|Year : 2017 | Volume
| Issue : 1 | Page : 34-38
Disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt (2014/2015)
Taghreed M Farahat1, Mohammad M AlKot1, Nora A Khalil1, Eman G Saleh2, Safa H Al Kalash1
1 Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia, Egypt
2 Department of Neuropsychiatry, Faculty of Medicine, Menoufia University, Menoufia, Egypt
|Date of Submission||13-Feb-2016|
|Date of Acceptance||26-Apr-2016|
|Date of Web Publication||25-Jul-2017|
Safa H Al Kalash
Department of Family Medicine, Faculty of Medicine, Menoufia University, Menoufia 32511
Source of Support: None, Conflict of Interest: None
Disruptive behavior disorders (DBDs) are psychiatric disorders of children and adolescents, including oppositional defiant disorder (ODD) and conduct disorder (CD). It is associated with an increased risk for negative developmental outcomes including substance abuse, school problems, and antisocial or criminal violence.
The objective of this study was to assess the prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, its types, and its risk factors.
Participants and methods
A cross-sectional study was conducted on 348 basic-learning schoolchildren and their parents, as well as their teachers. Children were subjected to mini-kids interview for diagnosis of DBDs and then 'Parenting Manner Scale' for the detection of parenting style. Parents and teachers rated the child's behavior at home and school, respectively, during the past 6 months. Parents were subjected to the socioeconomic status scale.
Prevalence of DBDs was 14.9%. The prevalence of ODD and CD was 8 and 6.9%, respectively. Mean age was significantly lower among patients (11.69 ± 1.6), with male sex predominance (69.2%). Low socioeconomic level (67.3%), interparental conflicts (36.5%), single parent (51.9%), and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases. Overprotection (28.8 and 28.8%), discrimination between siblings (28.8 and 28.8%), and authoritarian parenting styles (17.3 and 19.2%), were significantly more prevalent among cases.
Prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt, was 14.9%. Its types were ODD and CD represented by 8 and 6.9%, respectively. Risk factors for DBDs among the studied group were low socioeconomic status, low parental education, father smoking, parental conflicts, family history of neuropsychiatric disorders, and bad parental styles among fathers and mothers (overprotection, discrimination, authoritarian, and hesitancy).
Keywords: basic-learning schools, conduct disorders, disruptive behavior disorders, oppositional defiant disorder
|How to cite this article:|
Farahat TM, AlKot MM, Khalil NA, Saleh EG, Al Kalash SH. Disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt (2014/2015). Menoufia Med J 2017;30:34-8
|How to cite this URL:|
Farahat TM, AlKot MM, Khalil NA, Saleh EG, Al Kalash SH. Disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt (2014/2015). Menoufia Med J [serial online] 2017 [cited 2020 Sep 22];30:34-8. Available from: http://www.mmj.eg.net/text.asp?2017/30/1/34/211533
| Introduction|| |
Disruptive behavior disorders (DBDs) are a group of the most common forms of child psychopathology with serious long-term consequences. DBDs have many subtypes such as oppositional defiant disorder (ODD) and conduct disorder (CD), which has an estimated worldwide prevalence of 3.3 and 3.2%, respectively . ODDs according to diagnostic and statistical manual-IV criteria are characterized by a recurring pattern of negative, defiant, disobedient, and hostile behavior against authority figures . CD is a wide range of age-inappropriate actions and attitudes of a child that violate family expectations, societal norms, and personal rights such as serious violation of laws, aggression to people and animals, destruction of property, and deceitfulness or theft .
Behaviors involved in ODD and CD are exhibited in a variety of settings (at home, at school, and in social situations) and have an impact on the child's psychological development . DBDs are associated with an increased risk for a wide range of negative developmental outcomes including substance abuse, school problems, delinquency, and antisocial behavior or criminal violence. Although many of these problems persist into adulthood with high economic costs , there is a great shortage of researches dealing with DBDs among basic-learning schoolchildren. Therefore, this study was conducted to determine the prevalence and risk factors of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt.
| Participants and Methods|| |
The study is a cross-sectional comparative study conducted during the academic year 2014/2015 on basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt.
The study was approved by the ethics committee of the Faculty of Medicine, Menoufia University. Informed consent was obtained from parents and teachers of the studied children after simple clarification of the study aim and methodology.
Sample size was calculated based on the lowest and highest prevalence of DBDs from the previous literature and population size, which was calculated as follows:
Where N is the required sample size; t is the confidence level at 95% (standard value of 1.96); P is the estimated prevalence of DBDs; m is the margin of error at 5% (standard value of 0.05).
Sample size = N / [1 + (N/Population)]
The sample size required for this study was estimated by assuming a confidence interval of 95 and 5% SE. The lowest and highest prevalences were 3.04 and 19.5%, respectively. Accordingly, the sample size required for this study was 348 students, in addition to their parents (N = 348) and teachers (N = 18).
Two basic-learning schools were selected randomly from urban and rural areas in Quweisna District. Children were randomly selected from each school to represent different strata, and the sample was proportionally allocated according to the total number of children in each school.
