ADHD in children and adolescents: assessment, diagnosis and treatment in Panama

ADHD in children and adolescents: assessment, diagnosis and treatment in Panama

🧐 Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder of neurobiological origin characterized by a persistent pattern of inattention and/or hyperactivity-impulsivity that interferes with a person's functioning in various contexts, consequently affecting their development (APA, 2013). From an epidemiological perspective, ADHD has maintained a consistent prevalence over the last few decades, reaching an international prevalence of between 5% and 29% (Posner et al., 2020) . The variability in ADHD prevalence globally is attributable to methodological differences among studies conducted in each country, specifically in diagnostic criteria, data sources, and the level of functional impairment required for diagnosis in each region and country (Posner et al., 2020).

🧠 Neurobiological Perspective and Diagnostic Differentiation

🧠 From a neurobiological perspective, ADHD is a complex neuropsychiatric condition recognized for causing structural and functional changes in brain neurochemistry. Some of these changes structurally affect brain areas such as the prefrontal cortex, striatum, and cerebellum, while from a functional perspective, alterations in dopamine and norepinephrine levels are evident—neurotransmitters that are key to the pathophysiology of this neurodevelopmental disorder (Mehta et al., 2019).

🔎 Neuropsychological Assessment: Concomitance and Associated Symptoms

🔎 Based on these structural and functional alterations, in addition to medical evaluation, neuropsychological assessment is important. This assessment measures cognitive and behavioral functions to determine if the primary disorder may be affecting other processes that commonly appear when ADHD is diagnosed, a phenomenon known as co-occurrence (Fenollar-Cortés, 2022 ). Some co-occurring impairments that are usually (though not always) present in patients with ADHD-related symptoms include impairments in the emotional area (self-esteem and emotionality), motor coordination (handwriting and crafts), disruptive behavior (understanding limits and rules), and executive functions and time management (problem-solving, time management, and temporal sequencing).

▶️ ADHD vs. Dysexecutive Syndrome

▶️ It would also be worthwhile to distinguish between ADHD and Dysexecutive Syndrome. According to Conde and Del Olmo (2023), advances in neuropsychology present us with other diagnostic categories that should be considered when symptoms are present that affect a person's cognitive profile. We are referring to dysexecutive syndromes, which are a type of cognitive profile that results in impaired impulse control (such as in the case of orbitofrontal syndrome) and impaired ability to manipulate information. This can lead to errors, slowness, and a tendency to disengage from the task, thus losing sight of the objective and efficiency of the activity being performed (these types of symptoms occur in dorsolateral prefrontal syndrome).

🧐 ADHD is recognized as a type of developmental dysexecutive syndrome. However, not all dysexecutive syndromes are considered ADHD. Therefore, it is understood that the interaction between environmental factors can increase the risk of developing symptoms of inattention, hyperactivity/impulsivity, even if these symptoms were not necessarily present from early developmental stages.

⭐️ Environmental Factors and Dysexecutive Symptoms

Some environmental factors that can act as a risk factor for the appearance of dysexecutive symptoms are: lack of structure in the environment, not making prior organization before starting an activity, adopting multitasking as a habit (doing several activities simultaneously), habits that cause distraction when performing a task (such as looking at the cell phone while the child studies or works), acquired brain damage or substance use can be some factors that can interfere with our daily cognitive performance.

🤓 Standardized Tests for ADHD Assessment and Diagnosis

🤓 Focusing on one of the topics in this article related to assessment and diagnosis, we'd like to tell you about some of the standardized tests used for this purpose. You'll see the name of each standardized test in blue. This means that if you're interested in learning more about that test, clicking on the link will take you to a tab on our website where you can continue learning about this interesting topic (each link includes text and a video that you can watch on YouTube).

✅ ATENTO (Questionnaire for the Evaluation of Executive Functions and ADHD): This test incorporates various questionnaires administered to multiple informants who can assess symptoms of executive functions, ADHD, and associated difficulties in individuals between 3 years 0 months and 18 years 11 months. For this purpose, the ATENTO Test includes several questionnaires that vary depending on the age of the individual and the informants, providing great versatility and utility. This allows professionals to compare responses from different informants, including the client/patient. The questionnaires that can be administered are:

👉🏼 Questionnaires for families focused on children between 3 and 6 years of age.

👉🏼 Questionnaires for school focused on boys or girls between 3 and 6 years of age.

👉🏼 Questionnaires for families focused on children between 6 and 18 years of age.

👉🏼 Questionnaires for school focused on boys or girls between 6 and 18 years of age.

👉🏼 Self-report questionnaires completed by the child or adolescent. This self-report questionnaire can be administered to individuals between the ages of 8 and 18.

