Attention deficit and hyperactivity

GENERAL ASPECTS

What is Attention Deficit Hyperactivity Disorder (ADHD)?

It is a neurodevelopmental disorder characterized by disattentional and dysexecutive symptoms that interfere in the correct development of the person.

To understand this definition we will analyze its components:

• Attentional difficulties: distractions, fatigue throughout tasks, leaving tasks unfinished or letters not put at the end of the word.
• Executive processing difficulties: in inhibitory control expressed in interruptions, in organizing homework, tasks or materials, in being able to sit still, in adapting to changes or in regulating emotions.

What are the symptoms?

Symptoms may be different depending on age, sex or the environments in which the child interacts (family, school, social), and may be very marked in one environment and barely noticeable in another. However, we highlight certain features that are usually present:

• Loss of objects: articles of clothing at school, homework at home, etc.
• Loss of information: They focus more on extraneous details than on the explanation.
• Unfinished tasks.
• Delay aversion: They find it hard to wait for turns and need immediate reward.
• They do not know the delivery days or the syllabus that goes into the exams.
• Some children (hyperactive subtype) experience excessive motor activity.
• Occasionally they present tantrums, sudden anger and emotional dysregulation.

What are the main causes of ADHD?

Currently, a multifactorial hypothesis with factors related to genetics, environment and biology (Lasa-Zulueta).

Most of the genes linked to ADHD are related to Dopamine transmission, followed by those regulating Noradrenaline and Serotonin.

Neurobiologically, the most affected structures are the prefrontal and parietal cortex, basal ganglia, anterior cingulate and limbic structures.

In addition, low birth weight (less than 1.5 kg), exposure to toxic substances during pregnancy or malnutrition are considered possible risk factors.

In clinical practice we observe three characteristic forms of ADHD presentation:

Inattentive subtype (ADHD with predominantly inattentive presentation)

This subtype is the most difficult to diagnose because inattentive people tend to go unnoticed (they tend to be distracted, lost in their thoughts or ideas) which contrasts with those of the hyperactive subtype, which is more striking.

Hyperactive subtype (ADHD with predominant presentation with hyperactivity and impulsivity).

This type, together with the combined type, is usually detected earlier and is more frequently seen in consultations due to its striking symptoms (continuous movement, difficulty in remaining seated for a prolonged period of time, need to move or touch objects, etc.).

Combined subtype (ADHD with combined presentation)

This group includes those persons who present symptoms of the two previous groups.

Is it possible to have ADHD together with other pathologies?

Comorbidity is the term used to describe two or more disorders occurring in the same person.

In relation to research to date, 44% of the population diagnosed with ADHD has another disorder; 32% have two other disorders, and 11% have at least three associated disorders.

DIAGNOSIS

How do I know if my child has ADHD?

The assessment of a child with ADHD begins after the collection of life history data through an interview conducted by the neuropsychologist. Family members and teachers are asked to fill out questionnaires which will provide information about the child’s functioning in different environments and will be compared with the tests performed in the neuropsychological evaluation.

A neuropsychological evaluation is a diagnostic procedure whose objective is to determine the patient’s cognitive performance, information that is not available with other methods such as electroencephalography or magnetic resonance imaging. Reasoning processes, attentional processes in both sensory modalities, executive functions such as inhibitory control, organization and planning, ability to adapt to changes, anticipate and sequence, as well as to regulate emotions will be assessed.

With the data obtained, a neuropsychological report is prepared, which must be finally evaluated by neurology.

Once the clinical evaluation has been completed, several complementary examinations are usually requested.

TREATMENT

What is the pharmacological treatment of ADHD?

What are the non-pharmacological treatments for ADHD?

Non-pharmacological treatments are essential to improve the quality of life of people with ADHD and their environment.

Neuropsychological intervention is recommended, a treatment that is carried out through a scientific methodology that consists of the stimulation of the deficient cognitive processes by means of a series of activities chosen individually for each patient. The activities may consist of computer tasks, virtual reality, pencil and paper.

Methodological adaptations should be made to facilitate the evaluation of the concepts learned in the classroom, such as an increase in time for exams so that they can review and not do it impulsively, highlighting key words in the statement, separating the questions on the sheet, avoiding questions on the front of the sheet, being located in the front row and facilitating the completion of questions in the exams.