Interviewing Dr. Manuel Antonio Fernández: Pediatric Neurology and Child Development

11 November, 2020
These days, pediatric neuropathy is of key importance in the care, understanding, and detection of problems during child development. Here at Exploring the Mind, we talk to one of the best neuropediatricians in Spain, Dr. Manuel Antonio Fernández.

After our interview with Dr. Manuel Antonio Fernández, we realized that we’d discovered one of the best pediatricians in Spain. This doctor, who specializes in pediatrics at the Virgen del Rocío University Hospital in Seville, Spain, has devoted his life to pediatric neurology. Families, educators, and anyone interested in child development consider him to be one of the most admired and respected specialists you could meet.

Manuel Antonio Fernández is a neuropediatrician in charge of the INANP clinic in Seville. He invites us to reflect on the relevance that pediatric neurology is currently acquiring.

Many of us can associate this field of medicine with the treatment of certain deficits, disorders, or pathologies in child development. Therefore, it’s vital that we understand one essential aspect. This branch of pediatrics is also responsible for promoting and optimizing normal child development.

Manuel Antonio Fernández is a leading specialist in pediatric neurology who’s changed the lives of many families. He’s helped them to improve their well-being, quality of life, and happiness.

Our interview with Manuel Antonio Fernández

Fernandez stresses the importance of parents having adequate, clear, and reliable information about what a normal neurological development is like for a child. This would make it possible for them, among other things, to facilitate earlier detection.

Pediatric neurology is also an essential pillar in any advanced society. Quality care during infancy doesn’t only alleviate uncertainties and fears in parents. It also allows specialists to offer the best support in such common aspects as learning disorders and illnesses such as migraines, epilepsy, sleep disorders, and even some rare diseases. Let’s get to know a little more about this area!

A baby with a medical instrument.

What’s pediatric neurology?

Pediatric neurology is the branch of pediatrics that devotes itself to the study, development, and control of the normal functioning of a child’s nervous system.

Neurodevelopment is a process that begins at the moment of conception, and ends far beyond what we used to consider as the “pediatric age”. It doesn’t end (as we once thought) around the ages of four or five. In fact, this process can continue right through adolescence and even up until 18 or 21 years of age.

This is a little-known fact, and yet some countries are making significant advances in this area. Strangely though, in our own country (Spain), it isn’t being promoted. Quite the opposite, in fact.

Pediatrics should begin from the moment a woman becomes pregnant. This is what’s known as prenatal pediatrics. However, in many countries, the term doesn’t even seem to exist.

At the other end of the scale, pediatrics should continue right through the child’s development process. This can even stretch into early adulthood.

A long way to go

There’s still a long way to go before we can reach that level of development within the profession. Therefore, I’m very concerned when I hear that, in some parts of Spain, there’s talk of lowering the age of pediatric care to below 14. In all areas of medicine, it’s a well-known fact that the more developed a country is, the higher the upper age limit for a child to see their pediatrician.

This way, pediatric neurology deals with all sorts of aspects related to neurological development. This includes monitoring its normal evolution, as well as detecting and taking action regarding any problems that may arise. We can divide the most common ones into three groups:

  • Learning or behavior problems such as ADHD, dyslexia, or high ability children.
  • Maturation and developmental problems such as retarded development, autism, or Asperger’s syndrome.
  • General neurological problems such as migraines, epilepsy, and sleep disorders.

When should you see a pediatric neurologist?

Whenever there’s any kind of change in the process of normal neurological development, it’d be advisable for parents to consult a pediatric neurologist. In order to be clear about when to do this, it’s essential for them to have clear and reliable information about the process of normal neurological development.

According to what was mentioned above, I’d like to insist on the fundamental role of the neuropediatrician in the detection and treatment of learning, maturation, and developmental problems such as ADHD, dyslexia, or autism.

Parents aren’t clear about this situation. As a result, this can cause major problems in obtaining an early diagnosis and an early intervention in order to minimize complications. If we add to this the lack of time and means available to devote to children in primary care appointments, then we can understand why very advanced cases often arrive at our child neurology consultations.

What are the most frequent consultations in pediatric neurology today?

For some time now, most of the reasons for appointments in pediatric neurology units in Spain have been due to learning, behavioral, maturation, or developmental problems.

The figure for school dropouts has been around 25% for years now. It hasn’t gone down, despite greater investment in education. One of the existing limitations that make things difficult is the lack of attention to neurodevelopmental disorders.

The percentage of ADHD, dyslexic, and high-ability children is nearly the same as the school dropout figures. Correct attention could drastically reduce it.

Do you think there are enough resources and professionals for the diagnosis and treatment of neurodevelopmental disorders?

Clearly not. Most of these disorders have a series of characteristics that make them complex and difficult to address or detect. The current public health system and most of the private centers run by large health companies or insurance companies don’t have the necessary means to meet these needs.

