The Dr. Marina Romero (Child Psychiatrist) warns that the prejudices that surround the Attention Deficit Hyperactivity Disorder (ADHD) have a major negative impact on both children and their parents.
This week Malaga has become the national epicentre of child and adolescent psychiatry as it has hosted the 67th Congress of the Spanish Association of Child and Adolescent Psychiatry (AEPNYA), which brought together more than 350 professionals from all over Spain to discuss how to improve the transition to adulthood for young people with mental health disorders or problems. "Investing in childhood and in the transition to adulthood will reduce long-term costs in mental health", says the child psychiatrist Marina Romero GonzálezDr. Romero, vice-president of the scientific committee and organiser of the congress. Dr. Romero, a specialist in neurodevelopmental disorders such as Attention Deficit Hyperactivity Disorder (ADHD), practices at the Regional Hospital of Malaga and is coordinator of the Child Mental Health and Neurodevelopmental Unit of the Vithas Malaga Hospital.
What exactly is ADHD?
It is one of the most frequent disorders we see in child psychiatry. It is a neurodevelopmental disorder, which presents certain areas of the brain, especially those related to executive functions, which are in the prefrontal area, that are not sufficiently developed.
What are its symptoms or how can we recognise it?
These are children whose executive functions are altered, i.e. they are not able to regulate themselves emotionally, they find it very difficult to plan or organise themselves and, as they have this psychomotor restlessness, they find it very difficult to pay attention and concentrate on a specific activity. Therefore, they avoid any type of activity that requires sustained mental effort. And this has an impact at the academic level. In the first place, because they are often unable to keep up with their school work, even though they are children who intellectually do not have any problems. Then, it also interferes in the execution of day-to-day activities, as they are children whose parents have to constantly repeat to them what they have to do, so there is also an impact on family dynamics. In the end, they are very criticised children, because they are very much on top of them. And then also, on a social level, perhaps they are children who are not able to respect the normal ones because of their nervousness. It is a disorder that impacts and interferes in all areas of a child's development.
Do you think there is a stigma or prejudice surrounding ADHD?
Totally, there is a lot of prejudice. And for me the most painful thing is the burden that these parents have. There is not a single consultation in which a mother does not burst into tears when I tell her that she is doing well and that it is not her fault or her responsibility that the child has this neurodevelopmental disorder in which there is a genetic factor of more than 70%. Now, knowing that he has a disorder, it is the parents' responsibility to reorient this child with psycho-pedagogical support and facilitate the environment so that these children can be better structured.
So ADHD is a disorder that affects both the child and the parents?
Of course, and, above all, because of the feeling of guilt that is generated because they receive a lot of negative feedback from all environments of "how badly you are doing it", when this is not the case.
How do these labels of "lazy" or "unruly" affect children, and can they trigger other kinds of problems?
Yes, because in the end they receive a lot of criticism from different environments. So it's not the ADHD label that hurts, it's the criticism they receive from all environments. When I make a diagnosis of ADHD and I explain it to the child, I always ask them if there are children in their class who have glasses and if that is good or bad. And they all tell me that it doesn't matter, that it is neutral. Then I explain to them that just as if a child is short-sighted and does not wear glasses, they cannot see well, they do not study well or cannot play well, so it is the same thing. That simply, instead of having a vision problem, they have a brain problem and we need to help them, sometimes with pharmacological treatments, sometimes with environmental restructuring or with psycho-pedagogical and psychological support to help them put glasses on their brains so that they can "see better", concentrate better and be able to regulate themselves more emotionally. Then most of them understand and relax in the sense that they realise that they are not "a bad child", but that they simply have myopia in their brain and need that help.
What is the prevalence of this disorder in Malaga?
In Malaga I haven't checked it for a long time, but at European level, approximately 5%.
And have you seen an increase in the incidence of ADHD in children in recent years?
More than an increase in the last years, I have been a child psychiatrist for 15 years, I have seen that now schools are more aware, they are getting more involved and they are being more aware that this is not an unruly child, but a child who needs help because he/she has ADHD. So I see more and more collaboration and involvement from teachers. Even so, there is still a long way to go. Because the child who is simply inattentive and behaves well in class, that child goes unnoticed and undetected. They are simply labelled as "a child who can't get enough" or who is "very clumsy", but as they don't have behavioural problems because they don't have hyperactivity, the protocol is not activated. I think that this is the subtype that we have to pay more attention to because it goes a little more unnoticed and, nevertheless, it is a subtype that if you treat it in time, it can improve a lot.
So teachers play a key role in detecting those early warning signs?
