ebook_ADHD2019_engl.

The World Federation of ADHD Guide 121 At the same time, although it is yet controversial if ADHD treatment with me- dication can really decrease the risk of future substance abuse or dependence 25 as no longitudinal data suggests that people with ADHD treated with medication have a higher risk than ADHD people not treated with medication to develop substance use problems. On the other side, although we now have substantial evidence that treatment with medication might bring acute benefits including in outcomes that really mat- ter for people like decrease of accidents, higher academic test scores, lower rates of pregnancy and sexual transmitted disorders in adolescence and even mortality, clear long-run benefits of treating ADHD with pharmacological and non-pharma- cological interventions yet need to be fully demonstrated. 26 HOWTO EXPLAIN ADHD TO FAMILIES? Based on everything discussed up to now, we offer one model, among several others available in the literature, to introduce ADHD to families. After the assessment process, considering that we have enough evidence from both the described profile of symptoms and the medical, developmental and fa- mily history of the child/adult patient for a diagnosis of ADHD, we need to discuss ADHD with the patient and/or his/her family. Our starting point is to ask the patient and/or parents/family to describe what they understand as ADHD. This is an important stage since it allows us to recogni- ze and discuss some of the above-described misunderstandings about the disorder since they are part of the patient/family culture and values. We normally begin stating that there is no biological marker for ADHD, as there is no one for any mental disorders. Thus, the diagnosis relies on the clinical assessment. Second, we describe ADHD as a dimensional disorder making ana- logies with medical conditions like hypertension, diabetes and hypercholesterole- mia. This initial approach is relevant for informing the patient why sophisticated neuroimaging or even simple electroencephalogram (EEG) would not be needed in the diagnostic process and to connect ADHD to medical conditions. At this stage, we review with the patient the data from symptoms reported in the clinical interview or in scales collected with the patient/family/school, as well as data from the medical, developmental and family history that corroborates our clinical hypothesis of ADHD. We move then to characterize what constitutes ADHD. We state that ADHD is a disorder of the development of the brain caused by the interplay of our ge- nes with environmental factors. Analogies with medical conditions like asthma or gastritis might help here. Individuals who have a propensity in their genes for asthma when facing modifications in the weather or increase in allergens in the environment might have asthmatic attacks. This approach helps families to un-