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TDHA Y NEUROEDUCACIÓN

TDHA Y NEUREEDUCACION

estos mismos niños o adolescentes son capaces de estar concentrados durante periodos de tiempo prolongados jugando a su videojuego favorito y pueden desenvolverse de forma extraordinaria en tareas extraescolares muy alejadas de situaciones académicas de estrés continuo a las que están expuestos con frecuencia. Porque las dificultades cognitivas que persisten en el tiempo, las críticas o la sensación de que no resuelven las cosas como se espera pueden provocar, por ejemplo, ansiedad o un autoconcepto negativo. Y ello puede interferir en las interacciones sociales. ¿Podemos hacer los adultos algo al respecto? Asumiendo una mentalidad de crecimiento real, seguro que sí. Y mucho, tanto en casa como en la escuela, que es donde nos centraremos específicamente.

El cerebro en el TDAH

Sabemos que el TDAH se manifiesta con síntomas de inatención, hiperactividad o una combinación de ambos –tiene una gran comorbilidad con otros trastornos o déficits de aprendizaje–, es congénito y persiste en la edad adulta en el 65% de los casos (Hart et al., 2013).

No existe un biomarcador que permita detectarlo sino que el diagnóstico –si es completo será complejo– lo realiza el médico a partir de entrevistas, cuestionarios, escalas de evaluación o exploraciones físicas que le permitan descartar otras razones, y para su tratamiento se utilizan medicamentos psicoestimulantes (el famoso Concerta) junto a terapias cognitivo-conductuales. Estos medicamentos tienen una estructura química similar a la anfetamina y actúan sobre los neurotransmisores de la corteza prefrontal inhibiendo su recaptación, con lo que llegan a reducirse los síntomas del trastorno en el 70 % de los casos, aunque sus procesos de acción no son del todo conocidos (Rubia et al, 2014), al igual que sus efectos sobre la salud a más largo plazo.

En los últimos años, los estudios con neuroimágenes han identificado algunas de las particularidades que caracterizan a los cerebros de los niños y adolescentes con TDAH. Una investigación reciente (Hoogman et al., 2017) en la que han participado 1713 personas con TDAH y una media de edad de 14 años, frente a 1529 integrantes del grupo de control, ha revelado que el tamaño del cerebro de las personas con TDAH es menor, en concreto en regiones subcorticales (ver figura 1) como el núcleo accumbens (recompensa), la amígdala (procesamiento emocional) o el hipocampo (memoria). Esto no significa que los niños con TDAH sean menos inteligentes sino que los problemas que manifiestan están asociados a una estructura cerebral diferente.

 

Estudios anteriores habían identificado en personas con TDAH alteraciones en los circuitos que conectan la corteza prefrontal –sede de las funciones ejecutivas– con áreas emocionales y motoras, como los ganglios basales y el cerebelo, lo que justificaría la mayor dificultad que muestran los estudiantes con TDAH para inhibir los impulsos (Hart et al., 2013; ver figura 2).

 

También se han identificado niveles más bajos de dopamina en algunas regiones del sistema de recompensa cerebral, como en el núcleo accumbens (Volkow et al, 2011), lo cual explicaría la mayor necesidad de estimulación que tienen los niños con TDAH. Y junto a los estudios de neuroimagen, la evaluación neuropsicológica ha identificado un perfil muy heterogéneo de alteraciones cognitivas asociadas a la memoria de trabajo, el control inhibitorio, la planificación o la detección y corrección de errores, entre otras muchas. Sin olvidar los déficits motivacionales observados en estos niños que les dificulta aplazar la recompensa pero que no les impide ejecutar mejor tareas que les interesan. Y son la baja tolerancia a la demora, junto a las dificultades en el control inhibitorio, dos de los primeros signos que predicen el trastorno. Lo cual es muy importante porque la detección temprana del TDAH en las primeras etapas educativas es necesaria para intervenir y disminuir su prevalencia en etapas posteriores (Rueda et al., 2016a).

Existen pues evidencias sólidas que muestran que el TDAH es una alteración del desarrollo de origen biológico y que las conductas observadas son el resultado de estas anomalías. Aunque un entorno familiar desorganizado o un currículo escolar inadecuado pueden amplificar esas conductas.

En la práctica

La pregunta que nos planteamos los educadores es cómo podemos optimizar el potencial de los niños y adolescentes con TDAH para que disfruten y aprovechen realmente el proceso de aprendizaje. Pues bien, existen algunas estrategias que están en consonancia con los planteamientos que proponemos desde la neuroeducación y que también nos pueden ayudar a mejorar la atención y el funcionamiento ejecutivo de todo el alumnado. Pero antes, escuchemos a Michael Posner, un referente mundial en el estudio de la atención:

 

Bueno para el corazón, bueno para el cerebro

A los niños y a los adolescentes –también a los adultos– les cuesta focalizar la atención en las tareas durante periodos de tiempo prolongados, un hecho que se amplifica en aquellos estudiantes con TDAH. En general, el ejercicio puede ser un buen antídoto para mejorar la concentración durante las tareas. Por ejemplo, con parones durante las clases para realizar unos movimientos de cierta intensidad (Ma et al., 2015) o iniciando la jornada escolar dedicando unos minutos -15 o 20- a una actividad aeróbica moderada (Stylianou et al., 2016). Y se ha comprobado que los niños con TDAH –a diferencia del resto– resuelven mejor pruebas cognitivas en las que interviene la memoria de trabajo cuando se les permite moverse (Sarver et al., 2015; ver figura 3).

 

 

En consonancia con este enfoque activo del aprendizaje que está muy alejado de la enorme cantidad de horas que pasan los estudiantes sentados en una situación pasiva, los estudios parecen sugerir la necesidad de cambiar con frecuencia los entornos de aprendizaje. Y nada mejor para los estudiantes con TDAH que puedan moverse o jugar en plena naturaleza. Un simple paseo por un entorno natural de unos 20 minutos puede combatir la fatiga mental que les provoca la atención focalizada (Taylor y Kuo, 2009). Qué importante para el cerebro y el aprendizaje es abrir las puertas del aula y la escuela a la realidad cotidiana y a la naturaleza (ver figura 4).

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