Abstract / Summary
Unequal access to child mental health screening and early intervention remains a major public health challenge in geographically marginalized settings. Epidemiological data on the distribution of attention-deficit/hyperactivity disorder (ADHD) and oppositional defiant disorder (ODD) symptom levels among children in Thailand’s border regions remain limited. This study aimed to determine the prevalence of clinically significant ADHD and ODD symptoms identified through school-based screening among primary school students in Thailand’s border regions and to examine differences in symptom prevalence and severity according to geographic region, sex, and grade level. A retrospective chart review was conducted among primary school students participating in a mobile school-based mental health screening program implemented by the Faculty of Medicine, Srinakharinwirot University in 2022. ADHD and ODD symptom levels were assessed using the Thai version of the SNAP-IV scale, based on teacher-completed ratings. Differences by province, sex, and grade level were examined using chi-square tests and Fisher’s exact tests. Among 540 students, clinically significant symptom levels were most prevalent for oppositional/defiant behavior (38%,95%CI:34–42), followed by hyperactivity/impulsivity (15%,95%CI:12–18) and inattention (8%,95%CI:6–11). The prevalence of clinically significant symptoms varied significantly across geographic areas, with the highest proportions observed in Nan province for inattention (16.8%), hyperactivity/impulsivity (23.5%), and oppositional/defiant behavior (71.4%) (all P < 0.001). Sex- and grade-related differences in symptom-severity distributions varied across symptom domains. The prevalence and severity of clinically significant ADHD- and ODD-related symptoms identified through school-based screening differed according to geographic region, sex, and grade level among primary school students in Thailand’s underserved border regions. These findings provide descriptive epidemiological evidence on the distribution of behavioral symptoms in geographically marginalized populations and may inform future research, school-based screening programs, referral pathways, and service planning for the early identification and support of children with behavioral difficulties.