Original article

pISSN 2635-909X • eISSN 2635-9103

Ann Child Neurol 2024;32(4):226-231
https://doi.org/10.26815/acn.2024.00570

Prevalence of Attention Deficit Hyperactivity Disorder

among Primary School Children in Hyderabad, South India
Habib G. Pathan, MD1, Shalini Akunuri, DNB2, Shabahat Tayyab, MD3, Zafar Sultana, MD4
1
Department of Pediatric Neurology, Princess Esra Hospital, Deccan College of Medical Sciences, Hyderabad, India
2
Department of Pediatric Intensive Care, Ankura Hospital for Women and Children, Hyderabad, Telangana, India
3
Department of Pediatrics, Femcity Hospital, Hyderabad, India
4
Department of Developmental Neurology, Foster CDC Child Neuro Care, Hyderabad, India

Received: May 30, 2024

Revised: July 14, 2024 Purpose: Attention deficit hyperactivity disorder (ADHD) is among the most prevalent neurode-
Accepted: July 15, 2024 velopmental disorders in childhood, and its incidence has increased in recent years. However, the
frequency of ADHD varies significantly across different countries and regions. This study aimed to
Corresponding author:
determine the prevalence of ADHD among primary school children in Hyderabad, India, as well as
Shalini Akunuri, DNB
to raise awareness about ADHD among teachers.
Department of Pediatric Intensive
Care, Ankura Hospital for Women
Methods: This descriptive cross-sectional study included 700 school-aged children between 5
and Children, Hyderabad, and 12 years old, selected according to specific inclusion and exclusion criteria. The teachers’
Telangana, India version of the Vanderbilt Assessment Scale, a rating scale grounded in Diagnostic and Statistical
Tel: +91-9490386007 Manual of Mental Disorders (DSM) diagnostic criteria, was employed to diagnose ADHD.
Fax: +91-40-49599972 Results: The prevalence of ADHD in this study was 9.57% (67 out of 700), with a mean age of 8.9
E-mail: akunurishalini@gmail.com years. ADHD was more prevalent in boys than in girls, with a sex ratio of 3:1. The combined type
of ADHD was the most common (52.3%), followed by the attention deficit type (29.8%) and the
hyperactive-impulsive type (17.9%).
Conclusion: The prevalence of ADHD among schoolchildren in middle-income countries, such as
India, is sufficiently high to impose a significant societal burden. Therefore, it is imperative that
all elementary school teachers receive training on how to screen for indicators of ADHD.

Keywords: Attention deficit disorder with hyperactivity; Vanderbilt scale; Prevalence; Health poli-
cy; India

Introduction issues observed. These problems disrupt daily activities and nega-
tively impact academic performance. Often, ADHD is not diag-
Attention deficit hyperactivity disorder (ADHD) is character- nosed until the behaviors cause problems in school. Many children
ized by inattentiveness, restlessness, and impulsive behavior. It with mild symptoms go undiagnosed, impeding their optimal per-
is one of the most common neurodevelopmental disorders in sonality development. As these children mature into adults, they
childhood [1]. may develop behavioral and emotional disturbances, including de-
Being inattentive, overactive, preoccupied, forgetful, impatient, pression, mood swings, anger issues, addictions, and relationship
easily frustrated, overly talkative, and easily distracted are common problems in both their personal lives and at work.

© 2024 Korean Child Neurology Society

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Ann Child Neurol 2024;32(4):226-231

