Understanding and managing ADHD in your child

When Purity Kebongo’s eight-year-old son started making careless mistakes in his schoolwork, she thought that he had become too playful, inattentive, and undisciplined. He hardly completed his homework and couldn’t follow through with instructions.

Purity’s son is one of the many Kenyan children who suffer from Attention Deficit and Hyperactive Disorder (ADHD). According to psychiatrist Martin Oluoch, when a child has ADHD, they will display behaviours that border on carelessness, inattention, underachievement, inability to concentrate and complete one task at a time, and lack of focus and persistence. “Children with ADHD will squirm a lot, fidget and get out of their seats without any reason,” he says. “They may also be very vocal, often talking excessively and making random noises, and will have difficulty waiting for their turn. For example, during conversations, they will interrupt by blurting out answers and suggestions. They will also tend to intrude on other people’s conversations, games, and activities. In the classroom, they will have trouble remaining seated.

According to the Centre for Disease Control (CDC), ADHD is the most common neurodevelopmental disorder in childhood. In most children, inattention symptoms are likely to manifest at around the age of eight and nine and usually last a lifetime. Hyperactivity symptoms are usually evident by age five and peak from between the ages of seven to eight.

Children without ADHD can exhibit behaviours related to this disorder such as lack of focus and not following through with all instructions. However, Oluoch says, most children will outgrow these difficulties. Children with ADHD, though, are not able to outgrow their tendencies. However, as children mature, ADHD tendencies progressively decline and are downgraded to restlessness.

Impulsive behaviours are also linked to hyperactivity and peak at about age seven to eight, however, unlike their hyperactive counterpart, impulsivity remains even in adulthood, peaking during teenage.

“Impulsivity involves activities with high risk and the teenager will do things without thinking of the consequences, mostly because of low esteem.” Such children often become vulnerable to social and peer pressure and easily engage in drug abuse and risky sexual behaviour. Impulsive adults have a higher rate of financial mismanagement.

Psychiatrist Dr. Fredrick Omondi says that ADHD disorder is heritable. “Genetics is a factor in about 75 percent of all cases,” he says.  Hyperactivity also seems to be a primarily genetic condition. “A genetic predisposition has been demonstrated in (identical) twin and sibling studies. If one identical twin is diagnosed with ADHD, there is a 92 percent probability of the same diagnosis with the twin sibling. When comparing non-identical twin sibling subjects, the probability falls to 33 percent,” he says. In addition to genetics, the CDC lists other potential causes of ADHD as premature delivery, low birth weight, brain injury, exposure to environmental hazards such as lead during pregnancy or in infancy, and the use of alcohol and tobacco during pregnancy.

Types of ADHD

• Predominantly inattentive: Symptoms exhibited by the child will be related to lack of attention. For example, being distracted easily or unable to follow conversations.
• Predominantly hyperactive or impulsive: Symptoms will involve hyperactivity and impulsivity. For example, being fidgety and restless.
• Combined presentation: The child will exhibit both inattentive and hyperactive symptoms.

Treatment and management

Management of ADHD includes the use of medications and behaviour modification through counseling. These children require special attention through personalised care and training for both their parents and teachers. The training involves paying attention to appropriate behaviour, ignoring minor inappropriate behaviour, and giving tokens and rewards for good behaviour.

In addition, parents and teachers are taught to maintain a daily schedule, keeping distractions to a minimum, setting small and reasonable goals, rewarding positive behaviour, using charts and checklists to keep the child on track, and finding activities where the child will succeed. All associated disorders, such as depression, anxiety, antisocial personality disorder, and conduct disorders that coexist with ADHD, must also be addressed separately should they exist in the same child.

Hypothyroidism in the first trimester triggers ADHD

Children whose mothers get hypothyroidism while pregnant are more likely to suffer from Attention Deficit Hyperactivity Disorder (ADHD). This risk is highest when pregnant mothers get hypothyroidism within the first three months of pregnancy. After the second trimester, a pregnant woman’s hypothyroidism has an insignificant effect on her baby’s state of neurodevelopment. This is according to a 2021 research on the link between ADHD and hypothyroidism that was conducted by the New York University School of Medicine. The study followed 329,157 children from birth to the age of 17.

“Fetal growth and fetal brain development are largely influenced by chemicals and hormones that are produced in the thyroid gland located in the neck. ADHD in babies is exacerbated when this gland is affected by hypothyroidism,” says Dr. Morgan Peltier who led this research. Dr. Peltier recommends that babies whose mothers have low thyroid hormone levels during pregnancy should be monitored keenly and any signs of ADHD professionally attended to from the onset. Signs include impulsivity, irritability, lack of attention and focus, lack of restraint, and hyperactivity. These findings were published in the American Journal of Perinatology.

Hypothyroidism is a medical condition that results in the thyroid gland failing to produce enough of certain critical hormones. Symptoms of this condition are usually hard to spot during the early stages. However, as the condition manifests, a patient might start to suffer health problems such as joint pain, infertility, cardiovascular disease, and obesity. The onset of these complications will be preceded by the condition’s major symptoms which include increased sensitivity to cold, sudden weight gain, fatigue, and constipation.                  

How to recognise mental illness in your child

There are tell-tale signs that could show that your child may need further review by a mental health specialist.

1. Lagging behind in key childhood development milestones: Most children develop physical, social, and mental abilities at a certain pace. For example, most begin walking at around 12-18 months, they can engage in conversation with adults by 2-3 years and can read simple words by age 5. Children with mental illness may experience delays in the various developmental milestones and this can act as a red flag to an underlying problem.
2. Extreme feelings and mood changes: The child may become very sad or withdrawn with little explanation. In some cases, the child is relatively happy between these episodes of low mood. In other cases, the child may show extreme fear or irrational anger towards a particular situation.
3. Poor school performance: Difficulties concentrating and poor memory in a child usually indicate an underlying mental or emotional problem but it can also be a sign of a learning disability.
4. Unusual violence: Violence and repeated cruelty towards animals is a red flag when it comes to symptoms of mental illness in a child. They often have a desire to hurt other people. In most cases, the violence is directed towards younger siblings (these children may do things like push siblings down flights of stairs and other extreme forms of violence). Teens may begin to carry weapons.
5. Self-harm: These children may try and harm themselves by cutting or burning themselves. Older children may attempt suicide.
6. Out of control behaviour: Very difficult to control, hyperactive and children have problems obeying rules. Older children may engage in drugs/alcohol to cope with their feelings.
7. Physical symptoms: Unexplained headaches and tummy ache when they are dealing with extreme anxiety or sadness. Massive weight gain or loss may indicate an eating disorder.
8. Night terrors and hallucinations: Persistent nightmares and night terrors may be indicative of a mental disorder. In some cases, the child may actually hear or see imaginary people talking to them even when they are awake.