ADHD, a common disorder in the child population

October 27th is National ADHD Awareness Day in Spain. ADHD is a neurodevelopmental disorder whose symptoms begin in childhood and involve a pattern of inattention (easily distracted, having difficulty paying attention in class, forgetting appointments, frequently losing things), hyperactivity, and/or impulsivity (impatient, wanting things immediately, having difficulty waiting in line, not respecting turn-taking, and interrupting others). Depending on the predominant symptoms, we distinguish between inattentive, hyperactive/impulsive, and combined presentations. The latter is the one we most frequently encounter in our practice.

It is commonly associated with other problems or disorders such as learning difficulties, behavioral problems such as oppositional defiant disorder, and is also frequently associated with affective and anxiety disorders or sleep problems.

Its prevalence (number of people with a disorder or illness) is high: around 5% of the child population has ADHD . That is, in a class of about 30 students, between 1 and 3 students have it, making it one of the main reasons for seeking mental health services for children and adolescents.

Its origin is multifactorial, with genetics being the most significant factor. It has also been linked to tobacco or alcohol use during pregnancy, prematurity, low birth weight, intrauterine growth restriction, and severe brain injuries.

Clinical diagnosis is based on information gathered during interviews with the child and their parents, as well as data from the child's school environment and other settings, such as extracurricular activities. Currently, we do not have any laboratory, genetic, or neuroimaging tests that can diagnose ADHD.

The most widely recommended treatment according to Clinical Practice Guidelines (CPGs) is multimodal, which includes classroom modifications, psychological therapy (primarily psychoeducational groups with the parents of the children being treated), and, in moderate or severe cases or when initial measures have been insufficient, pharmacological treatment. In Spain, we have two main groups of medications indicated for ADHD in children from 6 years of age. The first group consists of stimulants (methylphenidate and lisdexamfetamine), and the second group consists of non-stimulants (atomoxetine and guanfacine). The medications indicated for ADHD are effective and safe. More than 70% of the children treated respond effectively to the first course of treatment. Side effects are mild and rarely require discontinuation of treatment. Among these side effects, the most frequent are loss of appetite, especially at midday, and difficulty falling asleep. To address decreased appetite, it's advisable to distribute food intake into 5-6 meals a day, aiming for larger portions at breakfast, afternoon snack, and dinner. At lunchtime, raw, unsalted nuts (almonds, hazelnuts, walnuts) can be included, provided there are no allergies to these foods. For sleep problems, we typically administer low doses of melatonin 30-60 minutes before the desired bedtime.

It is important to ensure these children have a varied diet , with sufficient intake of fruits, vegetables, and fish (Mediterranean diet), and limited consumption of simple sugars, artificial colors, and sugary or energy drinks. We also know the benefits of regular exercise; this should be fun and appropriate for each child's age.

There is also evidence of the benefit of mindfulness practice in children with ADHD, as reported in the Mindfulness for Health (M4H) Report ( Huguet and Alda, 2019).

Huguet, A. and Alda, Jose A. (2019). Mindfulness for Health (M4H): Mindfulness program for children with ADHD . Barcelona: Hospital Sant Joan de Déu (ed).