ADHD is primarily diagnosed through clinical methods, which college and hospital was chosen for the study after receiving ap-
include behavior rating scales, clinical interviews, physical exam- proval from the school principal. All children enrolled in primary
inations, and neuropsychological evaluations. There are several school, from first to fifth grade, were eligible to participate. Chil-
standardized behavior rating scales that effectively identify children dren under 5 years of age or over 12 years old, those with pre-exist-
with ADHD. ing neurological conditions such as cerebral palsy, epilepsy, deaf-
The global prevalence of ADHD is 7.6% among children aged 3 ness, or visual impairments, and children whose parents did not
to 12 years and 5.6% among teenagers aged 12 to 18 years [2]. In consent were excluded from the study.
India, the prevalence of ADHD, based on school and hospi- The Modified Kuppuswamy’s Socioeconomic Status Scale,
tal-based population studies, ranges from 4.7% to 29.2% [3]. Given 2019 (consumer price index [CPI]-328), was utilized to assess the
its vast geographical expanse, India has seen numerous studies socioeconomic status of the family, as depicted in Table 1. This
aimed at assessing the prevalence of ADHD in children. However, scale comprises three parameters: education, occupation, and in-
these studies are often confined to specific geographic areas and come. The total score, which ranges from 3 to 29, categorizes fami-
show significant variations in prevalence rates. In a school-based lies into five distinct groups: upper class, upper middle class, lower
study from the South Indian state of Tamil Nadu, the prevalence of middle class, upper lower class, and lower socioeconomic class.
ADHD among children aged 8 to 11 years was found to be 8.8% The income scale is periodically adjusted in accordance with
[4]. In another city within the same state, the prevalence among changes in the CPI [10].
children aged 6 to 11 years was reported at 11.32% [5]. From Deh- The Vanderbilt Assessment Scale, teachers’ version [11], which
radun in North India, another study reported an ADHD preva- is a rating scale based on the Diagnostic and Statistical Manual of
lence of 11.8% [6]. In contrast, the prevalence of ADHD in prima- Mental Disorders (DSM) diagnostic criteria for ADHD, was uti-
ry school children was reported at 5.7% in Belagavi, South India lized. This scale comprises 43 questions divided into two main
[7], and 2.3% in another study from a different city in the same components: symptom assessment and performance impairment.
state [8]. The symptom assessment component is designed to identify
Ghosh et al. [9] observed a 12.6% prevalence of ADHD among symptoms of both inattentive ADHD (items 1–9) and hyperactive
primary school children in Assam, North-East India. The variation ADHD (items 10–18). For a child to meet the diagnostic criteria,
in prevalence across different regions and nations may be attribut- they must exhibit at least six positive responses to either the inat-
ed to several factors, including poor awareness, a greater tolerance tentive or hyperactive core symptoms, or both, and must achieve a
for developmental deviations in certain cultures, stigma associated score of 4 or 5 on any of the performance items (36–43). A posi-
with seeking treatment, availability of resources, variability in as- tive response is defined as a score of 2 or 3, indicating “often” or
sessment tools, and inconsistencies in research methodology. “very often.”
There is limited literature on the prevalence of ADHD in the In primary school, each grade is divided into five sections, with
Telugu-speaking states of South India, highlighting a need to un- class sizes ranging from 28 to 35 students. A total of 25 teachers re-
derstand its magnitude in our region. This study aimed to deter- ceived training on how to use the Vanderbilt Assessment Scale
mine the prevalence of ADHD among primary school children, Teacher’s version across two sessions held at the school. The first
examine the socio-demographic profiles of these children, and session employed multimedia aids in English, Hindi, and Telugu to
identify the subtypes of ADHD present in our community. Addi- educate the teachers about ADHD and its impact on children's ac-
tionally, the study sought to raise awareness among schoolteachers ademic performance, quality of life, and broader societal implica-
about ADHD in children and to train them in the use of screening tions. In the second session, the teachers learned how to complete
tools for early diagnosis. the Vanderbilt Assessment Scale, Teacher's version.
The class teacher for each grade from first to fifth assessed the
Materials and Methods students who met the inclusion criteria using the Teacher’s version
of the Vanderbilt Assessment Scale. This assessment took place at
This descriptive cross-sectional study was carried out by the De- the convenience of the teachers over a period of 2 to 3 months.
partment of Pediatric Neurology at a medical college in Hyder- During this period, frequent school visits were conducted to ad-
abad, South India, from October 2018 to October 2019. This dress any concerns and to assist the class teachers in evaluating the
study was approved by the Institution Review Board of Shadan In- students and completing the questionnaire. Once the question-
stitute of Medical Sciences, Hyderabad. Written informed consent naires were completed, they were analyzed, and students who
was obtained from all patients. A school located near the medical screened positive were recommended to consult with a pediatric

https://doi.org/10.26815/acn.2024.00570 227
Pathan HG et al. • ADHD Prevalence in South India

