Child & Adolescent Psychiatry

In Oman
Dr. Marwan M. Al-Sharbati
Associate Professor
Dept. of Behavioural Medicine
College of Medicine
Sultan Qaboos University

Child and Adolescent Psychiatry

in Oman - 24 June 2006

Overview of the lecture:

General Introduction
Child & Adolescent Psychiatry in Oman:
(Clinical Studies):
- Profile of child psychiatry in Oman
- Attention Deficit Hyperactivity Disorder in Omani Youth
(School based studies):
- ADHD among Omani Schoolgirls
- ADHD among Omani Schoolboys

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:Overview of the lecture (cont.)

Social Anxiety Disorder in Omani Adolescents
Published work
Collaborative work with others
Conferences and other activities
Conclusions

Child and Adolesc

The importance of child and adolescent

:psychiatry in Oman
of the people are under the age of 18 % 44. 1
The high prevalence of behavioural disorders. 2
The reduction of the paediatric health problems. 3
The real challenge of child rearing at present. 4
Early diagnosis and treatment of behavioural. 5
problems can reduce the future complications
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The shortage of child & adolescent

!psychiatrists

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In the U.S.A.
- About 20% of U.S. children and adolescents (15 millions) have
diagnosable psychiatric disorders
- 9-13% of the US children and adolescents have serious emotional
disorders
- 5-9% of U.S. children and adolescents have extreme functional
impairments
* Mental Health: a report of the Surgeon General,1999

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:In the U.S.A. (cont.)

- There are now 6300 child & adolescent psychiatrists
projecting to be increased by 100% at 2020.*
- Maldistribution of child & adolescent psychiatrists
(1.3 to 17.5 per 100 000).*
*U.S. Bureau of Health Professions, 2000.

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:In Egypt
- 500 Psychiatrists (2% Child Psychiatrists)
- 40% of people under 16 (26 Millions)
- The child and adolescent Psychiatrist/child
ratio is 1 / 2,6 Millions
5
Child and Adolesc

In Oman:
The first child & adolescent Psychiatry
clinic has been established in

February 1999 in SQUH

There are two child and adolescent
psychiatrists

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Clinical Studies:

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10

(1) Profile of Child and Adolescent

Psychiatry in Oman

Al-Sharbati M., Al-Hussaini A., Antony S.

.Saudi Med J. 24(4):391-5 2003

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11

:Objective
To find the common behavioral
disorders in youth, their comorbidity,
.treatment, and other variables

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12

:Patients and methods

All patients who attended the child psychiatric
clinic in SQUH for a three-month period
(Nov. 2000 Feb. 2001) were investigated
for behavioral problems, in particular for
hyperactivity (by Conners Questionnaire).
The diagnosis was based on the, 4th Edition
(DSM IV).
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13

:Results
The total number of patients was 212
77 (36%) were new cases
Age range was from 226 Y
Average was 9.7 years ( 3.9)
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14

Table 1. Demographic variables, parental consanguinity

.and family history of mental disorders
Description
Nationality
Omani
Expatriate
Gender
Male
Female
Parental
.Consang
.relation
.Non-Con
Family
Present
History
Absent

N
189
23
137
75
111
101
110
102

Child and Adolesc

%
89
11
65
35
52
48
52
48
15

Table 2. Age-wise distribution of cases with

.diagnoses and treatment
Age (Y)

Common Diagnoses

Treatment
nil

+2

4>-2

10

Speech & ADHD

4-6

19

ADHD & MR

11

6-12

121

57

ADHD, Low IQ &

Anxiety

27

87

12-18

56

26

ADHD, Low IQ &

Anxiety

11

39

18

Anxiety, ADHD

Total

212

100

52

145

15

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Figure 1. Behavioral problems and/or somatic

.complaints as reported by parents/guardians

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Figure 2. Distribution of the intelligence levels

(N=212)
7%
Severe &
Profound MR

10%
Moderate MR

38%
Normal
Intelligenc e

25%
Mild MR

19%
Borderline
Intelligence

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.Table 3. Cases where monotherapy was adopted

Drug
Psychostimulants
Tricyclics

n
48
48

%
33
33

Anticonvulsants
A. Antipsychotics
T. Antipsychotics
SSRIs
Miscellaneous
Total

20
9
6
5
9
145

14
6
4
3
6
99

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(2) Attention Deficit/Hyperactivity

Disorder in Omani Youth
Marwan Al-Sharbati
Presented at the International Congress of
World Psychiatric Association, Florence,
Italy, November 2004.

