1. Trait Emotional Intelligence (TEI) in a sample of Egyptian children with ADHDBy
Dr: Walaa sabry
Associate professor of psychiatry
Faculty of medicine Ain shams University

2. Emotional Intelligence
EI was basically defined as the ability to comprehend and discriminate one’s , as well as others emotions, in a way that direct and modify his thinking and behavior (Salovey & Mayer, 1990). That includes four area; perceiving emotions, employ emotions to aid thinking, understanding emotions, and managing emotions to use them in relationships (Mayer, Salovey& Caruso, et al., 2001)

4. Models of EI
There are several models of EI: -The trait model, which encompasses behavioral dispositions and self perceived abilities; concerning one’s ability to recognize, process, and utilize emotion-laden information (Petrides, Frederickson & Furnham, 2004). TEI could be evaluated by self rated measures ( Pérez, Petrides& Furnham,2005;Petrides, 2011), which can be straightforward operationalized because it explicitly recognizes the inherent subjectivity of emotions (Petrides, Sangareau, & Furnham, Adrian,et al. 2006).

5. Models of EI
The ability Emotional Intelligence (AEI) model focuses on the individual's ability to process emotional information and use it to navigate the social environment, which could be measured by maximum performance tests. ( Pérez, Petrides& Furnham,2005; Petrides, 2011)

7. Research on relation between EI and ADHD has, for the most part, focused on the AEI with scarce literatures on TEI (Kristensen, Parker& Taylor et al., 2014), despite being insufficient to explain some impairments associated with ADHD (Kats-Gold and Priel 2009). Additionally, the self reporting tools to assess TEI have better predictive value for psychiatric and psychological conditions compared to the complex observational assessment in the other EI modules (Martins, Ramalho& Morin, 2010). Moreover, available studies focused on Global TEI, rather than its detailed domains, in relation to ADHD symptoms (Mavroveli, Peatrides& Shove et al., 2008).

8. Given the lack in research on relation between various TEI facets and ADHD core symptoms in children, this study was conducted aiming at comparing TEI in a group of children with ADHD and healthy participants, and to study the correlations of various TEI facets with the symptom profile of ADHD.

9. Study Participants
Across sectional comparative study conducted at Ain Shams University Institute of Psychiatry (ASUIP).
Cases
A convenient sample of fifty children diagnosed with ADHD was selected from the outpatient clinics of child psychiatry, in the period between Jan 2016 and June They aged between 8 to 12 years and both genders included. Both medicated and non-medicated patients were allowed to participate in the study. Children were excluded if their IQ was less than 90, had neurological or any other medical condition or other neuro-developmental disorders (e.g. Autism and schizophrenia).

10. Study Participants
The control group : consisted of 25 children who were matched with the case group for age, gender and other demographic variables as much as possible. They were recruited from, relatives of hospital employee. Typically developed children didn’t have any clinical symptoms/ signs that are suggestive of ADHD or other psychiatric disorder as clinically assessed by an interview guided by DSM-IV criteria for child and adolescent psychiatric disorders.

11. Measures:
1- Clinical history was collected using a Semi-structured clinical data sheet routinely used in ASUIP. 2- Arabic version of Kiddie-Schedule for affective disorders and Schizophrenia present and Lifetime Version (K-SADS-PL) (Kaufman et al., 2006). It was used to confirm the diagnosis of ADHD, to determine its type and exclude other axis-I co-morbid psychiatric conditions. 3- IQ was evaluated by the Arabic version (Taha , Abd ElSamea& Abu ElNile, 2011) of Stanford Binet intelligence scale, 4th edition (Throndike et al., 1986).

12. Measures:
4- Trait Emotional Intelligence Child form (TEI) (Mavroveli et al., 2008), was used. It has been specifically developed for children aged between 8 and 12 years. The scale comprises 75 items responded to on a 5-point scale and measures nine distinct facets which are emotional expression, emotional perception, emotional regulation, adaptability, affective disposition, self esteem, self motivation, low impulsivity, and peer relations. Arabic translated and validated version was used in the current study.

13. Results
Sample characteristics: The case group consisted of 35 male and 15 female children with ADHD, with mean age 9±1.2 years, and IQ 98.3±6.9. On the other hand, the control group contained 17 males and 8 females typically developing children, with mean age 8.8±0.9 and IQ 100.2±4.9. There was no statistical significant difference between the two groups regarding gender, age or IQ with p values 0.86, 0.39 and 0.22 respectively. Both groups were matched regarding other socio- demographic variables. ADHD diagnosis was confirmed using (K-SADS-PL). As regards K-SADS-PL results, 62% of the cases had mixed type of ADHD (31 patients), 26% were hyperactive (13 patients) and 12% were inattentive (6 patients)

