Fotolia_3485672_M CROP

Adult ADHD in Spain? Si!

Bookmark and Share

Dr. Elena Díaz De Guereñu, ADHD specialist in Northern Spain

I receive many e-mails from people in the non-U.S. Spanish-speaking world desperate to find information and knowledgeable treating professionals. So, I am always glad to meet such professionals in who have taken a special interest in ADHD. Recently, one such physician, Dr. Elena Díaz De Guereñu, asked for permission to translate into Spanish one of my blog posts from YouMeADD.org. Of course I was happy for the post to reach Spanish readers. More importantly, I was thrilled to learn that such a pro-active ADHD-treating physician is practicing in Spain (in the northern Basque region, near Bilbao; see map below), treating both children and adults.  The newspaper El Correo published this story about her work.)

I was curious about the state of ADHD awareness and treatment in Spain,  and so I asked Dr. Díaz De Guereñu if she would answer a few questions for this blog’s readers. Her answers below, in English. (Click here for her blog’s Spanish translation of this post, which also appears at the end of this English version.)

1. What is your interest in Adult ADHD? How and when did you come to it?

When I first started treating ADHD I would work with children and teenagers. It’s the population group in which awareness of the disorder is highest. However, daily practice has made me see that behind a child with ADHD is one or even two parents whose child’s symptoms remind them of their own childhood.

They managed to get ahead and succeed in life but there are some unresolved issues to deal with.

I also initially focused my own blog on children with ADHD but I’ve gradually seen how this disorder remains as they become adults and it keeps on seriously affecting them.

In addition, they have to face the lack of awareness on Adult ADHD and therefore the lack of specifically trained professionals in diagnosis and treatment.

So I am gradually diagnosing and treating more ADHD adults. This is a more complex issue: Over time, untreated ADHD can lead to more serious disorders, including depression, substance abuse, and conduct disorders, all of which make diagnosis and treatment more difficult. Others are moving more positively ahead in life but they want to better manage their time and meet their commitments.

2. What is your training and where do you practice? Are you a clinician, a professor, or both?

I graduated as Primary Care Physician and worked mainly in this field both with adults and children. I was introduced to ADHD and its challenges within my own family. First of these challenges: how to recognize and diagnose it. Eight years ago there was an enormous lack of information on ADHD and an overall scepticism among those professionals who should diagnose it.

So I decided to specialize in ADHD diagnosis and treatment. I trained for two years with specialists (psychiatrists, neurologists) and attended courses and seminars. I must particularly thank Dr. César Soutullo and Dr Sergio Aguilera for what they taught me. Then I opened my own office almost two years ago.

3. How would you describe the general awareness of ADHD in Spain and Adult ADHD in particular?

Fortunately, awareness has greatly advanced over the last ten years. There is greater knowledge and awareness about the disorder now, both among clinicians and educators. Many advice and support associations have arisen that provide invaluable help for people with ADHD and their families.

Nevertheless, there is still a long way to go. Acknowledgment and accommodation measures by public bodies are inconsistent—each Autonomous Community in Spain (there are 17) regulates these issues in a different way or not at all.

The current economic situation has provoked a cut-off in subsidies and assistive measures for dependent people and TDAH children are affected too. [TDAH is the abbreviation for ADHD in the Spanish language.]

View Larger Map

4. What do you enjoy most about serving this population?

According to research, the average time between when the first disabilities appear and treatment begins is about 6 years in Spain. You can easily imagine the kids as well as their families suffer during this long period: poor qualifications for education, humiliations, admonishments, and punishments, lowering self-esteem and family-wide frustration.

When they finally find out their child is not bad, lazy or stupid but rather has a disorder with a name and a well-known solution, the family’s lives change from night to day.

The best compensation for me personally comes when I see again the family who was first overwhelmed and discouraged now smiling and looking at the future with optimism; that kid who used to fail most of their subjects and saw himself as “the silliest kid in the class” now can pass and becomes self-confident.

5. How would you describe the general awareness of ADHD in Spain and Adult ADHD in particular?

There are still some clinicians who are skeptical to recognize ADHD as a real disorder; some of them say it is just “overdiagnosed”. Fortunately number of them is decreasing.

Sadly, the situation for Adult ADHD is largely worse. When kids reach 14 they are no longer treated by their pediatrician; instead they see a  general-practitioner physician. These are generally less trained in ADHD diagnosis and treatment; in best cases, they just keep on prescribing the same medication prescribed by the pediatrician but with no approach to make adjustments.

Psychiatrists who treat adults are generally more concerned about major disorders so they have no time to dedicate to ADHD.

