Awareness and knowledge of Attention Deficit Hyperactivity Disorder among general population of Makkah, Saudi Arabi

Abstract

Background and aim: Attention Deficit Hyperactivity Disorder ADHD is considered as one of the common neuro developmental disorders. It is common among children and young adults, affecting their social, academic, and occupational functioning. ADHD can be diagnosed using the revised DSM-5 diagnostic criteria. As there is lack of studies that assess the awareness and knowledge of ADHD among the general population of Makkah, our study targets the general population of Makkah to assess their awareness and knowledge regarding ADHD. Methods: A descriptive cross sectional study using an electronic survey formed by Google forms. Data were obtained from residents of Makkah city aging 15 years and above. Results: A Total of 603 participants have enrolled in this study, 69 of them were excluded for not meeting the criteria. (94.2%) had heard about ADHD and (39.9%) of responders knew about it from social media. 56.6% considered that it’s a mixed disorder (behavioral, neurological and psychiatric), whereas 24.2% believed it to be a behavioral disorder only. As for its cause, 80% of the participants believed it is a multi-cause disorder. In regard to the treatment, 75.1% determined that the best modality is combined medical and behavioral therapy, while 19.9% favored behavioral therapy, 2.6% preferred medications and 2.4% believed there is no treatment for ADHD. Conclusion: Our study reported the knowledge and awareness level of Makkah population regarding ADHD. Makkah residents would benefit from further education and
orientation regarding ADHD.

Full text

MEDICAL SCIENCE l ANALYSIS ARTICLE
Medical Science, 26, ms412e2440 (2022) 1 of 7
Awareness and knowledge of
Attention Deficit Hyperactivity
Disorder among general
population of Makkah, Saudi
Arabia
Hazem Mohammad Aljabri1*, Bassam Musleh Bin
Laswad1, Hasan Zuhier Binjabi1, Mohammed Hasan
Alturki1, Abdulaziz Omar Babukur1, Azzam Musleh Bin
Laswad1, Mohammed Osama Krenshi1, Mokhtar
Mahfouz Shatla2,3
ABSTRACT
Background and aim: Attention Deficit Hyperactivity Disorder ADHD is
considered as one of the common neuro developmental disorders. It is
common among children and young adults, affecting their social, academic,
and occupational functioning. ADHD can be diagnosed using the revised
DSM-5 diagnostic criteria. As there is lack of studies that assess the awareness
and knowledge of ADHD among the general population of Makkah, our
study targets the general population of Makkah to assess their awareness and
knowledge regarding ADHD. Methods: A descriptive cross sectional study
using an electronic survey formed by Google forms. Data were obtained from
residents of Makkah city aging 15 years and above. Results: A Total of 603
participants have enrolled in this study, 69 of them were excluded for not
meeting the criteria. (94.2%) had heard about ADHD and (39.9%) of
responders knew about it from social media. 56.6% considered that it’s a
mixed disorder (behavioral, neurological and psychiatric), whereas 24.2%
believed it to be a behavioral disorder only. As for its cause, 80% of the
participants believed it is a multi-cause disorder. In regard to the treatment,
75.1% determined that the best modality is combined medical and behavioral
therapy, while 19.9% favored behavioral therapy, 2.6% preferred medications
and 2.4% believed there is no treatment for ADHD. Conclusion: Our study
reported the knowledge and awareness level of Makkah population regarding
ADHD. Makkah residents would benefit from further education and
orientation regarding ADHD.
Keywords: ADHD, Attention Deficit Hyperactivity Disorder, awareness
Makkah, Saudi Arabia.
Medical Science
pISSN 2321–7359; eISSN 2321–7367
To Cite:
Aljabri HM, Laswad BM, Binjabi HZ, Alturki MH, Babukur AO, Laswad
AM, Krenshi MO, Shatla MM. Awareness and knowledge of Attention
Deficit Hyperactivity Disorder among general population of Makkah,
Saudi Arabia. Medical Science 2022; 26:ms412e2440.
doi:
https://doi.org/10.54905/disssi/v26i128/ms412e2440
Authors’ Affiliation:
1Medical student, College of Medicine, Umm Al-Qura University,
Makkah, Saudi Arabia
2Department of Family Medicine, College of Medicine, Menoufia
University, Menoufia, Egypt
3Department of Community Medicine and Pilgrims Health Care, College
of Medicine, Umm Al-Qura University, Makkah, Saudi Arabia
ORCID
Hazem Mohammad Aljabri: orcid.org/0000-0001-6194-1013
Bassam Musleh Bin Laswad: orcid.org/0000-0002-3449-6230
Hasan Zuhier Binjabi: orcid.org/0000-0002-2048-9902
Azzam Musleh Bin Laswad: orcid.org/0000-0003-2425-0584
Abdulaziz Omar Babukur: orcid.org/0000-0003-2066-4157
Mohammed Hasan Alturki: orcid.org/0000-0002-4294-1285
*Corresponding author
Medical student, Faculty of Medicine, Umm Al-Qura University,
Makkah,
Saudi Arabia
Email: hazemaljabri9@gmail.com
Peer-Review History
Received: 11 August 2022
Reviewed & Revised: 14/August/2022 to 06/October/2022
Accepted: 12 October 2022
Published: 15 October 2022
Peer-review Method
External peer-review was done through double-blind method.
URL: https://www.discoveryjournals.org/medicalscience
This work is licensed under a Creative Commons Attribution 4.0
International License.
Copyright © 2022 Discovery Scientific Society.
DISCOVERY
SCIENTIFIC SOCIETY

