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. 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.)
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.]
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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.