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Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study
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  • Published on: 16 June 2020
    Response to Professor Tomoyuki Kawada: Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon: a web-based cross-sectional study

    We would like to thank Professor Kawada for his interest in our paper (1) and the points he raised concerning the high prevalence of attention-deficit hyperactivity disorders (ADHD) among medical students in our study.

    We agree with the comment that the use of an internet-based survey might have biased the prevalence of ADHD reported in our paper. Our sampling technique was non-probabilistic and more likely to be non-representative of all medical students in Cameroon. As a result, the prevalence of ADHD reported in our study might not be reflective of the true prevalence of ADHD among medical students in Cameroon. As Professor Kawada rightly mentioned, discrepancies exist between diagnosis of ADHD using symptom screeners and diagnosis based on standard methods which involve clinical interviews with a specialist. The six-item adult ADHD Self-Report Scale (ASRS) v1.1 symptom screener, which has a higher false-positive rate compared to the standard diagnostic method, was used to define ADHD in our study. Screening tools for mental health disorders have low specificity primarily due to the overlap of symptoms between the different spectrum of mental disorders. Due to the above limitations, we cautioned against generalising and overinterpreting the prevalence of ADHD presented in our paper (Please see limitation point 1 and Discussion section Lines 12 and 15-16), and recommended a large-scale study which will use clinical interviews to ascertain the diagnosis of ADHD (...

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    Conflict of Interest:
    None declared.
  • Published on: 15 June 2020
    RE: Factors associated with symptoms of attention deficit hyperactivity disorder among medical students in Cameroon

    Njuwa et al. examined factors associated with symptoms of attention deficit hyperactivity disorder (ADHD) among medical students in Cameroon (1). The prevalence (95% confidence interval [CI]) of self-reported symptoms of ADHD was 24.4% (20.6% to 28.3%). Adjusted odds ratios (ORs) (95% CIs) of histories of chronic disease, family history of ADHD, severe depression and anxiety disorder for the symptoms of ADHD were 2.96 (1.49 to 5.86), 3.38 (1.04 to 10.44), 3.49 (1.82 to 6.77) and 2.06 (1.25 to 3.36), respectively. I have some concerns about their study.

    First, internet-based survey has a bias regarding prevalence and risk assessment. Standard diagnostic procedure and self-reported symptoms have some discrepancies, and response rate might also relate to the prevalence. Please imagine that about 1/4 of medical student have (a risk of) ADHD.

    Second, Shen et al. reported the prevalence of ADHD among medical college students in a Chinese population (2). Majority of students were females. According to web-based response, the prevalence (95% CI) of ADHD was 3.5% (3.02% to 3.98%). In addition, OR of suicidal ideation, suicide plans, suicide attempts, anxiety and depression for ADHD were 5.901, 5.46, 6.011, 8.037 and 7.88, respectively. Although risk factors of AHDH are common, prevalence was much lower that the report by Njuwa et al.

    Finally, Shi et al. investigated the prevalence of ADHD symptoms in medical students and the relationships between ADHD symptoms...

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    Conflict of Interest:
    None declared.