ADHD

Synonyms in a broader sense

Attention Deficit Hyperactivity Disorder, Fidget-Philipp Syndrome, Fidgety Philipp, Psycho-Organic Syndrome (POS), Attention Deficit Hyperactivity Disorder

definition

The Attention Deficit Hyperactivity Disorder includes a pronounced inattentive, impulsive behavior that manifests itself over a longer period of time in several areas of life (kindergarten / school, at home, leisure time). ADHD can also take the form of without hyperactivity ADS or appear as a mixed form.

Both ADD and ADHD are a clearly defined clinical picture that goes through different symptoms of ADHD or ADS. Neither people with ADD nor ADHD can direct their attention in a targeted manner and thus point out Deficiencies in the ability to concentrate on. These lack of concentration generally affect all areas of life for children and adults, i.e. kindergarten, school or work as well as the family and leisure areas. The lack of concentration becomes particularly evident in phases in which those affected have to focus their attention on a certain area over a longer period of time. While in the case of one ADS then that dream predominates, can with the hyperactive form negative side effects in the form of fidget up to an offensive refusal to work. Due to the changeable and sometimes below average ability to build up attention, especially the children are confronted with school problems. Many ADHD children develop one Reading weaknesses and or Arithmetic weakness.

In both forms of ADS, there is a faulty transmission and processing of information between the two brain segments (hemispheres). This in turn does not mean that people with ADHD are less gifted. The opposite is the case: also People with ADHD are not from a possible giftedness to exclude. The probability of giftedness is likely to be comparable to the probability that can be assumed for a “normal child or adult”. Due to the symptoms of the syndrome, especially ADHD, a diagnosis of giftedness is often much more difficult.

What can be signs of ADHD?

The first signs of ADHD can show up in any situation that requires a certain amount of concentration. In everyday life, ADHD manifests itself in a pronounced distractibility, forgetfulness and unreliability. Tasks are canceled and instructions are poorly followed. Affected people react impulsively and rashly. The mood changes often and they can be easily irritable, sometimes even aggressive. Children usually have problems at school, adults at work. It also comes to difficult social behavior as well as appropriate behavior in a social context.

Hyperactive forms of ADHD become noticeable through increased activity with a strong urge to move - hyperactive children are fidgety and disrupt class. In the non-hyperactive, possibly hypoactive (i.e. underactive) form, those affected tend to be quiet and dreamy, here the children seem to live in a dream world. But a blossoming imagination and a pronounced emotionality are also typical for ADHD.

Read more on the topic: How to recognize behavioral problems in babies

Which doctor should children or adults see if ADHD is suspected?

The first point of contact is at Child the pediatrician, at the Adults the family doctor. With enough experience, both can make the diagnosis and initiate treatment. When in doubt, however, refer to the Psychologists or psychiatrists and other specialists, as ADHD is a very complex disease with a wide variety of manifestations.
Not only the diagnostics, but also the therapy is very diverse and requires the cooperation of different specialists. It therefore makes sense to switch on the various disciplines at an early stage.

Frequency of occurrence

Due to the different external, sometimes much more unpleasant manifestations of ADHD, it is usually diagnosed more often, and usually faster.

Current studies result from one Frequency between 3 to 10% of the population, 3 - 6% being 6 to 18 year olds (3 - 4% children of primary school age, approx. 2% young people). The relationship between ADD and ADHD will be about 1/3 to 2/3 estimated, so that an ADHD frequency of 2 to about 7% can be assumed. Studies have also shown that boys are 7 times more likely to develop AD (H) D than girls.

AD (H) D cannot be ignored in adults either. It is assumed that about 1% of the adult population suffers from AD (H) D, although the studies and investigations show country-specific differences. Why country-specific differences arise cannot, however, be determined, since in addition to actual differences, the different state of research in science also plays a role.

Twin studies have been able to confirm that a genetic component of AD (H) D cannot be discussed away and that identical twins are usually affected jointly by the corresponding symptoms.

