Attention Deficit Hyperactivity Disorder (ADHD)
"Early and correct diagnosis of ADHD is essential to achieve the best results and reduce complications such as academic, family and social problems".
DR. PILAR DE CASTRO MANGLANO
SPECIALIST. PSYCHIATRY AND CLINICAL PSYCHOLOGY DEPARTMENT
What is ADHD?
Attention Deficit Hyperactivity Disorder (ADHD) is a neurobiological disorder that causes alterations in the child's learning and behavior.
It is one of the most frequent psychiatric problems in childhood and the most frequent cause of child psychiatry consultation. It is more frequent in boys (9%) than in girls (3.3%). These children have problems with attention, impulsivity and excessive activity. Due to these symptoms, they have difficulties in social interaction and school performance.
In addition, other problems are usually associated with them such as defiant negativistic disorder or conduct disorder (up to 40%), depression and anxiety.
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What are the symptoms of ADHD?
The characteristic symptoms of ADHD are inattention, hyperactivity and impulsivity.
There are three subtypes of ADHD:
With inattention, hyperactivity and impulsiveness. It is the one that most closely resembles the classic descriptions of the hyperactive child. It is more frequent in boys (80%) than in girls (60%).
Predominantly inattentive type
It is the most frequent type in girls (30%) than in boys (17%).
Predominantly hyperactive-impulsive type
It happens rarely.
The most common symptoms are:
- Excessive physical activity.
- Very low attention span.
- Diet to inhibit impulses.
- Problems in their family and social relationships.
- Low school performance.
- Low self-esteem.
- Comorbidity (oppositional-defiant, conduct and language disorders, anxiety, depression...)
Do you have any of these symptoms?
You may have attention deficit hyperactivity disorder
What are the causes of ADHD?
The origin of ADHD is still partially unknown. We know that it is not due to environmental or eating problems, nor is it the fault of the family or social environment.
In 75% of cases, the cause is genetic. There is a functional disorder of dopamine and noradrenaline, neurotransmitters located in the front part of the brain and responsible for the maintenance of attention, impulse control and the decision to perform or reject a certain action.
Among the non-genetic factors related to ADHD are the use of tobacco or alcohol by the mother during pregnancy, the lack of oxygen to the child during delivery, low birth weight, poor social conditions
In families where one of the children has this disorder the risk for siblings rises from 5% of the general population to 30-40%. It also increases the risk by a factor of 8 if one of the parents has ADHD.
How is ADHD diagnosed?
It is very important that the diagnosis and treatment be carried out by a multidisciplinary team like the one the Clinic has, integrated by different specialists who are experts in this pathology.
Some mild forms of this disorder can be controlled with non-pharmacological treatment, but studies indicate that the most effective treatment is a combination of medication, behavioral psychotherapy, parent training and school support.
On the other hand, the Child and Adolescent Psychiatry Unit of the Clinic is participating in international studies of new medications for ADHD.
In addition, the team of specialists of the Neuropediatrics Unit of the Clinica Universidad de Navarra has participated with the company Nesplora in the design of "AULA", an innovative test aimed at offering a more precise and complete diagnosis of this disorder.
It is equipped with "ecological" software, 3D glasses and headphones, and manages to place the patient in an environment very similar to that of a real school class.
How is ADHD treated?
Psychostimulants have proven effective in reducing 70% of ADHD symptoms, reducing movement, increasing attention span, facilitating the internalization of instructions and, consequently, reducing impulsivity.
Methylphenidate is a stimulant that improves both hyperactivity and inattention in children with this disorder. Although it is usually well tolerated, it can produce some side effects such as decreased appetite or sleep (the last dose should not be given later than 4 or 5 pm).
The effect of methylphenidate is rapid: in a few days you can notice improvement.
Immediate-release methylphenidate (Rubifen®) has a 4-hour effect, so it should be taken two or three times a day. It should be taken throughout the year, even on weekends and vacations.
Prolonged or intermediate-release forms can also be used, which have the advantage that they are only taken once a day (in the morning), such as long-acting methylphenidate (OROS® or Concerta®), whose effect lasts about 12 hours, or intermediate-acting methylphenidate (Medikinet®), which has an 8-hour effect after a morning dose.
Atomoxetine (Strattera®) is a new non-amphetamine drug effective in the treatment of ADHD. Its positive effect lasts all day (about 12 to 20 hours) and can be administered in a single dose in the morning. It has no potential for abuse, can improve anxiety and does not worsen tics.
However, the most effective treatment combines medication, behavioral psychotherapy, parent training and school support.
Non-pharmacological treatment is based on different psychotherapies:
Psychoeducation and training of parents
To control the child's behavior, prevent and anticipate explosive reactions.
At the Clinic we have developed a psycho-educational program that our ADHD nurses introduce to parents of children with this disorder.
In this program the symptoms of ADHD are reviewed in 5 sessions and in addition, parents are trained to better control different behaviors of their children, to motivate, distract, encourage and, if necessary, punish them more effectively. The goal is for parents to be able to participate as co-therapists in the child's recovery and improvement process.
If the symptoms of negativism are more intense, it is necessary to implement a more complete program of behavioral management by Clinical Psychology.
Family and Individual Therapy
Reduces family stress from the child's illness.
Support at school
In areas where the child is most in need. In our Unit we work in coordination with teachers, tutors, school counselors and school psychologists to adapt the demands and school environment to the individual needs of each child, taking into account their areas of greatest difficulty, and also their strengths.
At the school level, there is no need to diminish the demand, but there are strategies that improve the child's effectiveness to obtain better results. Since he cannot organize himself, sometimes tasks must be organized sequentially. Positive behaviors are rewarded and recognized, at home and at school, with a point system.
ADHD may be accompanied by other psychiatric problems, depression or anxiety, which require attention.
Communication between parents, doctors (pediatrician, child psychiatrist), psychologists and teachers must be fluid and coordinated, so that the child perceives homogeneity and does not detect cracks or disagreements.
4% of adults suffer from attention deficit hyperactivity disorder.
The main treatment for ADHD in adults is based on the use of psychostimulants, derived from amphetamines.
The Clínica Universidad de Navarra has participated in an international study of a new medication, a central action noradrenaline reuptake inhibitor, without a stimulant effect.
Symptoms of ADHD in the adult population
- The most obvious are the attention problems.
- These are people with poor planning and organization. They have a poor memory.
- Their interpersonal relationships are affected, with higher rates of divorce and layoffs due to poor performance.
- There are also cases of traffic or machinery accidents.
- Sometimes other psychiatric conditions appear: drug consumption or depression or anxiety.
What clinical trials do we have on TDAH?
Where do we treat it?
IN NAVARRA AND MADRID
The Department of Psychiatry and Medical Psychology of the
of the Clínica Universidad de Navarra
Through a multidisciplinary work, the Department of Psychiatry and Clinical Psychology assists patients in a comprehensive way: it identifies the main causes of the disease and provides an individual approach with the most appropriate and effective treatments.
Thanks to the experience of its team, it is able to offer the most advanced biological therapies, as well as an adequate psychotherapeutic orientation. In this way, the patient is helped to solve both personality problems and alterations in interpersonal and family dynamics.
Organized in specialized units
- Child Psychiatry.
- Adolescent Psychiatry.
- Adult Psychiatry.
- Family therapy.
- Psychiatric hospitalization.
- Clinical psychology.
Why at the Clinica?
- Integral evaluation of the patient.
- Personalized diagnosis.
- Multidisciplinary team.