Children and teenagers with ADHD can have serious difficulties in their academic performance. Multi-modal treatment offers the best results. This means coordinating pharmacological, psychological and psychopedagogical treatments.

Parents and teachers are key to helping to minimise the symptoms and effects of these treatment methods on academic performance. Below, we offer some advice both for parents and schools with the aim of improving learning.

What can schools do to help a child or teenager with ADHD?

• Define the rules clearly and simply. If the child or teenager breaks the rule, speak to them in private, avoiding embarrassing them in front of their peers.
• Orders should be direct and specific.
• Use behaviour change techniques such as time-outs or positive reinforcement.
• Set goals together with the pupil.
• They should only have items on the table that they need for the work they are doing at that time. When classes change, give them time to gather and put away items that they no longer need and prepare the next items.
• Make the surroundings suitable and monitor the level of distractions in the classroom. Try to place a pupil with ADHD far away from stimuli that may distract them, such as windows or doors. Choose a place where the teacher can easily maintain visual contact.
• Assess the pupil's level in the different subjects, as their performance may vary greatly. Apply suitable adaptations on that basis.
• They work better if they are in a small group of pupils with a positive working environment.
• Adapt tasks to the characteristics of the children, simplifying instructions. It is better if instructions are short, simple and specific.
• Complement information given verbally with visual reinforcement.
• Adjust assessment methods, changing the way tests and exams are delivered and marked. Depending on the difficulties presented, they may need more time, shorter tests, space set aside for each question, capital letters or text in bold for the salient parts of the question, oral tests, etc.
• Help the pupil to control their diary and complete tasks. Use the diary as a means to praise and positively reinforce the pupil.
• Plan tasks in which pupils have to move and which foster ownership, such as going to find or put away an item in another classroom.
• Help them with self-control, for example, if they make small noises or movements while seated, agree with them some type of signal (such as touching their shoulder) that reminds them that sounds can distract other pupils.
• Try to maintain a good level of motivation in the pupil, offering frequent positive reinforcement when they improve or make an effort.
• Foster activities that increase social integration of the child with ADHD within the class, such as games, team work, etc.

What can pupils with ADHD do?

Use self-instruction strategies, which are messages that we give to ourselves internally and that allow us to modulate our behaviour. Some examples:

• I am listening and paying attention
• I am reading carefully
• I am thinking about what I have to do
• I can do it well
• I am doing the exercise carefully
• I am checking the exercise carefully
• I have done it. Very good!
• Avoid arguing about school equipment, for example by packing a school bag the night before, thus avoiding having to do it in a hurry in the morning.
• Divide tasks you find complex into simpler sub-tasks and ask for help when required.
• Prepare work and exams in advance.
• Leave your mobile, tablet or computer in another room or switch it off when you don't need it to avoid distracting stimulating.
• Sleep the right number of hours.
• Stick to timetables for eating and follow a healthy diet.
• Pick a physical activity that you like and practise it regularly.

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The kidneys benefit from a healthy diet, from a relatively high intake of water and from avoiding tobacco. Regular bowel and bladder movements are also essential. Constipation and delaying urination are both damaging to kidney function. 

Plain water without anything dissolved in it is necessary for good kidney function, apart from liquids such as milk and broth and drinks such as tea and coffee. The amount of urine a healthy person produces varies depending on how much water they drink, the air temperature, whether they are at rest or doing exercise, etc. A healthy adult would normally required 1 to 2 litres per day. Kidney function does not necessarily improve if excessive water is consumed.

Exercise and a diet rich in fibre encourage healthy bowel and bladder movements and improve kidney function. In terms of related conditions, often diabetes, good metabolic control of the diabetes is essential to preserve good kidney function. Controlling arterial pressure, which often has an unknown cause, is also vital to maintain good kidney function.

Drinking is essential to avoid dehydration

Every time the child passes diarrhoea or vomits they lose fluids, and they need to replace them orally (by drinking). To achieve this, electrolyte solutions can be used.

If the child is vomiting, they will need to drink the solution bit by bit (one teaspoon every 5 minutes). If they are not vomiting, increase the amount gradually.

When they are not vomiting, offer them small amounts of food. Never force them to eat and make sure they drink plenty of fluids between meals.

How to prepare fluid solutions to treat diarrhoea

Low sodium oral electrolyte solution

• Dissolve the contents of the sachet in 1 litre of water (it does not need to be bottled water)
• Drink at room temperature and do not drink if it has been prepared for more than 24 hours. If they need more, make up some more.

