Erythrocyte sedimentation rate and C-reactive protein as inflammatory markers in children with attention –deficit hyperactivity disorder

Conclusion and recommendation:

• Further studies on large geographical scale and on larger sample size to emphasize our results.
• Encourage the studies supporting the use of anti -inflammatory drugs as ADHD treatment depending on the inflammatory basis in pathogenesis of ADHD.

Introduction    

Attention deficit–hyperactivity disorder (ADHD) is one of the most frequent neuropsychiatric disorders present in children, it is characterized by a lack of impulse control, inattention, and hyperactivity.^[1] ADHD may have a substantial influence on children’s school performance, familial relationships, and social interactions.^[2] The estimated preva-lence of ADHD in childhood worldwide, has been reported to be 5.3%. ^[3]

Inflammation is a biological condition characterized by increased levels of acute phase proteins and complement factors, cytokine cascades, and cellular immune responses. Inflammatory events induce cytokines, which may directly pass the blood–brain barrier or be carried into the brain via cytokine‐specific transporters.^[4]

The most widely used indicators of the acute phase response are the erythrocyte sedimentation rate (ESR) and C-reactive protein (CRP) levels.^[5]

Subjects and Methods

The study is a case control study, carried out at the Pediatric Department and Clinical Pathological Department, Minia University Children Hospital. It was conducted on 60 children during the period from (April 2021 to April 2022). The hospital ethics committee approved this study and a written consent was obtained from each patient caregiver.

Subjects

The children included in the study were divided as follows:

Group 1: 40 children, diagnosed as ADHD from children who had regular follow up in the Pediatric Neuropsychiatric Outpatient Clinic of Minia University Children Hospital. Their age ranged from 6 to 18 years.

They were further divided to the following subgroups:

Group 1A: included 20 newly diagnosed children to have ADHD before taking any medical treatment of ADHD, they were (90% male, 10% female) with age range (6-15), and (Mean ± SD = 8.15 ± 2.62).

Group 1B: included 20 previously diagnosed children to have ADHD and they were under treatment with non- stimulant ADHD medication for at least 6 months they were (70% male, 30% female) with age range (6-12), and (Mean ±SD = 8.15 ± 1.62).

Group 2: 20 apparently healthy children with matched age and sex to group І children. They were (65% male, 35% female) with age range (6-12), and (Mean ± SD= 9.15 ± 1.59).

Inclusion criteria

• Children age from 6 – 18 years old.
• Children newly diagnosed to have ADHD before taking any ADHD medical treatment or cognitive behavior therapy.
• Children previously diagnosed as ADHD children with at least 6 months duration from starting medical treatment and cognitive behavior therapy.

Exclusion criteria:

Children having the following diseases or conditions were excluded from the study.

• Children with any other chronic diseases.
• Children suffering from any inflam-matory or allergic diseases which may cause an increase of the inflammatory markers, masking our results.
• Children suffering from any another psychiatric or neurological co-morbidity.

Study design

The diagnosis of ADHD relies on clinical assessment and it is performed based on diagnostic classification systems, predo-minantly the Diagnostic and Statistical Manual of Psychiatric Disorders (DSM-5: American Psychiatric Association 2013).

The included children were subjected to the following:    

• Careful history taking including:

Name, age, sex, residence, socioeconomic standard and family history of blood diseases.

1. b. Full clinical examination: including

1- Vital data: respiratory rate, heart rate, blood pressure, temperature.

2- Systemic examination: full chest, cardiac and abdominal examinations

c-Laboratory investigation: ESR and CRP.

Discussion

Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder which cause emotional and behavioral disorders. The three main symptoms of ADHD (inattention, hyperactivity, and impulsiveness) are typically appeared in children before the age of 12 years old and can persist until the child reaches adulthood. ^[6]

Inflammation is a biological condition characterized by increased levels of acute-phase proteins and complement factors, cytokine cascades, and cellular immune responses. Inflammatory events induce

cytokines, which may directly pass the blood brain barrier or be carried into the brain via cytokine-specific transporters.^[7]

This study showed that there is significant higher increase in 1^st hour ESR (which is one of acute phase reactant that increases in inflammation) in ADHD un-medicated and medicated groups than control group. This result was  supported by study of Sahu et al.,  who reported that the 1^st ESR was significantly high in ADHD group compared to the control group. ^[8]