Assessment of life quality in the children with attention deficit hyperactivity disorder, investigation of the factors affecting life quality by comparison with type1 diabetes mellitus and healthy control groups

OBJECTIVE Attention-Deficit Hyperactivity Disorder (ADHD), which is characterized by developmentally inappropriate levels of hyperactivity, impulsivity, and inattentiveness, has been identified as an important psychiatric condition in terms of its prevalence (around 5% worldwide) and its impact on quality of life for patients and their families. Type 1 Diabetes Mellitus (DM) is one of the most common chronic diseases of childhood. In the present study, the life quality of children and adolescents with ADHD was compared both with the life quality of children and adolescents with Type 1 DM and healthy control groups. The factors affecting the life quality of children and adolescents with ADHD by comparison with Type 1 DM and healthy control groups were also investigated. METHOD 60 ADHD diagnosed cases, 60 Tip 1 DM patients and 60 healty controls, in total 180 children and adolescents aged between 8-16 years were enrolled in this prospective, case-control study. ADHD diagnosed cases were recruited from The Child and Adolescent Psychiatry Outpatient Clinic of Dokuz Eylul University Hospital. They were all medication-naive. According to age and sex, children and adolescents in the control groups were matched to subjects in the ADHD group. Individuals with chronic physical illness, Mental Retardation, Pervasive Developmental Disorders, Bipolar Disorder, Psychotic Disorder or Substance Use Disorder were excluded. Type 1 DM patients with psychiatric disorder and healthy control subjects with any physical and psychiatric disorder were also excluded. The diagnostic assessments of psychiatric disorders in the all of the subjects were made according to the DSM-IV criteria, the Kiddie-Schedule for Affective Disorders and Schizophrenia for School-Age Children?Present and the Lifetime (K-SADS PL). Sociodemographic scale, Child Behavior Checklist (CBCL) and Pediatric Quality of Life Scale for Children (PedsQL 4.0 TM) were applied to all parents. In addition, Pediatric Quality of Life Scale for Children (PedsQL 4.0 TM) were applied to all of the children and adolescents. DSM-IV Based Turgay Diagnosis and Screening Scale for ADHD and Disruptive Behavior Disorders and in order to determine the severity of the disorder, Du Paul and CGI scales were also applied to ADHD diagnosed cases. The data about HbA1c values of children and adolescents in Type 1 DM group were collected. The results were assessed with appropriate statistical analysis. RESULTS In our study, the mean age was found 130.25 ± 16.31 months(10.8 ± 1.4 years) in the case and control groups. The majority of ADHD subjects (%68.3 - 41 subject) were male. Children and adolescents in the control groups were matched to subjects in the ADHD group according to age and sex. As a result, no significant difference between the groups were found in terms of age and sex (p=0.995, p=0.633). Similarly, when the case and control groups were compared for other socio-demographic variables, no significant difference were detected between the groups (p>0.05). Compared with healthy controls, children and adolescents diagnosed ADHD reported lower self-concept in all subscales and total scores of PedsQL except ?Physical Health Summary? (?Emotional Functioning?, ?Social Functioning?, ?Academic Functioning?, ?Psychosocial Health Summary? and ?Scale Summary?). No significant difference were found in ?Physical Health Summary? score. Similarly, children and adolescents diagnosed ADHD reported lower self-concept in ?Emotional Functioning? and ?Psychosocial Health Summary? scores than children and adolescents with Type 1 DM. Compared with healthy controls, parents of ADHD subjects reported lower concept about life quality of their children in all subscales and total scores of PedsQL (?Physical Health Summary?, ?Emotional Functioning?, ?Social Functioning?, ?Academic Functioning?, ?Psychosocial Health Summary? and ?Scale Summary?). In ADHD group, self reports and parent reports were found to be positively correlated in all subscales and total scores of PedsQL. However, parents with ADHD report lower concept than their children. When the life quality scores were compared between the subgroups of ADHD, Combined Type ADHD subgroup was found to take lower scores in terms of all scales and subscales except ?Social Functioning? compared to Attention Deficit Type ADHD subgroup. In both self reports and parent reports, ADHD diagnosed subjects with one or more comorbidity were found to take lower scores in terms of all scales and subscales except ?Physical Health Summary? compared to ADHD subjects with no comorbidity. In ADHD group, comorbidity was found to be associated with a negative effect on psychosocial aspects of life quality. In both self reports and parent reports, a negative correlation was detected between disease severity and life quality among ADHD subjects. Another negative correlation was obtained between CBCL problem behaviour scores and life quality. CONCLUSION In our study, life quality in terms of ?Emotional Functioning?, ?Social Functioning?, ?Academic Functioning? and ?Psychosocial Health? were found to be impared in the ADHD diagnosed subjects. In the presence of ADHD, learning process and eventually academic achievement appears to be negatively affected by the shorter attention period. In addition, the rapid changes in the mood, temper disregulation problems and impulsivity related behaviours, such as repeating the same mistakes without taking the course/ acting before consideration, deteriorates the social skills and the relations with peers and authority figures. Although self reports and parent reports were found to be positively correlated in ADHD group, parents with ADHD report lower concept than their children. This finding suggests that ADHD diagnosed children and adolescents may be more prone to perceive their self life quality better than their parents. When the life quality scores were compared between the subgroups of ADHD, Combined Type ADHD subgroup was found to take lower scores in terms of all scales and subscales except ?Social Functioning? compared to Attention Deficit Type ADHD subgroup. This result reveals the close relationship between executive functions and social functioning. In ADHD group, existing comorbidity was found to have a negative influence on the psychosocial aspects of life quality. In both self reports and parent reports, it was found that increase in both disease severity and CBCL problem behaviour scores were associated with a decline in the quality of life among ADHD diagnosed children and adolescents. This results suggests that the core symptoms of ADHD negatively affects quality of life and the evaluation of life quality during treatment of ADHD may become a guide to find the vulnerability areas. Keywords: Attention Deficit Hyperactivity Disorder (ADHD), Type 1 DM, Pediatric Quality of Life Inventory (PedsQL 4.0 TM), Child Behaviour Check List (CBCL)