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1. INTRODUCTION
According to the American Psychiatric Association, attention deficit hyperactivity disorder (ADHD) is considered a chronic
disorder that affects mainly children and often extends into adult life, affecting their social, academic and occupational functioning,
characterized by elements of inattention, hyperactivity, and impulsivity (Harpin, 2005; Ghiasi et al., 2022). There are three major
types of ADHD; patients with the combined type, which is the most common, often have problems paying attention and
concentrating on activities, and may exhibit hyperactive or impulsive behavior (Biederman et al., 2006). The second type is the
inattentive type, in which the patients may have problems paying attention but do not exhibit signs of hyperactivity or impulsivity.
Lastly, the hyperactive-impulsive type is the least common type, which has less problems with attention and it is the most prevalent
in pre-schoolers where the hyperactive component usually predominates (Franke et al., 2012; Chou et al., 2015; Hadzic et al., 2017;
Adeyemo et al., 2014; Donzelli et al., 2019).
The prevalence of ADHD has been previously assessed in several studies around the world. As in the United States of America
and Korea, ADHD prevalence was found to be 6% and 8% respectively (Al-Ahmari et al., 2018). Locally, Al-Zaben et al., (2018) has
assessed the prevalence of ADHD among primary school students in the western region of Saudi Arabia and found it to be 5%.
According to DSM-5 criteria, the presence of 6 or more inattentive symptoms and/or 6 or more impulsive and hyperactivity
symptoms in children is required for a modern diagnosis of ADHD. Adults with ADHD have somewhat different requirements:
those aged 17 and up only need to demonstrate 5 symptoms to meet the criterion. DSM-5 further stipulates those symptoms must
be 2 or more environments, begin prior to age 12, cause notable dysfunction, and not occur primarily in the context of a psychotic
illness or be better accounted for by another mental disorder or medical condition (American Psychiatric Association, 2013).
Common Symptoms of ADHD present as attention deficit, including decrease in concentration and difficulty in following
instructions. Symptoms of hyperactivity include repetitive movements and inability to sit in one place (American Psychiatric
Association, 2013). ADHD patients are more likely to exhibit more antisocial behaviors than children without ADHD and they tend
to drop out of school, have fewer friends and in some cases not completing college (Barkley, 2014). When ADHD patients advance
to adulthood, they have more difficulty finding work; have higher rates of psychiatric disorders such as personality disorders,
depression and substance misuse (Barbaresi et al., 2013; Mash & Johnston, 1983). Moreover, the treatment of ADHD consists of a
combination of pharmacological and behavioral intervention with consideration of related comorbid disorders (Austerman, 2015).
2. MATERIALS AND METHODS
This is a cross-sectional study that included the general population of Makkah, Saudi Arabia as participants in this study. The study
population included both genders male and female, Saudi and non-Saudi individuals residing in Makkah city who were above 15
years of age, we excluded participants residing outside Makkah city and those under 15 years of age. An electronic Self-
administrated survey formed by google forms, that was distributed in May 2022 via social media platforms after obtaining the
ethical approval by the Biomedical ethics committee at Umm Al-Qura University (UQU), College of Medicine, Makkah, Saudi
Arabia, Approval No (HAPO-02-K-012-2022-05-1086). The study sample was calculated by OpenEpi website version 3.0 (AG, KM,
2013), in consideration of the following: the residents of Makkah city estimated to be 1.5 million according to the general authority
for statics Saudi Arabia, keeping the confidence interval (CI) level at 95% and considering 50% prevalence of the sample size. The
sample size was calculated to be 385 participants.
We used a valid assessment tool based on a previously published study (Al-Bluwe et al., 2020). Consent was obtained from all
participants; contact info was attached with the survey to answer any inquiries. The survey included three sections, the first section
contained demographic data such as: age, gender and educational level. The second section assesses the general knowledge of
Makkah population regarding ADHD. The third section consists of the diagnostic symptoms and signs of ADHD based on the
Diagnostic and Statistical Manual of Mental Disorders, fifth edition (DSM-5) criteria which include 15 items.
3. RESULTS
A total of 603 participants completed the questionnaire, 69 have been excluded for not meeting the criteria. As (Table 1) shows the
participants’ socio-demographic characteristics, in which 311 of the sample were female (58.2%) and 223 were male (41.8%). The
majority of them (n=143, 26.8%) were between 15-25 years, while (n=105, 19.7%) were between 26-35 years, and (n=133, 24.9%)
between 36-45 years and other age groups are shown in table 1. Regarding the educational differences among the participants, most
of them (n=355, 66.5%) had a university degree, (n=86, 16.1%) were secondary school graduates, (n=61, 11.4%) were Postgraduates.
Meanwhile, minority of the participants (n=19, 3.6%) and (n=13, 2.4%) had middle school education and elementary education,
respectively.