Historical consideration of ADHD

The is historically known History of the fidget philipp, first published in 1846 by Heinrich Hoffmann, a Frankfurt doctor. It is often said that Hoffman himself suffered from Fidgety Philip's Syndrome or at least wanted to draw attention to it. This may be the case, but it should also be borne in mind that perhaps he just wanted to achieve an entertainment factor with his book. This could be confirmed by the fact that Hoffmann was not a neurologist at all at the time of writing his book.

While the bad habits were still laughed at in children's books, in the following years the search for the causes was pursued. Similar to the history of dyslexia, there are different directions that have been taken, different opinions and views. Parallels to the history of dyslexia are evident: possible causes are accepted, revoked, and postulated anew.

In the 30's it was discovered by chance that special Medication Calm down hyperactive children. Wilhelm Griesinger, a Berlin psychiatrist explained in 1845 that hyperactive children cannot process the external stimuli in the brain accordingly and that problems / deviations from the norm must therefore exist in the area of ​​the brain. Since there was already controversial discussion back then, counter-opinions quickly developed. So one tried to relativize the statements of Griesinger and led the problems back to a hasty development (“hypermetarmorphosis”).
In the early 20th century, education was given a great deal of responsibility. Groups emerged that classified overactive children as difficult to raise. In the 1960s, a brain disorder was assumed to be the cause of ADHD and treatment was given accordingly. Heredity was not ruled out as early as 1870, but increasing social pressure was also pointed out. The more and more important virtues such as punctuality, order, obedience, ... could not be fulfilled in the same way by all children. Later he sat down multi-causal approach (= caused by many factors) by: Various factors came into consideration as the cause of the expression: minimal cerebral dysfunction (MCD, a form of brain damage), heredity (genetic transmission), consequences that result from the changed society.

Since the 1990s, the neurobiological explanatory approach, which is described below, was identified as another possible cause. However, here too it can be assumed that several factors play a role in the development. The first to be mentioned is changed childhood, but also the changed family situation.

The scientific attempts at explanations ran through all disciplines of medicine, psychology, but also education. Perhaps it should be borne in mind, however, that there cannot be the classic royal road that applies to everyone. The problems are very individual and therefore also require one individual therapy of ADHD.

To date, have in principle two contrary and extreme positions maintain. On the one hand, there are those who believe that AD (H) D is in principle treated with medication should be and, on the other hand, those who believe that only through Therapy and changed educational measures a goal can be achieved and drug therapy should be avoided. Today most forms of therapy can be found between the two views.

Causes of ADHD

The reasons and causes that sufficiently clarify why people develop ADHD have not yet been conclusively named. The problem lies in the individuality of people. However, some statements can be made:

Heredity (genetic component)

As already mentioned above, it has been shown that, especially in identical twins, both children are affected by symptoms. It could also be shown that altered functions in the area of ​​the brain are passed on genetically and can be made responsible for the neurobiological / neurochemical components mentioned below.

Neurobiological / neurochemical component

Since the 1990s, a neurobiological / neurochemical approach has been assumed, since biological studies show that affected patients under a Imbalance of the messenger substances serotonin, dopamine and norepinephrine in the brain suffer, as a result of which the transmission of information between the nerve cells of individual brain areas does not function adequately. The messenger substances influence people in different ways. For example, it is believed that serotonin essentially affects mood, while dopamine relates to physical activity. Norepinephrine, on the other hand, affects the ability to pay attention.

Again and again one comes up allergy as a cause for the development of an attention deficit under discussion. An existing allergy does not necessarily mean that there is also a lack of attention, but an allergy triggers a stressful situation, whereupon the body or the adrenal cortex causes an adrenaline release and ultimately with one increased cortisol productionn answers. Cortisol belongs to a group of so-called Glucocorticoids and causes a decrease in serotonin levels in the body. Since - as mentioned above - serotonin essentially influences the mood, fluctuations in this area are the logical consequence. It is precisely these mood and attention fluctuations that can be found in the attention deficit child.