Non-diagnosed adult ADHD is for sure the field where the gap between Spain and countries such as the USA and Canada is the highest. It is a nearly unexplored territory, as figures clearly show: only one out of 30 adults who might have ADHD actually takes medication for it.

6. The conservative estimate is that 4 percent of the U.S. Adult population has ADHD; that’s about 10 million, with only 10 percent diagnosed, or about 1 million. Do you know the statistics for Spain?

According to most conservative figures (2001) is 1.2% surprisingly far below France (7.3%), Germany (3.1%) or Italy (2.8%). More recent research suggests a prevalence of about 3-4% in adults.

More remarkable is the fact, according to 2010 research, that only 0.04% of adults are taking specific medication for ADHD. That percentage is higher among younger adults (18-24), about 0.2% of whom were likely diagnosed when children.
This means that only one out of 30 presumably ADHD adult is actually taking medication. Depending on the data, this could be even one out of 80!

7. Is the diagnosis made in Spain roughly the same as it is in the U.S.; meaning, do you use the DSM?

As far as I know, we apply nearly the same evaluation and diagnosis process and tools, based on DSM-IV criteria (and soon DSM-V).

As for treatment we also use a multimodal treatment: medication, educational training and psycho-education. As it happens elsewhere there are also “alternative” therapies, whose efficiency has never been proven but they still attract a number of patients.

8. Do we know how many psychiatrists and psychologists are trained to treat ADHD in Spain?

It’s really difficult to say. In Spain there is a public healthcare system both for Primary and Specialized Care. It covers over 90% of the population. Within this system there are no “ADHD specialists” but PCP, GP, psychiatrists or neurologists with larger or smaller knowledge, training, or experience in this specific disorder.

Among psychologists there are few who know and treating ADHD according to the mutimodal approach as mentioned above.

It can be hard to find a single psychologist with this expertise in a mid-size city as mine (est. 200,000 population).

So I’m really lucky to work with one of the best psychotherapists I’ve met, Daniel Montoya. He works in Pamplona, which is close to Vitoria so he comes here regularly, and has worked for decades in disabilities treatment and behavioural management. We are absolutely in tune and closely coordinate treatment, which means a high success for patients.

9. Is ADHD research taking place in Spain?

Yes, there are many researchers dedicated to ADHD. Just to name a few of them, Dr. Cesar Soutullo at Clínica Universitaria de Navarra, specialist in children and adolescents with ADHD researcher and author; Dr. Josep Antoni Ramos Quiroga at Hospital Universitari Vall d’Hebron, dedicated to adult ADHD; Dr. Celestino Rodríguez, at Universidad de Oviedo who studies learning disabilities related to ADHD, as Dra. Isabel Orjales (Doctor in Pedagogy and professor at UNED) and Dra. Ana Miranda (Universidad de Valencia) also do. Dr. Joaquín Fuentes is a Child Psychiatrist working at Policlínica Gipuzkoa; his research is focused on children ADHD and Autism.

10. I’ve heard many reports on the radio about the economic situation in Spain. My heart goes out to the people who are suffering. I wonder if the same is true there as here: People with untreated ADHD are, in general, less likely to attain a college degree or to be employed. If they are employed, they earn less. So, do you think that people with untreated ADHD in Spain are having a harder time in this economy than the average person?

Indeed. Academic failure is often related to undiagnosed ADHD. Work, social, relationship and family challenges are more frequent and intense for people with ADHD.

Economic crisis makes these people even more vulnerable. Protections, accommodations and integration measures have been dramatically cut back. If we also consider the still-remaining denial to ADHD we can clearly imagine how difficult life is for them.

11. We came to know each other when you asked to translate a post from my other blog, YouMeADD, and post it on your blog. Is that right?

Before reading your book I found your blog. What I liked most was the combination of a rigourous approach and deep knowledge on ADHD with the nimble, enjoyable and nearly addictive writing style of an American journalist (which for an European is almost redundant!)

Dr. Elena Díaz De Guereñu

When you kindly gave me  the opportunity to read your book, no wonder how easily and quickly I did, how useful I found the stories gathered in it and how deep knowledge they are narrated with.

It is much more than a “how-to” or “self-help” manual, it provides its readers with a wide basis of knowledge so they can face the challenges themselves and seek for the professional treatment they need.

I’m honestly looking forward to Spanish version being available. I’m sure many, many people will appreciate it.

Gracias, Dr. Díaz De Guereñu!

For more information, visit the website of Dr. Elena Díaz De Guereñu.

En Espanol:

 

1. ¿Qué le interesa del TDAH adulto?¿Cómo y cuándo llegó a él?

