Attention Deficit/Hyperactivity Disorder in African Children

Author: Oluwabukola Janet Adeyeri, MSc. Child & Adolescent Mental Health. Medically reviewed by: A. Odutola, MB.BS, PhD.

Wood block image abbreviation of ADHD on a pink background with an image of four bare chested African children posing together outdoors. Composite picture from Unsplash & Freepik

 

Highlights

• ADHD is one of the most prevalent neurodevelopmental disorders that affects children. Its cause is not yet known, but risk factors have been described.

• Lack of proper awareness, cultural beliefs, stigma, and limited access to mental health support systems often lead to misdiagnosis of ADHD in Africa.

• ADHD is more prevalent in male gender than female gender (2:1).

• The age of onset of ADHD in children frequently occurs before twelve years.

• 7.47% of children and adolescents living in Africa are diagnosed with ADHD.

 

Introduction

Attention Deficit/Hyperactivity disorder (ADHD) is a common long term neurodevelopmental disorder that affects millions of children worldwide, yet it’s often misunderstood in African settings. When a child is seen in class or at home constantly on the move, easily distracted, not wanting to complete assignments, or always jumping and refusing to follow instructions in many African  countries, the child is often said to be deliberately stubborn, impatient, or even tagged as having a spiritual problem. [1]

These misunderstandings about ADHD lead to late diagnosis, stigmatization, and harsh treatment of children with the disorder. Despite its prevalence, Attention Deficit/Hyperactivity Disorder still remains underdiagnosed and misunderstood in Africa.

This article will provide you with accurate information on ADHD in African children; its cause, risk factors, signs and symptoms, diagnosis, and treatment options. You will also learn why well organised community and national awareness raising are needed about the condition across many African countries. 

 

What is ADHD?

ADHD is a neurodevelopmental disorder that affects children's daily functioning and development. It starts in childhood and can span through adulthood. Children with this disorder exhibit some patterns of persistent inattention, hyperactivity, and impulsivity and this can continue till adulthood if early intervention is not sought. [2]

 

Types of ADHD

ADHD in children may occur in three types (See fig 1):

Fig. 1: Types of ADHD in children. Click on image to enlarge. AI generated image from ChatGpT
 

1. Predominantly Inattentive type

The predominantly inattentive type is the most common type of ADHD in Africa and it involves difficulty staying focused, getting easily distracted, and forgetting tasks easily. Children who present with this don’t have symptoms of hyperactivity/impulsivity. 

2. Predominantly Hyperactive/Impulsive type

In this type, most symptoms present as hyperactivity and impulsivity, rather than inattentiveness. The child is always restless, talks too much, fidgets, and acts without thinking about the consequences of their actions. 

3. Combined type

A child with combined ADHD type must exhibit the symptoms of both inattentiveness and hyperactivity/impulsivity. 

 

How common is ADHD in Africa?

Fig. 2: Pooled estimate of children and adolescents living with ADHD in Africa. Source

 

ADHD affects about 3-5% of school aged children globally. A systematic review and meta-analysis estimated that ADHD has a prevalence of 7.47% in children and adolescents living in Africa (see fig. 2) and it is more common in males than in females, with a ratio of 2:1 [2]

 

What are the Causes of ADHD in African Children?

The cause or causes of ADHD is/are unknown. The main problem with ADHD children is believed tp be due to the dysfunction in the prefrontal cortex. The prefrontal cortex plays a huge role in the brain’s executive functioning like regulating attention, impulse control, planning, and responding to stimulus and children with ADHD find it difficult to perform tasks that demand their optimum attention. [3]

Fig. 3: Cartoon illustration of the left view of the brain showing prefrontal cortex location. AI generated image from ChatGpT

 

What are the risk factors of ADHD?

Common risk factors associated with Attention Deficit/Hyperactivity Disorder are:

1. Biological risk factors

Common biological risk factors of the condition include:

• Genetics (children with family history of ADHD have a high risk of having the disorder)
• Maternal exposure to alcohol/tobacco use. [4]
• Head injury at birth.
• Neonatal illness.
• Very low birth weight. [5]
• Male gender.
• Preterm birth. [6]
• Neurochemical imbalance.

2. Social/Environmental factors

Social factors surrounding the child or parents can also pose a risk to the child having ADHD. Some of them include:

• Media exposure. [4]
• Parental depression.
• Child abuse/neglect.
• Parent’s substance use disorder. [4]
• Chronic sleep disturbance

 

What are the symptoms of ADHD?

