SUMMARY PAPER DR. CESAR Soutullo-Director of the Unit for Child and Adolescent Psychiatry, Dpto.de Psychiatry and Medical Psychology, University Clinic of Navarra.
ADVANCES IN THE TREATMENT OF ADHD
Recent scientific studies show differences in the development of very welcome, with different connectivity and altered connections, compared with unaffected subjects. There are lower levels of dopamine transporters.
ADHD is a developmental delay may be transient improve over time or may be a persistent delay.
A study of 302 patients who make their first visit, 82% are children aged from 7, but a large majority is about 11 years and even teenagers. There is an average delay of diagnosis of 3.5 years. A time and a lost opportunity that can have harsh consequences. Therefore, pediatricians advise the suspect referrals.
Treatment should be multimodal: FAMILY + SCHOOL + MEDICATION
The family must learn about ADHD. You have to make a parent training on handling behavior and troubleshooting.
The school should learn about ADHD. Teachers need to have management techniques. Must make a specific support in the student's deficit areas and encourage those that are of special skill, so you know it's not bad in everything he does. The school must see the child as a person. The school is to motivate and encourage. The professor is essential in these children (to help explain, adapt) make it easier but not different (change time, space on exams, use the clock, etc ...) to adapt to each type of difficulty.
In those tasks withdraw is not reached, ignore and delay (to allow some time in some respects) and try again when it sees fit.
In the majority of ADHD is lacking organizational skills, so, I could really use the figure of a "personal trainer", a person who is on their side to help you organize everything. And work to promote the ability to organize time and work. That gives you step-by-step training with daily tasks. Ahem. Recording assignments, to see that material needs, review the rucksack, do homework, review them and resave again. All these tasks are obvious and simple for an ADHD great complexity and difficulty.
treatment does not work:
Therapy (Tomatis, Sanon, joudry)
treatments herbs, minerals
Special Diets
and physical exercises laterality
Chiropractic
Psychoanalysis / psychotherapy group
Biofeedback / Neurofeedback
If it works for treatment:
Psychoeducation.
medication.
Besides medications currently on the market, is under consideration lisdexamfetamine, close to introduction in Spain.
Currently, 70% approx. improve with medication and between 10-30% of patients do not respond or tolerate stimulants. Improve more or are more noticeable benefit in those who are more serious.
The recommendations that Dr. Soutullo for medication and treatment are
- By introducing the medication at 4 weeks approx. value, if do well to follow and re-evaluate at 12 weeks, if not right, change the medication and no longer waiting to pass. Adjust dose to each patient and need, but still spend long periods of time. Optimizing the dose with more pace and use the full range of possibilities available to management.
- is up to only family and doctor which agent to use.
- Use and understand the available drugs. To analyze the different profiles with the family, costs, adverse effects, duration of effect, etc ...
- Monitor comorbidity: tics, Tourette's, epilepsy
- Assess the use of medication in school
- Each patient is different and so are their needs
- Give preference to parents and patients. Listen.
- Familiarity with the profile of each drug
- Perform an extensive initial assessment. It is important to know at all times what the problems are and where those problems. Because with the passage of time may be changing, disappear or emerge with new ones.
And very important:
- Know the symptoms profile the patient and his environment can be achieved with medication and can not be achieved. Leave unclear how far one can go.
- Apply psychoeducation, behavioral management and educational support as needed.
step at a time. One after another. THERE ARE NO SHORTCUTS.
FUTURE EXPECTATIONS:
ADHD In the future expect a better prediction of treatment for genetic characteristics. We will have definitive genetic studies. There will have to try so many different drugs and doses. There will be new receivers and more sophisticated. Improve teachers y los tratamientos psicológicos. Aparecerán nuevas técnicas.
No está muy lejos la opción de suministrar la medicación en parche. Dará más posibilidades y variaciones en la dosificación, sobre todo a chicos mayores que estudian por la tarde-noche ó en días alternativos. Facilitará la toma a necesidad. Se podrá aplicar el parche unas dos horas antes del estudio y se lo podrán quitar también dos horas antes de ir a dormir, así el efecto de la
medicación irá disminuyendo progresivamente. Para los adolescentes será una opción muy cómoda sin tener que tomar pastillas. Así también se evita el "Traffic type IV or snorting" of these substances.
As for Omega 3 raises doubts, there are currently limited but promising evidence. Studies in which good results are obtained in very high doses (5 times). But stress that the Omega 3 is an agent that stimulates the growth of the gray mass.
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