الفهرس 
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Abstract
Attention deficit hyperactivity disorder (ADHD) affects 1-10% of children and is characterized
by a persistent pattern of inattention and/or hyperactivity I impulsivity. ADHD is one of the most
common and important disorders in child neuropsychiatric clinics according to different surveys.
Research in ADHD is growing rapidly but most of the results are still controversial as regards the
etiology and pathophysiology of the disorder as it is a heterogeneous behavioral disorder of
uncertain etiology.
Diagnosis of ADHD are made on the bases of phenomenology, but information is accumulating from the
neuropsychology, neuroanatomy, neurochemistry and molecular genetics of ADHD document
abnonnalities in well defined neuroanatomical network and neurochemical pathways.
Up date studies on ”the catecholamine hypothesis” of attention-deficit hyperactivity disorder
(ADHD) indicated, a multistage hypothesis which emphasized the interaction of the role of
norepinephrine, epinephrine, and dopamine in modulation of attention and impulse control.
This study aimed to investigate one of neurotransmiters (epinephrine) in cases of ADHD with and
without anxiety after doing standardized series of mentally stressful tasks. The study also
investigated some psychological and clinical factors in the sample of children with ADHD and we
tr.ied to find any correlation between them and the biological findings. So, we used this type· of study, which is cross sectional case-control
study.
The practical part of our study consists of the clinical study, psychometric ·study and biochemical
study of both groups of patients and control.
A) Tile group of patients consists of 24 children collected form child neuropsychiatric clinic
of institute of psychiatry, Ain Shams University diagnosed as ADHD
. according to DSM-IV criteria. The age of patients group ranged between 6 to 12 years with a mean
age (7.58+2.5). Male to female ratio is 2.5:1. The children were examined physically and
neurologically to exclude any possibility of gross neurological or medical disease either from the
history or the examination.
This group of patients was subdivided into two subgroups:
The first subgroup is diagnosed as ADHD alone. It consists of 17 children (13 males and 4 females)
with mean age (7.08+2.25) ,
The second subgroup is diagnosed as ADHD comorbid with anxiety. It consists of 7 children (4 males
and 3 females) with mean age (9.66+2.58).
No. medication were given at least one month prior to examination and urine analysis.
B)· Tile control group consists of 19 children matched with the first (experimental) group as
regard age, sex and socioeconomic class. They were collected from children attending pediatric
clinic in Ain Shams University hospital and proved to have no neurological, psychiatric or
gross medical diseases and not receiving any
medication prior to ·psychometric and biochemical examination of urine.
IQ of the group of patient and control group was at least average to be included in the study.
The two groups were subjected to· complete neuropsychiatric assessment for diagnosis and also the
researcher collect the relevant clinical data.
Psychometric assessment include the measurement of attention and impulsivity by computerized
testing of the reaction time and discrimination time. The test is nam:ed computerized sermion
programme (train the brain). Impulsivity also measured by MFFT for both groups. IQ was assessed by
using all items ofWISC-R to measure the verbal, performance and total IQ and to put the child under
mental stress for 70 minutes. Behavior of the children were assessed by ·using questionnaire ·for
the parents of the children (in Arabic language). It is Revised Behavior Problem Checklist (Quary
and Peterson, 1987). The questionn ire, included[ six: scales, conduct scale, socialized aggression
scale, anxiety withdrawal scale, attention scale, motor .excess scale and psychotic behavior
scale.
The most iniportant step in the study was the assessment of level of epinephrine in urine by ELIZA
teclmique which is collected after intelligence testing and all psychometric measures which
consume at least 70 minutes of mental stress. This biochemical examination was done for all
patients and control group.
Results of the study were illustrated clearly.· The two groups were matched as regards age,
gender, socioeconomic states.
The clinical study showed that children with ADHD showed high rates of comerbid disorders of
conduct, anxiety and language disorder.
Psychometric study revealed frankly the poor performance of children with ADHD, on attention and
discrimination tests of the computerized sennion programe.
Matching Familiar Figure Test also revealed that the group of patients was more impulsive than the
control group. Also revealed .that ADHD/ ANX. group is less impulsive than ADHD alone ·group but
still more impulsive than the control group.
Also, the · questionnaire given to the parents of the children in both groups revealed that
children with ADHD have more aggressive, antisocial behavior, motor excess and inattention than
nonnal children.
The most important results ofthis work is the results of level of excretion adrenaline in urine
after mental stress. It was found that urinary adrenaline excr tion is less in cases of ADHD than
·the control group and coparing group of ADHD alone and ADHD/ANX. · group it was found that it is
significantly lower in ADHD alone than that in ADHD/ANX. which is near to the control group.
Our results are in agreement with other few studies of the biochemical studies of
neurotnmsmitters in children with ADHD using ELIZA technique to assess urinary epinephrine after
mental stress:
So our study give·s good evidence for the biological theory of ADHD. These results can be
integrated in the other theories of ADHD whether genetic, chemical and neurophysiology’s.