TDAH Spanish guidelines 2017
As part of a national focus on recommendations based on systematic review of the evidence and evaluation of the risks and benefits of different treatments, the Spanish Clinical Practice Guideline on Therapeutic Interventions in ADHD was released in 2017. The guideline focuses on the management of ADHD, outlining psychoeducational, psychological and pharmacological options and forming recommendations to aid with decision-making and promote a multidisciplinary approach.
This guideline was developed by healthcare professionals from a number of different specialities and societies involved in the care of patients with ADHD. This summary provides an overview of the recommendations made in the Spanish Clinical Practice Guideline on Therapeutic Interventions in ADHD, but it is not exhaustive of all recommendations and should not be used for the diagnosis or treatment of patients. Healthcare professionals should consult the full Spanish Clinical Practice Guideline, which is available online. Key recommendations for treatment include:
Children and adolescents
Psychoeducational and behavioural training programmes for parents should be offered first line when a child aged 3–12 years is diagnosed with ADHD. These programmes should be offered by trained professionals, be structured, include sufficient sessions, incorporate tasks at home, include strategies to improve child/parent relationships and allow parents to identify their own objectives. Educational interventions should also be included as part of treatment programmes for children and adolescents with ADHD. During primary education, the child’s teachers should receive training in behaviour-modification techniques, e.g. cognitive behavioural therapy and physical activity programmes, and parents should receive training on homework and home routines. Social functioning and autonomy skills training should be provided to the child with ADHD. During secondary education, non-pharmacological interventions can help parents to promote the academic responsibility of their child at home and at school, focusing on organisational skills, time management, homework and studying. Communication between parents and teachers is key, as is collaboration between parents and children to correct behavioural problems. Making a record of successes and failures, and rewarding of effort and progress, should also be implemented.
Cognitive behavioural programmes can be used to facilitate and maintain the incorporation of individuals with ADHD in the labour market. These programmes may include psychoeducation around the biopsychosocial nature of ADHD and skills training designed to improve functioning and adaptation at work. Organisational skills programmes can also be provided, including instruction on tools and routines to record tasks and deadlines, strategies for organising work to be completed at home, the use of checklists for the materials required for a job and how to divide tasks into steps.
The Spanish guidelines provide a comprehensive description of the evidence underlying the recommendations for pharmacological treatment in children and adolescents (Figure 1) and adults (Figure 2) with ADHD.
Figure 1: Summary of evidence for the recommendations in children and adolescents with ADHD
Figure 2: Summary of evidence for the recommendations in adults with ADHD
Children and adolescents
Pharmacological therapy for the treatment of ADHD is not recommended for children aged <6 years. In children and adolescents aged ≥6 years, pharmacological therapy is recommended when psychoeducational and/or psychological therapies have not been effective, or when the patient is severely affected by their symptoms of ADHD. The guideline states that methylphenidate, lisdexamfetamine, guanfacine and atomoxetine are licensed for the treatment of ADHD in children and adolescents in Spain.
Pharmacological therapy for the treatment of ADHD is recommended as a first-line treatment of ADHD in adults with moderate to severe symptoms. In adults with more mild symptoms of ADHD, a choice can be made between non-pharmacological and pharmacological treatments. The only medication licenced in Spain for the treatment of ADHD in adults is atomoxetine, although osmotic-controlled release methylphenidate and lisdexamfetamine can be continued into adulthood in patients established on these treatments during childhood and with a continuing need for pharmacological treatment in adulthood.
The 2017 Spanish guideline for ADHD discusses the non-pharmacological and pharmacological interventions available for the treatment of children, adolescents and adults. The guideline emphasises how to incorporate these interventions into the everyday environment of the individual. The recommendations in the guideline are based on a systematic review of the literature combined with the expert opinion of healthcare professionals with experience in the treatment of individuals with ADHD.
Guías de Práctica Clínica en el SNS. Grupo de trabajo de la Guía de Práctica Clínica sobre las Intervenciones Terapéuticas en el Trastorno por Déficit de Atención con Hiperactividad (TDAH). 2017.