Dr. Elena Díaz De Guereñu, ADHD specialist in Northern SpainI receive many e-mails from folks eager to find information on Adult ADHD in Spanish—and to find experts in Spanish-speaking countries. So, I am always glad to meet professionals 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. 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.
I was curious about the state of ADHD awareness and treatment in Spain, and so I asked her to field a few questions. Her answers below, in English. (Click here for her blog’s Spanish translation of this post.)
[Update: I regret to tell you that Elena passed away in 2021. She will be missed.]
1. How and when did you come to this specialty?
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, the 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?
I graduated as a 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 skepticism 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 ADHD awareness in Spain?
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 your work?
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 ADHD awareness in Spain?
There are still some clinicians who are skeptical to recognize ADHD as a real disorder; some of them say it is just “overdiagnosed”. Fortunately, their number 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 nearly unexplored territory, as figures clearly show: only one out of 30 adults who might have ADHD actually takes medication for it.
6. Do you know the ADHD prevalence statistics there?
According to the most conservative figures (2001), the rate is 1.2%. That is 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 adults is actually taking medication. Depending on the data, this could be even one out of 80!
7. What criteria are used for the ADHD diagnosis?
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).
When it comes to 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. How many professionals 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 multimodal 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 disability treatment and behavioral 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 with ADHD and Autism.
10. We “met” via my blog, right?
Before reading your book I found your blog. What I liked most was the combination of a rigorous approach and deep knowledge on ADHD with the nimble, enjoyable and nearly addictive writing style of an American journalist (which for a European is almost redundant!)
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 the 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.
Hi we live in spain in Marbella and my grandson of 10 needs to be examined to see if he has ADHD please , we gather he has loads of symptoms.. kind regards Cheryll
Hi Cheryll,
I encourage you to self-educate first, before even beginning to seek an evaluation.
That’s true here in the U.S. and it’s true in Spain.
I cannot refer you to any professionals, but you could search for Spain-based non-profits devoted to ADHD.
They are typically familiar with the “lay of the land”.
good luck,
Gina
Hi Gina!
I’m an adult woman with ADHD who has been living in Spain now for over 2 years and have found NO HELP for my ADHD. I was prescribed Vyvanse in the states and it literally changed my life. However here in Spain, I’m told I’m just depressed and that I don’t have ADHD because I’m able to “sit through a conversation” like they’re expecting me to be jumping out of my seat like a child. It’s ridiculous. I have been struggling more than ever because I’m unable to get my Vyvanse (elvanse here) prescribed. They will only give me concerta which doesn’t work for me.
I came across this article today and I was blown away that there is a doctor here in Spain who actually recognizes and treats ADHD in adults/women. However, her website no longer exists and I can’t find her ANYWHERE on Google.
Is she still practicing? Are you still in contact with her? Please let me know! I am absolutely desperate at this point to get some help.
Hi Jennifer,
Unfortunately, Elena passed away last year. She is sorely missed.
Have you tried this group, in Sabadell?
https://tdahvalles.org/
At the ADHD Europe site (an organization for professionals and researchers), I see three contacts in Spain:
https://adhdeurope.eu/about/members/
I hope this helps.
g
Hi Jennifer,
My wife has suffered from ADD/ADHD all through her childhood and adult life. She was not diagnosed as a child in the UK and we came to live in Spain in 1992. We have lived here since then with the exception of a 3 year break in the late 1990’s when I worked in South America.
In around 2003 at the age of 38 years, my wife was finally diagnosed with ADD (without the hyperactivity part) at the Amen clinic in Fairfield, CA, USA. She was prescribed Adderall. When we returned to Spain, with 3 months supply and my wife was like a different woman. She could concentrate, focus, complete tasks and read a book from start to finish for the first time in her life. The private doctor we used at that time, wrote to the Valencian Health Authority and asked for permission to import Adderall into Spain to prescribe for my wife. The reply came back, “No, there are alternatives available. The “alternative” that they mentioned was Ritalin. In 2004 we registered with our local authority health centre and on our first visit to the doctor we were allocated, we mentioned my wife’s ADD diagnosis. To our amazement the doctor replied “Adults do not suffer from
ADD/ADHD, only children do and they grow out of it.”
Needless to say we went straight out to the reception and asked to be allocated another doctor. The doctor we were allocated was much more understanding and sympathetic, but told us he was not allowed to prescribe any ADD/ADHD medications, they had to be prescribed by a psychiatrist. We made appointments with the local health authority psychiatrist but again the the best they could prescribe was Concerta or Ritalin, neither of which was any good for my wife.