Table 1. Modified Kuppuswamy’s Socioeconomic Status Scale, sary, with regular follow-up.
2019 (CPI-328) Data were analyzed using a Microsoft Excel sheet and SPSS soft-
Sc. no. Score ware version 21.0 (IBM Corp., Armonk, NY, USA). Frequencies
Education of the head
and percentages were calculated for qualitative data, while means
1 Profession or honors 7
2 Graduate 6 and standard deviations were computed for quantitative measures.
3 Intermediate or diplo- 5 The chi-squared test was employed to analyze categorical variables.
ma A P value of <0.05 was considered statistically significant.
4 High school certifica- 4
tion
5 Middle school certifica-
tion
3 Results
6 Primary school certifi- 2
cation The school had more than 2,000 children enrolled across grades
7 Illiterate 1 ranging from kindergarten to 10th grade. Of these, 756 primary
Occupation of the head school students were deemed eligible for the study. Three students
1 Legislators, senior offi- 10
cials & managers had migraines, seven had epilepsy, two had spastic diplegia (cere-
2 Professionals 9 bral palsy), and 44 students declined to participate. Consequently,
3 Technicians and associ- 8 56 children were excluded from the study (Fig. 1). Demographic
ate professionals
4 Clerks 7 data for the excluded students are not available.
5 Skilled workers and 6 Seven hundred students participated in the study, comprising
shop & market sales 389 boys (55.5%) and 311 girls (44.5%), as shown in Table 2. Six-
workers
6 Skilled agricultural & 5 ty-seven students (9.57%) screened positive for ADHD, including
fishery workers 51 boys (76.11%) and 16 girls (23.9%), as presented in Table 2.
7 Craft & related trade 4 The mean age of children diagnosed with ADHD was 8.91 years,
workers
8 Plant & machine oper- 3 compared to 8.65 years for those without the condition. The prev-
ators and assemblers alence of ADHD was highest in the 5-year-old age group (14.28%),
9 Elementary occupation 2 followed by the 10- and 11-year-old groups (12.1%).
10 Unemployed 1
Monthly family income in Rs.
The most common subtype of ADHD was combined (52.3%),
(1976)/Updated Monthly followed by attention deficit (29.8%) and hyperactive-impulsive
family income in Rs. (2019)
(17.9%). All subtypes were more prevalent in boys than in girls.
1 ≥2,000/≥50,587 12
2 1,000–1,999/24,294– 10 The majority of the study population belonged to the upper lower
49,586 (35.4%) and lower (50%) economic strata, with ADHD being
3 750–999/18,970–24,293 6 more prevalent in the lower socioeconomic group (10.8%) (Table
4 500–749/12,647–18,969 4
5 300–499/7,588–12,646 3
3). However, this difference was not statistically significant
6 101–299/2,555–7,587 2 (P=0.686).
7 ≤100/≤2,554 1
Score
1 26–29 Upper (I)a
Discussion
2 16–25 Upper middle (II)a
3 11–15 Lower middle (III)a According to a recent review by Kuppili et al. [3] on ADHD in In-
4 5–10 Upper lower (IV)a dia, the prevalence range of ADHD was found to be 4.7% to
5 <5 Lower (V)a 29.2%, which aligns with the 9.57% prevalence rate observed in
Modified from Dalvi et al. [10], with permission from Springer Nature. our study. A meta-analysis on the burden of ADHD among Indian
CPI, consumer price index; Rs., Indian Rupees.
a children indicated a pooled prevalence of 7.5% in school-based set-
Socioeconomic class.
tings [12], similar to global prevalence rates. In studies conducted
in Dehradun, North India, and Coimbatore using the Vanderbilt
neurologist and child psychologist, along with their parents, for a ADHD Diagnostic Teacher Rating Scale and Conner’s Rating
detailed evaluation and final confirmation of the diagnosis. Based Scale respectively, prevalence rates of 11.8% [6] and 11.3% [5]
on the evaluations, further management including behavioral were reported, both slightly higher than our findings. The preva-
modification therapy and medication was recommended as neces- lence of ADHD in a school-based study from Assam, North India,