In order to come back to the neurobiological or neurochemical component, the presentation of the information transfer now takes place, which must be imagined as follows:

A large number of nerve cells form a kind of network in the brain. All activities that we perceive implies the activity of the nerve cells and their ability to transmit stimuli. The nerve cells are not connected to one another, however, since otherwise permanent stimulus transmission and thus stimulus overload would occur. There is thus a gap between two nerve cells, the synaptic gap, which can only be overcome by the messenger substances (see: neurotransmitters). In plain language this means:
Stimulus arrives at nerve cell 1, nerve cell 1 releases messenger substances that dock on the receptors of nerve cell 2 via the synaptic gap and pass on the stimulus there.

If that stimulus transmission does not function adequately, the information transmission is disturbed. It is currently assumed that both the transporter gene and the docking point for dopamine are different in ADD patients.

Causes that lie in the pre-, peri- and postnatal area

Harmful influences in the pre-, peri- and postnatal area are still discussed. These include, in particular, complications during childbirth and accidents to the infant that relate to the head area. Diseases of the infant in the area of ​​the central nervous system can also be considered as a cause for the development of AD (H) D.
Examples of harmful influences in the prenatal area are:

  • increased alcohol and / or nicotine consumption by the mother, which means that the brain stem (thalamus) is not fully developed (organic brain component)
  • Brain-functional reasons, due to which the cerebrum is insufficiently supplied with blood.
  • Infectious diseases
  • Bleeding
  • ...

Educational deficits

Upbringing deficits, psychological stress such as high demands of the family / society on the child or the adult can also play a decisive role in the development of AD (H) D, as can excessive overstimulation. As a rule, however, the aspects mentioned are not considered the actual cause. Under certain circumstances, however, they intensify the problem many times over.

For more information, see: Causes of ADHD

Symptoms of ADHD

ADHD stimulus discrimination

Attention Deficit Hyperactivity Syndrome (ADHD for short) is a psychiatric-neurological disorder that develops in adolescence or childhood and can then be carried on into adulthood.

childrenThose who suffer from ADHD initially fall through a barely breastfeeding one Restlessness on. Sitting is difficult for the children and most of the time those affected have to be on the move. In addition to the permanent restlessness, the disease is still classified by Strength Difficulty concentrating. In most cases, those affected can only concentrate on a topic or activity for a very short time. In children, a certain reduction in the ability to concentrate is often normal and has no disease value. However, severe concentration disorders in adulthood should always make one think of ADHD.

Especially children who suffer from ADHD are often conspicuous by strong Mood swings. Often it is outbursts of anger and irascible attacks that do not match the surrounding circumstances. Children are often hard to calm down. Often the children also suffer from restlessness sleep disorderswhich then in turn means that you have no sleep during the day, which could then lead to increased aggression and mood swings. Also very often those affected become conspicuous by the fact that they are over defy social boundaries and certain behaviors do not fit the norms.

Other symptoms of ADHD are Disorganization and rapid exhaustion. Adults with ADHD in particular stand out at work because they cannot do their normal work properly and cannot finish the work on time. ADHD patients are often described as disorganized and chaotic, due to the fact that patients are never able to concentrate on a particular job for long. The rapid exhaustion is due to the fact that ADHD patients can see and assess their predicament. They notice that they cannot work through certain normal work sequences like others and that they lack a system and a common thread. Combined with constant restlessness, ADHD patients very soon reach their performance and stress limits.

Approx. 2 million people in Germany are affected by ADHD without knowing that they have the disease. Often the disease is not diagnosed because of a specific one individual trait responsible for the special behavior is made.
Critics of ADHD accuse that the diagnosis is made too quickly, but that the symptoms could also apply to special character traits. ADHD is one of the most discussed clinical pictures in psychiatry. The way of diagnosis is often called into question by accusing overdiagnosis and additionally criticizing the method of treatment. Critics denounce that drug treatment of ADHD is often not necessary and that it is started much too early and takes a long time.

Are children with ADHD always a mess?

This question can be answered in the negative. Unfortunately, it is not uncommon for those affected to be prematurely stigmatized. The ADHD spectrum ranges from quiet to loud, from calm to cranked, from dreamy to (very well) concentrated. On the one hand expresses itself ADHD is individual for each childSo it doesn't have to be chaotic, on the other hand, dealing with the symptoms is immensely important. Even if the child has an abnormal, chaotic, and hyperactive form of ADHD, the proper therapy and promoting his talents his Compensate for weaknesses.

