الفهرس 
Diagnosis of ADHD
Aetiology of HyperactivityOnly 14 pages are availabe for public view
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Abstract
Reports on attention deficit hyperactivity disorder have
uniformly indicated high rates of behavioral problems including
lower intelligence, poorer academic skills, increased motor activity
and is strongly associated with learning disabilities [(Gorden
(1991) and Klein and Mannuzza (1991)].
Although a considerable amount of work has been
appeared on the role of raised blood lead level as causative factor
in the development of hyperactivity, little work has been carried
out on the rest of metals.
In an attempt to elucidate the role of the elements lead, Cd,
Mn, Zn and Cu in the development of hyperactivity and to
investigate any possible relationship between hyperactivity,
Intelligence quotient and serum lipid levels, the present work was
conducted. A large pool of healthy primary school children of
Giza province were clinically examined to select the study
subjects.
The chosen sample included 38 children whose ages ranged
between 7 and 12 years, 28 were hyperactive and 10 normals
served as controls.
The incidence of hyperactivity in some primary schools of
Giza province was found to be 0.96%.
In the present work a child was diagnosed hyperactive if he
achieved a score greater than or equal to 50 per cent on both
Conners Abbreviated Teacher Rating Scale (ATRS) and Mother
hyperactivity rating scale (Werry-Wiess Peters Activity Scale After
Omitting School Behavior).
All subjects were submitted to the following investigations:
1) Good enough test was applied to the children for
calculation of IQ.
2) Anthropometric measurements were performed to assess
grov.th of hyperactive children.
3) Blood lead:
Blood samples were analyzed for lead concentration using
flameless atomic absorption spectro- photometer (high
graphite analysis).
4) Serum Cd, Mn, Zn and Cu:
Serum elements were assayed usmg atomic absorption
spectrophotometer (Zeiss FMD3)
5) Serum lipids:Serum cholesterol and triglycerides were determined by
enzymatic colorimetric method.
The results obtained can be summarized as follows:
The present results revealed that the Teacher rating scale %
is highly correlated with the Mother rating scale %.
On comparison between anthropometric measurements of
control and hyperactive children, our results showed no
statistical significance. Thus, there is no associated growth
slow-down due to hyperactivity disorder.
Blood lead concentration was significantly higher. The
mean value ±. SEM in the hyperactive group was 17.79 ±.
1.35 ug/dl compared to 13.63 ±. 1.29 ug/dl in the control
group (P<O.OS).
Elevated blood lead in the hyperactive group is positively
correlated ·with hyperactivity i.e. Teacher and Mother rating scale
%.
It is worthy to note that 9 out of 28 hyperactive children had
blood lead level above 24 ug/dl which may be considered in the
toxic range compared to non in the control group. Although blood lead reflects only recent exposure, however
at reasonable constant levels of environmental lead exposure it
has been shown that blood lead concentration are fairly stable.
Cadmium, is an important environmental hazard. Cd may
retard the development of certain neuro-chemicals which may
have long-term implication on the brain functions.
In the present work serum Cd rose significantly in the
hyperactive group compared to the control group. This rise is
highly significant (P < 0.001 ).
The concentration of serum cadmium in the hyperactive
group also correlated well \Vith hyperactivity i.e. Teacher and
Mother rating scale %.
Serum Mn in the hyperactive group of the present work was
not changed when compared to the non- hyperactive group.
Other investigators found that there was a raised
manganese level in hyperactivity and learning disabled children
and this they related to the possible use of infant formula, many
of which contain high manganese levels up to one hundred times
the level found in human milk.
Insignificant change was also found in serum Zn and Cu
between hyperactive and control group. There is no correlation
between hyperactivity and IQ on one side and serum Mn, Zn and
Cu on the other.
The results presented in our study revealed that the mean
value for IQ of the control group was significantly higher when
compared to the hyperactive group which was in the low average
range of normal intelligence.
Also a significant negative correlation was found between
IQ and elevated blood lead and elevated serum Cd of the
hyperactive children.
It is concluded that raised blood lead as well as cadmium
are associated with lower intelligence and increased hyperactivity
of children in Giza province.
Our results showed no statistical significant change between
total cholesterol in hyperactive and control groups. Also, there
was no correlation between serum cholesterol on one side and
hyperactivity or IQ on the other. However serum triglyceride increased significantly in the
present hyperactive group. Also serum triglyceride was positively
correlated with hyperactivity elevated blood lead and serum
cadmium.
Thus changes in blood lipid levels may indicate subclinical
trace elements poisoning.