1. You hear more and more often the phrase "is a hyperactive child". Is it really such a widespread problem or other issues that have nothing to do with ADHD you fit into this problem?
The classification of a child as "hyperactive" does not necessarily imply suffering ADHD. Some normal children develop a high level of motor activity without this being considered pathological. They must be met a certain number of criteria that include among others excessive motor activity, and especially a negative impact on various aspects of life. Then and only then we would be talking about a disorder and not just a few isolated symptoms or characteristics of a particular child. For example, a simple language delay can influence behaviors of "hyperactivity" to improve as do communication skills and, therefore, does not correspond to ADHD but a manifestation of a different problem. This, however, should not move away from an obvious reality and this is nothing that ADHD has a high prevalence rate in the population and therefore should not be surprising that increasingly has more echo in different levels of society.
2. What are the main signs or alerts to push parents to seek professional help? When so, to whom should use or what are the steps to take? Is pediatrician who should lead the process? When the diagnosis is, what is the message to be transferred to the parents?
Generally parents are concerned, own or transmitted by teachers that your child has behavioral problems or have low school performance or both. Sometimes other symptoms such as anxiety, persistent headaches or refusal to attend school may be the only warning signs. In any of these situations, the family should seek professional guidance. In this sense, the pediatrician is the reference person must mobilize adequate care resources to meet the challenge posed to address these concerns. Every time there is a greater awareness by the pediatrician and effort on their part to acquire the right skills for diagnosis, intervention, or at least guidance of the problem has meant significant progress in recent years. Every pediatrician has to self-assess their competence and decide to personally address the problem or refer you to another professional, well child neurologist or psychiatrist depending on the availability in each care area. Psychologists with clinical training may be helpful in some specific guidance in the neuropsychological study if deemed necessary and intervention on some common problems that commonly coexist with ADHD.
The message to be transmitted to parents is that ADHD is not a trivial problem and requires a sustained intervention has to involve the family, the school and the different health professionals or associations involved. While duty to consider an optimistic long horizon and when appropriate guidelines are established for intervention has been shown that you can change the negative evolution of this process. Seen in this way I believe that the diagnosis of ADHD should be good news for families as it gives answer to a problem and opens a realistic and generally favorable possibility of intervention, which often implies a substantial change in the evolution of boy.
3. There is talk of different subtypes of ADHD, some of them even quite questioned (hyperactive-impulsive). Which one is the most impact? Is treatment common to all of them or presents differences? Should everyone take medication? What are the most common problems associated? And the prognosis for vital development "normalized"?
Indeed, for several years now it poses the existence of three subtypes of ADHD of which the most common is the combined type, which coexist associated with attention problems and hyperactivity / impulsivity signs. The so-called hyperactive / impulsive subtype is commonly applied to younger children in whom symptoms of excessive hypermobility and low impulse control ability predominate. Actually there is a growing consensus that symptoms related to attention deficit disorder are also present but the intensity and conviction "visibility" of others is so prevalent that prevents overlaps or clearly demonstrate the manifestations related to attentional deficits They will become visible when the child is subjected to a system of academic demands they make to surface. On the other hand, some children go through 3 subtypes, simply because the changes involved age, many adolescents diagnosed predominantly inattentive subtype when combined previously met criteria for disorder and before that for the hyperactive / impulsive subtype.
Out of what would suggest from the manifestations of either subtype, it seems that the greatest impact would be combined. However, experience has taught us that many subtypes of attention deficit isolated respond less well to treatment, partly because it is possible that under this denomination processes that cause different brain involvement and inclusion. In medical research is the one that has received less attention since most of the studies have been conducted in patients with the combination.
Medication is an essential therapeutic weapon and in most cases essential, which does not imply that it must be used in all cases. Everything depends on the degree of involvement and impact mitigation and response measures introduced by the school and the family, which may be sufficient in most cases mild. In moderate or severe ADHD evolution it can be dramatic and drug treatment is absolutely required.
