Many families who arrive at the doors tired of touching various places , and some of them with more than 3 different specialists, and they have everything, in the end they don’t know what they have. Families looking for a label, a word, a phrase that gives answers to the reason for the problem (difference) that their children, their partner, or the person herself have. Currently there are two international classification systems of criteria to diagnose ADHD (Attention Deficit Hyperactivity Disorder): DSM-5 (APA, 2013) and ICD-10 (WHO, 1992). Being in Mental Health, as a Neurodevelopmental Disorder.
However, it is necessary to rule out other possibilities before diagnosing ADHD and perform some tests and tests.
ADHD has associated disorders, some of them:
• Childhood Autism
• Over-gifted children
• Mental retardation
And some others, which we have not yet been able to detect, which does NOT mean that they have, before … let’s define what a Disorder is in order to understand:
Disorder. – In generic terms, a disorder can simply be understood as an alteration of the normal state of health due or NOT to a disease. E l concept simply serves disorder to describe the signs of the state of abnormality and impaired health in which a person is .
In terms that you and I can understand , disorder is an alteration of what is said to be normal. There are other disorders that are not necessarily mental health disorders.
Generally when we speak of mental health, and we touch the word psychologist, psychiatrist, we associate it with madness, when this perception is wrong. Going to the psychologist, to the psychiatrist, is to seek help to know what we cannot understand within the normality that we live.
ADHD is generally accompanied by comorbidities, among the most frequent are:
• Learning disabilities
• Self esteem
What is a comorbidity?
- The presence of one or more disorders (or diseases) in addition to the primary disease or disorder.
- The effect of these additional disorders or diseases.
In short , ADHD is accompanied by…. Some comorbidity, some associated disorder, and even so, it may NOT be ADHD , this is where the importance of a correct diagnosis lies.
Here the importance of the DIAGNOSIS of a MULTIDISCIPLINARY team .
Your treatment must be multimodal and personalized, (includes family psychoeducation) remember that each person is different and neuro diverse, so no pharmacological or therapeutic treatment is the same, even when the diagnosis is ADHD.
Knowing that it IS ADHD and that it is NOT ADHD is very necessary, and we must know the broadest way to rule out and confirm when diagnosing ADHD, so I will try to address it in a summarized, concrete and real way.
There are many myths surrounding ADHD, some of them:
• Is the fault of the parents and its diagnosis is unreliable.
• ADHD is a new disease, and it only exists in the US and is an invention .
• The symptoms of ADHD are mild, it is a false disease, the result of the little endurance of today’s parents, perfectionism and excessive demands.
• ADHD only affects childhood and disappears in adolescence.
• Only affects boys and not girls.
• ADHD should be diagnosed and treated first by the neurologist or neuro pediatrician, and if it does not improve, then by the child psychiatrist.
• Treatment of ADHD should be first without medication, and if it does not improve, medication can be used, because drugs are dangerous.
• It is better not to give the child medication and to use psychotherapy or other non-pharmacological approaches.
• Medications are addictive because they are drugs.
• The medication produces the medication a reduction of the growth in height of the child.
• Is a fad.
• ADHD medicine causes bone cancer.
Among many others, but these MYTHS make families rule out the possibility of ADHD affecting the quality of life.
Well then, before all this it is necessary to know some antecedents to address correctly, among which are :
- Parenting Styles .
- Gestation and Neurodevelopment .
- Thyroid history.
- Addictive history (toxic substances).
The result will have to guide us to start or NOT an ADHD diagnosis protocol or to carry out a differential diagnosis that can give data.
1.- Parenting Styles. It is necessary to know the parenting styles , from what type of family they live in : if it is a nuclear , uni – parental or extended family to the way in which it develops in school, socially, etc.
The ADHD has types and subtypes, and need to know the surrounding context to determine whether ADHD Mixed or combined ADHD where inattention dominates, or ADHD where hyperactivity predominates, remember that the symptoms should prevail in all contexts of the person to diagnose more than 6 months.
