Everything you need to know about ADHD

Attention-deficit/hyperactivity disorder (ADHD) is a particular way of perceiving and processing information that influences how a person responds to certain environmental stimuli, often resulting in poor, inefficient, or dysfunctional behavior.

To help visualize how these people process information, let's give an example.

Imagine you have to transport a package from Madrid to Barcelona by car. An efficient processing system would plan the fastest and least expensive route on a map.

However, someone with ADHD would end up reaching Barcelona but would do so more inefficiently, as it would likely take them longer to find a route on the map and they would choose a longer, more expensive route.

People with ADHD have preserved learning capacity, cognitive and emotional functions; the difference is that they use them less efficiently.

For this reason, ADHD should not be approached from a "curative" perspective, but rather with the goal of helping the child, adolescent, or adult learn to be aware, to coexist, and to control their way of processing information, minimizing their limitations and maximizing their strengths.

ADHD symptoms at the behavioral, cognitive and emotional levels

Today there is some consensus in accepting that ADHD is a neurodevelopmental disorder in which the symptoms of inattention and/or hyperactivity and impulsivity predominate (subtypes: inattentive, hyperactive or combined).

These symptoms, which usually appear before the age of 12, affect the behavioral, cognitive, and emotional areas. At the behavioral level, they are usually observed behavioral problems, social impulsivity and lack of social interaction skills.

At the cognitive level, they show poor performance in working memory, processing speed, and tasks requiring sustained attention over a period of time. They also often show difficulty planning, organizing, and carrying out goal-directed actions (where time management, self-control, and motivation are required).

Finally, on an emotional level, it is not unusual to find problems with emotional regulation.

Inattention, impulsiveness and motor overactivity are natural in childhood, all children exhibit higher levels of these than other older children.

The difference in ADHD is that these "abnormally" high levels of inattention and hyperactivity/impulsivity are associated with significant impairment in the child's family, social, or school life.

Some authors have proposed a new subtype of ADHD, "Sluggish Cognitive Tempo." This proposed new ADHD subtype shares some of the attentional impairment of the inattentive subtype, but also includes motor and cognitive slowness. This new subtype has been extensively researched in recent years but has not yet been officially included within the diagnostic category of ADHD (either in the DSM-5 or the ICD-11).

Controversy in the diagnosis of ADHD

To this day there is still some controversy regarding the diagnosis of ADHD.

This is partly because it is the only childhood psychopathological disorder in which it is accepted, to a greater or lesser extent, that treatment is pharmacological and its diagnosis is "exclusively clinical."

Therefore, ADHD detection can be extremely variable and of questionable reliability. This means that the increase in diagnosis in recent years can be attributed to positive factors (greater social and professional awareness) as well as negative factors (laxity, lack of diagnostic rigor, and pressure from families to access assistance once diagnosed).

ADHD assessment should be multi-method, that is, using different assessment instruments (interviews, questionnaires, observational records, etc.) that explore general psychopathology, diagnostic criteria, ADHD symptoms and behaviors, cognitive and neuropsychological functioning, and the degree of symptom severity. Furthermore, the assessment should also be multi-source (evaluated by parents, teachers, and the child, if necessary), comorbid, and differential (evaluating and discriminating the presence of other disorders that could also explain the symptoms).

Pharmacological treatment is NOT recommended for children with ADHD.

Regarding treatment, it should be noted that drug treatment is NOT recommended for preschool-aged children with ADHD, nor is it the first option for school-aged children.

Pharmacological treatment should only be considered when the child presents severe symptoms and significant impairment in several aspects of his or her life, or when there is no other therapeutic option.

For ADHD with a moderate or severe combined subtype, treatment should include a multidisciplinary and multimodal approach, including pharmacological treatment (to improve attention span, impulsivity, and motor control), training for parents and educators in managing problem behaviors, curriculum adaptation, and extracurricular support to address learning difficulties.

For all other cases, the treatment that has proven most effective and will be the first choice is behavioral training for parents, educators, and/or peers, as well as organizational skills training.