AMRITA COLLEGE OF NURSING

AMRITA VISHWA VIDYAPEETHAM UNIVERSITY

AIMS , KOCHI -41

RESEARCH PROPOSAL

PREVALENCE OF ADULT ATTENTION DEFICIT HYPERACTIVITY

DISSORDER (ADULT ADHD) AND ITS RELATIONSHIP WITH BMI AND
BLOOD PRESSURE

Primary Investigator: Mr. Arun Kumar S K

Asst. Professor
Amrita College Of Nursing
Amrita vishwa vidyapeetham

Co – Investigators: Ms. Karthika Menon and Ms. Krishna s Kumar

IV year Bsc Nursing
Amrita College Of Nursing
INTRODUCTION
Adult Attention Deficit Hyperactivity Disorder (ADHD) is a mental health
condition that can lead to unstable relationships , poor work performance and low
self esteem. ADHD symptoms include trouble focusing , hyperactivity and
impulsive behavior.
Though it's called adult ADHD, symptoms start in early childhood and continue
into adulthood. In some cases, ADHD is not recognized or diagnosed until the
person is an adult. Adult ADHD symptoms may not be as clear as ADHD
symptoms in children. In adults, hyperactivity may decrease, but struggles with
impulsiveness, restlessness and difficulty paying attention may continue.[1]

Background Of The Problem

Almost everyone has some symptoms similar to ADHD at some point in their
lives. If your difficulties are recent or occurred only occasionally in the past
,you probably don’t have ADHD. ADHD is diagnosed only when symptoms
are severe enough to cause ongoing problems in more than one area of your
life. These persistent and disruptive symptoms can be traced back to early
childhood. Diagnosis of ADHD in adults can be difficult because certain
ADHD symptoms are similar to those caused by other conditions, such as
anxiety or mood disorders. And many adults with ADHD also have atleast one
other mental health condition , such as depression or anxiety.Attention deficit
hyperactivity disorder affects about 5% of children, and about half of them
will carry those symptoms into adulthood[1].Evidence from neurological
study suggest that ADHD symptoms may be related to disturbances in
dopamine levels in brain areas which also control blood pressure[2]. Studies
have revealed high rates of ADHD (26-61%) in patients seeking weight loss
treatment suggesting an association between ADHD and obesity[3].
Need And Significance of the study
]. Epidemiological studies have shown that ADHD is a common disorder seen in
5% to 10% of school age children. Longitudinal studies have reported that
ADHD symptoms would persist through adolescence years in 70% and
through adulthood in 50%.ADHD imposes an enormous burden on society in
terms of psychological dysfuction, adverse vocational outcomes ,stress on
families, and societal financial costs. The comorbidity between ADHD and
psychiatric disorders has been extensively explored , the association with
 somatic conditions have received much less attention . An increasing number
of clinical and epidemiological studies suggest a possible association between
ADHD and obesity or overweight.[4]

Pagoto etal conducted a study on association between Adult Attention

Deficit Hyperactivity Disorder and obesity in US population. Cross –
sectional data from the collaborative psychiatric Epidemiology Surveys were
used. Participants were 6,735 US residents (63.9% white ; 51.6% female )
aged 18-44 years. A retrospective assessment of childhood ADHD and a self
report assessment of adult ADHD were administered. The prevalence of
overweight and obesity was 33.9% and 29.4 % respectively , among adults
with ADHD , and 28.8 and 21.6% respectively , among persons with no
history of ADHD.[3]

In a study on 18-44 year old American workers , the prevalence of ADHD

was reported to be 4.2% according to DSM-IV . The prevalence rate was
3.4% among those aged between 18 and 29 years and 4.7% among those
aged 30 to 44 years. The prevalence of Adult ADHD did not differ across
different educational levels and career skills in the workers. Another study
was performed by WHO to determine the prevalence rate and career effects
of adult ADHD in ten countries. This study showed tht 1.3% to 4.9% (3.5%
on average) of the workers had adult ADHD. These subjects had 22 days
more missed role performance compared with healthy subjects annually.
Also , a study in a national American sample showed that the prevalence rate
of Adult ADHD is 4.4%.[5]