The symptoms of ADHD in children would have been much present before the age of 12 and must have lasted for at least 6 months.

For a child to be diagnosed with the condition the following symptoms must have been present in more than one setting (including home, school, church, mosque, etc.) and interfered with the child’s daily activities. [7]

These symptoms falls into two categories, which include (see fig. 4):

• Inattentive Symptoms
• Impulsivity/Hyperactivity Symptoms

Fig. 4: ADHD symptoms in children. Click on image to enlarge. AI generated image from ChatGpT.

Inattention symptoms

The child must meet at least 6 out of 9 of these symptoms: 

• Often fails to pay close attention to details, therefore making mistakes easily.
• Have a short attention span, and gets bored when a task is taking too much time.
• Finds it difficult to adhere to instructions even when spoken to directly.
• Doesn’t follow through on instructions given, especially their homework and house chores, or running errands.
• They are often disorganized, having their rooms scattered with toys, books, clothes, etc.
• They dislike any activity that requires them to sustain their mental effort like their homework and this often leads to procrastination.
• They lose their belongings easily (books, toys, school bags) and may not know where to find them.
• Get easily distracted by external stimuli (you may be talking to them now, but when they hear someone else talking, they shift their gaze to that person).
• Forget to do their daily activities, no matter how important those activities are.

Impulsivity/Hyperactivity symptoms

The child must meet six out of nine of the following impulsivity/hyperactivity symptoms:

• Often fidgeting or squirming on the seat (especially when told to sit still for some minutes).
• Always running and jumping around excessively even in dangerous places like the stairs.
• Finds it difficult to engage in quiet plays with friends because they’re often noisy.
• Can’t wait their turns on lines, in class, home, or anywhere that requires them to be patient.
• Leaves their seat even when others are seated like the classroom, church, etc.
• Talk excessively.
• Interrupts in discussions especially when they’re not called to engage in the conversation.
• Always on the go/move - want to be everywhere at the same time.
• Interrupts anyone questioning them and blurt out answers even before the question is completed.

 

How is ADHD diagnosed?

ADHD is diagnosed clinically using criteria detailed in the Diagnostic and Statistical Manual for Mental Disorders, fifth edition (DSM-5). 

The following conditions must be met before a diagnosis can be made by a skilled healthcare provider including any of the following: general practitioner/family doctor, pediatric neurologist, child psychologist, child and adolescent mental health professional, or psychiatrist. [8]

• The symptoms must be widespread in two or more contexts (including school, home, church, etc.) 

• The duration of the symptoms must have been at least six months.

• The child must have started exhibiting the symptoms before the age of twelve.

• The child must meet at least to six to nine of both inattentive and hyperactivity/impulsivity symptoms. [9]

• The symptoms must not be due to any other mental or physical health problems like anxiety, learning disorders, Tourette syndrome, or Obsessive Compulsive Disorder (OCD).

• Symptoms must have had a significant impact on the child’s development (including occupationally and academically) 

The assessment is done by interviewing the parents, asking questions based on the development of the child from conception till the point of visit. Also, school reports and observations of the teachers will also be put into consideration.

 

How can ADHD be treated?

ADHD can be managed effectively with the right interventions to help the child to cope well with family and friends. The two unique ways to treat/manage ADHD are:

1. Non-pharmacological/behavioral therapy

This is mostly recommended for parents of and children with ADHD. This is because certain drugs may create adverse effects on kids, particularly if they are younger than five. [9] Behavioral interventions are coping strategies parents and teachers can employ in managing ADHD and improving emotional regulation. Common behavioral therapies include:

• Parental Training in Behavioral Management  (PTBM)
• Individualized Education Plan (IEP)
• Behavioral Classroom Management.

2. Pharmacotherapy/medications

For older children above five, medications can be combined with behavioral therapy to help control the symptoms. The medications can either be stimulants (e.g., Methylphenidate and Amphetamine) or non-stimulants (e.g., Atomoxetine, Guanfacine, Viloxacine, and Clonidine). These medications must be prescribed by the child psychologist or psychiatrist because they are in the best position to determine the dosage and adjust medications as time goes by. 

 

Complications of untreated ADHD

If ADHD goes untreated, it can affect children’s perception of themselves and cause them to be withdrawn from others. 

Major complications associated with the condition are:

• Low self-esteem
• Academic struggles
• Increased risk for substance abuse, especially among adolescents.
• Difficulty getting and holding a job when the child gets older.
• Depression/anxiety.
• Relationship issues.

