How to diagnose ADHD today ? | Dr. Sasot Llevadot

The basic symptoms of ADHD are attention deficit hyperactivity and impulsivity.

To adequately identify these patients, it is advisable to follow a protocol in which the relevance of the symptom is assessed.

The most widely used criteria today are the DSM of the American Psychiatric Association, but it would not be correct in our clinical practice to reduce the diagnosis of a patient to the depersonalized requirement of a text.

Accordingly, it will always be the overall clinical understanding of the disorder that facilitates the diagnosis. Now, without using these diagnostic criteria.

It is advisable that the diagnosis of ADHD is clinical. The diagnosis requires the ability to contact the patient and his family in the first moments , knowing how to listen to the demand is fundamental. A careful anamnesis should also be carried out with appropriate open and closed interviews with parents and teachers. The Conners questionnaires (Conners, CK Barkley RA 1985) or Achenbach's Child Behavior Checklist (CBC) Achenbach, TM and Edelbrock, CS 1985), who usually offer us the first clues on comorbidity (associated disorders). Other interviews, although of long duration, are the Diagnostic Interview for Children and Adolescents (Ezpeleta, L 1997). and K-SADS (Shedule for Affective Disorders and Schizophrenia for School-Age Children) (Puig-Antich and Chambres, W. 1978).

At the pediatric psychiatric level, a personal interview with the child or adolescent should be performed , assessing hyperactivity, impulse control, self-concept and self-esteem, emotions, negative and challenging behaviors and possible dissocial behaviors.

Genetic, neuroimaging and neurofunctional studies do not yet have pathognomonic relevance ... although in the near future, will be essential, since ADHD is a neurobiological disorder.

From the current knowledge it is known that ADHD is one of the psychiatric pathologies with more genetic predisposition. At present they are investigating several genes related to dopaminergic activity, mainly the regulatory genes of the receptors and the transport of dopamine (DRD4 and DAT1), the main neurotransmitter involved in ADHD. . (Rutter M 2007) (Li D et al 2006), ((Faraone SV et al 2005), (Purper-Ouakil D et al 2005), (Cheuk DK, Wong V 2006), (Durston S et al 2005), (Acosta MT 2007), (Ramos-Quiroga JA et al 2007).

In certain brain areas, especially at the level of the prefrontal cortex, basal ganglia and cerebellum, structures which also appear to be significantly reduced in size. Overall, brain size in ADHD is 3.2% lower than in controls (Castellanos FX .Te to 2002.2004) (Carmona S. et al 2005). However more recent theories consider the presence of more diffuse alterations, involving frontal regions, basal ganglia and cerebellar vèrmix (Krainer AL, Castellanos FX 2006). The link that would condition the participation of multiple regions would probably be an alteration in connectivity, as shown by studies using functional magnetic resonance imaging in adults (Castellanos FX et al, 2008) (Fransson P, Marrelec G, 2008).

The current techniques that are being imposed in research are the MRI in the state of rest and those of functional evaluation that aim to know the response of the aforementioned areas of the brain, which show a lower performance in their functions.

The methods of functional non-invasive neuroimaging are fundamentally of two types, those based on electromagnetic techniques and those based on hemodynamic techniques.

Among those based on electromagnetic techniques, magneto-enlightenment (MEG) allows us to identify the circuits through which the information moves in the brain. (Mulas F et al 2007).

Among the hemodynamic techniques, we emphasize positron emission tomography (PET) and functional magnetic resonance imaging (MRF), which allow us to study neurological activity by measuring changes in cerebral blood flow. PET measures the neuronal activity by hemodynamic changes related to radiolabelled blood and MRI measures changes in cerebral blood flow according to its oxygenation. (Bush G. 2008).

It is essential that the psycho-diagnostic and psychopedagogical examinations accompany the study of a child or adolescent ADHD. Psychodiagnostic exploration should include a broad neurocognitive examination, fundamentally valuing the selective attention (Process that responds to a stimulus ignoring others) and sustained (process that allows us to maintain the attention to perform a task during a determined time), the control inhibitor (ability to control the impulse that allows us to delay a response) and executive functions (joint processes that allow us to analyze what is wanted and how to establish the most appropriate action plan for its achievement) and psychopathological. Finally, psychopedagogical exploration must identify the academic level of instrumental school techniques.

Obviously ADHD is a serious diagnosis that may require long-term treatment with psychological and pharmacological assistance and therefore it is important that the specialist first seeks and treats the many causes of these behaviors first, so it is necessary to practice an adequate diagnosis differential.