Dr. Sasot is an eminent psychiatrist and pediatrician in Barcelona, currently directs the Paedopsychiatry Unit of the Teknon Medical Center and is former president of the Catalan Society of Child and Adolescent Psychiatry. In addition, he combines his practice with the position of Postgraduate Professor in Child and Adolescent Psychiatry at the Autonomous University of Barcelona.
What is ADHD and why does it occur?
ADHD is a neurodevelopmental disorder. It is not a disease, we are talking about a disorder of the neuromaturation of the nervous system and we are going to find it with a series of symptoms that we will discuss later and it is related to the maturation process of children that is slower. There is research that is based on evidence. We have many studies, starting with Professor Castellanos, we are talking about many years ago, who discovered that the brain of these children was smaller, approximately between 3 and 5% at a volumetric level. The fact that these brains may be smaller is not the only important thing, but in the process of maturation of the cortex has been investigated, in other works of Professor Philip Shaw, and we are told that there is a delay in the maturation of this brain, a delay of approximately between 1 and a half and 2 and a half years, commonly we speak of 2 years. It is a brain that matures but that goes slower in this maturation process throughout childhood and throughout adolescence. We also know that the connectivity in the parietocerebellar frontostriatal circuit, there is a decrease in this connectivity, so we already know very well which structures are producing this symptomatology caused mainly by this slower maturation process. And not only this but in current works we confirm that in these structures of the central brain, more in the limbic areas, the amygdala, nucleus accumbens, putamen, etc… there is also a decrease in volume and this also justifies not only these symptoms that we know of attention deficit, hyperactivity, impulsivity, but also at the emotional level there is also a certain difficulty that is born precisely in this slowed maturation process.
How do I know that my child has ADHD?
Parents will have to ask themselves many times if this child they have has ADHD. First of all, it is important to know that the diagnosis of ADHD is not the same for all children. There are basic symptoms which are inattention, hyperactivity and impulsivity. These symptoms do not occur equally in all children, there are children who will fundamentally have problems of hyperactivity, impulsivity and behavioral problems, others, on the contrary, will have for example few problems of hyperactivity, few problems of impulsivity, above all they will have attention problems, in these children it is necessary to be careful with school learning. We must also say that the vast majority will present all the same symptoms and we must also know that depending on the age the symptoms will appear in the hyperactive child, for example, they will be more present in the younger child, as they get older this decreases, but all the impulsive symptoms will be maintained over time and especially the attention problems, and what will come later, which we will also see, are the attention problems. All these symptoms will appear and we have to follow them in order to define very well if this child has or does not have an attention deficit hyperactivity disorder.
Is ADHD hereditary?
ADHD is hereditary, yes, and in day-to-day clinical practice you see it through the parents, who when they consult you about their children’s problems are often talking to you about themselves, and the most curious thing is that they realize that they have problems that they had when they were children, adolescents or that still occur to them. In many studies done with twins we see that the heritability coefficient, that is to say, this percentage in which heredity plays a very important role is very high in ADHD, it reaches almost 0.8 and if we compare it with other populations and other types of patients, for example, we would be much higher than in other types of diseases. Think that out of every 5 families that we visit, in 4 – 3 1/2 there will be problems in mom or dad. Nowadays genes are being studied, they are being researched, but we cannot do a genetic study of a child with ADHD, it is something that is still being researched, but the day will come when we will find a lot of information from genetics that will help us in the treatment of these children and adolescents.
How should ADHD be treated?
The treatment of ADHD is a treatment that has to be multimodal because each child is different and probably this child or this adolescent, this girl, this adolescent, will need an approach in which several specialists intervene, from the psychologist who can help us a lot in emotional issues, a lot in behavioral and behavioral issues, to the figure of the pedagogue who is vital when these children have learning problems, that is, psychologist, perhaps in some cases, psycho-pedagogue or pedagogue perhaps in others. The doctor also has a role, these ADHD problems sometimes require pharmacological treatments that are of great help and can range from treatments for small children using fatty acids even at high doses, which can help us a lot in young children, to pharmacological treatments for preschoolers or school children, and products that among all those we have today we can say that we have an important range that we can give with certainty because they are treatments that are not born now, they are treatments that have been used since the 50’s some of them and that have a history of 50, 60, 70 years. All of this is very important, but we must also combine it with the help of parents, parents who need some educational training, and also help teachers who also ask for our collaboration in the design of individualized programs for day-to-day programs within the school, I repeat, not for all children, but for those who may really need it. The treatment is multimodal but it also has to take into account that not everything is so easy because in many cases we find associated difficulties, what we call comorbidity, which have to be very well assessed, if the child has an anxiety problem, a depressive problem, has a serious behavioral problem, dyslexia, in short, knowing how to label well, really knowing at the diagnostic level where we are, can allow us to do well this multimodal treatment and the role of children within the school is very important.