The problems most commonly associated with ADHD itself are low self-esteem and the continued criminalization suffered by affected throughout his life, seeing compromised their academic, social and family expectations and a substantial increase in the risk of accidents, substance abuse or job insecurity.
On the other hand, is very common that there repercussions for other processes that often concur with ADHD and comorbid disorders that are called ADHD. They include specific learning problems, the most common dyslexia, oppositional defiant disorder, conduct disorders and other tics. More often, language problems or coordination are also presented each of them needs a specific intervention.
The prognosis is difficult to establish. We know that close and controlled intervention is effective and that changes the evolution of the affected. Figures for remission of the disorder vary depending on the design of the studies that have raised this issue. If we talk about functional remission, defined as that at a given time could be considered that ADHD has not been a problem in the life of the affected and therefore could be considered a precedent or almost an anecdote, the proportion of people who reach this Evolution is low, possibly around 15%. Up to an additional 35-40% could reach other referrals where demonstrations are not enough to keep the diagnosis but are still present in some way. The rest would hit a major mode and possibly tax would continue to maintain medical treatment.
4. Which one or more current ADHD treatments are?
In Spain we have a growing arsenal of drugs but still more limited than that present in other countries. Right now we have 3 pharmacological preparations into two families of different drugs:
- Stimulants: Ritalin, with different forms of drug release and commercial presentations Lisdexamfetamine different-and that is actually what is known as a prodrug and is based on a controlled of its active ingredient, and blood, so release completely negating the possibility of generating addition.
- No stimulants atomoxetine. They are intended to improve the way that neurons in crucial locations are activated so that they can play their role.
- Will soon be available in Spain guanfacine, within no stimulants,
5. Does the health networks or socio-sanitary public have sufficient resources and ordained for the care of these children? And the school? What is missing?
In this field there remains a long way to go. It is true and can be considered positive that the increased awareness about the disorder has led to an increase in resources for their care, diagnostic and therapeutic. Keep throwing in a need for greater awareness by some estates, among which must be included the health sector, academia, politics and the public itself. It is easy to maintain absurd myths exempt slightest rigor and generally apply to adverse effects of treatment or nonexistent properties thereof. This fact alone is defended today from positions anchored in the past and away from any scientific evidence. Professionals have our share of guilt for not transmitting the information objectively and existing developments. The schools, which both help some children become the martyrdom of others when they blame him or his family, not put in place the necessary supports and accommodations or minimal information without questioning the need for drug treatment. Fortunately, a growing number of education professionals, both teachers and school counselors to those who are not currently escapes reality of ADHD and provide invaluable help.
6. What progress or lines of research are being developed in this field? Is there any study on the situation of patients when they reach adulthood?
They are pursuing multiple avenues of research in the field of ADHD, which include changes in diagnostic criteria, as seen in the latest edition of DSM-5. The scientific literature has experienced exponential growth in recent years. It works on the neurobiological basis and there are many evidences of brain areas involved in ADHD. Available data on the thickness of the cerebral cortex of the affected and the demonstration that a group including the reduced brain volume normalization experience over the years in this sense, are highly enlightening. This finding opens interesting doors to know the brain functioning and gives explanation to the fact why in many affected the popular saying that time will play for and in the end the process forward has its share of truth. They are interesting too and we hope that soon dispongamos training project altered functions that do not always respond well to drug treatment, including improved organizational skills, time management and planning functions.
Several studies have set their interest on negative evolutionary consequences of ADHD. They are eloquent and disturbing the results provided by Barkley in his study "13 years later", which assesses various indicators of adaptive development in adulthood of a large series of patients diagnosed with ADHD in childhood. In the aspects analyzed, the data show a significant increase, compared to people without ADHD low academic achievement, low access to university studies, work penalty and risky sexual activity with young offspring among other problems.
Article submitted to Top Doctors by Dr. Jesus Eiris Puñal the November 22, 2015