A study was conducted by Fuemmeler B F, Ostbye T, Yang C etal to examine

the association between ADHD symptoms , Obesity and hypertension in
young adults.The study population consisted of 15,197 respondents from the
National Longitudinal Study of Adolescent Health, a nationally
representative sample of adolescents followed from 1995 to 2009 in the United
States. Linear association was identified between the number of inattentive (IN)
and hyperactive/impulsive (HI) symptoms and waist circumference, BMI, diastolic
blood pressure and systolic blood pressure.Self reported ADHD symptoms were
associated with adult BMI and change in BMI from adolescents to adulthood
,provided further evidence of a link between ADHD symptoms and obesity.
In a cross sectional study about the prevalence and correlation of adult
ADHD among 11422 subjects aged 18-44 years from 10 countries in
America , Europe and Middle East , the mean prevalence rate of adult
ADHD was 3.4% (minimally 1.21 in spain and 7.32 in France ). The
prevalence rate was lower in countries with poor economic status (1.9%)
compared to those with high economic status (4.2%). The authors concluded
that adult ADHD is often accompanied by other DSM IV disorders and
would result in major disability. Only small percentage of patients with
ADHD referred to psychiatrists to seek treatment for ADHD symptoms and
also those who referred for treatment mainly had emotional and behavioural
problems.[6]

Children who have a high blood pressure are more likely to have learning
disabilities and ADHD than children who are not hypertensive[5].
Contradictory to this a study from the nationwide German Health Interview
and Examination survey for children and adolescents revealed a significant
association between low blood pressure and ADHD symptoms . In total
cohort of n=6922 study participants aged 11-17 years , mean arterial blood
pressure was significantly higher in controls (86.7 +_8.2mmhg) than in the
two groups of confirmed (85.5+_7.8mmhg,p=0.004 , n=430) and suspected
ADHD patients (84.6+_ 8.2 ,p<0.001 , n=399)[2]. This contradictory finding
developed curiosity in researchers to conduct studies on adult ADHD and
blood pressure.[7]

Statement of the study

Study to assess the prevalence of Attention Deficit Hyperactivity Disorder
(ADHD) symptoms among adults residing in selected wards of
Nayarambalam Panchayat, Ernakulam District.

Objectives of the study

Primary objective

1.Estimate the prevalence of Attention Deficit Hyperactivity Disorder

(ADHD) symptoms in adults.
 Secondary objectives

2.Investigate the relationship of Attention Deficit Hyperactivity Disorder

(ADHD) symptoms between BMI and Blood Pressure in adults.

3.Find out the association between prevalence of Attention Deficit

Hyperactivity Disorder (ADHD) symptoms and selected demographic
variable of adults and identified determinants.

Assumptions
1.There is a high prevalence of Attention Deficit Hyperactivity Disorder
symptoms in adults.

2. There is physical and psychosocial factors associated with Adult ADHD

symptoms.

3. There is an association between ADHD symptoms and sociodemographic

characteristics of adults and identified determinants.

Definition Of Terms
ADULTS
In this study adults means those aged 18-44 years.
ADULT ADHD SYMPTOMS
Adult ADHD symptoms may include Impulsiveness, Disorganisation and
problems prioritizing , poor time management skills, Problems focusing on a
task , Trouble multitasking, Excessive activity or restlessness , Poor planning ,
Low frustration tolerance , Frequent mood swings , Problems following
through and completing tasks, Hot temper and Trouble coping with stress.
In this study Adult ADHD symptoms are symptoms rated by the subjects in
Adult ADHD Self Report Scale (ASRS-V1.1)
BMI
BodyMass Index is a number calculated by dividing a person’s weight in
kilograms by his or her height in meters squared.
 In this study BMI calculated using Qutelet’s Index and BMI ,18.5-24.99 as
normal.
BLOOD PRESSURE
Blood pressure is the pressure of your blood on the walls of your arteries as
your heart pumps it around your body. It is a vital part of your heart and
circulation works. Normal is 120/80 mmhg.