Oral rehydration salts (ORS)

• Dissolve the contents of the sachet in 250 ml of tepid water and stir until dissolved.
• It can only be taken for 24 hours. If they need more, make up some more.

Rice water

• Add a small cup of rice to a litre of boiling water. Boil for approximately half an hour.
• Take off the heat, sieve the rice and, once cooled, put the water in the fridge.
• It can only be taken for 24 hours. If they need more, make up some more.

Homemade oral rehydration solution

• Add a teaspoon of salt and two teaspoons of sugar to 250 ml of water and stir until it dissolves.
• You can add a few drops of lemon juice
• It can only be taken for 24 hours. If they need more, make up some more.

Food

The child should not be fasting. Offer them food without forcing them to eat. Infants with gastroenteritis normally lose some of their appetite. If they are breastfeeding, the number of feeds should be increased. Milk bottles should continue to be given in the normal doses, they should not be diluted.

A dry diet is not necessary, soft foods can be eaten if preferred. The foods that tend to be tolerated better are cereals (rice and wheat), potatoes, bread, lean meat, vegetables, fish, yoghurt and fruit. Avoid foods that are difficult to digest, with lots of fat and sugar.

Go to A&E

• If they vomit a lot and do not tolerate solid foods or liquids, or if they vomit despite not having eaten or drunk anything.
• If the vomit is green, bloody or looks like coffee
• If they are sleepy, excessively depressed, very thirsty, cry with no tears, pass little urine, have sunken eyes or are hard to wake up.
• If stools are very watery, abundant and frequent, meaning that the child is unable to recover the fluids lost
• If they have a high fever that does not go down with the usual antipyretics
• If they are younger than 3 months and have vomited two or more times after feeding
• If vomit is accompanied by a lot of abdominal pain and a headache

Further recommendations

To recover lost fluids, do not use homemade solutions or commercial drinks. Solutions prepared specifically for rehydration are recommended.

Do not administer medications for vomiting or diarrhoea without consulting a paediatrician.

Tips

Nowadays, Alzheimer’s disease is the most common form of dementia in older people. The families of people with this illness often have to adapt to the new situation. If you are caring for someone with Alzheimer’s, here are some tips:

• Wherever possible, maintain a routine
• Check that the patient is taking their medication correctly
• Respect their tastes and customs
• Ensure correct lighting, in the day and at night, of the space in which they live
• Physical contact may calm them down when they get anxious, but be careful to make sure they do not interpret it as a dominant gesture
• Avoid confrontation
• Distract them so that they focus on real things
• Stay calm and reassuring, help them to stay calm
• Adjust your language to the limitations caused by the illness. Be receptive to their attempts to communicate
• Do not argue with hallucinations and delusions. If they persist or are very serious, see a specialist
• If you notice any changes or discomfort in the patient, it is important to note that fever, dehydration, constipation, infections (urinary or respiratory) or the side effects of medications may be the cause.
• Hearing and sight tests are also important

This illness manifests itself in cognitive deterioration and behavioural disorders, resulting in a high degree of dependency. In the majority of cases, the family looks after the person and within the family, in 76% of cases, a woman is the main carer. If you are caring for someone with Alzheimer’s, bear in mind these tips:

• Look after your own health. A good diet, physical exercise and visits to the doctor when needed are key
• Take time for yourself. Take time to rest
• Accept help

The World Health Organization considers a day with this illness to be as debilitating as tetraparesis, and it is considered the seventh most debilitating illness, in terms of years lost, suffering and lack of productivity.

You need to learn how a brain with a migraine functions: how a migraine manifests itself, what makes you more likely to suffer attacks or why it gives you a headache. This information is essential for managing the predisposition to suffer a migraine.

What do you need to bear in mind if you suffer migraines?

To manage the illness it is useful to put together a diary featuring the days and the scales to quantify the level of disability and the impact of the migraine on the patient’s life. Using the valuable data in these records, medical personnel are able to advise the best treatment for the person affected.

A migraine diary allows:

• A correct diagnosis to be made.
• The most effective treatment methods to be found for each particular case, as each person's symptoms, triggers, daily routine, activities and age all make their migraine unique.
• Timely detections of the headache’s evolution and if it is necessary to reduce, increase or change medication.
• Headaches to be controlled, prevented, improved and alleviated.

On the website www.midolordecabeza.org you will find, alongside online diaries for you to fill in, other patients, families and doctors interested in learning about migraines and other types of headache. As well as different resources to better control and manage migraines, with tips and blogs, there is also a forum to share your experiences.

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What do you need to bear in mind if you have meningitis?