Yes, fundamental. They are the ones who should, together with the family, detect what are the warning signs. They don't have to diagnose it, because that's what we professionals who work with children are there for, but at least they have to perceive that something is not working. They have to activate the protocol, make some evaluations at school and then refer them to mental health so that we can make a proper differential diagnosis. Because maybe it's not that they have ADHD, but that they have some intellectual disability or a learning disorder. Then they also play a fundamental role when it comes to providing specific support which, sometimes, are simply very basic guidelines, but which often change the child's life, such as allowing them a little more movement, giving them more errands or putting them in the front line.
Have you detected that there is over-pathologisation or over-diagnosis?
Rather than overdiagnosis, what I see is misdiagnosis. Because, as I said, there are children who simply have inattentive ADHD and go completely unnoticed. But then there are children who are more active, such as, for example, children with high abilities who are not ADHD. So, perhaps in some subtypes there is more overdiagnosis, and in others there is underdiagnosis. There are also children who are inattentive, absent-minded, hyperactive, but what is at the base is an emotional condition, a traumatic process or who are perhaps suffering from bullying. They are not really children with ADHD, but they express it through similar clinical manifestations. So, I would say that more than an over- or under-diagnosis, there is often a misdiagnosis of ADHD.
How is ADHD treated and can it ever be cured?
It is possible to compensate. If we treat ADHD from early childhood, the possibility of compensating for it is much greater and, therefore, there will come a time when we can even stop taking pharmacological treatment for ADHD because we have already spent a few years, in some way, stimulating the brain. And if the environment has also been structured in a way that facilitates the child's daily life and, therefore, he or she acquires his or her own resources to compensate for ADHD. So, for me, if there is a compensation, there is no interference at academic level, at home or at social level. For me, he is cured. He is no longer ADHD, even if he has an ADHD base and functioning and has had that neurodevelopmental problem at the base.
Today there is still a certain amount of suspicion about psychotropic drugs, what is the reaction of parents when they are told that their child needs to be medicated?
It is very difficult for them to understand because there is also a stigma that a minor is being drugged, which is not the case. It's like if your child is asthmatic and you don't give them inhalers. There are children who are born with certain conditions and we have to treat them, that's what medicine is for. Just as if you read the leaflet for a paracetamol you throw your hands up in the air, so do you if you read the leaflet for psychotropic drugs. What happens is that nobody reads the package leaflet for paracetamol and everybody reads the package leaflet for psychotropic drugs. So, of course it has side effects, but they are short term and very mild. There are studies that show that in the long term there are no significant effects. On the contrary, there are studies that compare treated and untreated children with ADHD in adolescence, and in the latter there is a much higher risk of accident and tragic trigger, such as death by car accident when they start driving, because what improves a lot is impulsivity and absent-mindedness.
ADHD is usually associated with childhood, but adults can also suffer from it. What are the consequences of undiagnosed ADHD?
For me, the issue of identity is very important, above all. When a parent has their child diagnosed and they see themselves reflected and say to you: "If I had known this before, what would have changed my perception of myself". Because they have lived their whole life thinking that they were a disaster, a naughty and unruly child, because that is the feedback they had been given, and yet now they identify that what they had was ADHD. So it has such a profound impact as it is on your own identity, your own self-esteem and the perception you have of yourself.
In addition to ADHD, what other disorders are frequently encountered in consultation?
I also encounter a lot of neurodevelopmental disorder or autism spectrum disorder because I am more specialised in it. But eating disorders (ED) are also very frequent. And also in psychiatry, the transition to adulthood is very important because they often start with a first psychotic episode, which is rare. Schizophrenia is 1% of the population, but the debut is often in adolescence.
And in the case of ATTs, have you noticed that there has been an increase in recent years?
More than an increase in the last few years, which are getting younger and younger. Because, from a psychological point of view, adolescence starts earlier, so there are also more and more young people with ED, which is closely related to self-esteem or body image. Before, at the age of 12 you were playing with your doll, and now at the age of 12 they start to worry a lot about body image.
The theme of the congress is the transition to adulthood for people with mental health problems, are there sufficient resources to best support them in this process?
I don't think so. Often up to the age of 18, when we child psychiatrists deal with them, they have a much closer follow-up, because the agenda allows us to do so. And now that they go to adult health centres, they can perhaps see them once every 6 months. So there is an important gap in which there is a worsening of the clinical situation. Because in childhood they were a bit more protected in all areas, including the school where they have their structure, and now, suddenly, they no longer have it and they depend more on themselves. We really need more resources there. Especially in Andalusia, because in Madrid and Barcelona there are many more facilities that are specifically dedicated to the transition to adulthood. But we don't have them here. We have some support programmes, but from my point of view they are insufficient.
SOURCE OF THE NEWS: https://www.laopiniondemalaga.es/malaga/2024/05/27/tdah-trastorno-interfiere-ambitos-desarrollo-102926092.html