228 https://doi.org/10.26815/acn.2024.00570
Ann Child Neurol 2024;32(4):226-231

756 Students studied was noted to be 12.6% [9]. Epidemiological studies reporting
in primary school
higher prevalence rates should be considered as providing screen-
ing prevalence estimates, as they may include many false positives,
according to Kurtzke [13]. This could partially explain the varia-
700 Students 56 Students
tions observed in different studies. Another study in Kancheepur-
participated excluded
am, South India, focusing on children aged 4 and 10 years using
7 Students had Conner’s rating scale, reported an overall prevalence rate of 8.8%
epilepsy
389 (55.5%) 311 (44.5%) [4]. In contrast, two studies in Bengaluru City, South India, report-
Boys Girls 3 Students had ed lower prevalence rates of 1.3% [14] and 2.3% [8], despite also
migraine
using Conner’s rating scale for diagnosing ADHD. ADHD preva-
2 Students had
cerebral diplegia lence estimates are higher in the Middle East and North America
44 Students didn't
compared to African and Asian countries [15]. Significant hetero-
consent geneity was found across studies, with one notable factor being the
"setting" of the study. Higher prevalence rates were observed in
Fig. 1. Schematic flowchart illustrating sample selection process.
school-based studies compared to community studies, likely due
to the influence of teachers' assessments of children's behavior in
Table 2. Distribution of study population by diagnosis according to diagnosing ADHD. The studies also exhibited clinical heterogene-
age ity due to the use of a variety of screening and diagnostic tools, as
Age (yr) ADHD (total no.) Prevalence (%) well as differences in the age ranges of the participants [12].
5 2 (14) 14.28 Children with ADHD were also stratified based on their age. In
6 7 (84) 8.33 this study, the prevalence of ADHD was highest among 10-year-
7 11 (129) 8.52
8 7 (100) 7
old, similar to findings in Bengaluru, where the highest prevalence
9 9 (114) 7.89 was observed among children aged 11 to 12 years [14], and in
10 15 (124) 12.09 Dehradun, where it was higher among those aged 8 to 10 years [6].
11 11 (91) 12.08 Similarly, a study in Coimbatore reported the maximum preva-
12 5 (44) 11.36
lence in children aged 9 and 10 years [5]. This consistent age pat-
Total 67 (700) 9.57
tern may be due to the increased demands for attention at school
Chi-square=3.548, P=0.940 (not significant).
ADHD, attention deficit hyperactivity disorder. and home as children grow older. In a study conducted in
Kancheepuram, the highest prevalence of ADHD was seen among
8-year-old, although the study only included children ranging from
Table 3. Distribution of students according to gender, socioeco- 8 to 11 years [4]. In Assam, ADHD was predominantly found in
nomic status, and ADHD subtype
children aged 7 and 8 years [9]. Despite these findings, there is no
Variable ADHD Normal Total consistent evidence across studies to pinpoint the most prevalent
Sex
Male 51 (13.11) 338 389 (55.5)
age group for the diagnosis of ADHD. However, most studies, in-
Female 16 (5.14) 295 311 (44.5) cluding ours, have reported a higher prevalence in the age groups
Socioeconomic status of 9 to 10 years.
Upper 0 6 6 ADHD is predominantly observed in males, with a reported sex
Upper middle 1 (4.5) 21 22
ratio of approximately 2:1 in children. In our study, the prevalence
Lower middle 6 (8.1) 68 74
Upper lower 22 (8.8) 226 248 of ADHD was higher in boys (13.11%, n=51) than in girls (5.14%,
Lower 38 (10.8) 312 350 n=16), resulting in a ratio of 3.2:1. This finding aligns with a study
Total 67 (9.5) 633 700 conducted in Germany, which reported that boys were three times
ADHD subtype (male/female) more likely to have ADHD than girls [16]. Similarly, a study from
Attention deficit 12 (60)/8 (40) 20 (29.8)
Hyperactive 10 (83.3)/2 (16.7) 12 (17.9)
Spain found a sex ratio of 2.8:1, which is close to our results [15].
Combined 29 (82.8)/6 (17.2) 35 (52.2) Various studies from India have also reported a comparable sex ra-
Values are presented as number (%). Chi-square=2.269, P=0.686 (not sig- tio of around 3:1 [5,6,8]. However, some studies have noted even
nificant). higher ratios of 5:1 [9], while others have reported lower ratios,
ADHD, attention deficit hyperactivity disorder. down to 1.6:1 [14]. The predominance of ADHD in boys may be

https://doi.org/10.26815/acn.2024.00570 229
Pathan HG et al. • ADHD Prevalence in South India

