World ADHD Awareness Day

World ADHD Awareness Day 13-07-2021

By: Heidi Guerra Saleta

The World Attention Deficit Hyperactivity Disorder (ADHD) Awareness Day, celebrated today, July 13, was proposed in 2012 by Professor Russell A. Barkley through a letter to who.

This day provides us with the opportunity to provide reliable information that helps educate and clarify the myths that revolve around ADHD.

What is ADHD?
ADHD is a neurobiological disorder that affects both adults and children. It is described as a persistent or continuous pattern of inattention and/or hyperactivity and impulsivity that prevents daily activities or typical development. Individuals with ADHD may also experience difficulties maintaining attention, executive function (or the brain's ability to start an activity, organize and perform tasks), and working memory.

WHO IS AFFECTED?
El TDAH afecta alrededor de un 5 a 7% de niños/as y un 4 a 5% de adultos en todo el mundo.

¿QUÉ TIPOS HAY?
ADHD affects about 5 to 7% of children and 4 to 5% of adults worldwide

WHAT TYPES ARE THERE?
According to the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), there are three types of ADHD described:

• Inattentive
Hyperactive-Impulsive
• Inattentive and hyperactive-impulsive combined

WHAT ARE THE MAIN CHARACTERISTICS?
Shows a lack of attention
A pattern of inattention often has the following characteristics:

  • Fails to pay attention to detail or makes careless mistakes in schoolwork
  • Has difficulty staying focused on tasks or games
  • Seems not to listen, even when spoken to directly
  • Has difficulty following directions and is unable to complete homework or choolwork
  • Has trouble organizing tasks and activities
  • Avoid or dislike activities that require a mental effort of concentration, such as choolwork
  • Loses items needed for tasks or activities, e.g. toys, school assignments, pencils
  • Easily distracted
  • Forgets to do some daily activities, such as household chores

Hyperactivity and impulsivity
A pattern of hyperactivity and impulsivity symptoms often exhibits the following characteristics:

  • Is restless or tapping with hands or feet, or squirming in the seat
  • Has difficulty remaining seated in the classroom or in other situations
  • He/She is constantly moving
  • Goes back and forth or climbs in inappropriate situations
  • Having trouble playing or doing quiet activities
  • Talks too much
  • Gives hasty answers or interrupts questioner
  • Has difficulty waiting for his turn
  • Interrupts or interferes in conversations, games, or activities of others

WHAT CAUSES ADHD?
Current research has shown that ADHD is largely the result of genetic factors, although it can also occur as a result of prenatal damage to brain development and, in a small percentage, is due to brain injuries caused after birth.

Most cases of ADHD can be purely attributed to genetic causes. Environmental factors, which do not seem to play a relevant role in the initial etiology of ADHD, nevertheless have a marked influence on its evolution. In other words, genes set the stage, but certain environmental causes could trigger ADHD symptoms.

WHAT HAPPENS IN THE BRAIN OF SOMEONE WHO HAS ADHD?
The brain of someone with ADHD is unique. Regulates attention and excites it differently. It is also wonderfully creative, adventurous and responsive.

Brain scientists have found that deficiencies in a neurotransmitter, norepinephrine, are related to ADHD. Norepinephrine is linked with dopamine, which is responsible for controlling the centers of reward and pleasure of the brain.

The ADHD brain appears to be linked to deficiencies in four functional regions of the brain:

  1. Prefontal cortex: This region is responsible for coordinating the functioning of care, executive function and organization.
  2. Limbic system: This region regulates emotions and attention. Deficiencies in this region can cause inattention, emotional volatility, or restlessness.
  3. Basal Ganglia: These neural circuits regulate communication within the brain. Deficiencies in this region can cause the information to have a "short circuit" resulting in lack of attention and impulsiveness.
  4. Reticular Activator System: It is the largest retransmission system of the brain. A deficiency in this system can lead to difficulties in attention, hyperactivity, or impulsivity.

HOW IS ADHD DIAGNOSED?
A diagnosis of attention deficit/hyperactivity disorder is usually made unless the central symptoms of ADHD begin early in life (before age 12) and create significant problems at home and at school on an ongoing basis.
There is no specific test for ADHD. A multidisciplinary approach involving health professionals is required (e.g. paediatrics, psychiatry, neurology, psychology and psychopedagogy).

WHAT IS TAKEN INTO CONSIDERATION TO MAKE A DIAGNOSIS?