In 2015 we discovered Elvanse was available in Spain, but again the psychiatrist would not prescribe it. We had to use our private doctor and each 28 supply cost us 116 Euros. Last year my wife was hospitalised with a mental health issue. Upon discharge she was told to see the psychiatrist at our local health centre. Imagine our joy when we found that the we saw was a much more sympathetic doctor, understood about ADD and wrote out a prescription for Elvanse 50mg. He told us to wait a few days before trying to collect the prescription as the health authority had to authorise the prescription. When we finally went to collect the Elvanse, we were told by the pharmacist that they could not dispense it as permission had been refused. We then contacted the psychiatrist who gave us a private prescription but we are back to paying out 166 Euros a month. For the life of me I cannot see what the problem is with the health authority prescribing Elvanse.
Is it purely about the cost or is it ignorance and lack of understanding of Adult ADD/ADHD? My advice is, if you can afford it, find an understanding, sympathetic understanding private doctor or psychiatrist to prescribe it for you. Good luck, stay safe and take care.
Dear Roy,
I feel your frustration. So do my friends who are Spanish ADHD experts.
I can only hazard a guess as to why it’s so difficult to get an amphetamine—mainly, they have a bad reputation (and justly so, in large part), change comes slowly, and Elvanse is expensive compared to generic Ritalin.
I give a lot of credit to the Spanish non-profits that are working to create awareness.
g
Hi Jennifer ! (Or anyone else that is studying abroad, moving to Spain for a certain amount of time)
This was a couple of months ago, so I don’t know if you have figured something out yet, but this information has been a lot of help, and through this I may have found a solution for you.
You’re living in Spain so this may not be applicable to your situation, but I feel as if any information can help get you closer to what you need to find in order to get the help you need, and hopefully this can help anyone else that is currently in my situation moving to Spain for a shorter duration of time.
I am moving to Spain for a year and I currently take 40mg Vyvanse and 10mg Adderall, these are both heavily controlled as you know. I’ve found that if you still have insurance in the US, which may not be your case since you’ve been living in Spain for a while and probably have health insurance there…
But if you do have a US health insurance, you’re able to contact the pharmacy distributor that you received your medication from and discuss their overseas distribution options.
In the case of Spanish Law, it allows delivery of prescription by mail through a verified distributor (An official pharmaceutical company that is provided by your insurance) -This is the only case that you’re able to receive prescription of Schedule II drugs through mail. Family isn’t able to mail prescriptions because it’ll most likely be confiscated by customs and you could possibly get arrested or receive a hefty fine.
There’s a process to go through, but anyone who is studying or living outside of the US needs to call their insurance and verify that they will be covered for their medication out of the country, which is fine as long as it is being paid in the US, and then get the phone number for the pharmacy distribution company, let them know that you will be outside of the US for an extended period of time and need a plan to receive medication abroad through the mail and if there is a plan so you can get it delivered.
In this case, I found I’m able to get a supply of over 180 in the mail through their process.
Sorry if this was hard to follow, lmao I’m ADHD and did my best. Not the best at explaining things.
Let me know if you have any questions !
I’m sorry if this wasn’t helpful to anyone struggling to obtain their medication while already living in Spain, but this is the only loophole that i’ve found.
Dear Christina,
Thank you SO MUCH for taking the time to detail that strategy. It’s new to me, and i know it will be valuable to others.
best,
Gina
Hi Gina,
I am a clinical psychologist specializing in Adult ADHD in Barcelona. What I have found is that medication and psychological support here are hit and miss. Misinformation is rampant and many Spanish healthcare providers are both afraid to prescribe stimulant medication and unaware of the value of education and psychological support. The good news? Things are changing.
Thank you, Gina, for raising awareness and helping to accelerate this change!
Sincerely,
Dr. Teresa Newman
https://es.linkedin.com/in/tnewman1
Hi Teresa,
I’m glad to know of another ADHD professional in Spain. Thank you for serving that community. I’m sure you must run into plenty of opposition from colleagues.
best,
g
Hi Dr Newman
Your last post was 2015; so i’m not sure if i will get a reply.
However, we live in Spain and would like our 15 year old son evaluated for ADHD; I cant find anywhere in Orihuela costa who specialises in ADHD, so was wondering if you have any advice or still practice in Barcelona?
Kind regards
Sian
Hi Sian,
You might want to try contacting Dr. Newman more directly. Try a Google search?
