Dr. Casaprima, a specialist in Family Medicine, explains in the following article the importance of correctly diagnosing cases of possible ADHD. Rushing into an erroneous diagnosis can undermine the child’s life, behavior and school success or failure.
Attention difficulties, or patients already diagnosed with ADHD, are frequently received in consultations. Although it is increasingly occurring at younger ages (kindergarten students with whom medication has even been started), the most common demands correspond to children between 8 and 12 years of age. Family Medicine specialists with experience in this pathology state that we must be very critical with the concept of attention deficit disorder with or without hyperactivity (ADHD).
Importance of differentiating and diagnosing the cause of a possible (or not) ADHD.
It should not be denied that there are children with difficulties in attention control, and children with restlessness, precipitation and impulsivity behaviors. But these aspects are symptoms of a nervous system reaction, as could be a headache, with pruritus or gastroenteritis. What is really important is to diagnose the cause of the reaction and to what extent these reactions interfere with school performance, social adaptation and self-esteem.
Attention is a complex neurofunctional process in which many brain sectors are involved: prefrontal cortical areas, midbrain – thalamus, limbic system (basal emotions, RAS…), and different neurotransmitters. This attention requires a process of stimulus selection, with activation of inhibition and control systems. An example would be like when we choose a TV channel, and we stay on it, inhibiting zapping, if we zap we change the source of the stimulus repeatedly and we do not follow any of them effectively.
The first thing is to accept that there are two factors involved:
– The nature of the patient’s nervous system.
– The external and biographical components of their development.
Each person is born with a brain of different qualities and characteristics: people with active or passive predominance, primary and secondary, with fast or slow personal rhythms and with different levels of sensitivity, which makes them more or less vulnerable to certain stimuli. Thus, the predominantly active, more sensitive and fast-paced brains have potentially greater difficulty in developing the brain’s inhibition and control systems, and must be educated from an early age to improve their self-control at each stage of their development.
But there are also children with a so-called “contemplative” brain, because they are children with great curiosity, who are fascinated by the environment and are caught by stimuli that for others are banal, but not for them. Although this is a normal way of being, in our society it can be labeled as ADD without hyperactivity, because they are quiet children who go unnoticed and “travel in their world of imagination”, “they are in the clouds”…. It is true that if they are not educated to be aware of their priorities (what is necessary and what they have to do), they may suffer from difficulties in school performance, forgetfulness or absent-mindedness; but, educated from the beginning, accepting their way of being and respecting their excellent quality of observation and their curiosity, teaching them to “be here and now” when necessary, they are brilliant students.
It is better to talk about inattentive behaviors and not about pathology.
It is always better to speak of inattentive behaviors or impulsive behaviors, and not of disorder, since this concept often makes children and adolescents interpret that they are sick and that they are like that, that it is a chronic state, and this thought conditions their confidence and behavior.
Reactions are and are given depending on each patient, their age and circumstances. A correct diagnosis will allow a comprehensive treatment that addresses the possible causes and, at the same time, teaches the patient to develop self-control. Thus, in patients as young as eight or nine years of age, specialists can work directly on self-awareness and help them develop resources. The concept that the brain is our servant and that we must learn to manage it helps them to better visualize situations and emotions, as well as the fact that it is in their power to modify these situations.
Diagnosing the causes of inattention and the behaviors that result.
The human brain can exhibit inattentive behaviors for many reasons:
– Immaturity in reaction to demand, a frequent occurrence in children under school stress (sometimes related to their date of birth).
– Functional deficits that make their effort to be superior.
– Loss of motivation.
– Other priorities: psycho-affective causes that focus attention on other objectives that are a priority for them. This can be frequently observed in children adopted from certain countries.
Treatment of attention deficit behaviors
Once the possible cause of the behaviors of inattention, restlessness or impulsivity is determined, the necessary therapeutic measures must be adopted. As recommended by the World Health Organization (WHO), treatment is multidisciplinary: psychological, pedagogical, neurofunctional and medical.
The error occurs when treatment is limited to pharmacology and no measures are taken to correct the primary cause, the factors that influence its maintenance, nor are resources offered to the patient to improve self-awareness and self-control. In such cases it is usually necessary to increase the dosage according to weight, age and the demand for effort, with the possibility of increasing the appearance of side effects, as well as psychophysical dependence.
Traditional pharmacology would not be the first choice and should be a complementary and necessary therapy in some cases, but should not be interpreted as definitive or chronic.