  • Medical examination to help rule out other possible causes of symptoms
  • Collection of information, e.g., any current medical problems, personal and family medical records, and school records
  • Interviews or questionnaires for family members, your child's teachers, or others who know your child well, such as caregivers, babysitters, and coaches
  • Criteria* of the Diagnostic and Statistical Manual of Mental Disorders. DSM-5 (Diagnostic and Statistical Manual of Mental Disorders), published by the American Psychiatric Association.
  • At least 6 criteria present before 12 years of age, for a continuous period of at least 6 months, for Inattention and/or Hyperactivity/impulsivity, in two scenarios (for example, school and home) and that the symptoms interfere with social, school, work or quality of life functioning.
  • ADHD rating scales to help gather and evaluate information.

WHAT TREATMENTS ARE THERE?
Standard treatments for ADHD include medication, behavioral therapy, counseling, and educational services. These treatments can relieve many of the symptoms of ADHD, but do not cure it. It may take a while to determine what works best for each case.

ADHD is among the psychiatric pathologies with the greatest possibility of therapeutic approach. Between 75% and 90% of people with ADHD respond positively to available treatments, including medication, with a greater degree of improvement in the most significant areas of their lives than is achieved in any other psychiatric condition.

HOW TO HELP OUR SON / DAUGHTER?
The first step is to accept that this condition requires multidisciplinary intervention and a collaborative attitude among parents, teachers and health professionals. It is necessary to remember that we are all unique and different. The different rhythms and styles of learning must be respected. The family should foster a stable environment where they feel accepted, respected and loved. Positive discipline strengthens self-esteem and helps them feel safe.

To motivate children and adolescents, it is necessary to:

  • Reinforce their self-esteem. Help them discover their qualities and abilities, which can be many according to their predominant intelligence type. They can be distracted, but at the same time be creative, cheerful, intelligent, spontaneous, affectionate, funny, kind.
  • Congratulate them on their progress and achievements, even if they have not achieved the expected results.
  • Understand and accept that error is part of learning. If they become frustrated easily, help them find solutions, providing support, guidance, and alternatives. Remember that parents are the best models.
  • Respect their ideas and points of view; if they disagree, it is necessary to substantiate why.
  • Avoid comparisons with siblings or others.

To build organizational capacity, it is recommended to:

  • Help them find a comfortable space to work, with as few distractors as possible.
  • Teach them to plan and organize their work by preparing the necessary material in advance.
  • Guide them in the preparation of their schedule. For young children it is recommended that they prepare a physical schedule with drawings or illustrations. For those who manage technological tools, it is recommended to use tools such as Google calendar coding the courses by colors, with the advantage that the alarm will warn them 10 minutes before.
  • Guide them to use your school agenda or other planner to organize their monthly, weekly, and daily work. This will help them sequence and dose tasks.
  • Recommend them to start with the most important tasks (Prioritize) to do them with better disposition. Guide them to learn how to break down complex tasks, performing them in small parts.
  • Get them used to using lists and making comparisons.
  • Recommend that they schedule a break time between tasks, so that they can stretch, walk, drink water, or do relaxation exercises.
  • Teach them various strategies for organizing information: underlining, outlines, factsheets, concept maps, use of mnemonic techniques to remember important information.
  • Help them reflect on progress and review their work before submitting.
  • Train them to develop autonomy and healthy habits of hygiene, nutrition, study and sleep. Habits convey security and structure.
  • Motivate them to share responsibilities at home according to their age: For example, take dirty clothes to the tack, set the table, feed the pets, etc.

References:
Additude magazine. Larry Silver, M.D.,“The Neuroscience of the ADHD Brain” Sacado de: https://www.additudemag.com/neuroscience-of-adhd-brain/

American Psychiatric Association (2013). Diagnostic and statistical manual of mental disorders (DSM-5), Washington, D.C.: American Psychiatric Association.

Centers for Disease Control and Prevention (CDC). Attention Deficit/Hyperactivity Disorder (ADHD). Taken from: https://chadd.org/understanding-adhd/recursos-en-espanol/

Centros para el Control y la Prevención de Enfermedades (CDC). Trastorno de Déficit de Atención e Hiperactividad. Sacado de:
https://www.cdc.gov/ncbddd/spanish/adhd/index.html

Spanish Federation of Attention Deficit and Hyperactivity Aid Associations (FEAADAH). Manifest Taken from: http://feaadah.org/admin/directorioarchivodocumental/docdow.php?id=166

May Clinic. “ADHD in Children” Taken from: https://www.mayoclinic.org/es-es/diseases-conditions/adhd/symptoms-causes/syc-20350889

May Clinic. “ADHD in Children” Taken from: https://www.mayoclinic.org/es-es/diseases-conditions/adhd/diagnosis-treatment/drc-20350895

Ministry of Education of Peru Handout for Families of Attention Deficit Hyperactivity Disorder https://resources.aprendoencasa.pe/perueduca/orientaciones/familia/inclusion-cartilla-para-familias.pdf

Heidi Guerra
EN