GEITDAH CONSENSUS on attention deficit disorder / hyperactivity
Friday, March 11, 2011
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by experts in child psychiatry (some with double degree for pediatrics or psychology) in Spain: Francisco Montanes-Rada, Xavier Gastaminza-Pérez, Miguel A. Catala, Francisco Ruiz-Sanz, Pedro M. Ruiz-Lazaro, Oscar Herrera-Rodríguez, Marta García-Giral, Juan Ortiz-Guerra, José A. Alda-Díez, Dolores Mojarro-Práxedes, Tom Sang-Díez, María J. Mardomingo-Sanz, Jordi Sasot-Llevadot, Montserrat Pàmias, Francisco Rey-Sanchez.
The GEITDAH, Special Interest Group on Attention Deficit Disorder / Hyperactivity Disorder (ADHD), introduced in this article published last November 16, 2010: A committee of experts from all over Spain on the management of ADHD. Agreement was reached on basic issues that should be the starting point for future local or regional consensus. A further aim of this consensus reducing variations in care that occurs in our country to ADHD and provide a stimulus for learning. Its small size will allow wider dissemination, in order to achieve these ends more effectively. The conclusions of the consensus have been structured around an introduction to basic aspects and recommendations for diagnosis, treatment (pharmacological and psychotherapeutic), flow patients and organizational issues.
impulsivity, which affects the functioning of the sufferer in various areas of your life. Some people are predominantly hyperactive and impulsive, while others are predominantly inattentive.
Some of the manifestations of ADHD are also present in the normal population. The level of involvement in daily life is one of the frontiers for diagnosis. ADHD symptoms may overlap with symptoms of other psychiatric disorders . is needed differential diagnosis careful.
Diagnosis Screening for ADHD should be part of the psychopathological assessment of every patient.
The assessment of ADHD requires a clinical interview with the patient and, where appropriate, parents / family / spouse and reports of other observers, including teachers, etc. The information to be obtained includes the possible existence of problems in the family, school, work and social, as well as the evaluation of personal and family medical history. tests, scales and questionnaires are an aid does not replace the clinical interview.
not require additional tests (laboratory, neurological, radiological, etc..) Where the personal or family medical history is normal. psychological tests are necessary if cognitive deficits seen or low yields.
should evaluate possible
cardiac rating if cardiovascular personal or family history (especially dyspnea moderate to severe stress syncope, sudden death, heart palpitations or disorders heart rate).
Risk of abuse or misuse of the drug.
- Evaluation of the presence of symptoms or psychiatric disorders may be caused or exacerbated by drugs (periodic inspection).
- Diagnosis and patient flow
- diagnosis and treatment of ADHD and comorbid must be supervised by a physician with expertise in ADHD.
- If the level of involvement is mild or moderate, you should start, at least, a psychoeducational approach. If problems persist after 10 weeks, assessing the referral to specialized care.
- If the degree of impairment is severe, you should refer to specialized care.
Referral to specialized care from the school for counseling teams that have evaluated the child, will be made through primary care.
The treatment of children under six years and nonresponders in another health care is a criterion for referral to specialized care.
school and parents. This plan must address the psychological difficulties and educational / occupational .
The combination of evidence-based psychotherapy and psychotropic drugs is the most effective treatment.
therapy is applied must be based on evidence. At present, behavioral therapy or cognitive behavior is the one that has shown greater support.
The first choice pharmacological treatment is methylphenidate. choice is atomoxetine in patients who respond to methylphenidate in high doses or with intolerance in moderate doses, and patients with tics worsen with methylphenidate. At least once a year, should assess the need to continue treatment.
organizational aspects
talk
of the diagnosis, ruling out the recommendation not to screening in the general population, leaving the local context the recommendation.
The statement that "the tests and scales do not replace the interview" was completed, to explain in another recommendation, when psychological tests are indeed necessary.
also qualified their part concerning neurological and laboratory tests. and not just limited to drugs.
It has avoided a specialist referral algorithm
( proposed a similar to the NICE guidance) and therefore does not specify at what time or what severity or circumstances has to derive from primary to specialized care or how to derive from psychoeducational counseling teams. This, in part, is due to the high standards of derivation proposed by the NICE guideline
was discarded drugs that can be used are only those approved by U.S. drug agencies (FDA) and European (EMEA), for obvious and effect size data of various drugs. It dismissed the creation of the guardian's case, but added the need to treat the child's environment.
generally rejected the argument that in which the working group considered that lacked adequate scientific evidence and chose different options, those with more scientific evidence. hope this guide easy to standardize on minimum standards, care for patients with ADHD, and may be modified as needed locally. It plans to review every two years or the appearance of new evidence to justify its modification. To read the full article: http://www.neurologia.com/pdf/Web/5110/be100633.pdf
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