cohort study. BMC Psychiatry 2016;16:306.
37. Shahim, Sima, Leila Mehrangiz, and Farideh Yousefi. “Prevalence
of attention deficit hyperactivity disorder in a group of elementary
school children.” Iranian Journal of Pediatrics 17.s2 (2007): 211‑216
38. Shooshtary MH, Chimeh N, Najafi M, Mohamadi MR,
Yousefi‑Nouraie R, Rahimi‑Mvaghar A. The prevalence of
attention deficit hyperactivity disorder in Iran: A systematic
review. Iran J Psychiatry 2010;5:88‑92.
39. Venkata JA, Panicker AS. Prevalence of attention deficit
hyperactivity disorder in primary school children. Indian J
Psychiatry 2013;55:338‑42.
40. EL‑Gendy SD, El‑Bitar EA, El‑Awady MA, Bayomy HE,
Agwa EM. Attention‑deficit/hyperactivity disorder: Prevalence
and risk factors in Egyptian primary school children. Egypt J
Commun Med 2017;35:1‑16.
41. Willcutt EG, Pennington BF. Comorbidity of reading disability and
attention‑deficit/hyperactivity disorder: Differences by gender
and subtype. J Learn Disabil 2000;33:179‑91.
42. Pierrehumbert B, Bader M, Thévoz S, Kinal A, Halfon O.
Hyperactivity and attention problems in a Swiss sample of
school‑aged children: Effects of school achievement, child gender,
and informants. J Atten Disord 2006;10:65‑76.
43. Soma Y, Nakamura K, Oyama M, Tsuchiya Y, Yamamoto M.
Prevalence of attention‑deficit/hyperactivity disorder (ADHD)
symptoms in preschool children: Discrepancy between parent
and teacher evaluations. Environ Health Prev Med 2009;14:150‑4.
44. Meysamie A, Fard MD, Mohammadi MR. Prevalence of
attention‑deficit/hyperactivity disorder symptoms in
preschool‑aged Iranian children. Iran J Pediatr 2011;21:467‑72.
45. Arfaie A, Mohammadi A, Sohrabi R. Relationship between
marital conflict and child affective‑behavioral psychopathological
symptoms. Procedia Soc Behav Sci 2013;84:1776‑8.
46. Taghaza M, Abolmaali K, Saberi H. Comparsion of familys
emotional setting in hyperactive versus normal children. J Behav
Sci 2012;4:9‑26.
47. DuPaulGJ, McGoeyKE, EckertTL, VanBrakle J. Preschool children
with attention‑deficit/hyperactivity disorder: Impairments in
behavioral, social, and school functioning. J Am Acad Child
Adolesc Psychiatry 2001;40:508‑15.
48. Counts CA, Nigg JT, Stawicki JA, Rappley MD, von Eye A. Family
adversity in DSM‑IV ADHD combined and inattentive subtypes
and associated disruptive behavior problems. J Am Acad Child
Adolesc Psychiatry 2005;44:690‑8.
49. Hurtig T, Ebeling H, Taanila A, Miettunen J, Smalley S,
McGough J, et al. ADHD and comorbid disorders in relation to
family environment and symptom severity. Eur Child Adolesc
Psychiatry 2007;16:362‑9.
50. Gustavson K, Ystrom E, Stoltenberg C, Susser E, Surén P,
Magnus P, Knudsen GP, Smith GD, Langley K, Rutter M,
Aase H. Smoking in pregnancy and child ADHD. Pediatrics.
2017 Feb 1;139(2).
51. Kabir Z, Connolly GN, Alpert HR. Secondhand smoke exposure
and neurobehavioral disorders among children in the United
States. Pediatrics 2011;128:263‑70.
52. Mohamed F, Syed H, Salah M. Prevalence of attention
deficit hyperactivity disorder in children. Sci J Public Health
2015;3:274‑80.
53. Khushabi K. Study of Prevalence of ADHD and Comorbid
Disorders in Primary School Students of Tehran. Iran, Tehran:
University of Welfare and Rehabilitation; 2002.
)