 

Conclusion

Children in Africa are frequently afflicted with ADHD, a neurobehavioural disorder. There is a need to increase awareness, train healthcare professionals, parents, teachers, and provide resources to support children living with the disorder. With early diagnosis, intervention, and reduced stigma, these children can live a productive and fulfilling life.   

 

FAQs

What is an ADHD person like?

A person with ADHD finds it difficult to pay attention, remember things, stay organized, and can be quite restless.

Is ADHD a mental health disorder or illness?

Yes, ADHD is a mental disorder that affects a person’s ability to function due to an impairment in the brain’s prefrontal cortex.

Does ADHD run in families?

Heredity is one of the prevalent risk factors linked to ADHD. So, it runs in the family if there’s a prior history of ADHD in that family.

Can ADHD be cured?

ADHD can’t be permanently cured. However, with proper management and treatment, a child with ADHD can also function optimally among his/her peers.

Is ADHD the same as Autism Spectrum Disorder (ASD)?

No, they are not the same disorders. ADHD affects a child’s focus, attention, and impulse control while ASD affects a child’s social interaction, communication, and behavior patterns. Despite some similarities, such as sensory impairments and emotional instability, they are still two different conditions. It’s also common for a child to have both disorders (Autism and ADHD). This is because children who present with Autism always have some symptoms of hyperactivity too.

Where can I get help for my ADHD child?

Talk to your primary healthcare provider first if you suspect your child may have ADHD. There are several secondary and tertiary health institutions that offer specialist or advanced assessment, diagnosis, and treatment services for children with ADHD in different African countries. Your primary care provider will assist you to identify a specialist facility near you that will serve the needs of your child. You can also find special schools/facilities that prioritise taking care of children with the condition. 

 

References

1. Olatunji, Gbolahan et al. “Navigating unique challenges and advancing equitable care for children with ADHD in Africa: a review.” Ann Med Surg (Lond). 2023 Aug 14;85(10):4939-4946. doi: 10.1097/MS9.0000000000001179. Available from here.  

2. Ayano G, Yohannes K, Abraha M. Epidemiology of attention-deficit/hyperactivity disorder (ADHD) in children and adolescents in Africa: a systematic review and meta-analysis. Ann Gen Psychiatry. 2020 Mar 13;19:21. doi: 10.1186/s12991-020-00271-w. Available from here.

3. Arnsten AF. The Emerging Neurobiology of Attention Deficit Hyperactivity Disorder: The Key Role of the Prefrontal Association Cortex. J Pediatr. 2009 May 1;154(5):I-S43. doi: 10.1016/j.jpeds.2009.01.018. Available from here.

4. Rattay K, Robinson LR. Identifying Risk Factors for Attention-Deficit/Hyperactivity Disorder (ADHD): a Public Health Concern and Opportunity. Prev Sci. 2024 May;25(Suppl 2):195-202. doi: 10.1007/s11121-024-01667-w. Available from here.

5. Hatch B, Healey DM, Halperin JM. Associations between birth weight and attention-deficit/hyperactivity disorder symptom severity: indirect effects via primary neuropsychological functions. J Child Psychol Psychiatry. 2014 Apr;55(4):384-92. doi: 10.1111/jcpp.12168. Available from here.

6. Soheilipour F, Shiri S, Ahmadkhaniha HR, Abdollahi E, Hosseini-Baharanchi FS. Risk factors for attention-deficit/hyperactivity disorder: a case-control study in 5 to 12 years old children. Med Pharm Rep. 2020 Apr;93(2):175-180. doi: 10.15386/mpr-1407. Available from here.

7. Magnus W, Anilkumar AC, Shaban K. Attention Deficit Hyperactivity Disorder. [Updated 2023 Aug 8]. In: StatPearls [Internet]. Treasure Island (FL): StatPearls Publishing; 2025 Jan-. Available from here.

8. Drechsler R, Brem S, Brandeis D, Grünblatt E, Berger G, Walitza S. ADHD: Current Concepts and Treatments in Children and Adolescents. Neuropediatrics. 2020 Oct;51(5):315-335. doi: 10.1055/s-0040-1701658. Available from here.

9. Eiland LS, Gildon BL. Diagnosis and Treatment of ADHD in the Pediatric Population. J Pediatr Pharmacol Ther. 2024 Apr;29(2):107-118. doi: 10.5863/1551-6776-29.2.107. Available from here.

 

 

Published: September 8, 2025

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