Attention problems, hyperactivity and impulsivity are the main symptoms of ADHD that 6.8 per cent of Spanish children experience, according to studies by Pediatría Integral.

Some other secondary symptoms also stand out, directly impacting school and work performance, daily activities and social relationships. The Andalusian regional government (Junta) says that non-primary symptoms affect 63 per cent of people with ADHD. For this reason, it stresses the importance of early detection and coordinated intervention in all cases.

On 13 July, International ADHD Awareness Day, the Junta outlined its ADHD care protocol. "A disorder with no clear etiology and multiple contributing factors (neurological, genetic, psychological and social) that represents a risk factor and causes psychosocial maladjustment in childhood, adolescence and adulthood," the protocol says.

The first step is detecting symptoms within the education system. This includes impaired development of learning or language skills, emotional stability or difficulty coping with frustration. The presence of these factors at ages when they are not expected is what, according to the protocol, should first alert the child's tutor.

The next step is to confirm these symptoms. This involves a meeting with the educational team, including at least one member of the school's guidance team, to share the identified evidence of ADHD, discuss the next steps and establish a plan for evaluating these measures over time.

Once the family have been informed of the decisions and their role in the student's educational development, a minimum of three months will be given to analyse the measures. If the student's symptoms persist or the plan appears ineffective, the tutor may request a psychoeducational assessment, which will not be considered a clinical diagnosis.

A meeting with the same requirements as the first will be necessary beforehand to gather the information needed to request the assessment and obtain a positive evaluation from the guidance team.

If this approval is not obtained, the guidance counsellor must submit a report justifying the decision and proposing new measures. This three-month period may be shorter if there is evidence that the student's situation has worsened.

The final step in the protocol involves the psychoeducational assessment. This is a comprehensive, contextualised, interactive and participatory analysis of the child's entire environment. If symptoms are present, the assessment will serve as the basis for determining the child's appropriate schooling at their educational stage.

If the assessment does not detect ADHD, the report's findings will still be provided, along with guidance for the family and teachers on how to address the child's difficulties.

Meanwhile, the family can request a clinical diagnosis from primary care at any time. This consists of an interview with the family, a general assessment and any other tests deemed necessary.

According to the regional government, the goal of any ADHD treatment process is to reduce symptoms and psychosocial risks, educate the child and their family and adapt the environment to the child's needs.

The severity of the condition can worsen due to factors such as misdiagnosis or delayed diagnosis, the presence of other disorders, poor acceptance of ADHD by the child's family, incorrect medication, a conflictive environment and even the child's family's educational and socioeconomic level.

The role of the family, the Juna says, is key due to its influence on young people. "The manifestations [of ADHD] in children, their friction with external rules and obligations, can create feelings of guilt and stress in parents, generally adding to the external pressure (...) that they share with their peers, who don't quite understand the reasons behind the behaviours they exhibit," the action protocol concludes.

Although ADHD can be classified as "mild" or "moderate" due to its impact on the child and their environment, it is considered "severe" when there is not sufficient support. This occurs when support measures fail and the child's needs are neglected.

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