Symptoms of Attention-Deficit Hyperactivity Disorder in an Italian School Sample: Findings of a Pilot Study

doi:10.1097/00004583-199309000-00026

Journal of the American Academy of Child & Adolescent Psychiatry

Volume 32, Issue 5, September 1993, Pages 1051-1058

https://doi.org/10.1097/00004583-199309000-00026 Get rights and content

ABSTRACT

Objective

The objective of this study was to complete a teacher questionnaire on a sample of children (N = 232) in nine fourth grade classes in schools in two regions of central Italy to assess the frequency of occurrence of symptoms of attention-deficit hyperactivity disorder (ADHD) and the rates of probable cases in the sample.

Method

Each ADHD symptom was rated by the teacher as either absent (0), sometimes present (1) or frequently present (2).

Results

Of the children 3.9% had eight or more DSM-III-R Criterion A symptoms of ADHD scored at a “frequent” level (score of 2) and were considered to be “likely cases” of ADHD; an additional 6.9% did not meet this threshold but had a total score of 16 or more on the scale and were considered to be “possible cases.”

Conclusions

The findings suggest the need for more systematic epidemiological investigations to evaluate the true prevalence of the syndrome and its risk factors in the Italian population. J. Am. Acad. Child Adolesc. Psychiatry, 1993, 32, 5:1051–1058.

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Cited by (38)