Children were invited after their parents' consent to fill the mini-kids international neuropsychiatric interview  for detecting those having DBDs. In addition, they were subjected to parenting manner scale  for the detection of parenting style through the child's point of view. Children were divided into the DBD group as cases and the non-DBD group as controls to study different risk factors.
Parents were invited to fill a revised form of behavior problem checklist  of their children at home during the past 6 months to diagnose DBDs. In addition, parents were subjected to 'the socioeconomic status scale' . They were asked about medical, neuropsychiatric, perinatal, developmental, and social history, including any marital conflicts, and substance abuse, including nicotine smoking, of their children to detect any organic diseases and exclude those having any other psychiatric or neurological disorders such as epilepsy.
Teachers were asked to fill a revised behavior problem checklist for the teacher  to confirm the diagnosis of DBDs according to behavior of the children at school during the past 6 months.
Data were analyzed using statistical package of social sciences software program, version 20 (SPSS Inc., Chicago, Illinois, USA). Data were expressed in two ways:
- Mean value and (SD) for quantitative data
- Frequency and percentage for qualitative data
- t-Test for comparison of two independent quantitative variables that are normally distributed
- U-test (Mann–Whitney test) for comparison of two independent quantitative variables that are not normally distributed
- c2-Test for comparison between two independent qualitative variables that are normally distributed.
| Results|| |
Prevalence of DBDs was 14.9%. ODD and CD were 8 and 6.9% of cases, respectively [Figure 1]. Mean age was significantly lower among patients (11.69 ± 1.6), with male sex predominance (69.2%). Low socioeconomic level (67.3%), interparental conflicts (36.5%), single parent (51.9%), and family history of neuropsychiatric disorders (65.4%) were significantly higher among cases than among controls [Table 1]. Overprotection (28.8 and 28.8%), discrimination between siblings (28.8 and 28.8%), and authoritarian parenting styles (17.3 and 19.2%), respectively, were significantly higher among cases than among controls [Table 2]. The significant risk for prediction of DBDs was single-parent family followed by middle and low socioeconomic status [odds ratio (OR) were 16.5 and 3.4, respectively] [Table 3].
|Figure 1: Prevalence of disruptive behavior disorders and its subtypes among basic schoolchildren at Quweisna District, Menoufia Governorate, Egypt 2014/2015.|
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|Table 1 Risk factors for disruptive behavior disorders among basic-learning schoolchildren at Quweisna District, Menoufia Governorate, Egypt|
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|Table 2 Parenting styles of each parent as a risk factor for disruptive behavior disorders: among the participants|
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|Table 3 Logistic regression analysis for predictors of disruptive behavioral disorders among the participants|
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| Discussion|| |
This study showed that the prevalence of DBDs among basic-learning schoolchildren was 14.9%. ODD and CD represented 8 and 6.9% of cases, respectively. Prevalence of CD was in agreement with an Egyptian study and showed a prevalence of 6.6% . In addition, the prevalence of ODD was in agreement with a Spanish study, which showed a prevalence of 6.9% . In this study, DBDs were significantly higher among boys than among girls (89.5% vs. 10.5% in CD and 60.7% vs. 39.3% in ODD, respectively), which is in agreement with a Palestinian study that showed a higher prevalence of CD among boys (6–16%) than among girls (2–9%) . In addition, another Spanish study showed a higher prevalence of ODD and CD in males (5 and 8.6%) than among females (2.8 and 5.8%) . In the current study, DBDs were significantly higher among children with low socioeconomic status (67.3%), which is in agreement with an American study that clarified that behavioral problems were more common among children of low socioeconomic level . This study found that parental educational level of cases was significantly lower than that of the controls, and this is in agreement with an American study that found that low paternal education was associated with DBDs among their children . The current study showed that paternal nicotine smoking was statistically higher among the case group (63.5%) compared with the control group (30.4%), and this is in agreement with a case–control Egyptian study that showed that 40% of children exposed to second-hand smoke had CD compared with 13.3% in the control group .
The study showed that marital conflict between parents was statistically significantly higher among cases (36.5%) than among controls (22%), and this result approximates that of an Iranian study that revealed that the prevalence of CD among students of predisrupted families and separated parents was significantly higher than students having intact families . The present study denoted that DBDs were significantly higher among children with single-parent families (51.9%), and this result is in concordance with that of a Romanian study, which revealed that children in single-parent families have a high rate of DBDs compared with those with intact families . The study showed that parental authoritarian style (28.8% of both fathers and mothers; OR: 11.2 and 20.9) and discrimination between siblings (28.8% of both fathers and mothers; OR: 12.9 and 32.8) were significantly higher among cases. These results were supported by studies that demonstrated that children who were exposed to authoritarian parenting style and discrimination were associated with an increased risk of having reactive aggression and DBDs more than their other peers ,.
