Understanding ADHD symptoms in children

Attention Deficit Hyperactivity Disorder (ADHD) is more common among children in their early school years (between six and 12 years) when a child begins to have problems paying attention. However, it also affects adults. 

At the beginning of last year when schools resumed, Akello enrolled her then six-year-old son in a new school. Because there had been a long break from school as a result of the Covid-19 induced lockdown, Akello thought it was too early to conclude that her child did not seem to understand most of what he was taught in class. So, she visited his school to have a chat with his class teacher.

“Your son never settles in class. He is talkative and distracts other children. He never completes copying homework from the board unless you are there to police him,” she was told.

“I did not know what to do. At home, whenever I would ask him to do something, within five minutes, he would stop, say he wants to use the toilet and on coming out, he would have forgotten what he was doing. I resorted to beating him whenever he did not complete a task but it was not helping. I thought he was just being stubborn but there was still no change,” Akello says

Akello’s son sometimes forgets to brush his teeth yet this is part of his daily routine. Many times he misplaces his socks, sweater or even the school uniform and cannot remember where he places it while at home.

Lois Nakibuuka, a child psychologist, says ADHD, also known as Attention Deficit Disorder (ADD), is quite common but there is a lack of information, so many parents are ignorant about it while others are in denial since they fear their children will be labelled as living with a disability.

ADHD is a brain disorder that affects how you pay attention or control your behaviour. It happens mostly in children and teens and may continue into adulthood.

ADHD types, signs

According to Dr Joyce Nalugya, a child psychiatrist at Mulago National Referral Hospital, the different types of ADHD are categorsied according to the signs and symptoms. These include the inattentive type, the hyperactivity type or combined. 

On the symptoms, she remarks: “A child is easily distracted or does not pay attention and makes careless mistakes. This can happen when the child is at home, school or place of worship. The teachers usually notice this sign first because sometimes, it even leads to poor academic performance yet the child understands most of what they are taught.”

A child with ADHD forgets their daily activities, finds it difficult to organise themselves or often loses things. Such children do things out of impulse without first thinking about them and do not follow directions or finish tasks. They do not seem to be listening at all. 

ADHD causes a child to fidget, be restless, bounce when seated or sit still. Such a child talks excessively and finds trouble playing quietly and is always moving, climbing or running. 

About 50 to 70 percent of the childhood ADHD progress into adult ADHD according to Dr Nalugya and the symptoms may include but not limited to anxiety, mood swings, depression, impulsiveness, trouble controlling their temper, relationship problems, substance misuse or addiction, trouble concentrating and often being late or forgetting things, among others.

Causes
Although it is said to be hereditary, psychiatrists are not sure what causes ADHD and, therefore, ask parents not to blame themselves for their child’s behaviour. 

A stressful home life, food allergies, sugar or too much TV do not cause ADHD.  However, smoking, drinking, substance abuse, poor nutrition, infections during pregnancy may affect the baby’s development. Also, being born prematurely, damage to the frontal lobe of the brain, autism and poor nutrition can predispose a child to ADHD.

Diagnosis 
According to Dr Nalugya, diagnosing ADHD is all about observation and it will take some time for the specialist to detect the signs and symptoms and be able to come up with a confirmatory diagnosis.  Once the diagnosis is made, such a child needs to be managed holistically right from home, at school and within the community. 

“Different children with ADHD present differently and, therefore, their management is also different. It ranges from their diet, what television programmes they watch and how they are handled in class,” she says, adding that diagnosing children with ADHD may be hard, requiring the efforts of a teacher, parent and health worker to observe the child’s behaviour. 

To confirm a diagnosis of ADHD or learning differences, a series of tests to check a child’s neurological and psychological status are done. The tests should be given by a pediatrician or mental health professional such as a psychiatrist or psychologist. 

“It is, therefore, important that parents become vigilant and observe their children more keenly. If your child does not behave like their age-mates, take them for professional assessment,” Dr Nalugya advises.

Living with ADHD

ADHD is the most commonly diagnosed mental disorder in children and can neither be cured (may only reduce but cannot be treated completely) nor be prevented.

Dr Nalugya, however, says if diagnosed early, a good treatment and education plan can help a child or adult with ADHD manage their symptoms. The most important aspect is for the parent not fight it but rather acknowledge and manage it.

She recommends a lifestyle change that would help manage the symptoms. This may include substituting junk, fast foods and carbonated beverages with a healthy diet with plenty of fruits, vegetables, whole grains, and lean protein. 

Exercise helps children with ADHD to control impulses and other behavioural problems. You should also limit the time such children spend watching TV, using phones, tablets or computers and instead let them have enough time to play and exercise. The child can be part of a basketball, football or netball team and this will teach them to socialise and be able to follow instructions.

“Simplify your child’s tasks by allowing them to have a break in between. Also, help them with organisation. Sit with them while they do their homework to help them remain focused and reward them for the things they have been able to accomplish,” says Dr Nalugya.

Note
It may be frustrating raising a child with ADHD but taking an active part in the management of the symptoms can be helpful. Make clear instructions, maintain routines, reward good behaviour, and be calm and consistent with discipline. It is also important that you boost your child's self-esteem. 

“This is because they are easily misjudged and bullied since they may have trouble processing directions and other information. They may be overwhelmed with corrections, leaving them with low self-esteem,” Dr Joyce Nalugya, a child psychiatrist at Mulago National Referral Hospital, remarks.

Treatment
Research suggests that for many children, the best way to manage symptoms is using multiple methods of treatment that work together. Children with mild cases can be managed with a change in behaviour while those with severe symptoms are usually treated with both medication and therapy. It requires close cooperation among therapists, doctors, teachers and parents.

Dr Joyce Nalugya says: “Although there is controversy about their possible overuse, stimulants are the most commonly prescribed medications for treating ADHD. They are helpful in controlling hyperactive and impulsive behaviour and improving attention span.”

When a family has a child with ADHD, it is important that they undergo counselling to learn how they can help such a child. If it is an adult, counselling would help them learn better ways to handle their emotions and frustration. It could also help improve their self-esteem.