The risk of contracting meningitis increases if you come into close contact with someone who has it (if you sleep in the same room, live in the same house, kiss on the cheek, etc.), but there is no need to disinfect objects or areas because meningococcus bacteria do not live long outside of the human body.

Prevention

The measures to prevent this illness are:

• Chemoprophylaxis (antibiotic treatment)
• Vaccination

With meningitis, the appropriate measure is to administer antibiotics to the family and other people who live with the affected person.

If the illness was caused by meningococcal group B, the only preventive measure, and the most common in Spain, is chemoprophylaxis, which aims to eliminate the microorganism from the pharynx. This stops it from spreading, in the space of a few days, between the people who have taken the medication.

If the illness was caused by meningococcal group C, as well as administering chemoprophylaxis, people close to the affected person will be vaccinated if they have not already been so.

If there is evidence that someone has had intimate contact with the patient in the ten days prior to the occurrence of the disease, and they have not been administered chemoprophylaxis, healthcare staff must be informed.

What do you need to bear in mind if you take tuberculosis (TB) drugs or if you want to detect side effects early?

Currently, tuberculosis (TB) drugs are safe and effective, and the majority of people take them without any problems. In some cases side effects may appear, so it is important to follow the treatment plan under supervision and see a doctor in case of doubt.

Once treatment begins, and to make sure it has the desired result, follow the instructions below:

• Take medicine on an empty stomach (30 minutes before breakfast).
• Do not take it alongside any antacids or gastric protectors.
• If you are diabetic or have gout, tell your doctor.
• The medication may cancel out the effect of hormonal contraceptives; where required, you will need to take other measures to avoid pregnancy.
• Tell medical personnel about any other medication you may be taking.
• Even if you feel better, continue treatment for the time indicated. If for any reason you are not able to take your medication, tell medical personnel beforehand.
• The use of other medicines (cough medicine, antipyretics, natural remedies, etc.) may result in intolerances (digestive, kidney, etc.). It is important that you consult your doctor before taking any other medication.
• Do not drink alcoholic drinks during treatment.
• Use high factor sun cream when exposed to sunlight.

Warnings

Urine, faeces, sweat and tears may be red/orange in colour. This change is normal and will disappear when the treatment comes to an end.

Advise medical personnel if you have any of these symptoms

• Loss of appetite
• Nausea
• Diarrhoea
• Abdominal pain
• Gastric discomfort
• Eyes or skin become pale
• Joint pain or inflammation (knees, ankles, etc.) or significant
• skin outbreaks
• Blurred vision or changes in perception of colours

What do you need to bear in mind if you have complex glomerular disease or you are caring for someone who does?

On the one hand, the function of the kidneys is to eliminate impurities from the body through the urine, and regulate the amount of liquid and chemical elements that we need, such as sodium, potassium, phosphorus or calcium.

On the other hand, the kidneys also help in regulating blood pressure by activating vitamin D, which is required to maintain healthy bones, and producing erythropoietin, which is required to produce red blood cells in the bone marrow.

When the kidneys do not work properly, the impurities we generate and the water that the kidneys cannot eliminate accumulates in the blood and the tissues, and this causes major disruptions to the patient’s general health, fluid retention and hypertension. They are also unable to properly get rid of some medications we take, which can accumulated in the body, increasing the risk of side effects.

As the kidneys are unable to help make vitamin D, or to retain phosphorous,  the bones are weakened. The kidneys are also unable to produce erythropoietin and therefore anaemia appears.

The main types of renal replacement therapy are:

• Haemodialysis
• Peritoneal dialysis
• Kidney transplant

Where patients will not benefit from renal replacement therapy, conservative treatment will be carried out, aimed at controlling the different disorders and symptoms that appear during evolution of the illness.

The majority of cases of glomerulonephritis cannot be prevented, although a healthy lifestyle is advised, as promoted by the Spanish National Health System:

• Keep glycaemia levels (blood sugar) and blood pressure within normal range.
• Avoid toxic habits
• Do moderate physical exercise
• Avoid obesity

In addition, the application of dietary and pharmacological measures can help prevent or decrease the progression of the illness:

Dietary measures that should be taken

Maintain a balanced diet and limit:

Salt

As substitutes, the following items can be used to eliminate or reduce consumption:

• Use vegetables as seasoning: celery, garlic, leek, onion, tomato, carrot.
• Add aromatic herbs and spices: if the herb is dry, it is better to add it towards the end of cooking, as this will make the most of its flavour.
• Flavour oil.