Psychopathological features in Noonan syndrome
2018, European Journal of Paediatric Neurology
Noonan syndrome (NS) is an autosomal dominant disorder characterized by short stature, skeletal and haematological/lymphatic defects, distinctive facies, cryptorchidism, and a wide spectrum of congenital heart defects. Recurrent features also include variable cognitive deficits and behavioural problems. Recent research has been focused on the assessment of prevalence, age of onset and characterization of psychiatric features in this disorder. Herein, we evaluated the prevalence of attention deficit and hyperactivity disorder (ADHD), anxiety and depressive symptoms and syndromes in a cohort of individuals with clinical and molecular diagnosis of NS.
The Kiddie Schedule for Affective Disorders and Schizophrenia for School-Age Children Present and Lifetime version (K-SADS PL) has been used for the assessment of psychiatric disorders according to Diagnostic and Statistical Manual of Mental Disorders (DSM-IV). Multidimensional Anxiety Scale for Children (MASC) and the Children's Depression Inventory (CDI) have been assessed for the evaluation of anxiety and depressive symptoms and syndromes, whereas Conners Teacher and Parent Rating Scales-long version (CRS-R) have been used to evaluate ADHD.
The study included 27 individuals (67% males) with an average age of 10.4 years (range 6–18 years) receiving molecular diagnosis of NS or a clinically related condition, evaluated and treated at the Neuropsychiatric Unit of Children's Hospital Bambino Gesù and at the Center for Rare Diseases of Fondazione Policlinico Universitario Agostino Gemelli, in Rome. Twenty individuals showed mutations in PTPN11, five in SOS1 and two in SHOC2. The mean IQ was 94 (Standard Deviation = 17, min = 56, max = 130). Seventy percent of the individuals (n = 19; 95% Confidence Interval = 52–85%) showed ADHD features, with six individuals reaching DSM-IV-TR criteria for ADHD disorder, and thirteen showing subsyndromal traits. Symptoms or syndrome of anxiety were present in 37% of the cohort (n = 10; 95% Confidence Interval = 19–56%), with two individuals showing anxiety disorder and eight cases exhibiting subsyndromal traits.
Our results show individuals with NS do present a very high risk to develop psychiatric disorders or symptoms during paediatric age. Based on these findings, preschool assessment of inattentive, hyperactivity/impulsivity and anxiety/depressive symptoms is recommended in order to plan a personalized treatment for psychological/psychiatric issues in affected individuals. Dedicated prospective studies are required to confirm the present data and better characterize the psychopathological profile in NS.
The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder
2014, Social Science and Medicine
Citation Excerpt :
Italian professionals tended to diagnose ‘learning disability’ or ‘personality disorder’ where Americans denoted ‘behavioral disorder’ or ‘hyperactivity’ (Frazzetto et al., 2007). Until recently, many Italian clinicians had limited knowledge of ADHD as it is defined in the DSM and ICD – utilizing instead a predominantly psychodynamic–psychoanalytic approach and tending to use a fairly generic label of “problem child” or “developmental difficulties” (Bonati, 2005; Gallucci et al., 1993). In a 2001 study, approximately 60% of the primary care pediatricians were cognizant that ADHD existed but were unfamiliar with how to diagnose it; only 10% were following up ADHD cases directly (Bonati et al., 2001b; Marchini et al., 2000).
Attention Deficit Hyperactivity Disorder (ADHD) has been medicalized in the United States since the 1960s. Primarily used in North America until the 1990s, ADHD diagnosis and treatment have increasingly been applied internationally. After documenting the expansion of ADHD in a global context, this paper presents five brief international examples examining ADHD usage and expansion: the United Kingdom, Germany, France, Italy and Brazil. We then identify and describe several vehicles that facilitate the migration of the ADHD diagnosis: the transnational pharmaceutical industry; the influence of western psychiatry; moving from ICD to DSM diagnostic criteria; the role of the Internet including the related advent of easily accessible online screening checklists; and advocacy groups. Finally, we discuss what this globalization of a diagnosis reflects about the potential global medicalization of other conditions.
Atomoxetine hydrochloride in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder: A placebo-controlled Italian study
2009, European Neuropsychopharmacology
The primary aim of this study was to assess the efficacy of atomoxetine in improving ADHD and ODD symptoms in paediatric patients with ADHD and comorbid oppositional defiant disorder (ODD), non-responders to previous psychological intervention with parent support.
This was a multicentre, randomised, placebo-controlled trial conducted in patients aged 6–15 years, with ADHD and ODD diagnosed according to the DSM-IV criteria by a structured clinical interview (K-SADS-PL). Only subjects who are non-responders to a 6-week standardized parent training were randomised to atomoxetine (up to 1.2 mg/kg/day) or placebo (in a 3:1 ratio) for the following 8-week double blind phase.
Only 2 of the 156 patients enrolled for the parent support phase (92.9% of males; mean age: 9.9 years), improved after the parent training program; 139 patients were randomised for entering in the study and 137 were eligible for efficacy analysis. At the end of the randomised double blind phase, the mean changes in the Swanson, Nolan and Pelham Rating Scale-Revised (SNAP-IV) ADHD subscale were − 8.1 ± 9.2 and − 2.0 ± 4.7, respectively in the atomoxetine and in the placebo group (p < 0.001 between groups); changes in the ODD subscale were − 2.7 ± 4.1 and − 0.3 ± 2.6, respectively in the two groups (p = 0.001 between groups). The CGI-ADHD-S score decreased in the atomoxetine group (median change at endpoint: − 1.0) compared to no changes in the placebo group (p < 0.001 between groups). Statistically significant differences between groups, in favour of atomoxetine, were found in the CHIP-CE scores for risk avoidance domain, emotional comfort and individual risk avoidance subdomains. An improvement in all the subscales of Conners Parents (CPRS-R:S) and Teacher (CTRS-R:S) subscales was observed with atomoxetine, except in the cognitive problems subscale in the CTRS-R:S. Only 3 patients treated with atomoxetine discontinued the study due to adverse events. No clinically significant changes of body weight, height and vital signs were observed in both groups.
Treatment with atomoxetine of children and adolescents with ADHD and ODD, who did not initially respond to parental support, was associated with improvements in symptoms of ADHD and ODD, and general health status. Atomoxetine was well tolerated.
Factor structure and cultural factors of disruptive behaviour disorders symptoms in Italian children
2006, European Psychiatry
Citation Excerpt :
Cronbach alphas measured in the Italian sample were similar to those measured by Pehalm et al. [38] with the original questionnaire, suggesting that the DBD rating scale could be used with Italian samples as well as with US samples. The higher internal consistencies for teachers compared to parent ratings measured in the present study are consistent with existing data on other instruments [3,16,19,43]. Every teacher rated one to four children.
Objective: Poor parent and teacher awareness for attention-deficit/hyperactivity disorder (ADHD) and the scepticism of many clinicians on the prevalence of the disorder, make Italy an interesting environment in which to verify neuropsychological constructs generated in a predominantly Northern American cultural contest. The aim of the study was to verify, by factor confirmatory analysis, the empirical validity of the DSM constructs underlying the diagnostic criteria for developmental disruptive behaviour disorders in Italian school-age children.
Methods: Scores for DSM-IV inattention and hyperactivity/impulsivity, for oppositional defiant disorder (ODD) and for conduct disorder (CD) symptoms in 6–12 years old Italian children were analysed from 1575 parent and 1085 teacher forms of the disruptive behaviour disorders questionnaires collected in four different Italian regions.
Results: Reliability indicates high internal consistencies for both parent and teacher rating of inattention, hyperactivity/impulsivity, and oppositionality, but not for conduct problems. In accordance with the literature, a relatively low inter-rater convergent and discriminant validity correlation was observed comparing measures obtained by between parents and teachers. Confirmatory factor analysis of both parent and teacher data showed a better fit for a four-factor model, indicating a factor structure in accordance with the DSM-IV taxonomy. When completed by parents and teachers of clinically assessed ADHD, dyslexic or normal children, the disruptive behavioural disorder questionnaires showed a significant predictive diagnostic value.
Conclusion: Although an informant variance higher that dimensional (trait) variance was observed, the study provides support for DSM-IV taxonomy for developmental disruptive disorders, showing construct validity of ADHD. ODD and CD could also be distinguished from each other.
Teacher reports of ADHD symptoms in Italian children at the end of first grade
2006, European Psychiatry
Citation Excerpt :
In Italy, psychostimulants, the most widely used pharmacotherapy treatments for ADHD, are not as yet available. This situation makes prevalence studies in this country particularly interesting, since the lack of effective medications may have an impact on the perception of the disorder among the practitioners and in the community [13]. Even though clinical interviews and multiple informants both contribute to a reliable assessment of ADHD in referred samples [9], this diagnostic methodology is difficult in epidemiological community-based studies, in which prevalently more rapid parent and/or teacher DSM-IV referenced rating scales are used as proxies for diagnosis [32,33].
Objective: To determine the prevalence of teacher-rated ADHD symptoms in Italian first-graders.
Method: 1891 first-graders aged 6.6–7.4 years were evaluated using a 34-item DSM-IV-referenced ADHD teacher rating questionnaire which included all the 18 DSM-IV ADHD diagnostic criteria, some Oppositional-Defiant Disorder (ODD), Conduct Disorder (CD), depression and anxiety symptoms, and questions about the child's social and scholastic impairment.
Results: Criteria for ADHD were met in 7.1% (n = 135) of the subjects (10.4% males and 3.8% females), 3.5% with the Inattentive subtype, 2.3% with the Hyperactive/Impulsive subtype and 1.3% with a Combined subtype. Internalizing (depression and/or anxiety) symptoms were reported in 25.9% of the subjects with ADHD symptoms, 17% showed externalizing symptoms (ODD or CD), and 12.6% showed both. Comorbid symptoms were 10 times more frequent than in subjects without ADHD symptoms. Inattentive subtype and scholastic impairment were more frequent in females, Hyperactive/Impulsive subtype and social impairment were more frequent in males.
Conclusions: Even though the real prevalence of ADHD in first graders is presumably lower than that found in the present study, this screening procedure might allow detecting those children who could benefit from referral for more comprehensive assessments.
Maternal anxiety, depression and sleep disorders before and during pregnancy, and preschool ADHD symptoms in the NINFEA birth cohort study
2019, Epidemiology and Psychiatric Sciences