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:The objectives
To find the proportions of different subtypes
of ADHD
To find the associated demographic, personal
and other variables associated with ADHD

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Source data
Period: Feb 2000 to Sept 2003
Children attending Child and Adolescent
Psychiatry Clinic, Department of Behavioral
Medicine, SQUH

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Study method
A questionnaire given to parents:
personal, health & demographic variables
+ADHD Diagnostic Criteria (DSM IV)
The data was analyzed by SPSS

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:Results

221 cases suffering from ADHD

70% of ADHD cases were boys
Average age was 8.1 years
Consanguinity among parents: 48%

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.Figure 1. Subtypes of ADHD

70

68

60
50

40
30
20

20

12

10
0

C. Type

I. Type

H-I. Type

ADHD type
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Head Trauma (HT) in the

:sample
72 children (32%)
Of these 77.8% had fallen from heights
RTA: 8.3%
1/3rd had more than one occurrence of HT
Most HT before 7 years
29 (40%) had symptoms of ADHD before HT
5 (7%) had no symptoms of ADHD prior to HT
36 (50%) did not know??
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Figure 2. Treatment options.

. No
of cases

49
%
30
%

15
%

8%

Treatment options
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Figure 3. Distribution of intelligence

. No

67%

of cases
28%
6%

Intelligence Level
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Comorbidity
Majority 176 (79.6%) had comorbidity
141 (63.8%) had single comorbidity
(mainly mental retardation)
29 cases (13%) had 2 comorbidities
6 cases (3%) had 3 or more comorbidities

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Figure 4. School enrollment

. No
of cases

13
9
63%

41
19%

35
16%

6
3%

Type of School
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School based studies: National Omani Figures)

(1) ADHD in a Sample of Omani Schoolboys*

* Canadian Journal of Psychiatry, 2004, Aug;49(8):572

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School based studies: National Omani Figures)

During 2002
1502 schoolboys randomly selected
From 8 public elementary schools in Muscat
Age: 6-14 Y
ADHD

7.8%

Aggression

4%

School Failure

18%

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(School based studies: National Omani Figures

ADHD in Omani Schoolgirls*

* J Am Acad Child Adolesc Psychiatry, 2004; 3(2):132-3

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(School based studies: National Omani Figures

During 2000
708 schoolgirls
Three public elementary schools in Muscat
ADHD

5.1%

Aggression

3.9%

School Failure

22.7%

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(School based studies: National Omani Figures

Validating Liebowitz Social Anxiety Scale

(LSAS) in Omani adolescents.

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(School based studies: National Omani Figures

The study was conducted during 2003

The sample size was 1512 (boys = 565;
Girls = 947)
Secondary schools in Muscat & Nizwa
Age 16- 19 Y
Modified Liebowitz Social Anxiety Scale
(LSAS)
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Prevalence of Social Anxiety Disorder

(N= 1512; boys = 565; Girls = 947)
Gender

n.

(%)

Boys

(19%)

107

Girls

(28%)

266

Total

(25%)

373

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School based studies: (National Omani Figures)

Figure 1. Severity of Social Phobia in both sexes

10
9
8
7
6
5
4
3
2
1
0

10
8
7
6 6

6
male
female
3
2

Moderate Marked
Child andSevere
AdolescV. Severe

38

:Published researches
1. Al-Sharbati M. et al. A case of bilateral ptosis with
unsteady gait for one-year in Oman: suggestibility and
culture in conversion disorder. Intl.J.Psychiatry in
Medicine, 2001, 31(2): 243-250.
2. Al-Sharbati M. et al. Severe Conduct Disorders: Two-case
reports. Oman Medical Journal, 2001, 18(2): 44-47.
3. Deliberate self-poisoning in Oman. Trop Med Int Health,
2002 Jun; 7(6): 549-56.

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39

:Published researches (cont.)

4. Al-Sharbati M. et al. Profile of Child and Adolescent
psychiatry in Oman. Saudi Med J 2003, 24(4): 391-5.
5. Al-Sharbati M. et al. Urbanization, Culture and
Hyperactivity: An Exploratory Study of Omani
Schoolgirls. Women's Health and Urban Life: An
International and Interdisciplinary J, 2003, 2(2): 43-60.
6. Al-Sharbati M. et al. A strange type of pica. SQU Journal
For Scientific Research: Medical Science, 2003, 5(1-2):
49-50.
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40

:Published researches (cont.)