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Table 1 participants’ socio-demographic characteristics
Variables
N
%
Gender
Male
Female
223
311
41.8
58.2
Age
15-25
26-35
36-45
46-55
56-65
<66
143
105
133
108
37
8
26.8
19.7
24.9
20.2
6.9
1.5
Educational level
Elementary
Middle school
Secondary
University
Postgraduate
13
19
86
355
61
2.4
3.6
16.1
66.5
11.4
In addition, Table 2 shows participants’ knowledge of ADHD. Impressively near all of them (n= 503, 94.2%) have heard about
ADHD and could specify from where have they heard about it; (n=213, 39.9%) chose social media, (n=106, 19.9%) by reading a
medical website, (n=103, 19.3%) through previous experience with an ADHD patient, (n=54, 10.1%) from books, journals, and
newspapers and (n=27, 5.1%) did not know. Moreover, more than half of the participants (n=302, 56.6%) presume the nature of
ADHD to be mixed disorder (behavioral, neurological and psychiatric), while (n=129, 24.2%) believed it to be a behavioral disorder,
(n=38, 7.1%) considered it as a neurological disorder, (n=32, 6.0%) thought it’s a psychiatric disorder and (n=33, 6.2%) did not know.
In regard to the cause of ADHD, more than three quarters (n=427, 80%) believed it’s a multi-cause disorder, (n=76, 12.5%)
considered it to be genetic cause, (n= 17, 3.2%) thought it’s due to nutritional habits, (n=21, 3.9%) accused food preservatives and
dyes and (n=2, 0.4%) charged smoking as the cause. When the responders were asked about the treatment method, (n=401, 75.1%)
preferred medical and behavioral therapy, (n=106, 19.9%) favored behavioral therapy, while the rest of them (n=14, 2.6%) chose
medications and (n=13, 2.4%) considered it as an untreatable disorder.
Table 2 Participants’ knowledge of ADHD
N
%
Have you heard about ADHD?
Yes
503
94.2
No
31
5.8
If yes, Source of information:
Previous experience with an ADHD patient known to me
103
19.3
Reading a medical website
106
19.9
Books, journals, and newspapers
54
10.1
Social media
213
39.9
Don’t know
27
5.1
Nature of ADHD:
Behavioral disorder
129
24.2
Neurological disorder
38
7.1
Psychiatric disorder
32
6.0
Mixed disorder (behavioral, neurological and psychiatric)
302
56.6
Don’t know
33
6.2
Underlying causes of ADHD:
Genetic disorder
67
12.5
Nutritional habits
17
3.2

