30 October 2020 Author : Vítor Leite Among the various skills that children gradually acquire over their normal developmental processes are, for example: Increase in periods of sustained and concentrated attention; Self-regulation of psychomotor activity; Control of impulses. For younger children, of pre-school age, these skills are arduous tasks and are difficult to overcome, due to the immaturity of their central nervous system. Thus, we will hardly and very sparingly dare to diagnose a hyperactivity disorder with attention deficit (ADHD) at preschool age. This disorder involves dysfunction of different brain regions (for example, connections between prefrontal cortex, nuclei of the base and cerebellum) and implies several genes related to neurotransmission (of dopamine, norepinephrine, and serotonin, for example). ADHD has a neurobiological basis and a marked genetic etiology. This unquestionable genetic and biological component allows us to deconstruct prejudices and stereotypes unfairly seen in public debate. Although ADHD and “lack of education” can coexist, they are not the same. ADHD should be subject to medical treatment; The “lack of education” requires intervention in the family, under penalty of behavioral escalation. What characterizes and how ADHD evolves ADHD is characterized by an inappropriate pattern of inattention, hyperactivity and / or impulsivity , persistent and transversal to different contexts. The disorder manifests itself through a behavioral heterogeneity, and impact varies from mild and transient to severe and persistent. Behavioral changes related to mood and anxiety spectrum may also be present, as well as different neurodevelopmental disorders , for example: Learning difficulties; Tics; Autism spectrum. However, other difficulties may invade the daily lives of children with ADHD, for example: Relational difficulties; Greater exposure to danger; Academic demotivation and divestment. ADHD has a chronic evolution character, although its expression tends to change and attenuate over time. It affects approximately 5% of children, of whom about three quarters will tend to maintain impairment in adolescence, and half in adulthood. Diagnosis and treatment of ADHD The diagnosis of ADHD is clinical and based on defined criteria, often avoiding diagnostic tests. Even so, certain neuropsychological assessments and behavior questionnaires (directed to parents and teachers) may be informative, especially in situations of an important academic impairment. The approach to hyperactivity disorder with attention deficit is intended to be comprehensive and multidisciplinary . As a hereditary condition, it is important to explore family history. It is not uncommon in a consultation for parents to review themselves in their child symptoms; Due to the possible persistence of ADHD in adulthood and of late diagnosis, currently there are also ADHD consultations within the scope of adult psychiatry. The pharmacological treatment alternatives available for ADHD are safe, are perfectly studied and are consensually indicated in situations of moderate to severe impairment. However, prescription must follow previous evaluation by a pediatrician or developmental pediatrician and framed in a more comprehensive plan. The basis of the intervention must be psychoeducation with the child and family and investment in a cohesive therapeutic relationship, which facilitates compliance with the established plan. Additional strategies from other clinical areas may also be implemented, depending on the particularities of each child, for example clinical psychology, occupational therapy, psychomotricity, among others. Meet the child and adolescent psychiatry team from Hospital da Luz network. The content published in the Health Guide is intended for the general public and is provided for informational and educational purposes only. It does not replace individual medical assessment, diagnosis, or personalized clinical advice from a qualified healthcare professional. The content is produced or reviewed by physicians and other healthcare professionals at Hospital da Luz and is based on the knowledge available at the time of publication or the most recent update, as indicated at the beginning of each item.