Cuando empecé a tratar el TDAH, lo hice con niños y adolescentes. Es el grupo de población donde más reconocido está el trastorno. Sin embargo, la práctica diaria me hizo ver que, con frecuencia, tras un niño con TDAH hay uno (o incluso ambos) padres que reconocen en su infancia los mismos síntomas que ahora presenta su hijo. Han conseguido salir adelante en la vida, pero siguen teniendo cuestiones por sin resolver.

Por otro lado, a través de mi blog, orientado en principio al TDAH infantil, he podido comprobar que el trastorno permanece y sigue afectando seriamente a muchos adultos. Estos se enfrentan, además, a la falta de reconocimiento de la persistencia del trastorno tras la adolescencia y, consecuentemente, a la falta de profesionales formados específicamente en su diagnóstico y tratamiento.

Así que estoy en mi camino hacia el tratamiento de adultos con TDAH. Es un tema más complejo pues, frecuentemente, la falta de diagnóstico hace que aparezcan otros trastornos más graves: depresión, consumo de sustancias, trastornos disociales… que dificultan el diagnóstico y el tratamiento. Otros han conseguido salir adelante, pero necesitan poner muchas cosas en orden en su cabeza.

2. ¿Cuál es su formación y dónde ejerce? ¿Tiene una consulta, se dedica a la enseñanza, o ambas cosas?

Me he formado como médico de familia y comunitaria. He desarrollado mi actividad en el campo de la atención primaria, tanto de adultos como de niños.

A través de mi propia familia conocí el trastorno y sus problemas asociados; el primero de ellos, su reconocimiento y diagnóstico. Hace ocho años, había una enorme falta de información sobre el TDAH y un escepticismo generalizado entre quienes deberían diagnosticarlo.

Así, decidí especializarme en el diagnóstico y tratamiento del TDAH. Durante dos años estuve formándome con especialistas (neurólogos, psiquiatras infantiles) y asistiendo a cursos sobre la especialidad. En particular, debo agradecer mis conocimientos a los Dr. César Soutullo y Sergio Aguilera. Hace año y medio, abrí mi propia consulta.

3. ¿Cómo describiría el grado de sensibilización que existe en España acerca del TDAH, en general, y del TDAH adulto, en particular?

Afortunadamente, la situación ha cambiado mucho en los últimos diez años. Hay mayor conocimiento y sensibilidad hacia el trastorno, tanto en el ámbito sanitario como educativo. Han surgido muchas asociaciones de afectados que son una ayuda inestimable para las familias de los afectados.

Sin embargo, queda aún mucho camino por recorrer. El reconocimiento por la Administración es muy irregular (cada Comunidad Autónoma regula las adaptaciones curriculares de diferente manera, o aún no lo hace en absoluto). La situación económica ha provocado el recorte de muchas ayudas a personas dependientes, y los niños con TDAH están entre los perjudicados.

Entre los profesionales sanitarios, aún hay quien se muestra reacio a reconocer el TDAH como trastorno o dice que está “sobrediagnosticado”. Afortunadamente, cada vez son menos quienes piensan así.

En cuanto al TDAH adulto, desgraciadamente, la situación es mucho peor. Al cumplir 14 años, los niños dejan de ser tratados por su pediatra y pasan a un médico de adultos. Estos, por lo general, tienen mucho menor conocimiento del trastorno y su manejo; en el mejor de los casos, se limitan a continuar recetando la medicación anterior, sin atreverse a modificarla.

Los psiquiatras de adultos han de tratar con trastornos más severos, por lo que les resulta difícil atender el TDAH.

El TDAH adulto no diagnosticado es quizá el campo donde mayor es la distancia entre España y países como EEUU o Canadá. Es un terreno casi inexplorado.

4. ¿Qué es lo más gratificante de tratar a estas personas?

Según las estadísticas, el tiempo medio que transcurre hasta que una persona con TDAH es diagnosticada está cerca de los seis años. Podemos imaginar el sufrimiento del niño afectado y de su familia durante ese tiempo, las humillaciones, riñas, castigos, la pérdida de autoestima y la frustración de toda la familia.

Cuando, finalmente, descubren que su hijo no es malo, tonto ni vago, sino que tiene un problema con un nombre y una solución, su vida cambia como de la noche al día.

La mayor satisfacción es volver a ver que aquella familia desanimada y abrumada, al cabo de unos pocos meses sonríe y mira la vida con optimismo; que aquel niño que suspendía la mayor parte de sus asignaturas y se creía el tonto de la clase, ahora consigue aprobar y confía en sí mismo.

