How do I know if my child has ADHD

Attention Deficit Hyperactivity Disorder (ADHD) is the most common neurodevelopmental disorder in childhood. It is a cognitive-behavioral disorder with a very heterogeneous clinical symptomatology although identifiable through some core symptoms: inattention, hyperactivity and impulsivity, generally well defined, which evolve throughout life.

It most frequently affects males, but can be suffered by any person regardless of gender, race or socio-cultural level.

Because of its repercussions in the academic, emotional, social and family environment and the high impact it has on the socio-economic level, it should be considered a public health problem of the first order.

All this conditions the importance of early diagnosis and treatment to improve, as far as possible, its prognosis.

How can we tell if our child has ADHD?

Symptoms can appear from preschool through adulthood, and at each stage the signs and symptoms may vary.

The diagnosis is usually made between 6 and 9 years of age, at which time, increased academic demands require a good level of attention and/or inappropriate activity status definitely draws the attention of teachers.

Warning signs

• 1st Infancy or Preschool:

Hyperactivity may be expressed in the form of caregiver complaints of inability to sit still in assembly, continually changing activities without having finished the previous one, and being disorganized. Sometimes they are destructive.

The consequences of this hyperactivity can manifest themselves in the form of an increased number of accidents, frequent tantrums and oppositional-challenging behaviors that alter their relationships, adaptive problems…

1. Inattention: they are scattered, especially in monotonous tasks. They do not pay attention when spoken to. They lose things…etc.
2. Impulsivity: expressed with difficulty following rules in play, intolerance to frustration.
3. Specific problems: some have problems related to eating, sleeping, or present functional symptoms such as recurrent abdominal pain without a justifiable medical cause for example.

• Between 6 and 13 years old:

Continued hyperactivity.

1. Attention problems and impulsivity are more evident.
2. Low frustration threshold.
3. Problems in planning and execution of school tasks: planning problems, they need an adult to do the tasks, they do not manage time well. They may have specific difficulties in writing, reading fluently, remembering what they have read, or performing mathematical operations… etc. They do not manage their time well, neglect the material, do not learn from their mistakes…etc.
4. From the behavioral point of view, they can be impulsive, respond hastily without thinking, do not privatize their emotions, have low tolerance to frustration, and in the case of hyperactive children, they do not see danger, do not respect the rules of the game, do not see danger and are able to interrupt their actions.
5. In this period deficits in social skills may appear. A self-concept problem and low self-esteem may be established if we have not intervened in time.

What implications it has:

1. Learning difficulties.
2. School failure.
3. Social relationship problems.
4. Low self-esteem.

Does this pathology improve or disappear with time?

This pathology improves with time. However, it is estimated that approximately 75% of children with ADHD present symptoms in adolescence, 25% of them severe, affecting academic, social and emotional performance.

The main factors that determine a negative evolution of ADHD are the presence of an important component of impulsivity/hyperactivity, associated conduct disorder, family history of ADHD, poor parent-child relationship or a poor approach to the disorder from the therapeutic point of view.

We can affirm that there is a situation of under-diagnosis in adolescents and adults, so we must raise awareness in order to carry out an adequate detection in adolescents.

What are the symptoms in adolescents and adults?

• Adolescents

1. Feeling of inner restlessness, rather than hyperactivity.
2. Disorganized school work, difficulty working independently.
3. Risky behaviors (substance abuse, early and risky sexual relations, gambling, etc.) – Low self-esteem and self-confidence
4. Low self-esteem
5. Poor relationship with peers
6. Difficulties with authority, although not always their fault.

• Adults

1. Inattention and concentration problems.
2. Disorganized in their plans.
3. Forgetful.
4. Difficulty initiating and completing projects.
5. Changes activities prematurely.
6. Misjudges time available.
7. Impulsive decisions.
8. Job instability and marital problems.

What treatments are currently available?

We must start from the premise that the fundamental objectives of treatment should not be limited to short-term improvement of the core symptoms of the disorder. Therefore, it is important to point out the need to treat children in a comprehensive manner that includes not only the treatment of ADHD symptoms, but also the treatment of possible comorbid disorders and to promote the necessary changes in the family and school environment to achieve the best possible integration of the child.

We must carry out a multimodal and individualized treatment plan that includes not only pharmacological treatment, but also behavioral, psychoeducational and psychological interventions.

The first line drugs in the pharmacological treatment of ADHD can be divided into two large groups: psychostimulants and non-stimulants.

Currently in Spain we have methylphenidate in different forms of presentation (concerta, rubicrono, equasym, medikinet, rubifen, medicebran…etc) and lisdexamfetamine (elvanse) as stimulant drugs and Atomoxetine (Strattera) and guanfacine (Intuniv) within the group of non-stimulants.

The choice of one or the other will depend on the particularities of the individual, his or her preferences and those of the family.