✅ Assessment of attention levels (d2-R Attention Test): Without attention, there is no learning. This is why it's useful to consider tests like the d2-r, which measures selective attention, sustained attention, concentration, processing speed, error rate, and work style. If you're interested in learning more about attention, we recommend reading the article: Attention and its relevance to learning from a neuropsychological perspective.

✅ Intelligence assessment provides valuable information regarding an individual's current and future learning capacity, considering a profile of normative and personal strengths and weaknesses. The WISC-IV intelligence test allows for the qualitative and quantitative analysis of a patient's performance on tasks involving verbal comprehension, perceptual reasoning, working memory, and processing speed. If you wish to delve deeper into the importance of evaluating intelligence from a neuropsychological perspective, I recommend reading the article titled: Intelligence from the Perspective of Neuropsychology and Education.

✅ Memory (TOMAL): Several diagnostic criteria associated with ADHD state that individuals with ADHD often lose materials needed for tasks, such as pencils, books, instruments, keys, work papers, glasses, etc. Similarly, another diagnostic criterion states that individuals with ADHD frequently forget to perform everyday activities, such as completing chores and errands at home. For this reason, assessing memory is of paramount importance. This cognitive function refers to the ability to recall past events, learn new information, and plan for future tasks (Tirapu-Ustárroz & Muñoz-Céspedes, 2005). If you would like to learn more about memory, I recommend reading the article: “Memory Assessment and Its Importance in Educational Neuropsychology.”

✅ Executive Functions (ENFEN, BANFE-3): Continuing with the diagnostic criteria and associated difficulties usually linked to ADHD, we have the concept of executive functions, the ability to regulate, anticipate, plan, manage, monitor, and direct our own behavior toward achieving goals and objectives. Additionally, there are diagnostic criteria related to impairment in executive functioning, for example: "frequently has difficulty following instructions, organizing tasks, and managing time." If you would like to learn more about executive functions, I recommend reading the article: Neuropsychology of Executive Functions in Education.

✅ Behavior and emotion (BASC-3): In our experience working with school-aged children, most suspected cases of ADHD are patients referred by the school (educational counselor). ADHD is sometimes confused with factors related to anxiety, depression, oppositional defiant disorder, and other disorders. Therefore, it is essential to include in the evaluation the application of tests such as the BASC-3 (Behavior and Emotion Scale for Children and Adolescents) , a multi-method and multidimensional test that allows for the collection of information from various contexts related to the behavior and emotions of the patient being evaluated.

Treatment Options for ADHD in Panama

  Regarding treatment, it is recommended that the following be considered:

✅ Pharmacological treatment: depending on the severity of the symptoms, it is valuable for the family to consider visiting medical professionals specializing in neuropediatrics in order to determine whether or not the case warrants pharmacological treatment.

✅ Non-pharmacological treatment: Cognitive stimulation programs have proven effective in improving impaired cognitive processes in patients with ADHD. For example, a cognitive stimulation program conducted by Ríos-Gallardo et al. (2016) showed improvements in the group of children who received the intervention through the stimulation of executive functions, resulting in improved mental flexibility in children diagnosed with ADHD. Mental flexibility refers to the cognitive ability to adapt mental activity and behavior to the demands of the environment, helping the individual to consider new solutions to problems or demands depending on the context.

Practical Strategies to Improve Concentration and Impulsiveness

In general, people of all ages, including children or teenagers, can make use of the following strategies (click on the blue link to expand with a YouTube Shorts on that topic).

▶️ Pomodoro Technique:   This technique involves using physical or digital timers to track work time. It's important to avoid multitasking when using this technique. Once work time is over, we can reinforce our efforts with a break. During this break, avoid screen time. Instead, we can take an active break, drink water, take a short 5-minute nap, or simply socialize with a colleague or family member.

▶️ Using the One Sec app:   The One Sec app lets you monitor and regulate your screen time when using your phone. When you try to open an app, it will ask if you really want to open it. This can be useful for controlling and reducing your screen time while you're working on important tasks. If you're a parent, this app will also allow you to monitor your children's screen time.

▶️ Recommendations for parents regarding executive functions in children:   As adults, we may also need to strengthen executive functions in the youngest members of the family. Creating a structured work environment, implementing extracurricular activities, and establishing family board game routines are key allies in strengthening executive functions within the family.

💪 Remember to schedule your Educational Neuropsychology appointment at the Comprehensive Center for Educational Neuropsychology Located in Panama City, in the Mar del Sur Business Center, just 200 meters from the Vía Argentina Metro Station. For more information, please contact us at +507 6535 6362 and we will be happy to assist you.