5. Según una estimación conservadora, el 4% de la población de EEUU tiene TDAH; eso significa unos 10 millones de personas, de las cuales sólo un 10% está diagnosticado, esto es, cerca de un millón. ¿Cuáles son las estadísticas en España? 

La estimación más conservadora, en 2001, es del 1,2% (por debajo de Francia (7,3%) Alemania (3,1%) o Italia (2,8%). Estimaciones más recientes consideran que puede estar en torno al 3-4%.

Más llamativo resulta que, según datos de 2010, sólo un 0,04% de los adultos recibe tratamiento específico para el TDAH; el porcentaje es mayor entre los adultos jóvenes (cerca del 0,2%) que posiblemente fueron diagnosticados de niños. Esto significa que sólo uno de cada 30 adultos con TDAH está diagnosticado y recibe tratamiento.

6. El diagnóstico, en España, ¿se realiza más o menos como en EEUU, esto es, se utiliza el DSM?

Hasta donde yo sé, sí. Utilizamos básicamente las mismas herramientas de diagnóstico, basadas en la clasificación y los criterios DSM-IV (y, próximamente, los DSM-V).

En cuanto al tratamiento, seguimos el esquema de “tratamiento multimodal”: medicación, entrenamiento cognitivo y psicoeducación.

Al igual que en otras partes, también vemos terapias “alternativas” de eficacia nunca demostrada, pero que consiguen atraer a ciertos pacientes.

7. ¿Cuántos psiquiatras y psicólogos preparados para tratar el TDAH puede haber en España?

Es muy difícil de determinar. En España predomina un sistema sanitario público, tanto en Atención Primaria como especializada, que cubre a más del 90% de la población. Dentro de ese sistema, no hay especialistas en TDAH, sino médicos de familia, psiquiatras o neurólogos con mayor o menor experiencia sobre el trastorno.

En cuanto a los psicólogos, son muy escasos los que conocen y tratan el trastorno conforme a los criterios que mencionaba. Puede llegar a ser difícil encontrar uno solo en una ciudad de, digamos, 150.000 ó 200.000 habitantes.

En este sentido, tengo la enorme fortuna de trabajar con uno de los mejores psicoterapeutas que conozco, Daniel Montoya (gabinete “ATULADO”, Pamplona) con el que comparto una total sintonía en el método de tratamiento.

8. ¿Se están realizando estudios sobre el TDAH en España?

Sí hay muchos investigadores dedicados al TDAH. Por nombrar sólo unos pocos, el Dr.  Cesar Soutullo, en la Clínica Universitaria de Navarra, investigador y autor de libros especializados en TDAH infantil y adolescente; el Dr. Josep Antoni Ramos Quiroga, del Hospital Universitari Vall d’Hebron, dedicado al TDAH adulto; el Dr. Celestino Rodríguez, de la Universidad de Oviedo, especialista en problemas de aprendizaje relacionados con el TDAH, al igual que la Dra. Isabel Orjales (Doctora en Pedagogía y profesora en la UNED) y la Dra. Ana Miranda (Universidad de Valencia); por último, el Dr. Joaquín Fuentes es un psiquiatra infantil que trabaja en la Policlínica Gipuzkoa; su investigación está centrada en el TDAH infantil y el autismo.

9. ?Suelo escuchar muchas noticias  sobre la situación económica en España. Pienso, sobre todo, en las personas que lo pasan peor y me pregunto si ocurre lo mismo que aquí: aquellas personas con un TDAH no tratado tienen más dificultades para obtener un título universitario o para conseguir trabajo y, cuando lo consiguen, están peor pagados. ¿Cree que las personas con TDAH en España lo están pasando peor en esta crisis que las demás?

Sin duda. El fracaso escolar está asociado, en muchísimos casos, a un TDAH no diagnosticado. Problemas laborales, sociales, conyugales y familiares afectan con mayor frecuencia e intensidad a personas con el trastorno.

Los problemas económicos hacen a estas personas aún más vulnerables. Las medidas de protección, adaptación e integración han sufrido recortes dramáticos, dejando fuera del sistema de bienestar a miles de personas. Los más débiles, como siempre, son los más incomprendidos y perjudicados. Sumemos a esto el escepticismo que aún flota acerca del TDAH y podemos imaginar lo complicado de su situación

10. Nos conocimos cuando Ud. quiso traducir un artículo de otro de mis blogs, YouMeADD para incluirlo en su blog, ¿cierto?

Antes de conocer su libro, tuve contacto con su blog. Lo que más me gustó es la combinación del rigor y ortodoxia de quien conoce el TDAH en profundidad con el estilo ágil, ameno y adictivo del periodismo americano (que para un europeo, es como decir dos veces periodismo).

