It is important to distinguish between the hyperactive “everything” (because it has a neurobiological problem) and the hyperactive “what there is” (because otherwise it has a hyperactive attitude). Hyperactivity is a behavioural disorder, which must be detected by analyzing the behavioural patterns of the child, and there have been a multiplication of under-evaluated and over-diagnosed cases (neurobiological problems are present in between 2 and 3% of the population, but many more children diagnosed). The topic is discussed in the report The negative consequences of the wrong diagnoses (nº 2255) and we bring it back to these pages, as the coordinator of Research in Pharmacotherapy of Navarra, Luis Carlos Saiz, has published relevant data in the Pharmacotherapeutic newsletter of the Foral Community.

First, Saiz referred to surveys and studies among pediatricians and child psychiatrists, according to which the evaluation of symptoms is often based on the interpretation of parents and teachers, and what for them is an “abnormal” conduct (lack of objective references, the factors to measure are not clear either), and even when a high percentage of the criteria is not met, the disorder tends to be diagnosed.

Influence of short- and long-term pills

Once the diagnosis has been made, the solution is usually the pharmacological response. In Navarra, between 2000 and 2012, the consumption of methylphenidate and atomoxetine has increased 30 times among children. What is the particular use of methylphenidate sold under the brand Ritalin? In the short term, it has been shown that the child hinders others' conversations less, serves to maintain and concentrate attention and reduces the child's ability to move. “This new socially more acceptable behavior,” Saiz warned, is related to the decrease in emotional expressions, the decrease in curiosity and cognitive flexibility, the decrease in the ability to surprise and ask, the loss of initiative and spontaneity, and the promotion of neutral humor and passive attitude.” And in the long term, does methylphenidate get the child to progress academically, socially and with family?
The MTA study is the most detailed example so far conducted by Saiz (579 children aged 7 to 10 years). The children were divided into four groups: some took medicine, others followed psychosocial treatment, the third the combined treatment and the fourth the conventional therapy. Afterwards, variables such as aggressiveness, social skills, anxiety, depression, relationship with parents, academic activity were measured... At 14 months, the score of all the variables improved in the four groups and the differences between them were small. Eight years later, the results of all the teams were the same. That is, children did not get better results from medication intake, while Saiz has stressed that drugs can have adverse effects on the cardiovascular, psychiatric or endocrine system and can lead to addiction.

How to cover the problem of the social model

Who and how does the concept of disease define? To what extent do we use psychoactive drugs to facilitate social control of what is culturally approved? Is it more convenient for us to focus on the person than on problems with more complex dysfunctions in the family, in the educational system or in society? Luis Carlos Saiz puts the debate on the table and suggests that the dynamics of the current social model does not help to achieve the level of reflection, intellectual development and emotional maturity we ask of the child. “In this context, parents and teachers are often overwhelmed by complex behaviors, due to lack of time, lack of concrete skills, lack of capacity, lack of determination of authority, competitive pressure… And once we have labeled the child as ill, free from the responsibility one can have, the drug is a comfortable option, with short-term results and more economical than other alternatives. The medication strengthens and perhaps remakes the child's identity. There is no doubt that penalties, expulsions and family conflicts will be avoided, but the satisfaction is that the autonomy and capabilities of the child and the child are subject to the pill.”

The conclusion is clear for the professional: to perform more elaborate and deep evaluations, to approach them from a broader perspective with the involvement of the child, his/her relatives and the educational community, and that the pharmacological option is the last resort.