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Food preservatives and dyes
21
3.9
Smoking
2
0.4
Multi-cause disorder
427
80.0
Treatment:
Behavioral therapy
106
19.9
Medication
14
2.6
Medical and behavioral therapy
401
75.1
There is no treatment for ADHD
13
2.4
On the last part of the questionnaire as shown in (Table 3), which assess the participants’ ability to recognize the diagnostic
signs and symptoms of ADHD according to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-V)
criteria, (n= 399, 74.7%) of the participants agreed that ADHD patients have poor attention and concentration, similar to (n=414,
77.5%) who were convinced that patients suffer from hyperactivity and inhibition issues. (n=314, 58.8%) believed that the aff ected
persons do not listen to the instructions given to them and (n=163, 30.5%) noted that patients fail to complete the tasks they started.
A quarter of the participants (n=134, 25.1%) thought that patients avoid difficult tasks which require mental effort and attention and
(n=230, 43.1%) considered that ADHD patients face difficulty in organizing their tasks and activities. (n=151, 28.3%) of responders
agreed that ADHD patients misplace their belongings such as “pens, games, and books”, (n=129, 24.2%), (n=260, 48.7%) believed
that patients encounter academic failure or difficulty in learning and difficulty waiting for their turn, respectively. Interestingly,
(27.9%) thought that patients do not enjoy playing and do not sit quietly with others, as (34.6%) thought they show excessive
speaking.
Of the total participants (n=182, 34.1%) only, were agreeing that the child quarrels with other children often, while (n=336,
62.9%) thought that patients show excessive running, jumping and climbing. Lastly, (n=297, 55.6%) believed that the patient cannot
control his actions and (n=162, 30.3%) agreed that these different signs and symptoms should be demonstrated in two settings for
instance at home and school (Figure 1).
Table 3 Signs and symptoms based on the DSM-V criteria for ADHD
N
%
Poor attention and concentration
399
74.7
Not listening to instructions
314
58.8
Failure to complete the tasks they start
163
30.5
Avoid difficult tasks that require mental effort and attention
134
25.1
Difficulty in organizing tasks and activities
230
43.1
Misplacing their belongings such as pens, games, and books
151
28.3
Experience academic failure or difficulty in learning
129
24.2
Show hyperactivity and inhibition issues
414
77.5
Show excessive running, jumping, and climbing
336
62.9
Not enjoying playing and not quietly sitting with others
149
27.9
Speaking excessively
185
34.6
Find it difficult to wait for their turn
260
48.7
Quarrel with other children often
182
34.1
Cannot control their actions
297
55.6
The problem should be present in two settings (e.g., home
and school)
162
30.3

