title: Prevalence of attention deficit hyperactivity disorder (ADHD) in children presenting with self-inserted nasal and aural foreign bodies.
abstract: BACKGROUND
  Attention deficit hyperactivity disorder (ADHD) is one of the commonest behaviour disorders in children, characterized by hyperactivity, inattention and impulsiveness. Tendency towards risk-taking behaviour and accident proneness is well recognized in these children. Accordingly, it could be hypothesized that children with ADHD are at increased risk for self-inserting foreign bodies, but a Medline search did not reveal any studies that investigated this possibility.
  
  
  OBJECTIVE
  To study the prevalence of ADHD among children seen with self-inserted foreign bodies.
  
  
  METHODS
  Children attending ENT service in a tertiary care children's hospital with self-inserted foreign bodies were assessed for the presence of ADHD. Two rating scales, Strengths and Difficulties Questionnaire (SDQ)-Parent Version, and Conners Parent Rating Scale (CPRS) were used to identify the cardinal features of ADHD.
  
  
  RESULTS
  A total of 34 children, age 3-10 years, participated in the study. Majority (51.6%) were female. Nearly 25% had one or more previous incidents of foreign body insertion and 20% had previous accidental injuries that needed hospitalization. A prevalence of 14.3% for ADHD was identified, which is almost 3 times more than that reported in a previous study among children attending medical and surgical outpatient clinics (5.1%). High rates for abnormal hyperactivity scores were reported by parents, 37.4% with SDQ and 20% with CPRS. Although 64.7% of the sample was under 5 years, almost all children who were identified with ADHD belonged to 5-10 year age group, thus effectively excluding younger aged children who may have age related apparent hyperactivity.
  
  
  CONCLUSIONS
  Awareness of possible association between self-insertion of foreign bodies and ADHD is needed and an assessment for hyperactivity/ADHD is justified in such children, especially in those over the age of 5 years.
authors.affiliation: Department of Psychological Medicine, University of Colombo, Faculty of Medicine, Kinsey Road, Colombo 008, Sri Lanka. hemamali_p@yahoo.com
authors.forename: H
authors.initials: H
authors.lastname: Perera
authors.forename: S M
authors.initials: SM
authors.lastname: Fernando
authors.forename: A D K S N
authors.initials: AD
authors.lastname: Yasawardena
authors.forename: I
authors.initials: I
authors.lastname: Karunaratne
mesh_terms: D017677:Age Distribution; D001289:Attention Deficit Disorder with Hyperactivity / Q000175:diagnosis / Q000453:epidemiology*; D002648:Child; D002675:Child, Preschool; D015331:Cohort Studies; D004423:Ear; D005260:Female; D005500:Follow-Up Studies; D005547:Foreign Bodies / Q000175:diagnosis / Q000453:epidemiology* / Q000628:therapy; D006801:Humans; D008297:Male; D009666:Nose; D015995:Prevalence; D012189:Retrospective Studies; D018570:Risk Assessment; D017678:Sex Distribution; D013188:Sri Lanka / Q000453:epidemiology