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Is there such a thing as Attention Deficit Disorder or are we over-diagnosing kids? 

What can we, teachers, do when faced with one, two…or even seven students with ADHD?

Do you have or have you ever had any students suffering from or diagnosed as ADHD sufferers and would like to be able to tackle this problem?

(This post is the first of four (1/4), to be published once a month between December 2016 and March 2017)

 We hope this will help any teacher who has students with any kind of attention deficit disorder.

That is why we are publishing this post in English and in Spanish. I would also like to highlight the fact that:

• The questions were sent to me by 17 English teachers, in English.
• I translated them into Spanish and sent them to the specialist.
• He has replied in Spanish and what you are reading here is my faithful English version.
• Obviously, Dr Fernández has his style and I have mine. This may  —most likely will be reflected in our respective posts.
• Yet, I act here as a mere translator.
• The explanations come from an expert in neuropediatrics.
• My only interest in the matter is to try and help teachers in their classroom practice.
• I am aware of the fact that this tends to be a hotly disputed issue.
• I am ignorant about the topic but determined to find out more about it. Are you?
• Whether you agree, have any questions concerning the information provided here, or you have further questions, you are welcome to send them and we’ll see how we can solve or discuss them.
• If you know of any teacher who is interested in this issue but finds it difficult or prefers to read it in Spanish, you can access the Spanish Version here 

And now, without any further ado, let’s then start with the first part.

Trying to understand what ADHD is and is not

Does ADHD really exist or, on the contrary, is it just that kids nowadays have too many attention-grabbing “distractors”?

A straight question deserves a straight answer: YES, IT DOES. Significant data prove so.

No doubt at all there, despite those who would like to cast doubts in that respect.

A different thing is whether the society we live in has evolved in such a way that does not in the least favour people suffering from it.

As you well say, current society has certain features which show those limitations more clearly, but it is also because we adapt better.  If you have some kind of attention deficit in the jungle, you probably won’t last long enough to tell the story, while if you are hyperactive you may become King. It is all a question of adaptation.

And can you tell us what the causes of the disorder are?

ADHD is one of the most and best-researched disorders. Gene and brain research studies show conclusive data in this regard.  Indeed, it could be said that ADHD appears because our “instruction manual”, i.e. the genes, do not always work properly.

This is because there are some genes that alter the maturing development in some brain areas. These areas are in charge of monitoring attention span, movements, impulsiveness, i.e. those areas which control executive functions. They are in the frontal cortex of our brain.

On the other hand, it is not that ADHD is something new but that it has always gone unnoticed. It can be as simply explained as it can be used demagogically by those who want to deny its existence.

Neurological disorder with behavioural manifestations

Even though it is a neurological disorder which can be objectively proved, its manifestations are behavioural.

And is there anything more subjective than behaviour? Is it easy to measure how much a child moves around, the length of his concentration span, or how patient he is? Is there a clearly-cut limit?

On this everybody seems to feel capable of having an opinion, even when they know nothing about the issue. Does anybody deny that headaches exist? They cannot be easily measured either.

Tests can provide diagnoses

Still, there are methods to measure all this. Today, there are tests that can provide conclusive diagnoses.

• There are genetic studies: TDAgen+, Neurofarmagen TDAH
• There are benchmarks to measure the way the eye works: BrainGaze
• There are virtual reality tests that measure attention span, hyperactivity, etc.: Aulanesplora

Those who are willing not to see it will not see it, but it is there. Only fools deny what is evident.

If so, why are there so many cases now compared to some years ago? Are we over-diagnosing the disorder?

Thanks to the knowledge acquired in the last few years, we are beginning to detect cases which were eluding us before.

Overdiagnosing?

There are those who, quite happily, say that ADHD is being over-diagnosed in children, but it is not so. Quite on the contrary.

When you start properly analysing figures, then you come to face reality. Research studies carried out throughout various regions in Spain are clear.

For instance, in Andalusia, we find very telling figures. Studies carried out in schools throughout the whole autonomous region have shown very similar figures of children suffering from ADHD to those from other regions in Spain and in Europe. Roughly 5-7% of researched children between 6 and 14 years of age.

Would you care to guess how many of those children had been previously diagnosed? You might be surprised.

• Only 1 in 3 had been diagnosed.
• And, in case that was not enough, only 1 out of 7 were under treatment.

What do those figures mean?

Simply that, contrary to what many demagogues with vested interests say, it is not that too many kids have been diagnosed but rather that there are fewer than there should have been.

That is the problem. Many children are being deprived of a diagnosis and therefore, of a normal development.

In Andalusia around 30% of school children are dropouts.

• One part of them are gifted children
• Another part are dyslexics
• Another part suffer from some kind of ADHD.

When are we going to start addressing the problem properly?

A different question is the quality of the diagnoses.  They should not be done lightly without every single patient undergoing a thorough examination.  Diagnosis cannot be made by just anybody. It must be done by a specialist.