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Figure 1 Signs and symptoms based on the DSM-V criteria for ADHD
4. DISCUSSION
Attention deficit hyperactivity disorder (ADHD) is one of the commonest childhood mental disorders, as it is associated with
serious comorbidities including sleep disorders, learning deficit, and psychiatric disorders (See et al., 2021). This is why we need the
general population to have awareness about such a common, serious condition that requires early recognition (See et al., 2021). Our
study aims to assess the awareness and knowledge of ADHD among the general population of Makkah, Saudi Arabia in where
there is a lack of studies about ADHD. The results showed that the overall knowledge of the general population of Makkah about
ADHD was fair. Most of the study participants were aging between 15-25 years of age. (58.2%) of the participants were female and
(41.8%) male, whereas in a similar study conducted in Hail region (Al-Bluwe et al., 2020), (83.9%) of the participants were female
and (16.1%) were male. The vast majority of our participants (94.2%) have heard about ADHD in contrast to a study conducted by
University of Chicago among United States of America residents (McLeod et al., 2007) showed lower percentage (64%).
We have found that social media is the main source of information regarding ADHD for Makkah population which is similar to
the study conducted in Hail region (Al-Bluwe et al., 2020), followed by reading medical websites and through previous experience
with ADHD patient; reflecting the prevalence of ADHD. Although social media is not the optimal source of information, yet it
provides elemental knowledge, hence there should be supervised and reviewed content on relevant social media platforms to
enhance the knowledge and correct false information regarding ADHD. Despite that many participants believed ADHD to be a
mixed behavioral, neurological and psychiatric disorder; there were a considered number of participants that presumed ADHD to
be only a behavioral disorder. Moreover, (80%) of participants believe that ADHD is a multi-cause disorder dissimilarly when
compared to a study conducted in Madina region (Alghamdi et al., 2017) only (19.4%) of participants believe that ADHD is a multi-
cause disorder.
399
314
163
134
230
151
129
414
336
149
185
260
182
297
162
050 100 150 200 250 300 350 400 450
Poor at tention a nd concentra ti on
Not li stening to in st ructions
Failu re to complete the ta sk s t hey st ar t
Avoid d if ficult task s th at requi re m ental
effort an d attent io n
Diffi cu lty in o rg anizing tasks and a ct ivit ie s
Mi sp lacing their belongin gs s uch a s pens,
games, a nd books
Exp er ien ce aca de mic failure or di ff iculty in
learnin g
Show hy peractivity and i nhibition issues
Show ex ce ssive r un ning, jumpin g, a nd
climb i n g
Not en joyi ng p la yi ng and n ot qui et ly sitt in g
with o thers
Spea ki ng exc essively
Find i t difficu lt t o wait for t he ir turn
Qua rr el with oth er children often
Ca nn ot c ontrol th ei r action s
The p ro blem sh ou ld be present i n two
sett in gs (e. g., ho me and school)
No.

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However, we have noticed that many participants were not completely oriented about the symptoms and the disease
presentations in the affected person with ADHD in contrast to the study conducted in Hail region (Al-Bluwe et al., 2020) which
showed higher orientation level regarding ADHD signs and symptoms. The most common recognizable sign by the participants is
that the patient “shows hyperactivity and inhibition issues” followed by “poor attention and concentration”. The least recognizable
sign is that they “experience academic failure or difficulty in learning”; thus, we think that it’s very important to clarify these
diagnostic signs and symptoms. Furthermore, most of the study participants believed that combination of medical and behavioral
therapy is the most efficient modality of treatment.
5. CONCLUSION
This study showed the awareness and knowledge level of Makkah general population regarding ADHD, based on our findings we
recommend raising the awareness of ADHD through educational campaigns, online videos, as we encourage the specialists to
utilize their social media accounts in order to explain the disorder nature, causes, signs and symptoms as well as the treatment
methods and its importance. Therefore, we advocate for further similar studies in different regions of the kingdom of Saudi Arabia
which would benefit from a larger study sample to get more accurate and generalized results and correlate these results with the
participants’ gender, age, and educational level.
Ethical approval
The study was approved by the Medical Ethics Committee of Umm Al-Qura University (ethical approval number: HAPO-02-K-012-
2022-05-1086).
Informed consent
Informed consent was obtained from participants at the beginning of the electronic questionnaire.
Acknowledgment
The authors would like to thank all the participants who contributed in this study.
Funding
This study has not received any external funding.
Conflicts of interest
The authors declare that there are no conflicts of interests.
Data and materials availability
All data associated with this study are present in the paper.
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