Methodology
Research Approach: Quantitative approach
Research Design : Descriptive survey design
Research setting : selected ward of Naayarambalm Panchayat
Population
Target population : All adults of Ernakulam
Accesible Population :adults aged 18-44 years residing in selected wards of
Ernakulam district
Sample
Sample Size :500
Sampling technique :The sampling technique used for the present study is
Convenient sampling technique.
Inclusion Criteria :Adults aged 18-44 years.
Exclusion criteria :Adults aged >44 years.
Tools for data collection
Tool 1 : Structured questionnaire to assess demographic characteristics of adults.

Tool 2 : Adult ADHD Self-Report Scale (ASRS-v1.1)

Tool 3 : Checklist to determine the physical and psychosocial factors associated
with Adult ADHD symptoms.
PILOT STUY
Pilot study is planned to conduct on the month of December . Sample selection is
by convenience sampling technique and after obtaining informed consent.
Researcher must spent atleast 30 minutes for each participant.
PLAN FOR DATA COLLECTION
Data Collection or the study is planning from the month of January. Subjects
meeting the inclusion criteria were selected by convenience samping technique and
rapport established with them. The purpose of study will be explained to them and
a written informed consent of investigator will take from the subjects in the study.
The tools will be distributed the subjects and with the help, they will take around
30 minutes to complete the questionnaire. The investigator will also take the
height, weight and blood pressure of the subject.
PLAN FOR DATA ANALYSIS
The data will be analysed using descriptive and inferential statistics
Work plan
Proposal presentation : IInd week of july 2018
Ethical clearance :First week of December 2018
Pilot study : Last week of December
Data collection :First week of January
Data analysis and manuscript preparation :Last week of February
Proposed Budget

Sl.no. ITEM RUPEES

1. Transport 2000/-
2. Print 500/-
3. Publication 5000/-
Total 7,500/-

Ethical Considerations
Ethical clearance will be obtained from ethical committee AIMS , research
committee Amrita College Of Nursing and from Panchayat president ,
Nayarambalam panchayat , before data collection.
REFERENCES
1.DTE staff . More Indians were diagnosed with hypertension than diabetes in
2017. Thursday 21 june 2018 Times of India.
2.Meyer T ,Becker A , Sundermann J , Rothenberger A , Herrmann – Lingen C ,
Attention deficit hyperactivity disorder is associated with reduced blood pressure
and serum vitamin D levels results from the Nation wide German health interview
and examination survey for children and adolescents(KIGGS). European child and
adolescent psychiatry.2017 february 1 ;26(2):165-75
3. Pagoto SL , curtin C , Lemon SC , Babdini LG , Schneider KL ,vodenlos JS ,
Ma y.association between adult attention deficit/ hyperactivity disorder and obesity
in the US population, Obesity. 2009 march ; 17 (3): 539-44
4. Pinho R , Wang B , Becker A , rothenberger A , Outeiro TF , Herrmann-Lingen
C , Meyer t. Attention – deficit/ hyperactivity disorder is associated with reduced
levels of serum low – density lipoprotein cholesterol in adolescents. Data from the
population – based German KIGGS study. The World Journal of Biological
Psychiatry. 2018 Jan 10-19.
5. Adams H , Szilagyi P , Gebhardt L , Lande M .Learning and attention problems
among children with pediatric hypertension . pediatrics.2010;126(6):1425-9.
6. Simon V ,czobor P , Balint S, Meszaros A , Bitter I. Prevalence and correlates of
adult attention deficit hyperactivity disorder : meta – analysis . British journal of
Psychiatry. Cambridge University Press; 2009 ; 194 (3): 204-11.
7. Belirgan S , Ersoy MA , Topcu Ersoy H. Prevalence of adult attention deficit
hyperactivity disorder and comorbid axis-I disorders among first time applied
cases of a general psychiatry outpatient clinic and a private psychotherapy centre.
Psychiatry and Clinical Psychopharmacology . 2018 Jan 2; 28(1): 25-35.
8. Malek a , Amiri S , Sadegfard M , Abdi S , AMINI S . Associated factors with
attention deficit hyperactivity disorder (ADHD): a case – control study.