Potassium

Part of the potassium in food can be removed by:

• Water: once peeled and cut, soak foods. The longer foods are soaked for and the smaller the pieces, the more potassium will be lost. They can also be washed several times, changing water.
• Boiling: boiling foods removes potassium, as it stays in the water. You should therefore avoid consuming cooking water. It is better to change water after 10-15 minutes of boiling foods, adding clean boiling water.
• Frozen foods: frozen vegetables and legumes have less potassium than fresh ones, although they retain many of their other properties.
• Preserved food: when food is preserved in liquid, the potassium remains in the liquid and the food contains less. This liquid should be poured away.

Proteins

Although proteins are required for repairing and creating cells and tissues, as well as for the proper functioning of the immune system:

• Dried fruits and nuts are not recommended as they have a high potassium content.

Fluids

Fluid intake should be adjusted to each particular case:

• Reducing the sensation of thirst.
• Drinking only when thirsty and drinking small amounts.
• Not getting into the habit of drinking.
• Taking medication with the liquids in meals and using the smallest amount possible.
• Using citrus slices to stimulate salivation and moisten the mouth.
• Adding a few drops of vinegar to water.
• Chewing sugar-free gum.
• Adding a few drops of lemon juice to ice cubes before putting them in the freezer.
• Freezing fruit pieces.
• Reducing the intake of drinks such as coke, orange juice, etc., and replacing them with ice tea and homemade lemonade.
• Avoiding alcohol.

Pharmacological measures that should be taken

• Patients many need to take the same medications as patients undergoing dialysis. Some drugs may include:
  • Hypotensors: drugs to reduce blood pressure (angiotension converting enzyme [ACE] inhibitors or angiotension receptor blockers [ACB]).
  • Corticosteroids: better known as steroids, these are anti-inflammatory medications.
  • Immunosuppressants: drugs that inhibit the immune system.
• Medication that helps patients to alleviate the symptoms,  such as itching, pain, etc., may also be taken.
• Other measures may also be adopted, such as:
  • Avoid consuming nonsteroidal anti-inflammatory drugs (NSAIDs).
  • Avoid contact with organic solvents and polluting substances, such as mercury.

Other related health information

• Looking after the peritoneal dialysis (PD) incision and catheter.
• Looking after a tunnelled central venous catheter (CVC)
• Looking after an arteriovenous fistula (AVF)
• Training and health education for patients and carers in PD treatment.
• Recommendations on discharge for patients with nephritic syndrome
• Advice for patients undergoing immunosuppressive therapy

What should you bear in mind if you have lupus and you have been hospitalised?

Patients with lupus who have been hospitalised should bear in mind a series of indications when it comes to re-establishing their normal routine:

• Skin protection: it is advisable to protect your skin from exposure to sunlight, especially in summer, using high factor sun creams and hats to cover your head. If you have any skin lesions, you should let a doctor know.
• Joints: a level of physical activity suited to the physical ability of each patient should be maintained (walking, swimming, yoga, tai chi, etc.)
• Kidneys: follow a diet low in salt (reducing the amount of salt in meals as well as avoiding cured foods, tinned foods, salty snacks, etc.)
• Leisure activities: do activities that allow you to maintain an active social life and, if you find yourself getting tired, plan them so that they are spaced out a bit more.

You must always take medication as prescribed by medical personnel and see your doctor if you get any of the following symptoms:

• Fever (temperature > 38 ºC)
• Swollen legs or feet
• High blood pressure
• Increased heart rate when resting
• Difficulty breathing
• Joint pain
• Problems with your vision
• Depressed mood

What do you need to bear in mind if you have resistant osteoarticular infections?

When the patient is discharged, nursing staff will give them all the support and information they need to be able to look after the wound themselves. Most patients will be fitted with an external fixator that needs daily care, so healthcare staff will emphasise the importance of hygiene in the affected area, which should be cleaned daily and the correct dressing applied.

If patients are not independent and do not have a relative or carer to look after them, the local health authority will be contacted (through the PREALT discharge preparation unit), so that they may be provided with nursing care. If patients are being treated with intravenous medication, the Hospital at Home Unit will be contacted to follow up and provide the relevant treatment.

It is also necessary to explain the importance of taking the medication prescribed. On being discharged, most patients will receive long-term oral antibiotics (prescribed by the Infectious Diseases Unit) and they are reminded of the importance of maintaining a fixed schedule and not forgetting to take their medication.

They are also reminded of the need to maintain healthy habits, such as:

• Being well hydrated
• Eating properly (protein-based diet)
• Stopping toxic habits (should they have any), such as alcohol and tobacco