7. Al-Sharbati M. et al. The prevalence of hyperactivity
among Omani Schoolboys. Can J Psychiatry, 49(8): 2004.
8. Al-Sharbati M, et al. ADHD in Omani schoolgirls. J Am
Acad Child Adolesc Psychiatry. 2004 Feb;43(2):132-3.
9. Association of the risk allele of dopamine transporter gene
(DAT1*10) in Omani male children with Attention-deficit
Hyperactivity Disorder. Clin Biochem., 2005; 38(8):73942.

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41

:Published researches (cont.)

10. DAT1 VNTR Allele Frequencies in the Omani Population.
Human Biology, 2005; 77 (2): 281-286.
11. Al-Sharbati et al. School Failure: An Exploratory
Observational Study in Omani Schoolgirls. J B N R,
October 2005; 3: 29-39.
12. The VNTR polymorphism in the human dopamine
transporter gene: improved detection and absence of
association of VNTR alleles with ADHD. Genet Test. 2006;
10(1): 31-4.

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42

Booklets, chapters.etc
1. Al-Sharbati. 2005. Behavioral Disorders. In: Encyclopedia
of Disability. SAGE Publications.
2. Al-Sharbati & Al-Jabri. 2006. Exam presure, emotional
disorders and on probation medical students. In: Landew M
(Ed). Stress and Mental Health of College Students. Nova
Science Publishers, Inc.
3. Culture and prevalence of social phobia in a college
population in oman. In: College Students: Mental Health
and Coping srategies. Etditor: Mery V. Landow, 2006,
Nova Science Publishers, Inc.
4. Al-Sharbati M. & Al-Wohaibi Kh. Causes of Scool Failure.
SQUH, Muscat. (In press, In Arabic).
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43

Conferences, meetings & presentations

Al-Sharbati M. et al. Teachers awareness about ADHD in
Oman. The first ADHD Conference in Middle East, December,
2004, Riyadh, KSA.
Al-Sharbati M. Social Impact of ADHD. The first ADHD
Conference in Middle East, December, 2004, Riyadh, KSA.
Al-Sharbati M. Attention Deficit/Hyperactivity Disorder in
Omani Youth, International Congress of World Psychiatric
Association, November 2004, Florence, Italy.
Al-Sharbati M. Common Behavioral Disorders in Omani Youth.
Al-Dakhiliya 7th pediatric Annual meeting, Sept. 15 th, 2005.

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44

Conferences, meetings & presentations

Al-Sharbati M. Child abuse. UNICEF, December 21st
2005, Muscat, Oman.
Al-Sharbati M. Attention Deficit Hyperactivity
Disorder in Omani Youth: Clinical & Community
Studies. ADHD expert board meeting Sept. 21-22nd
2005, Dubai, UAE.
Al-Sharbati M. Positive thinking, Najjiya al-hajri
secondary school, November 2005

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45

Conferences, Meetings & Presentations

Al-Sharbati et al. ADHD in Al-Fikriya School, 4th
GCC medical Colleges, January, 2006.
Al-Sharbati M. Adolescence: concept, problems and
treatment. Al-Qurum Private School, February,
2006.
Al-Sharbati M. The role of the principle in dealing
with students having behavioral disorders. April 15th 2006, Ministry of Education, Muscat.

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46

Collaborative work
With Maryland University
{A Comparison between Omani and American children
perceived parent-child and friendship relationships}
With Harvard University
{Genetics of Human Epilepsy and Cognitive Disorders
(Autism, Mental Retardation)}
With the department of child health
{Bullying in Muscat schools}
With the department of Biochemistry
{ADHD genetics}
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47

:Conclusions
psychiatric morbidity in children and
adolescents is not rare.
More psychiatric clinics are needed in different
district hospitals in Oman.
Parents, teachers & even primary health
personnel should be made aware about the
nature and prevalence of mental problems
in children and adolescents.
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.:Conclusions cont
Social phobia and ADHD are the commonest
disorders encountered in Oman.
The combined type of ADHD is the
commonest one.

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49

Thank you

for your patience!

Child and Adolescent Psychiatry
in Oman - 24 June 2006

50