Cuando tuve ocasión de leer su libro, no fue ninguna sorpresa la facilidad y rapidez con que lo leí, lo útiles que me parecieron las historias que se recogen y el conocimiento con el que se tratan. Más allá de ser un “manual de autoayuda”, lo que proporciona son bases de conocimiento para saber cómo afrontar el problema y buscar la ayuda de un profesional.

Espero sinceramente que pronto sea posible disponer de la versión española del texto. Estoy segura de que muchas personas lo agradecerán.

Gracias, Dr. Díaz De Guereñu!

For more information, visit the website of Dr. Elena Díaz De Guereñu

Bookmark and Share

Tags:

  1. Lara’s avatar

    Thank you for this really interesting article/interview !

    Reply

  2. Lucy’s avatar

    Bravo!! We need professionals like her in Mexico!!

    Reply

    1. Gina Pera’s avatar

      Hi Lucy,
      The 9th annual conference on ADHD in Mexico City will take place the first week in October. I will be joining other ADHD experts in offering presentations. Maybe you can join us!

      http://www.proyectodah.org.mx/

    2. ClearView Coach’s avatar

      It’s great to read about progress in other countries! Have you found a growing number of coaches to work with adults as we have here in the U.S.? Thank you for sharing your experiences with ADHD diagnosis and treatment in Spain Gracias, Dr. Díaz De Guereñu.

      Sincerely,
      Mark Julian

      Reply

      1. Gina Pera’s avatar

        Hi Mark,

        I met some ADHD coaches in Turkey, on my recent visit there. And I know there are ADHD coaches throughout Europe. My friend Charlotte Hjorth is in Denmark: http://www.linkedin.com/in/adhdkompagniet

      2. Sophie’s avatar

        Hi, thank you for posting this on your blog. I am British 30+ and have been on ADD medication for most of my adult life (and yes I have tried all the alternatives, no one in there right mind would take these drugs without having to.) I moved to France 7 years ago and it has been a complete and utter nightmare getting medication here as an adult. I am currently on Dextragine and each month have to make (with the aid of my doctor) a special request to the head of health in Paris and some months it gets approved and some it does not. this makes for a very stressful life when you are trying to hold down and job. I am thinking of moving to Barcelona, Spain as I have heard it might be easier there. Do you you this is true?

        I know that some people find training helpful but I would suggest they are the people that have very mild cases of ADHD and have chosen jobs that fit in around ADHD

        Reply

        1. Gina Pera’s avatar

          Hi Sophie,

          Wow, you are able to get stimulant medication in France? I thought it was impossible. Instead, I’ve heard that people with ADHD, like everyone else, get the ever-so-helpful psychoanalysis.

          It drives me batty when ADHD skeptics use countries such as France as proof that ADHD is a American invention perpetrated by Big Pharma.

          I don’t know if it’s easier in Barcelona. Probably anyplace is easier than France, though.

          Here is the website for ADHD Europe; it might contain some helpful information or contacts:

          http://www.adhdeurope.eu/calendar.html

          You could also contact my friend, Dr. Elena Díaz de Guereñu. She’s more in the Basque region, but she might be able to tell you about Barcelona and environs.

          http://tdahvitoriagasteiz.com/2014/03/23/tdah-cuando-es-tu-hijo-el-acosador/

          Bonne Chance!

          Gina

        2. Sophie’s avatar

          HI Gina,
          Yes I am on dextroamphetamine but the prescription is totally unreliable and i have to visit the hospital and specialist three times a month (hard when you are trying to hold down a responsible job, to be popping out to the hospital all the time.)and special permission is sent from Paris (I live in the South) comes from the health board. One month I have it and the next I don’t. I also have to get my heart tested every three months. Ritalin and Concerta are easier to get but you can still only get 28 days worth and you are treated like a drug addict. It seems to be at the wim of the chemists in Paris. I am actually thinking of moving out of France because it is such a nightmare. I only am able to get my medication because I was on it in the UK before I moved to France. I would not recommend moving to France if you have ADHD or ADD and need medication. Sad but very true.

          Thank you for the links. that is truly a great help.

          Reply

          1. Gina Pera’s avatar

            That is just beyond the pale, Sophie.

            I guess Gauloise and espresso are the self-medications of choice then.

            g

Reply

Your email address will not be published. Required fields are marked *

You may use these HTML tags and attributes: <a href="" title=""> <abbr title=""> <acronym title=""> <b> <blockquote cite=""> <cite> <code> <del datetime=""> <em> <i> <q cite=""> <strike> <strong>