14. Sample characteristics:

15. Comparison between the cases and controls regarding global score of TEI and its’ facets:

16. control group regarding the TEI.
Table (2): Comparison between different ADHD subtypes as diagnosed by K-SADS-PL and the control group regarding the TEI.
Control
Mixed
t test
Hyperactive
Inattentive
Mean SD
p value
TEI Global Score
3.276
0.220
2.379
0.312
<0.001**
2.640
0.432
2.680
0.378
Adaptability
2.828
0.555
2.636
0.414
0.144
2.839
0.439
0.948
2.313
0.245
0.036*
Emotional Expression
3.247
0.487
2.115
0.515
2.233
0.371
2.355
0.808
0.001*
Emotional Perception
3.358
0.513
2.273
0.427
2.377
0.483
2.857
0.849
0.216
Self Motivation
3.587
0.334
0.491
2.714
0.751
2.587
0.823
0.030*
Self Esteem
3.714
0.392
2.465
0.429
2.856
0.319
2.597
0.454
Low Impulsivity
3.102
0.297
2.075
0.437
2.397
0.674
0.003*
2.462
0.900
0.143
Peer Relations
3.303
0.467
2.600
0.534
2.834
0.573
0.010*
2.917
0.651
0.102
Emotion Regulation
3.477
0.482
2.527
0.386
2.848
0.458
2.898
0.748
0.025*
Affective Disposition
2.933
0.566
2.349
0.445
2.541
0.540
0.047*
2.712
0.535
0.393

17. Table (3): TEI facets among children with different ADHD subtypes (Hyperactive/Inattentive/Mixed)
Mixed
Hyperactive
Inattentive
ANOVA
Mean SD
p value
Tei Global Score
2.379
0.312
2.640
0.432
2.680
0.378
0.037*
Adaptability
2.636
0.414
2.839
0.439
2.313
0.245
0.039*
Emotional Expression
2.115
0.515
2.233
0.371
2.355
0.808
0.535
Emotional Perception
2.857
0.427
2.377
0.483
2.273
0.849
0.042*
Self Motivation
0.491
2.714
0.751
2.587
0.823
0.236
Self Esteem
2.465
0.429
2.856
0.319
2.597
0.454
0.020*
Low Impulsivity
2.075
0.437
2.397
0.674
2.462
0.900
0.128
Peer Relations
2.600
0.534
2.834
0.573
2.917
0.651
0.274
Emotion Regulation
2.848
0.386
2.5272
0.458
2.898
0.748
0.048*
Affective Disposition
2.349
0.445
2.541
0.540
2.712
0.177

18. Table 4: Correlation between TEI facets and ADHD symptoms by Connors scale
TEI
Conners
TEI Global Score
Adaptability
Emotional Expression
Emotional Perception
Self Motivation
Self Esteem
Low Impulsivity
Peer Relation
Emotion Regulation
Affective Disposition
Opposional rs
-0.239
-0.021
-0.176
-0.256
-0.134
0.006
-0.254
-0.114
-0.233
-0.187 P
0.094
0.884
0.221
0.072
0.354
0.967
0.075
0.432
0.104
0.193
Hyperactivity
-0.274
0.197
-0.081
-0.295*
-0.199
-0.057
-0.191
-0.202
-0.074
0.054
0.169
0.577
0.037*
0.165
0.696
0.184
0.160
0.192
0.611
Impulsivity
-0.532**
-0.227
-0.240
-0.358*
-0.325*
-0.316*
-0.423**
-0.517**
-0.319*
-0.313*
<0.001**
0.113
0.093
0.011*
0.021*
0.026*
0.002*
0.024*
0.027*
Cognitive
-0.298*
-0.166
-0.071
-0.216
-0.436**
-0.318*
-0.151
-0.215
-0.026
-0.146
0.036**
0.249
0.622
0.133
0.294
0.134
0.860
0.311
Social problems
-0.464**
-0.056
-0.126
-0.309*
-0.431**
-0.332*
-0.371**
-0.386**
-0.132
-0.344*
0.001**
0.702
0.384
0.029*
0.018*
0.008*ed
0.006*
0.359
0.014*
Emotional liability
-0.387**
0.022
0.123
-0.278
-0.350*
-0.070
-0.410**
-0.096
0.005*
0.878
0.394
0.051
0.013*
0.631
0.003*
0.505
Inattention
-0.272
-0.157
-0.072
-0.252
-0.393**
-0.087
-0.119
-0.331*
-0.086
0.056
0.275
0.078
0.548
0.410
0.009*
0.552

19. Conclusion
Trait Emotional intelligence (TEI) is extensively affected in children with ADHD. It is suggested that low TEI may be a contributing for the development, maintenance and exacerbation of the symptomatology.
At the same time Low TEI could be due to the pervasive symptoms of inattention, hyperactivity-impulsivity, causing secondary distress and difficulty in understanding and regulating their emotions, which in turn eroded their self-efficacy and confidence.
Further studies are needed to investigate the directionality of this relation. Schools and parents need to be aware of these difficulties and help these children in terms of their social development and behavior.

20. Strengths and limitations
It is one of the fewest studies that investigated Trait Emotional Intelligence (TEI) in children with ADHD and the correlations of various TEI facets with the symptom profile of ADHD. While most of other studies have either focused exclusively on studying only the TEI in adolescent age group, without analyzing possible interaction between TEI and different ADHD symptoms.
However, our study was limited by its' cross-sectional design, a longitudinal follow-up might provide more information. It could only determine the association between low TEI and various ADHD symptoms, but not the cause-and-effect relationship. A larger sample size would have allowed more analyses and might have shown clearer differences between the groups. Limited number of studies which investigated the relation between TEI and ADHD and absence of studies that correlate facets of TEI and ADHD symptoms; made it difficult in comparison and interpretations of the study results.