Higher rates of ADHD inside ‘poorer, denser’ harbour areas

Researchers link higher rate to social and economic factors including higher population density, smaller homes, poverty and higher smoking rates

ADHD rates are higher in districts associated with low socio-economic status, primarily northern and southern harbour areas
ADHD rates are higher in districts associated with low socio-economic status, primarily northern and southern harbour areas

Cases of severe Attention Deficit Hyperactivity Disorder (ADHD) are more common in the two harbour regions of Malta than in others, in what could be an indication that the condition is linked to higher population density and lower social economic status.

This emerges from a study undertaken by psychiatrists Chris Role, Nigel Camilleri and Rachel Taylor East and health statistician Neville Calleja, published in the Malta Medical School Gazette.

ADHD is a common disorder associated with hyperactivity, impulsivity and reduced attention. If left untreated it can lead to lower educational attainment, increased risk of accident-prone behaviour, substance misuse and anti-social behaviour.

The study is based on a sample of all 709 children under the age of 18 attending the child psychiatry governmental clinics up until February 2018, who were diagnosed with severe ADHD by a psychiatrist and were receiving pharmacological treatment.

These accounted for 0.84% of all Maltese children, with percentage values ranging from 0.57% in the northern district (which includes Naxxar, Mosta, St Paul’s Bay, Mgarr and Mellieha) to 1.12% in the north harbour district (which includes Qormi, Birkirkara, St Julian’s and Sliema). The second highest rate of ADHD (0.9%) was registered in the south harbour district (which includes Cottonera, Valletta, Paola and Zabbar).

One limitation of the study is that it does not take into account children who seek private treatment. The authors point out that it is possible that more affluent families, particularly those residing in the northern regions of Malta, prefer to attend private clinics rather than make use of the governmental clinics.

Percentage of children aged 0-18 diagnosed for ADHD

North Harbour 1.2%
South Harbour 0.9%
Western region 0.8%
Gozo 0.7%
South Eastern 0.7%
Northern 0.6%

The study, limited to those attending government clinics, shows that ADHD rates are higher in districts that are associated with low socio-economic status, that is primarily the northern and southern harbour areas. “Both northern and southern harbour areas are associated with high population numbers and density as well as lower levels of education compared to the other districts of Malta,” the authors said.

The northern harbour region was also associated with higher rates of smoking in those aged 18 and over. The two harbour districts “also demonstrate higher numbers of single-mother families as well as a larger number of individuals economically considered at risk of poverty”.

But surprisingly, relatively high ADHD rates were also reported in the Western district (which includes affluent localities like Lija, Zebbug and Attard). In fact, this region registers a higher rate than both the south-eastern region which includes Birzebbugia and Zurrieq, and the Gozo region. “People in this district might be more aware of ADHD symptoms and would, therefore, more readily seek professional advice,” the authors surmise.

While noting a lower prevalence of ADHD in the more affluent northern regions, the authors also point out that localities with higher educational levels are also more likely to be aware of the disease, and more likely to seek professional help.

In fact, the authors acknowledge that their study may be hampered by a “referral bias, with potential cases being missed, either due to lack of awareness about ADHD both by professionals, as well as parents.”

The study also does not take into account less severe cases of ADHD managed by using other techniques such as behavioural therapy.

The study recommends that more resources should be allocated to districts that are associated with higher rates of ADHD.