Priscilla Nyakio’s daughter began to make careless mistakes with her homework. She became inattentive and did not seem to listen when directly spoken to. “She could not seem to follow through instructions and often failed to finish her homework,” says the mother of three.
Initially, Priscilla thought that her seven-year-old daughter was just growing horns. And so she embarked on a ‘spanking spree’. However, her daughter’s short-comings were not a result of oppositional behaviour or the failure to understand instructions.
Priscilla’s daughter, Brigit Mumbi, was one among the four to19 per cent of Kenyan children who suffer from Attention Deficit and Hyperactive Disorder (ADHD). According to Dr Pius Kigamwa, a psychiatrist at Nairobi Hospital, inattention, hyperactivity and impulsiveness are the common behaviours of children with ADHD.
“Children with this condition display inattention, underachievement, carelessness, lack of persistence on tasks and, or shifts from one task to another before the first one is completed, and, failure to finish assignments, and an apparent lack of adequate focus.”
Children with ADHD also tend to be very ‘motor’. They squirm a lot, fidget and get out of their seat without any reason, and may also be vocal, often talking excessively and making random noises. Inattention symptoms are most likely to manifest at around eight to nine years of age and usually last a lifetime. Hyperactivity symptoms are usually evident by five years of age and peak in severity from between seven to eight years of age.
With maturation, these behaviours progressively decline and are often downgraded into restlessness. Impulsive behaviours are commonly linked to hyperactivity and also peak at about seven to eight years of age; however, unlike their hyperactive counterpart, impulsivity issues remain well into adulthood. It is, however, more prominent during teenagehood. “It often involves activities that contain high risks as the teenager does things without thinking of the consequences, mostly because of low esteem.”
In most cases, such children 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 such as impulsive buying and gambling.
Psychiatrist Dr Fredrick Omondi observes that this disorder is inheritable. “Genetics are a factor in about 75 per cent of all cases,” he says. Hyperactivity also seems to be primarily a genetic condition. “A genetic predisposition has been demonstrated in (identical) twin and sibling studies. If one identical twin is diagnosed with ADHD, there is at 92 per cent probability of diagnosis with the twin sibling. When comparing non-identical twin sibling subjects, the probability falls to 33 per cent.”
Management of ADHD includes use of medications and behaviour modification through counselling. These children may 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 symptoms, antisocial personality disorder, and conduct disorders that coexist with ADHD, must also be addressed separately should they exist in the same child.
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. These include:
Lagging behind in 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.
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.
Poor school performance: Difficulties concentrating and poor memory in a child usually indicates an underlying mental or emotional problem but it can also be a sign of a learning disability.
Unusual violence: Violence and repeated cruelty towards animals is always a red flag when it comes to symptoms of mental illness in a child. They also 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.
Self-harm: These children may try and harm themselves by cutting or burning themselves. Older children may attempt suicide.
Out of control behaviour: This child may be very difficult to control, hyperactive and have problems obeying rules. Older children may engage in drugs/alcohol to cope with their feelings.
Physical symptoms: Children with a mental health condition may develop unexplained headaches and tummy aches when they are dealing with extreme anxiety or sadness. Massive weight gain or loss may indicate an eating disorder.
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.