View all citing articles on Scopus

: This study was made possible by an award from the Viola Bernard Fund. Data entry and data analyses were provided by the Biostatistical Core of the Child Research Center in the Department of Child Psychiatry at Columbia University (P50 MH43878), with invaluable input provided by Mark Davies, M.P.H. Special thanks to the Italian teachers who devotedly participated in the study, as well as to Dr. Luccherino, Dr. Milone, and Dr. Antonelli for their significant contribution to its coordination. Finally, thanks to Lisa Thomason for her assistance in the preparation of this manuscript.

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Journal of the American Academy of Child & Adolescent Psychiatry

ABSTRACT

Objective

Method

Results

Conclusions

REFERENCES (23)

Child psychiatric diagnosis by computer algorithm: theoretical issues and empirical tests

J. Am. Acad. Child Adolesc. Psychiatry

Teacher ratings of DSM-III-R symptoms for the disruptive behavior disorders

J. Am. Acad. Child Adolesc. Psychiatry

A general population screen for attention deficit disorder with hyperactivity

J. Am. Acad. Child Adolesc. Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

DSM-III disorders in preadolescent children

Arch. Gen. Psychiatry

A comparison of objective classroom measures and teacher ratings of attention deficit disorder

J. Abnorm. Child Psychol.

Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch. Gen. Psychiatry

EEG and clinical findings during Pemoline treatment in children and adults with attention deficit disorder

Neuropsychobiology

II bambino iperattivo: Un'esperienza italiana

Acta Pediatrica Latina

Rating scales and checklists for child psychopharmacology

Psychopharmacol. Bull.

Cited by (38)

Psychopathological features in Noonan syndrome

The impending globalization of ADHD: Notes on the expansion and growth of a medicalized disorder

Atomoxetine hydrochloride in the treatment of children and adolescents with attention-deficit/hyperactivity disorder and comorbid oppositional defiant disorder: A placebo-controlled Italian study

Factor structure and cultural factors of disruptive behaviour disorders symptoms in Italian children

Teacher reports of ADHD symptoms in Italian children at the end of first grade

Maternal anxiety, depression and sleep disorders before and during pregnancy, and preschool ADHD symptoms in the NINFEA birth cohort study

Original ArticleSymptoms of Attention-Deficit Hyperactivity Disorder in an Italian School Sample: Findings of a Pilot Study

ABSTRACT

Objective

Method

Results

Conclusions

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

J. Am. Acad. Child Adolesc. Psychiatry

Diagnostic and Statistical Manual of Mental Disorders

DSM-III disorders in preadolescent children

Arch. Gen. Psychiatry

A comparison of objective classroom measures and teacher ratings of attention deficit disorder

J. Abnorm. Child Psychol.

Attention Deficit Hyperactivity Disorder: A Handbook for Diagnosis and Treatment

Estimates of the prevalence of childhood maladjustment in a community survey in Puerto Rico

Arch. Gen. Psychiatry

EEG and clinical findings during Pemoline treatment in children and adults with attention deficit disorder

Neuropsychobiology

II bambino iperattivo: Un'esperienza italiana

Acta Pediatrica Latina

Rating scales and checklists for child psychopharmacology

Psychopharmacol. Bull.

Original Article
Symptoms of Attention-Deficit Hyperactivity Disorder in an Italian School Sample: Findings of a Pilot Study