Disorders affecting school performance are underdiagnosed: only 10% are detected in public schools and 30% in concerted schools.

Neurodevelopmental disorders that affect academic performance – ADHD (attention deficit), dyslexia, dyscalculia, dysgraphia or communication difficulties – are underdiagnosed in the educational system: only the 10% of cases in public schools and 30% in the concerted and private. For the first time, a study in Spain, carried out by the psychiatry service of the Vall d’Hebron and Sant Joan de Déu hospitals (Barcelona), has followed up during 10 years to almost 7. students between five and 17 years in 28 educational centers in Catalonia to detect and offer treatment to affected minors. According to the sample, the 18, 3% of students present some type of disorder ―according to the international classification of the American Psychiatric Association, the prevalence in childhood is between 15% and the 20% -. Of these, 66% had not been diagnosed before the study began.

What is the origin of this lack of detection? Miquel Casas, former head of the Vall d’Hebron psychiatry service and co-author of the study The psychobiological factors that influence school failure, considers that it is due to the lack of resources in the educational centers themselves and in the primary care services of the health centers, in which the only neurodevelopmental disorder that is treated is ADHD (Attention Deficit Hyperactivity Disorder), for which medication is often prescribed . “It is very common to attribute school dropout to the socioeconomic profile of the families, but we have verified that these alterations are not being diagnosed, which, in addition, affect the social relationships that these children maintain, their emotional state, and their mental health in the adult life and even loss of employment ”, explains Casas.

To make a diagnosis, the process usually lasts between four and six hours. The team of psychiatrists and psychologists of this program distributed these hours over three days and assessed the students also in the classroom, at recess, and analyzed the interactions with other classmates and with their families. “These disorders multiply by five the probability of not being competent in subjects such as mathematics, Spanish and Catalan or English,” says Rosa Bosch, coordinator of the study and psychologist at Sant Joan de Déu. To ensure that these alterations have less impact, it is important, says Bosch, that they are detected and treated before the 12 years. Early intervention has shown improvements in academic performance, behavior and social interaction.

“The smaller the child, the more plastic the brain is, and the easier it is to introduce changes. One of the most serious problems of detecting it already in adolescence is that self-esteem or anxiety problems are added to the original disorder, “he adds. The fact that this student has internalized messages such as that “it is not useful for studying”, or that he is “lazy” or “does not make an effort” end up damaging the image he has of himself. “A case that is repeated is that of the student who has been told by different teachers for years that he does not comply … when he reaches the 14 or 15 years begins to miss high school ”, he says.

Although in the last decade in countries like the United States it has been questioned whether there is an overdiagnosis of ADHD among children under 20 years , Dr. Casas assures that in Spain until now it was a hypothesis that has not been demonstrated with data. “Our study has analyzed a significant volume of schoolchildren and for the first time it has been found that the opposite happens: underdiagnosis is obvious.”

Clase de un colegio de Barcelona en septiembre de 2020.
Class at a school in Barcelona in September 2020. Baptist consolation

Private therapy

Yolanda Rodríguez, from 40 years old, has three daughters and the median, who is now 17 years old, he entered the program at nine. “At school they told me that I was a lazy girl, that she didn’t want to do anything and that she had bad behavior. Look, I moved so that they looked at her and nobody detected anything officially, ”says the mother, who is a school monitor. It was the Vall d’Hebron specialists who diagnosed him with ADHD and dyslexia. “Since I was little I realized that her short-term memory was difficult, for example she forgot that I had sent her for a glass of water, and then she was very impulsive, a car trip with her without medication was too hectic for the whole family”. Cristina, his daughter, has been taking medication since she was nine. They see her at the health center once a month and offer her a consultation with a psychologist once every two months. “It is insufficient. We pay some 250 euros per month for four therapy sessions that are very good for socializing, and others 100 euros to a private teacher who helps her with study techniques ”. Now she is studying a FP in dependency care technician.

“The psychopedagogue at her school, a public, saw her twice and told us that she might have dyslexia, at that time and in the absence of We went to private treatment ”, he says. Another of the study’s conclusions is that within the 6% of the children who were officially diagnosed before participating in the research, the majority were men with visible behavior problems and students from the concerted and private schools. In the course 2019 – 2020, the 67, 1% of the 8.2 million non-teaching students university students were enrolled in public centers, the 25, 5% in the concerted one and 7.4% in the private one.

“In the girls it goes more unnoticed”, explains Rosa Bosch. According to the information that Bosch and his team collected, the psycho-pedagogical counseling teams that the centers have do not have enough staff to attend to all cases and are dedicated to the most serious ones. “In primary school they go to school once a week to make evaluations and follow-up, and the expert in therapeutic pedagogy and the speech therapist who are there cannot attend to all of them”, ditch.

Bosch believes that at Final treatment depends on the socioeconomic level of the families. “It’s like orthodontics, without money you won’t be able to do it.” The Pins del Vallès school, in Sant Cugat del Vallés, with almost 500 students, is one of those that has participated in the draft. Its director, Marta Aliart, confirms this: “The therapeutic team focuses on the most obvious cases and in the private sector the prices are high, the test costs a few 300 euros ”. Aliart says that in first grade suspicions can already appear when a child is easily distracted or shows more disruptive behavior than usual. “Communication between the specialist and the teachers is very important, since they give them guidelines to work differently.”

At the Proyecto 3 neuropsychology center, in Madrid, the 90% of the children who attend are enrolled in the concerted or private. Nerea González, the coordinator and one of the neuropsychologists, certifies that when the disorder is detected early, the results are visible in the short term. “We do exercises that seek to make neural connections work differently, they are training in capacities that allow them to maintain their attention for a longer time.” Those who arrive from secondary school tend to be more complex cases, with behavioral problems and family conflicts. “They usually require more time,” says Nerea. Behind these treatments there is a team of psychologists, occupational therapists, neuropsychologists and speech therapists.

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