The Elisabeth d'Ornano Association for ADHD

Abstract:

“97% of adults with ADHD are not diagnosed, 75% of children with ADHD are undiagnosed and 25% of patients who come to our psychiatric consultations have a wrong diagnosis from pediatricians or from primary care physicians. These figures give us an idea of how the diagnosis and treatment of this illness is in our country. The diagnosis of this illness is an authentic chaos in Spain”, revealed Dr. Francisco Montañés, Chief of Psychiatry at the Alcorcón Foundation Hospital, coordinator of a group of psychiatrists that brings together the best specialists in the treatment of ADHD from across Spain named GEITDAH, abbreviations that correspond to the name of the Special Interest Group on ADHD.

According to this psychiatrist, "25% of the cases that come to us do not have ADHD, but do suffer from other disorders such as Asperger’s syndrome, defiant behavior or more serious neurological illnesses. Instead the figures of under diagnosis in our country are alarming, as pointed out three years ago by Doctor Mar Domingo, Psychiatrist at the Gregorio Marañón Hospital. We remain at the level of Latvia in diagnosis, but even so, they make even more errors,” the doctor Montañés finished by saying.

Psychiatrists point out that it is very easy to confuse the diagnosis of ADHD, because these children have an 80% of co-morbidity with other psychiatric and neurological diseases such as autism, specific language disorders, developmental disorders of coordination, depression, slow mental maturity, defiant behavior disorders, Tourette's syndrome, sleep disturbances and irritability.

According to both doctors, what is clear is that the primary care physicians and pediatricians are not the adequate professionals to diagnose ADHD, nor to treat this condition in an adequate manner. "Spain has a great void in this area because there are no public hospitals that are reference centers in the treatment of this disease in Spain, because this would mean a research expense to administration, and this does not interest them even though there would long-term savings because there would be fewer young addicts. We live in a short-term political situation,” stresses Dr. Montañés.

Moreover, this specialist highlights that the cases of adults with ADHD should also be diagnosed and treated by child psychiatrists for two reasons. First, because this disorder is genetic in 80% of the cases. And secondly, because in many occasions before treating the child, the specialist should analyze the behavior of the parents and learn which behaviors are projected onto their children. "On occasions we find that it is more convenient to medicate parents than the children. And if they improve, the condition of the children collaterally improves,” explained these psychiatrists.

Given these figures and the great risk of error in the primary diagnosis, the Chiefs of Psychiatry of the major hospitals have announced that they will urgently publish a Spanish Consensus Guide about the Diagnosis and Treatment of ADHD that is very simple and short. "The Ministry has published a guide of 200 pages that is too extensive and impractical. The data shows that it has not been consulted/read,” explains Dr. Montañés.

This guide is also very important because it is not the same to treat a patient that shows ADHD and depression, as to treat a person suffering from ADHD and defiant negative conduct. 85% of ADHD cases show other collateral psychiatric disorders. “The treatment of substance in both cases is delayed action methylphenidate such as Medikinet, which lasts exactly the length of the school day, but the other substance must be strictly different in function from the co-morbidity that also is presented. Psycho-stimulants are dopamine blockers that have proven effective in 62 clinical trials in 77% of the cases. But we must know to combine them with the rest of the co-morbidities that the patient presents. And that alone should be done by a psychiatrist or neurologist,” affirms Dr. Montañés.

Another novelty that this scientific group of psychiatrists has discovered is that many children with ADHD suffer from multiple organ failure. One of the more striking subjects that these specialists are studying is that a high percentage of these children and adults also suffer from other illnesses. "We have analyzed that 20% of patients with ADHD suffer a greater incidence of diabetes, kidney disease, intestinal problems, low levels of growth hormone and vegetative hyper-reactive immune systems with many more allergies.

In this area the Doctor Gastaminza, Psychiatrist at the Vall d'Hebron Hospital will present to his psychiatric colleagues the results of a recent study in his hospital in which he has found has been found, along with the Transplant Unit, that 22% of children who have received a kidney transplant suffer from ADHD. The doctors have received a great surprise. This correlation does not occur with other organ transplants. With this information, the psychiatrists in this Catalan hospital have begun to work together in order to analyze whether urea or other determining factors in the kidney may affect the neurotransmitters that determine our attention and learning capacity.