Also, there are a few Spanish charities devoted to ADHD. You might want to try contacting those.
good luck,
Gina
Hi, I am writing to you regarding a friend who lives in Sitges. He is English and does not speak Spanish. He has not left his flat in three months and has not been looking after himself or his flat. He lives alone and is becoming unable to work (remote software developer ) and therefore falling into debt – I believe he has ADHD as he finds it so hard to complete small everyday chores or maintain any kind of feeding and sleeping routine but is such a talented programmer. Please can you advise if anyone or any group who could visit him in Sitges and assist him in getting a diagnosis and medication .
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.
That is just beyond the pale, Sophie.
I guess Gauloise and espresso are the self-medications of choice then.
g
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
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
Dear Sophie, if you think France is a nightmare for ADD/ADHD treatment, forget Spain, it is an even bigger nightmare.
We live in Spain, have done since 1998. In 2004, my wife, at the age of 39 visited the Amen clinic in Fairfield, California. She was diagnosed with Adult ADD, an illness she has had since a child, which was suspected by her Aunt who is in medical research. She was given 2 months supply of Adderall XR 30mg and returned to Spain.
The change in my wife was unbelievable and for the first time in her life she read a book cover to cover. We promptly discovered Adderall was not available in Spain. Through our doctor we tried to get permission to import it, but it was denied, we were told there were “alternatives” available, ie, Ritalin (Rubifen in Spain).
Her miserable existence continued for the next 5 years, when we again visited the Amen Clinic, where this time we came away with 3 months supply of Adderall. Any amphetamine medication is not allowed in Spain. Treatment for Adult ADD/ADHD (TDAH in Spain) is none existent, at least in the Alicante region. It is only recognized, and then only fairly recently, in children and adolescents.
In fact one Dr(?) at our local heath centre told us that there was no such thing as Adult ADHD, you grow out of it he said, we immediately changed doctors. My wife is now 50 and is still in exactly the same boat.
Anybody who says ADD/ADHD does not exist in Adults should try living with a sufferer of this terrible illness for a month, that would soon change their mind. We have been married 24 years. Thankfully our daughter does not have it, but it is common for it to “skip” a generation.
Both my wife’s father and mother have it, although none of her three sisters do. However, two of her sisters have a child each with it. I wish I knew the answer, but I doubt you will see it in Europe and definitely not in my lifetime, I am 68.
Hi Roy,
I know several excellent ADHD specialists in Spain, but it’s a big country and such specialists are rare.
But I have a question: Why didn’t your wife try Ritalin? It might have worked just as well, if not better, than Adderall.
Did she actually try it, to no avail, and you just didn’t mention it?
Gina
She has been on Rubifen (Ritalin) since returning from the Amen Clinic in 2004. In addition she has tried both Concerta and more recently Medikinet, both slow/sustained release Methylfenidate. All prescribed privately. Nothing has compared to Adderall XR. We are at our wits end about the lack of understanding and help there is for Adult ADD/ADHD available from the Spanish Health Service in particular and Europe in general. If people understood the “hidden costs” of untreated ADD/ADHD, perhaps things would change, however I doubt it.
Hi Roy,
I’m really sorry to hear this. It’s unconscionable, to deprive people of better access to their own brain.
It’s true that for about 40 percent of people with ADHD, they respond better to amphetamine (Adderall, Vyvanse, etc.) or methylphenidate (Ritalin, Rubifen, etc.).
I assume you have been in touch with the Spanish advocacy organizations, such as this one: http://www.feaadah.org/es/
It might be that “Big Pharma” will be the only factor to break the logjam.
I wish you both all the best.
g
Thanks Gina, but I don’t hold out much hope that anything will change any time soon. It’s like trying to fight with your hands tied behind your back. Very frustrating. I will check out the link.
I can only imagine, Roy. Especially after the economic meltdown. But one thing we can count on is change. 😉
g
As usual, the link only refers to ADHD in children and adolescents, not reference to Adult ADD/ADHD, as far as I can see.
Yes, but sometimes you have to make a personal contact. g
We have recently been given, by a Dutch psychiatrist, the name of a Spanish psychiatrist, working for the Spanish Health Service at Villajoyosa Hospital, near Benidorm. We intend to follow it up.
Good luck!
Thanks Gina, I will keep you posted.
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
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
Bravo!! We need professionals like her in Mexico!!
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/
Thank you for this really interesting article/interview !
Pingback: “¿TDAH adulto en España? ¡Sí!” Gina Pera entrevista a la Dra. Elena Díaz de Guereñu | Dra. Elena Díaz de Guereñu