ADHD in adults

ADHD often goes undetected in adults.

The attention deficit hyperactivity disorder becomes usually diagnosed in childhood and adolescence. The reason is that the complaints and symptoms that are triggered are much more common in childhood than in adults. Children stand out due to an unusual restlessness and also due to an age-atypical concentration disorder as well as strong mood swings. Adults usually have the same symptoms, but they are often viewed as a character trait that cannot be influenced.

The number of adults who suffer from ADHD and may not know this is believed to be around 2 million people. Almost all diseases start in childhood and are carried over unnoticed into adulthood. Adultspeople who suffer from ADHD usually fail theirs in society severe mood swings and more common Irritability on. They are difficult to assess and their mood is unpredictable. They are also called chaotic and disorganized and often adults fail above all Underperformance negatively on work.

A doctor is only very rarely consulted, and attention deficit hyperactivity disorder is even less common. Rather, all possible internal diseases are examined, such as the overactive thyroid, which can also lead to such symptoms. Diagnosis in children and adults is supported by the psychiatrist posed. During several personal conversations, he will first observe the patient and assess them in various situations. There are also accompanying ones Questionnairesthat can corroborate a suspicion of ADHD.

Treatment should begin as soon as the diagnosis is made. In no case does this have to be done exclusively with medication, but can first be tackled with a psychotherapeutic measure. Regular Conversation and Behavioral therapies should ensure that the patient is better able to reflect and assess himself better in different situations. Furthermore, the patient should be shown measures to independently and sustainably improve his concentration and to better control his aggressions and not to let them arise in the first place. The psychotherapeutic sessions should be carried out for several months and, if necessary and successful, also be extended.
In addition, or if there is no success, treatment can also be started with one of the two common medications for the treatment of ADHD. The standard drug still used today is Ritalin®. The somewhat newer drug that hit the market is Atomoxetine. It is now used as a second-line drug. Both drugs are said to lead to a reduction in mood swings and concentration disorders and to allow the patient to be better integrated into society.

Possible accompanying symptoms in ADHD

Here you can find out more about accompanying problems. In relation to the school sector, these include not only reading and writing weaknesses but also weaknesses in numeracy. On the lack of concentration - page you can find out more about the problems that also appear as symptoms in the area of ​​ADHD.

  • LRS / Dyslexia
  • Arithmetic weakness / Dyscalculia
  • Poor concentration

ADHD and depression, what is the relationship?

Depending on the study situation, the HFrequency of depression in ADHD patients in 10-20%.
Social Exclusion, Stigma, Fear of failure and bad experiences with ADHD symptoms lower self-esteem and make those affected prone to depression. The association between depression and ADHD is particularly important in children. Because depression and ADHD make each other worse, patients should be screened for it and treated early.

Diagnosis of ADHD

As already mentioned in the thematic section “Frequency”, the Diagnosis not always easy. As with all diagnoses in the field of learning, warnings must be given against a diagnosis that is too quick and too one-sided. However, this does not encourage one to be blinded and hopeful that the problems will grow.

IF there are problems, they should be over a period of approximately six months have appeared in different areas of a child's life.

0. Accurate observations

1. Interviewing the parents

2. Assessment of the situation by the school (Kiga)

3. Preparation of a psychological report

4. clinical (medical) diagnostics

What tests are there for ADHD?

The internet offers a variety Questionnaires and self-teststhat the person concerned can fill out. However, you are not bdemonstrating for an ADHD condition. Other tests, such as Behavioral and intelligence tests are also part of the diagnostics. Although the various self-tests have no evidential value, they are a good tool for detecting the first signs of ADHD.

Since ADHD expresses itself differently for everyone, no standardized test can replace a detailed discussion with the doctor and further diagnostics. There are no laboratory tests or the like for ADHD.

Tests for adults

The popular Self-tests ask about typical ADHD symptoms and are useful if you suspect ADHD. There are e.g. on the website of the WHO (World Health Organization), with various self-help groups, medical-run associations and many more.
Further tests will be carried out by the doctor and include among others the Determination of attention span, IQ and behavior. Which tests are used in which patient depends on the individual appearance of the disease and the doctor's judgment.

