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 guidelines focus on the management of attention-deficit hyperactivity disorder (ADHD), or hyperkinetic disorder (HKD), outlining psychoeducational, psychological and pharmacological options and forming recommendations to aid with decision-making and promote a multidisciplinary approach.1
These evidence-based guidelines were developed by healthcare professionals from a number of different specialities and societies involved in the care of people with ADHD.1 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 ADHD. Healthcare professionals should consult the full Spanish Clinical Practice Guideline, which is available online. Key recommendations for treatment are included below.
These guidelines are directed at healthcare professionals in Spain, some of the medications recommended may not be approved in other countries.
Children and adolescents
Psychoeducational and behavioural training programmes for parents are recommended to be offered as a first-line treatment when a child aged 3–12 years is diagnosed with ADHD. These programmes are recommended to 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 may also be included as part of treatment programmes for children and adolescents with ADHD. During primary education, the child’s teachers are recommended to receive training in behaviour-modification techniques, e.g. cognitive behavioural therapy and physical activity programmes, and parents are recommended to receive training on homework and home routines. Social functioning and autonomy skills training may 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, is recommended.1
Cognitive behavioural programmes may 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 may 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.1
The Spanish guidelines 2017 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.1
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 individual is severely affected by their symptoms of ADHD. These guidelines state that methylphenidate, lisdexamfetamine, guanfacine and atomoxetine are licensed for the treatment of ADHD in children and adolescents in Spain.1
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 may be made between non-pharmacological and pharmacological treatments. The only medication licensed in Spain for the treatment of ADHD in adults is atomoxetine, although osmotic-controlled release methylphenidate and lisdexamfetamine may be continued into adulthood in those established on these treatments during childhood and with a continuing need for pharmacological treatment in adulthood.1
Figure 1: Non-pharmacological and pharmacological management of ADHD in children and adolescents. Figure developed using information from the Spanish guidelines 2017.1
Figure 2: Non-pharmacological and pharmacological management of ADHD in adults. Figure developed using information from the Spanish guidelines 2017.1
- 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.