2.- Gestation and Neurodevelopment. It is necessary to know the evolution of the person from gestation to know if there are neurodevelopmental stages involved that actively participate and that intervene in the hyperactivity or inattention that is occurring, it is necessary to know what type of delivery it was, and how you experienced it, how many weeks of gestation, how the growth developed, etc. Determine the maturation and evolution of the person to be diagnosed.
It is here during Neurodevelopment that motor, sensory, visual, auditory, touch, taste, smell, language areas are valued.
3.- Thyroid history. It is necessary to know a thyroid history. The thyroid gland is part of the endocrine system . This system is made up of glands that produce, store, and release hormones into the bloodstream so that they can reach the entire body.
Some of the thyroid symptoms that can be mistaken for ADHD are:
- Increased appetite
- Difficulty concentrating
- Difficulty to sleep
The thyroid gland has many more symptoms and classifications, the ones that I show you here, are because they have similarities with the symptoms of ADHD.
The function of this thyroid gland is to produce and release the thyroid hormones, T4 or thyroxine and T3 or triiodothyronine, which are involved in growth, in the maintenance of most of the bodily functions and in the regulation of metabolism.
The production of thyroid hormones is controlled by another hormone called TSH (Thyroid Stimulating Hormone) which is synthesized in the pituitary gland of the brain . TSH stimulates the production of T4 and T3 and varies exponentially with small changes in T4 and T3. That is why TSH is a very good indicator of alterations in the production of thyroid hormones.
Among others, but these symptoms can be confused with a false ADHD.
There are several scientific papers on the relationship between thyroid dysfunctions and psychiatric disorders. For those who like research, a very interesting study by the Spanish psychiatrist Teresa Lorenzo Gómez, published in the Journal of Psychiatry and Mental Health, entitled ” Prevalence of thyroid disorders in admitted psychiatric patients .” This and other research not only confirms the influence of the thyroid in these medical cases, but is concerned that a misdiagnosis of the thyroid could land someone in a psychiatric facility.
In our case, they may be going to mental health treatment when it should be an endocrinologist treatment.
4.- Addictive antecedents. It is related to Neurodevelopment . Although we know that the use of illicit drugs during the gestation period increases the risk of congenital malformations and other defects in the future baby, such as spina bifida , esophageal atresia, absence of anus, rupture of the abdominal wall, cardiovascular disorders, malformations renal and urinary.
The habitual consumption of these substances during pregnancy harms the development of the fetus, causing:
- Reducing the weight of newborns.
- The alteration of the cognitive-mental functions of children.
- The appearance of attention disorders and hyperactivity.
These last two are diagnostic symptoms for ADHD.
In the multidisciplinary team involving the medical pediatrician , neurologist or Paido psychiatrist, psychologist, teacher or educator, family psychoeducation . Of these, I will only touch two very important that we families overlook .
They generally ask:
Why do you need a medical evaluation if you are not sick?
Well … the medical check-up is necessary because this is where it is determined if there are visual, hearing, motor problems, among others, or if they are physically violated at home, which triggers them to be aggressive or withdrawn, inattentive or hyperactive, and from here … change the path to correctly approach the person.
Why psychoeducation or workshops?
Well … the simple reason is that we are not ready as a family to address an ADHD person, the ignorance of NOT knowing: What is ADHD? How does an ADHD brain work, think and process? It reduces the results of multidisciplinary treatment.
Since by not knowing you have no idea how to help, support and give correct continuation at home, at school and in the social area correctly.
This ignorance conflicts with the family, the partner and the siblings of an ADHD person, and the family disintegrates.
Well, now you know what are the necessary areas to know a possible ADHD, if it is confirmed then we begin to define associated disorders or comorbidities.
If you have come this far, it is because now if we begin with multidisciplinary treatment , which we will address on another occasion.