Should they be medicated or would it be better for the kid to follow some kind of therapy?

Lack of balance of some brain transmitters

ADHD symptoms are a malfunctioning of brain mechanisms that modulate attention span, and impulse and movement controls.

This malfunctioning is due to a poor regulation in the balance of some brain neurotransmitters in the frontal areas. These neurotransmitters are Dopamine and Adrenaline.

The mechanism can be brought back to normal using a variety of treatments which allow a better functioning of these neurotransmitters.

So as not to have any doubts about it, I recommend you to read the following articles from my blog (in Spanish).

• “Entender el TDAH“
• “El tratamiento farmacológico del TDAH“

They will help you understand things better.

Finding the balance

When the balance is met, then the symptoms are under control. Once this is achieved, you can start with the specific therapy every individual child needs.

First, you need to check the learning levels the child has, once they have started treatment, then you set the strategy to use.

• Initially, all the learning which has been inappropriately absorbed needs to be improved.
• Then, you can set it to progress to cruise speed.

Here, I do not wish a significant —though little known even by professionals—  aspect to go unnoticed.

Treating this disorder has an accelerating effect on the brain maturing process.  Research studies show how the maturing process evolves with and without treatment. Not just that, but also how maturation levels are kept once treatment has been stopped.

This means that pharmacological treatment also has a “healing” effect, even though it cannot be in 100% of the cases. The possibilities will depend on several factors:

• The maturity level we start from,
• The age at which treatment began and
• The follow-up therapy used.

In this case, what type of therapy? (ADHD & Teachers: Sometimes, one —as a teacher— gets the impression that the kid should not be medicated)

In medicine, like any other profession, there are good and bad practitioners. Besides, every patient is a different case.

What I mean here is that the one providing the diagnosis and the appropriate treatment must be a professional specialised in children’s neurological disorders and with experience in handling ADHD.

And then, medicine is an art in as much as every patient is different and the doctor needs to have a sixth sense when it comes to dealing with every case.

This goes for every patient and every kind of medication. Not all types of medication are appropriate for every patient and there may always be side-effects even when the doctor is very careful.

The best therapy

Concerning the best therapy, this will depend on the symptom and the specific problem the kid has. You cannot treat every kid suffering from ADHD in the same way. It is not the same to suffer from attention deficit as it is to suffer from impulsiveness.

• When there is attention deficit the focus should be on improving cognitive function, habits, routines, learning, etc.
• When there is hyperactivity or impulsiveness the therapy should be behavioural to reduce restlessness and help the kid to control his/her impulses and improve social relations.

And why do you think some specialists do not want to diagnose ADHD?

I have various opinions in that regard. It would be long and difficult to explain but, since I am not politically correct, I’ll tell you bluntly.

There are many who criticise the pharmaceutical companies’ interest in ADHD. They say the companies have created the problem because there is medication to treat it. Well, inept people talking nonsense are found everywhere.

Treating ADHD is expensive

Then you ask about the interest of some practitioners in denying its existence. A key issue is that this disorder is expensive. It requires pharmacological treatment, behavioural therapy, etc. and this does not suit everybody. Sometimes it does not suit Health Authorities, either.

I always tell them the same. If you want to know whether ADHD really exists and the acute effects it has if not treated properly, come to my surgery one day and see patients with me for the whole day. Listen to the stories told by parents, their problems, their anguish, and their desperation. Let’s see what your opinion is then. Listen to what they say, too, and how the kids and their families are once they have started treatment.

Here you have a link to Access for the opinions from families I see every day on the treatment results and their development, before and after treatment.

• Opiniones en Doctoralia

ADHD deniers

Those who deny that ADHD exists and blame the parents or society for creating a non-existing problem may have two reasons to do so.

1. Either they are inept without the faintest idea of what they say or where their mind is, or, even worse
2. They are scoundrels who, although they know that what they are saying is a lie, deny it with the sole aim of making money from selling books or cheating families to attend their doctor’s practice and follow useless therapies.

On many occasions, I have seen families coming to my practice with kids who have been going from one place to the next, looking for an answer to their problem without finding it.

Sometimes they could not get a diagnosis, other times they were told that their child had some kind of mental retardment, some others that it was the parents’ fault.

All this is due to incompetence, lack of understanding or maliciousness. The final outcome is that precious years are lost when families might have been prevented from going through lots of suffering and complications. It still happens.

But I have noted a change in the last few years among many practitioners who have seen with their own eyes everything I am telling you here.

More and more often do I get families sent by schools or some other such institution which has told them that their child may suffer from ADHD and that it is important that they are seen by a neuro-paediatrician to confirm the diagnosis and assess whether medication is required.

There is still a long way to go, but we are going in the right direction.

In the next three months we are going to answer:

• In which way does ADHD affect their learning process & their behaviour in class?

• How can teachers identify the disorder?

• How can we deal with them in class & what type of activities should be designed?