
Algunas formas leves de Trastorno por Déficit de Atención e Hiperactividad se pueden controlar a veces con tratamiento no farmacológico. Sin embargo, los expertos indican que el tratamiento más eficaz para el TDAH es la intervención multimodal, es decir, la combinación de tratamiento farmacológico, intervención psicológica, intervención familiar e intervención escolar. El uso de la medicación es por tanto un pilar más del tratamiento para el TDAH.
Los niños con TDAH tienen un desequilibrio químico de los neurotransmisores Dopamina y Noradrenalina (sustancias químicas del cerebro), lo que ocasiona desajustes en el funcionamiento cerebral. Principalmente, se ve afectado el lóbulo frontal y las áreas prefrontales, afectando a las funciones ejecutivas, lo que provoca alteraciones en la atención, en el control de impulsos, la inhibición de respuestas y la toma de decisión (Soutullo y Díez, 2007.)
Existen varios tipos de mediaciones disponibles en la actualidad que ayudan a los niños/as con TDAH. Se trata principalmente de los medicamentos estimulantes como el Metilfenidato (en otros países, existen otros medicamentos como Pemolide y la Dextroanfetamina) y los no estimulantes, como la Atomoxetina y el grupo de los antidepresivos tricíclicos. Los fármacos estimulantes aumentan los niveles de dopamina en el cerebro y la Atomoxetina aumenta los niveles de noradrenalina.
Es necesario conocer que la medicación es segura y que los efectos secundarios son pocos y no son graves. Dichos fármacos son prescritos de acuerdo con el criterio del médico y con la aprobación de los padres y de acuerdo a las circunstancias y características de cada caso, realizando siempre un estudio médico previo a la administración de los fármacos.
Fármacos psicoestimulantes
Los medicamentos estimulantes están entre los psicofármacos más seguros y eficaces que tenemos disponibles y con una larga historia de uso en población infantil.
Dentro de los fármacos estimulantes, el Metilfenidato (MPH) es el tratamiento farmacológico de elección para el TDAH (Castells et al., 2004). El metilfenidato es un estimulante que mejora tanto la hiperactividad como la inatención en niños con TDAH. Más de 60 años de experiencia con esta medicación, y más de 150 estudios en diversos países confirman que es eficaz y segura en el tratamiento del trastorno por hiperactividad.
Fármacos no estimulantes
La Atomoxetina es el medicamento no derivado anfetamínico de primera elección en pacientes con TDAH en España. Su efecto positivo dura todo el día y puede administrarse en una sola toma por la mañana. Entre los beneficios que presenta frente a los tratamientos psicoestimulantes es que no tiene potencial de abuso, puede mejorar la ansiedad y no empeora los tics, así como que su efecto se mantiene constante entre las tomas, lo cual no supone un descenso del principio al olvido de una toma como en el caso de los estimulantes.
A pesar de ser la Atomoxetina un medicamento reciente, está muy bien estudiado, y lleva varios años siendo utilizado en muchos países (EE.UU., Gran Bretaña, Alemania, Canadá, Australia?).

Eficacia del uso de fármacos para el TDAH
El Metilfenidato y la Atomoxetina son los fármacos recomendados en la actualidad para tratar el TDAH en niños y adolescentes por su eficacia y seguridad a las dosis recomendadas (NICE, 2009).
El "Estudio de Tratamiento Multimodal de niños/as con TDAH" (MTA) publicado por el instituto Nacional de Salud mental de EE.UU, mostró que un tratamiento farmacológico adecuado y estandarizado reduce de una forma significativamente mayor la sintomatología nuclear, que un tratamiento psicoterapéutico o la intervención psicosocial. Sin embargo, la combinación de una terapia farmacológica y de intervención psicológica, obtuvo mejores resultados que aquellos niños que sólo fueron tratados con farmacoterapia. Los resultados positivos no sólo se reflejaron en una mejora de la sintomatología sino que también se obtuvo una mejoría significativa en aspectos relacionados como el trastorno como mejora de la autoestima, la conducta social, los trastornos asociados (ansiedad, oposicionista desafiante, comportamiento?) y el rendimiento académico (Soutullo y Díez, 2007). Por tanto, el uso combinado de fármacos y terapia se muestra como la alternativa terapéutica más eficaz para le TDAH.
Supervisión y seguimiento del tratamiento farmacológico
El tratamiento farmacológico debe iniciarlo y continuar su seguimiento un médico adecuadamente cualificado y experto en el tratamiento del TDAH y sus comorbilidades más frecuentes.
El neurólogo pediatra encargado de la medicación deben llevar seguimientos y revisiones periódicas de talla, efectos de la medicación y evaluación del funcionamiento global del niño.
Aunque el metilfenidato suele tolerarse bien, al ser un fármaco estimulante, a veces puede producir algunos efectos secundarios comunes como la disminución del apetito o del sueño, fácilmente reversibles reajustando las dosis. En el caso de la falta de apetito o la alteración en los ritmos de las comidas, especialmente cuando nos encontramos con el caso de que el niño o niña presenta tallas mínimas o por debajo de los índices de normalidad, es necesario revisar el tipo y la dosis de medicación y aplicar medidas específicas como un estudio del estilo de alimentación, uso de complementos vitamínicos, adaptaciones nutricionales, etc.
Supervisión del tratamiento farmacológico en el colegio
Si un alumno está medicado y los profesores del niño/a lo conocen, éstos pueden colaborar observando y registrando si aparecen mejoras o no en el rendimiento académico, en el comportamiento y en las relaciones con sus compañeros. Su información puede ser de gran utilidad para los padres y médico que trata este/a alumno/a a la hora de valorar la efectividad del tratamiento farmacológico o bien la necesidad de ajustar la dosis.
También, desde el centro escolar pueden colaborar en la observación de posibles efectos secundarios tales como, irritabilidad, dolor de cabeza, náuseas, disminución del apetito, etc., y trasladar la información a los padres.
Es importante que cuando el alumno muestre resultados positivos tras la administración del fármaco, el profesor refuerce su buena conducta o buen rendimiento y no lo atribuya al fármaco; como lo haría con frases tipo "se nota que hoy te has acordado de tomar la pastilla" o "que bien trabajas cuando tomas la pastilla".
A veces los niños salen adelante sin medicación, pero quizás tienen demasiados apoyos que les hacen perder autonomía. Esto puede generar estrés en la familia; ya que los esfuerzos a lo que se ven sometidos son demasiados. Además, en el colegio se corre el riesgo de que los demás niños les etiqueten como el "niño diferente".
Es importante destacar que son muchos los niños que se benefician de estos tratamientos farmacológicos y que es necesario en un 80% de los casos, pero siempre combinados con otras intervenciones tanto psico-educativas como socio-familiares, para mejorar la autonomía del niño, su déficit de atención, hiperactividad e impulsividad.






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