The comorbidity of internalising disorders on attention deficit hyperactivity disorder in primary schools in Lepelle-Nkumpi Municipality, Limpopo Province

Abstract

Attention Deficit Hyperactivity Disorder (ADHD) is the most common diagnosed neurocognitive behavioural developmental disorder among school going–age children. ADHD in most instances is found to comorbid with internalising disorders such as anxiety and depression, therefore causing impairment on behaviour, emotions, academic, social and many areas of functioning. The existence of comorbid internalising disorders complicates the presentation of ADHD symptoms than if it was pure ADHD. The aim of the study was to explore the comorbidity of internalising disorders and ADHD symptoms. The study investigated whether children with ADHD have more symptoms of anxiety and depression than children without ADHD. The study went further to investigate whether children with ADHD have low self-esteem than children without ADHD. Also, that internalising comorbidities (anxiety and depression) are more prevalent in girls than in boys who have more externalising comorbidities which are Oppositional Defiant Disorder (ODD) and Conduct Disorder (CD) and anger issues. The null hypotheses further showed that, children with ADHD do not have more symptoms of anxiety and depression than children without ADHD. Moreover, children with ADHD have no lower self-esteem than children without ADHD. Also, internalising disorders (anxiety and depression) are not prevalent in girls than in boys who do not exhibit more externalising disorders which are Oppositional Defiant Disorder (ODD), Conduct Disorder (CD) and anger issues. The study was conducted in Lepelle-Nkumpi Municipality in Lebowakgomo sub circuit.

A total of 250 children (94 boys and 156 girls, aged 6 – 12) who were purposively selected participated in the study. A total of 125 clinically diagnosed ADHD were matched to 125 control group for age and gender. Participants were assessed on a battery consisting of Parent/Teacher Disruptive Behavioural Rating Scale (DBD), which was used to assess the presence and degree of ADHD- related symptoms (inattention and hyperactive/ impulsive); Oppositional Defiant Disorder and Conduct Disorder and Beck Youth Inventory Second Edition (BYI II), which was used to assess emotional and psychological issues that children experience. ADHD scores obtained on the DBD scale were correlated with scores obtained on BYI II scale. The study only focused on learners from primary schools in Lepelle-Nkumpi in Lebowakgomo sub circuit. In this research study, children who were reported to have a history of neurological problems such as head injurie, epilepsy, cerebral palsy or severe psychiatric disorders were excluded from the study. The results were analysed using the analysis of variance (ANOVA) and post hoc benferoni analysis to determine the significant difference within ADHD subtypes. Results of the study showed that children with ADHD had comorbid internalising disorders (anxiety and depression) when compared to their neurotypical group. Both boys and girls with a clinical diagnosis of ADHD showed symptoms of anxiety and depression. More symptoms of anxiety and depression were observed within the ADHD-HI, ADHD-PI and ADHD-C subtypes. Comorbid internalising disorders (anxiety and depression) were also associated with impairments with ADHD symptom, in particular inattention. Children with ADHD also showed more symptoms of low self-esteem when compared to their neurotypical group. Both boys and girls showed significant difference level of low self-esteem in all ADHD subtypes (ADHD-HI, ADHD-PI and ADHD-PI). The results further revealed that both boys and girls equally showed symptoms of comorbid internalising disorders (anxiety and depression), whereas girls showed significantly more symptoms of externalising comorbidities such as ODD, CD and anger issues. In conclusion, the findings suggest that the comorbidity of internalising disorders in a clinically diagnosed child with ADHD worsens or complicates the child’s expected normal functioning unlike when the child was presenting with only ADHD. The results further suggest that a child with clinical diagnosis has double impairment as a result of many impairments which are occurring at the same time. Moreover, the existence of externalising comorbidities which are salient in girls with ADHD may require proper screening and assessment.