Keywords: Attention Deficit Hyperactivity Disorder, neurodevelopmental, pre-eclampsia, eclampsia, Nigeria.
Introduction.
Attention Deficit Hyperactivity Disorder – Nigeria. What sort of disorder is this? Do Nigerians suffer from it? How does it present? What can bring it about? And are there treatment for the disorder?
Most people do not know about the disorder. And for those who do know about the disorder, many believe that it is a problem with the children of the Caucasians. But it actually affects children globally.
Attention Deficit Hyperactivity Disorder (ADHD) – Nigeria.
What is ADHD?
This is a nuerodevelopmental disorder diagnosed in early childhood i.e. between the ages of 6 years 7 years of age and continues through adolescent age and up to adulthood. For some children, it can begin as early as 4 years of age. It is neurodevelopemental disorder in the sense that there is a problem in the development of the central nervous system, affecting the brain and behavior of the child.
Does it occur in Nigeria?
In Nigeria alone, research studies have shown that it affects between 3% to 23% of school children, depending on the state and if it is an urban or rural area. The predominantly inattentive and the combined type are more common in Nigeria.
How does it present?
There are three main types or subtypes of ADHD, and each has its own way of presentation or symptoms, which the child must displays in at least two places, for a diagnosis to be made, e.g. at home and at school. But note that not all the symptoms must exist before the doctor can make a diagnosis.
Predominantly INATTENTIVE type:
The symptoms include – difficulty in concentration in any activity, like being unable to take part in activities that require thinking or calculating. Completing homework is a problem, because the child is easily distracted.
The child will have issues with remembering either what was taught in class, or where things are kept. So, the child can easily loose things, like socks, underwears, uniforms, pencils, books, etc. Even daily routines may not be remembered.
When spoken to it seems as if the child is not listening, as if the child is day dreaming. So keeping to instructions is very difficult.
Predominantly HYPERACTIVE / IMPULSIVE type:
The child finds it difficult to sit still. So in the class, the child will be running about while the teacher is teaching and other children are sitting still. Staying in line is an uphill task.
Because the child fidgets a lot school books may be torn and pencils broken.
The child will blurt out answers before the teacher finishes asking the question, even when the answer is wrong. The child is talkative and can easily talk to an unfamiliar adult.
Working alone or in a group is difficult, because the child gets easily distracted and may abandon the work and run out to play. The child may even intrude into other children who are working or playing, thus distracting or disrupting them.
The COMBINED type:
This presents with some of both the inattentive symptoms and the hyperactive symptoms, all in one child.
Causes and risk factors for ADHD.
Genetic factors.
This genetic problem affects some chemicals in the brain of the child i.e. neurotransmitters, such as dopamine, nor epinephrine and serotonin, making their levels inadequate. Other chemicals that are also not functioning normally are also some brain enzymes.
Genetic factors can also affect the structure of some parts of the brain, making them smaller and under functioning. For example, the frontal lobe needed for paying attention and concentration, is smaller than normal. This reduces its functioning. So, the child will have problems concentrating and paying attention.
The amygdala part of the brain, which helps us to remember things, is smaller than it should be, so the child finds it difficult to remember things and can easily loose thing.
Even the basal ganglia, which is the part of the brain that helps reduce impulsive and excessive movements, is also reduced in size, causing the hyperactivity and impulsivity seen in children affected by ADHD.
Environmental risk factors.
Poverty:
This is a risk factor for developing the disorder. The disorder is seen more in children who are born into and grow up in the middle and lower socioeconomic class and who live in cities and towns. This does not mean that it never affects the children from rich families, or those who live in the rural areas.
During pregnancy:
If the woman is exposed to alcohol intake, cigarette smoking, infectious diseases such as rubella, toxins such as pesticides and lead, the risk to get the disorder is high for the unborn child. Also exposing the pregnant woman to Xray, receiving a blow to the abdomen, bleeding, are risk factors. Even attempted abortion is a risk factor as well, for the unborn child.
Pre-eclapsia and eclapsia, during pregnancy and labour, can affect the baby and bring about ADHD, later in childhood. Pre-eclapsia is a complication that can arise during pregnancy. The symptoms are raised blood pressure, swelling of the face, hands and feet, protein in the urine,etc. in the pregnant woman. Eclapsia is actual fitting or convulsion during pregnancy, delivery or after delivery.
Trauma to the brain of the baby:
Damage to the baby’s brain can cone during prolonged labour, traumatic delivery through forceps or vaccum to deliver the baby. The child sustaining a fall at the early age and hitting the head on a hard surface can be a risk factor to ADHD.
Delivery issues:
A baby born prematurely, or having low weight at birth, is also at risk for that baby. And so is an unplanned or emergency C/S. This happens more in cultures that do not accept this method as a pattern of delivery, like Nigeria. This will psychologically affect the mother who will not provide adequate care for the baby.
Nutritional and substance abuse issues.
Malnutrition, exposure to heavy metals such as zinc and lead from wall paints and water pipes, at the early childhood, can be risk factors.
Exposing the unborn baby to maternal alcohol use or other forms of substances can predispose to ADHD.
Other issues:
These also can predispose children to ADHD, include being in an incubator, being given oxygen within the first two months of life, etc. As well as epilepsy in childhood.
Adverse Childhood Experiences:
Early maternal deprivation, when the mother is not available to adequately care for the child, either due to death, separation or illness (including mental illness). All forms of ACEs early in infancy and family conflicts, can be risk factors. Having an unwanted pregnancy is a risk factor.
Complications from ADHD.
If the disorder is not treated, it can lead to complications both during childhood and adulthood. The complications include, having difficulties with peers, i.e. difficulty in making friends, the child is prone to injuries and accidents, there is low self esteem, depression, anxiety, as well as the abuse of substances such as alcohol, cannabis (Indian hemp), etc. suicide or suicidal behaviours are possibilities. The child may become delinquent and indulge in crime, as well.
Academics will be quite difficult for the child who may have poor grades, and drop out of school. The worst hit of all the subtypes is the inattentive, when it comes to academics. Even learing a trade may not be so simple. Being able to concentrate to work is difficult.
Not only is the child adversely affected, even the siblings, parents and teachers will get frustrated and highly stressed due to abnormal behaviours the child presents.
Treatment.
Early identification and treatment is very important. So in the early or preschool age, the psychologist can do talk therapy. As the child gets older to middle childhood and adolescent age medication will need to be introduced by a psychiatrist. Recently, some children as young as 4 years old may require medication treatment.
There is need for the government to train the teachers, the psychologists and the psychiatrists. They in turn will educate the parents on how to handle children suffering from the disorder.
The parents must ensure that the child gets a good night sleep, get good nutrition with plenty of fruits and vegetables, as well as limit the amount of time the child spends on screen like television and phone, etc.
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