Doctors and specialists are loaded down with work and patients. They can barely spend a decent amount of time on each appointment and this can cause significant difficulties for patients

One of the most relevant aspects here is the fact that, even though neurological problems have a physical and biological foundation, usually no traditional medical tests allow a classic diagnosis, as in other illnesses such as multiple sclerosis, for example.

If we also take into account the fact that the symptoms they produce are of a highly subjective nature, such as behavior, attention, conduct, and motivation, then we can understand why there’s such controversy surrounding them.

This leads to contradictory “opinions”. On many occasions, it makes it difficult to provide adequate training and awareness within the different professional sectors involved in the detection and treatment of many of these disorders.

In spite of all this, these days, we have new technology that allows us to detect, diagnose, and even treat many of these cases. This is all thanks to virtual reality, analysis of functional neurological parameters, and digital platforms. They also allow us to carry out the whole process in a completely objective, measurable, and even remote way.

Has there been an increase in problems related to neurodevelopment in recent years and why?

This hasn’t happened. While the statistics have increased, we can’t really say that this is exclusively due to the existence of more cases or more illnesses. What has improved incredibly is the availability of diagnostic tools and resources. All this coupled with a greater awareness at a social level regarding learning, behavior, maturation, and development problems in childhood.

Years ago, when a child had problems at school, people would say that they “weren’t fit to study”. However, these days, we’ve managed to change that. We’ve helped families be concerned about finding the cause and finding a solution to it.

A smiling girl at the doctor's.

Have you noticed an increased awareness of these kinds of difficulties in society?

The situation is better than it was 10 years ago, but there’s still a lot to do. On the one hand, we have made a lot of progress in terms of the knowledge and awareness in this respect regarding the families concerned. However, on the other hand, there hasn’t been any parallel follow-up by health or education professionals.

Much of the blame for this has fallen on the short-term outlook of the administration., which has given priority to financial savings over investment and long-term benefits.

It may be tempting to avoid major economic investments in the short term. However, we must be aware that such investments would bring major benefits, both economically and socially. It would prevent many cases of failure at school. In addition to this, it would improve the overall level of training, qualifications, and scope of a large number of people concerned with these cases.

Could you tell us about ADHD? We know that there are currently very conflicting opinions regarding this disorder and we’d like to know your expert opinion.

I’m going to explain what ADHD is in a very concise way. It’s not my opinion as an expert, but, rather, based on the objective scientific data we currently have.

ADHD is a disorder that produces an abnormal development in some regions of the brain, mainly the frontal lobe, due mainly to genetic factors. This generates changes in the regulation of the brain neurotransmitters that are responsible for the body’s self-control mechanisms of attention, movement, and impulses.

As a result, symptoms such as attention deficit, hyperactivity, and impulsivity appear. The long term consequences here are the cause of academic, social, and behavioral difficulties of people who suffer from it.

It’s a rather long definition, but quite a simple and clear one at the same time. It shows that there aren’t any doubts about the biological origin of the problem. It also rules out any educational, emotional, or psychological origin that people may think ADHD had.

How’s ADHD treated?

The treatment of ADHD must be based on combining the different tools we have with the needs of each patient. I’m saying this to clarify the well-known term “multimodal”, that’s often used to define the best approach to treatment for ADHD.

Multimodal doesn’t mean that every child with ADHD has to receive the full range of tools we have at our disposal for their treatment. It means that, depending on the profile of each case, we must select the best, and most effective, combination of tools possible.

Among the tools we have, there are fundamental aspects. These include pharmacological treatment, cognitive stimulation, cognitive-behavioral psychological therapy, academic reinforcement, family psychoeducation, and social relations therapy.

What should parents know about ADHD?

The first thing that parents of a child with ADHD should know is that they’re not to blame for their child’s problems.

Once this is clear, they then need to become real experts on their child’s ADHD, in order to understand their situation. By doing so, they’ll be able to help and accompany them as they try to overcome their difficulties.

Finally, I’d like to say that the most important thing is to always see the light at the end of the tunnel. You need to know that there’s always hope. These days, we have sufficient data to be able to demonstrate that the treatment of ADHD has such a positive effect that can be a real cure.

What I mean here is that there’ll come a time when all the difficulties will be overcome. The only problems they’ll have will be ones that all children experience on a normal basis. We must be positive about this.

A boy with ADHD.

Finally, we’d like to talk about the role of parents and the education system as enablers and partners in the child’s development. Could you share a few recommendations?

The best recommendation I can give in this regard is centered around properly informed and sincere mutual collaboration.

It’s essential for both parents and educators to have sufficient knowledge to help all children in their individual development. It’s vital that they work together openly all the time. Their sole objective should be to take each child’s abilities to the highest possible level. In this way, they’ll ensure that they can become happy adults, and fully integrated into society.

Without a doubt, Manuel Antonio Fernández is a wonderful specialist who’s helped us reflect on the importance of neuropediatrics in child development.