The current study showed that the most significant risk factors for DBDs were single-parent family (OR: 16.05) followed by middle and low socioeconomic status (OR: 3.4), which is in agreement with a study that concluded that low family socioeconomic status, parental substance abuse, age from middle childhood into adolescence, parental mental illness, single parent, parent–child conflict, and inter-parental conflict had the highest rates of DBD diagnoses.
| Conclusion|| |
Prevalence of DBDs among basic-learning schoolchildren in Quweisna District, Menoufia Governorate, Egypt, was 14.9% where ODD and CD represented 8 and 6.9% of the cases, respectively. Risk factors were young age, male sex (OR: 1.56), low socioeconomic status (OR: 3.4), single-parent (OR: 16.5) family, low parental educations (OR: 1.07 and 2.9) of fathers and mothers, respectively, smoking of the fathers (OR: 1.4), marital conflict (OR: 1.3), family history of psychiatric disorders (OR: 1.6), and bad parenting styles among fathers and mothers, respectively [overprotection (OR: 49.4 and 22.2), discrimination (OR: 12.9 and 32.8), authoritarian (OR: 11.2 and 20.9), and hesitancy (OR: 8.8 and 28.7)], which must be screened for early detection and management of behavioral disorders among schoolchildren.
Financial support and sponsorship
Conflicts of interest
There are no conflicts of interest.
| References|| |
Canino G, Polanczyk G, Bauermeister J. Does the prevalence of CD and ODD vary across cultures? Soc Psychiatry Psychiatr Epidemiol 2010; 45:695–704.
American Psychiatric Association. Diagnostic and statistical manual of mental disorders
ed. Washington, DC: American Psychiatric Association; 2013.
McMahon R, Frick P. Child and adolescent conduct problems. Hunsley; 2007. pp. 41–60.
Murray J, Farrington D. Risk factors for conduct disorder and delinquency: key findings from longitudinal studies. Can J Psychiatry 2010; 55:633–642.
Bonin E, Stevens M, Beecham J. Costs and longer-term savings of parenting programs for the prevention of persistent conduct disorder: a modeling study. BMC Public Health 2011; 11:803.
Ghanem M, Beheri A, Almerghany H, Ibrahim M, Abdelhakam Z, Ali A, Ibrahim A. Development and validation of the Arabic version of the Mini International Neuropsychiatry Interview (MINI). The Annual International Conference of the Egyptian Psychiatric Association; Cairo, Egypt; 29 and 30, Sep, 1999.
Abdel Maksood A. Parenting manner scale through the child's point of view. The Anglo Egyptian bookshop; 2011. Available from: https://www.anglo-egyptian.com/
El Sayed M, Mohamed F, Effat S, Abdel Hamied A, Mohamed Y. Study the role of parental rearing in the development of conduct disorder in Egyptian children
. Cairo: Ain-Shams Univ.; 2014:125–160.
El-Gilany A, El-Wehady A, El-Wasify M. Updating and validation of the socioeconomic status scale for health research in Egypt. East Mediterr Health J 2012; 18:962-968.
Abdel Hamid A. Prevalence of emotional and behavioral problems among 6-12 year old children in Egypt. Soc Psychiatry Psychiatr Epidemiol; 2009; 44:8.
Ezpeleta L, Delaosa N, Doménech J. Prevalence of DSM-IV disorders, comorbidity and impairment in 3-year-old Spanish preschoolers. Soc Psychiatry Psychiatr Epidemiol 2014; 49:145–155.
Elumour I, Thabet A. Prevalence of attention deficit hyperactivity disorder and conduct disorder among a school-based sample of palestinian children in the gaza strip. Arab J Psychiatry 2014; 25:119–130.
Lopez-Villalobos J, Andrés-De-Llano J, Slnchez-Azn M, Sanguino-Andrés R, Alberola-Lpez S. Disruptive behavior disorders: multidimensional analysis. Med Eng Phys 2012; 12:405–417.
Dunworth C. Demographic disparities in children with behavioral or conduct disorders [theses and dissertations – public health]. Lexington, Kentucky, U.S.A: University of Kentucky; 2015. Available at: http://uknowledge.uky.edu/cph_etds/40. [Last accessed on 2016 Feb13].
Hadzic R, Magee C, Robinson L. Parental employment and child behaviors: Do parenting practices underlie these relationships? Int J Behav Dev 2013; 37:332–339.
Zaky E, Fouda E, Nabih E, Youssef O, Mohamed N. Association of second hand smoking with mental disorders in children-An Egyptian study. J Psychol Abnorm Child 2015; 4:2.
Yousefi F, Hoshiari S. Prevalence of conduct disorder and associated factors among the high school students in Sanandaj. J Kerman Univ Med Sci 2015; 19:37–43.
Jumara A. Impact of divorce and mother's psychological wellbeing on children's emotional, behavioral and social competences. Rev Cercet Interv Soc 2015; 48:69–82.
Lokoyi O. Parenting styles as correlates of aggressive behavior among in-school adolescent with mild intellectual disability. Psycholo Behav Sci 2015; 4:94–100.
Healy K, Sanders M, Iyer A. Facilitative parenting and children's social, emotional and behavioral adjustment. J Child Fam Stud 2015; 24:127–140.
Trentacosta C, Hyde L, Goodlett B, Shaw D. Longitudinal prediction of disruptive behavior disorders in adolescent males from multiple risk domains. Child Psychiatry Hum Dev 2014; 44:561–572.
[Table 1], [Table 2], [Table 3]