attributed to the effects of sex hormones such as testosterone tings. Additionally, the study focused on children from schools pri-
during the intrauterine period. These hormones are thought to act marily serving middle and low socioeconomic groups, without a
on the dopaminergic neural system in the prefrontal cortex and comparative analysis of students from affluent schools. This lack of
striatum, influencing the severity and clinical manifestations of diversity among the participants makes it difficult to generalize the
ADHD [17]. Additionally, recent research suggests that sex chro- findings across the entire country. Another limitation is the use of
mosome genes (X- and Y-linked genes) and stress hormones could the Vanderbilt Assessment Scale, Teacher’s version, which has a
also play a role in the sex differences observed in ADHD through sensitivity of 69% and a specificity of 84% for predicting ADHD.
molecular mechanisms [18]. Moreover it is possible that girls are This suggests that some children with potential ADHD features
under-diagnosed and under-identified due predominance of inat- may have been overlooked. Further investigation into environmen-
tentive symptoms and fewer hyperactive/impulsive symptoms, tal factors, exposure to chemicals, dietary habits, maternal status
and fewer disruptive behavior causing less trouble to family and at during pregnancy, and social factors could have provided addition-
school. al insights.
Our study revealed that the combined subtype of ADHD was In conclusion, over the past few years, there has been an increas-
the most prevalent at 52.2%, followed by the attention deficit sub- ing focus on various aspects of etiology and clinical interest, leading
type at 29.8% and the hyperactive-impulsive subtype at 17.9%. to a rise in ADHD research within Indian contexts. This study has
These findings align with research from Assam and Bangalore, yielded crucial epidemiological data that helps us understand the
where the combined subtype was also commonly observed [9,14]. prevalence of ADHD in our South Indian community. We recom-
In contrast, a study by Mannapur et al. [8] in Bangalore identified mend screening all children for ADHD as they enter primary
the hyperactive-impulsive subtype as the most frequent, although school. Additionally, it is essential that schoolteachers receive train-
it involved a small sample size (only 23 students). Meanwhile, re- ing in ADHD screening to promptly identify and support vulnera-
search conducted in Dehradun found the inattentive subtype to be ble children, ensuring timely referrals. Further qualitative research
most prevalent [6]. A recent global meta-analysis reported that is necessary to explore carer burden, parental awareness, and atti-
each subtype constituted approximately one-third of the cases [2]. tudes. Such studies are vital to address issues significant to families
Environmental factors, including vehicular pollution and lead and to conduct thorough research that deepens our understanding
exposure, have been implicated in associations with ADHD. Other of the disorder.
relevant factors that increase the risk of developing ADHD include
parental alcohol consumption, lack of breastfeeding, being the Conflicts of interest
firstborn, a history of pregnancy or delivery complications, ongo-
ing parental discord, and parental psychiatric illness or aggression No potential conflict of interest relevant to this article was report-
[19]. ed.
The prevalence of ADHD decreased with improvements in so-
cioeconomic status. The highest prevalence was observed in the ORCID
lower socioeconomic group at 10.8%, followed by the upper lower
at 8.8%, lower middle at 8.1%, upper middle at 4.5%, and upper at Habib G. Pathan, https://orcid.org/0009-0001-0378-2912
0%. However, the chi-squared test did not reveal this trend to be Shalini Akunuri, https://orcid.org/0000-0003-3285-0512
statistically significant. These findings align with those of Venkata
and Panicker [5] who noted a higher prevalence of ADHD in the Author contribution
lower socioeconomic stratum compared to the middle socioeco-
nomic class. A potential correlation exists between socioeconomic Conceptualization: HGP. Data curation: ST and ZS. Formal analy-
deprivation and the risk of ADHD, which may be influenced by sis: SA and ST. Methodology: HGP, ST, and ZS. Project adminis-
factors such as maternal smoking during pregnancy, parental dis- tration: HGP. Visualization: HGP. Writing - original draft: SA and
cord, and parental mental health issues. ST. Writing - review & editing: HGP and SA.
The strengths of this study include its large sample size and the
comprehensive training provided to schoolteachers on using Acknowledgements
screening tools to identify ADHD in children. However, the study
has several limitations. Firstly, the sample was drawn from a school- We would like to express our deep gratitude to the parents and
based setting, which limits the generalizability to community set- lovely children who have participated in the study. We also thank

