Association of attention deficit hyperactivity disorder with unintentional injuries among children age 4-11 years : hospital based matched case control study

Date of Award


Document Type


Degree Name

Master of Science in Epidemiology & Biostatistics (MSc Epidemiology & Biostats)


Community Health Sciences


To determine the association of attention deficit hyperactivity disorder (ADHD) with unintentional injuries among children, age 4-11 years, in Karachi, Pakistan. Introduction: ADHD and unintentional injuries are common among young children. However, epidemiological data investigating association between ADHD and unintentional injuries is scarce, both from developed and developing countries. Method: A hospital based case control study was conducted. A total of 300 children, 4-11 years of age with unintentional injuries (case) and 600 children (two for each case) with health conditions other than unintentional injuries (controls), matched for age and gender, were recruited from the emergency room (ER) of three tertiary care hospitals of Karachi: on each belonging to public and private sector. Unintentional injuries (cases) were falls, burns, drowning, poisoning and road traffic injuries, as defined by the consulting physician in the ER. Children with complaints and diagnosis other than injuries (controls) were selected from the same hospital ER within a week of case recruitment. ADHD was defined by administering strength and difficulty questionnaire (SDQ), a validated instrument for screening of ADHD, to the primary care givers of the children (parents or guardians). Conditional logistic regression was conducted to determine association of ADHD with unintentional injuries, adjusting for potential confounders. Results: Children with ADHD were twice likely (mOR = 2.2, 95% CI: 1.5-3.0) to have unintentional injury. In addition, children with low socio-economic status (mOR = 1.7, 95% CI: 1.1-2.4), more than two siblings (mOR =2.1, 95% CI: 1.1-4.4), low mother education (mOR = 2.0, 95% CI: 1.3-3.0) and history of previous injuries (mOR = 1.9, 95% CI: 1.4-2.7) were independently related to unintentional injuries. Conclusion: Screening of ADHD among young age children along with parental counseling for the prevention of injuries would help in decreasing the disease burden. Prevention plans focusing on low socio-economic background children and with children of mother with low education may further reduce the incidence of unintentional injuries.

This document is available in the relevant AKU library