230 https://doi.org/10.26815/acn.2024.00570
Ann Child Neurol 2024;32(4):226-231

the schoolteachers for assisting in conducting this study, the school Cachar, Assam, North-East India. Open J Psychiatry Allied Sci
principal, and our head of department Dr. Devaraj K for their sup- 2018;9:130-5.
port. 10. Dalvi TM, Khairnar MR, Kalghatgi SR. An update of B.G.
Prasad and Kuppuswamy socio-economic status classification
References scale for Indian population. Indian J Pediatr 2020;87:567-8.
11. American Psychiatric Association. Diagnostic and statistical
1. Polanczyk G, de Lima MS, Horta BL, Biederman J, Rohde LA. manual of mental disorders: DSM-IV. 4th ed. Washington, DC:
The worldwide prevalence of ADHD: a systematic review and American Psychiatric Association; 1994.
metaregression analysis. Am J Psychiatry 2007;164:942-8. 12. Chauhan A, Sahu JK, Singh M, Jaiswal N, Agarwal A, Bha-
2. Salari N, Ghasemi H, Abdoli N, Rahmani A, Shiri MH, Hash- nudeep S, et al. Burden of attention deficit hyperactivity disor-
emian AH, et al. The global prevalence of ADHD in children der (ADHD) in Indian children: a systematic review and me-
and adolescents: a systematic review and meta-analysis. Ital J ta-analysis. Indian J Pediatr 2022;89:570-8.
Pediatr 2023;49:48. 13. Kurtzke JF. Neuroepidemiology. Ann Neurol 1984;16:265-77.
3. Kuppili PP, Manohar H, Pattanayak RD, Sagar R, Bharadwaj B, 14. Ramya HS, Goutham AS, Pandit LV. Prevalence of attention
Kandasamy P. ADHD research in India: a narrative review. deficit hyperactivity disorder in school going children aged be-
Asian J Psychiatr 2017;30:11-25. tween 5-12 years in Bengaluru. Curr Pediatr Res 2017;21:321-6.
4. Catherine TG, Robert NG, Mala KK, Kanniammal C, Arulla- 15. Perez-Crespo L, Canals-Sans J, Suades-Gonzalez E, Guxens M.
pan J. Assessment of prevalence of attention deficit hyperactivi- Temporal trends and geographical variability of the prevalence
ty disorder among schoolchildren in selected schools. Indian J and incidence of attention deficit/hyperactivity disorder diag-
Psychiatry 2019;61:232-7. noses among children in Catalonia, Spain. Sci Rep 2020;10:
5. Venkata JA, Panicker AS. Prevalence of attention deficit hyper- 6397.
activity disorder in primary school children. Indian J Psychiatry 16. Akmatov MK, Steffen A, Holstiege J, Hering R, Schulz M,
2013;55:338-42. Batzing J. Trends and regional variations in the administrative
6. Chawla GK, Juyal R, Shikha D, Semwal J, Tripathi S, Bhattacha- prevalence of attention-deficit/hyperactivity disorder among
rya S. Attention deficit hyperactivity disorder and associated children and adolescents in Germany. Sci Rep 2018;8:17029.
learning difficulties among primary school children in district 17. Banaschewski T, Coghill D, Zuddas A. Oxford textbook of at-
Dehradun, Uttarakhand, India. J Educ Health Promot 2022; tention deficit hyperactivity disorder. Oxford: Oxford Universi-
11:98. ty Press; 2018.
7. Joshi HM, Angolkar M. Prevalence of ADHD in primary school 18. Loke H, Harley V, Lee J. Biological factors underlying sex differ-
children in Belagavi City, India. J Atten Disord 2021;25:154-60. ences in neurological disorders. Int J Biochem Cell Biol 2015;
8. Mannapur R, Munirathnam G, Hyarada M, Bylagoudar SS. 65:139-50.
Prevalence of attention deficit hyperactivity disorder among ur- 19. Manjunath R , Kishor M, Kulkarni P, Shrinivasa BM,
ban school children. Int J Contemp Pediatr 2016;3:240-2. Sathyamurthy S. Magnitude of attention deficit hyper kinetic
9. Ghosh P, Choudhury HA, Victor R. Prevalence of attention disorder among school children of Mysore city. Int Neuropsy-
deficit hyperactivity disorder among primary school children in chiatr Dis J 2016;6:1-7.

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