Tests for children

The tests for children are based on their age. Very young children show e.g. An attention disorder when playing, older children can be tested in writing like adults. It plays with the child Assessment by parents and teachers plays a major role, which is why questionnaires must be filled out by the child and the environment. Further tests and examinations will also be needed to rule out other causes of the symptoms. Because of the very individual appearance the tests for children have certain limitations, similar to the tests for adults.

How useful are online tests?

If you suspect ADHD, you want to be quickly certain as a person affected or as a parent. Online tests promise quick answers, but they are just conditionally useful.
There are a large number of providers who make questionnaires available on the Internet. Few come from trustworthy sources such as of the WHO (World Health Organization). In addition, the typical symptoms occur not only in ADHD, but also in other diseases and also in healthy people. So not every positive test result is necessarily ADHD. The final diagnosis to the exclusion of other causes can therefore just ask the doctor.

Differential diagnosis in ADHD

As in the area of ​​ADD and other areas, the problem of diagnosing “ADHD” lies in the fact that one tends to assign a supposedly “small” problem directly to a central learning problem. That means: Children can “just” suffer from a lack of concentration. This is not always an ADHD that applies to the child. Not least because of this, a differential diagnostic delimitation of the symptoms is necessary.

Based on the various diagnostic surveys, it is already clear that some areas specifically try to rule out other diseases. By means of various internal and neurological examinations, the doctor tries to exclude various metabolic disorders, visual disorders, hearing disorders and neurological disorders through differential diagnosis and, in particular, to assign the actual cause of any existing exhaustion.

Differential diagnostic diseases also include the exclusion of profound psychological impairments, such as Tourette's syndrome, depression, anxiety disorders, mania, obsessive-compulsive disorder (ticks), autism and bipolar disorders. Only rarely does it happen that children suffer from one of the diseases mentioned in addition to ADHD.

In the cognitive area, reduced intelligence, partial performance disorders such as dyslexia or dyscalculia should be ruled out, as well as giftedness or partial poor concentration. In particular, the accompanying symptoms (secondary accompanying symptoms) of dyslexia and dyscalculia can sometimes be very similar to the symptoms of ADHD.

Differential diagnosis should also distinguish profound developmental disorders, affective disorders and a domestic environment that intensifies symptoms (pressure, expectations, lack of understanding, no rules, ...).

therapy

Therapy of ADHD should always individually tailored to the child's deficits and start holistically if possible. At this point, holistic means on the one hand that Therapist, parents and school pulling together to pull through cooperation wanting to achieve the best possible results together. In addition, the social-emotional area are addressed in the same way as the psychomotor and the cognitive area. The educational work should be based on the level of learning, the learning conditions and the work opportunities of each child.

It must be made clear to everyone involved in the upbringing of the child that an ADHD child must not be verbally abused. First and foremost, this requires self-discipline and control from these people, because the behavior often “upsets you”.
Clear rules and agreements, and especially too consistent behavior of adults represent the starting position. Step by step you have to work with the child on the Compliance with agreed rules to be worked. If ... then - consequences must be calmly explained and made understandable, but also adhered to. You must make sure that the Consequences for rule violations always the same are.
However, it is essential to avoid punishments that are too harsh. Even if negative behavior is suppressed as a result, it reappears in another place, due to feelings of revenge or the like - perhaps even more violently.
In addition, the Principle of positive reinforcement proven. This means: every success, every adherence to rules etc. should be praised. But make sure that it comes from the heart. Children, especially ADHD - children notice the difference.

Please note the following: Consistent educational measures and all of the above-mentioned assistance will not help you to cure the ADHD. They only help you to reduce tensions and fears in the child and to save your own strength. Screams, house arrest or even beatings always cause a child to react defiantly. If you feel that you have been treated unfairly - and this is the same for almost all people - you do not achieve any change in behavior and destroy any will to make an effort and comply with rules.

The educational measures also include fine motor exerciseswhich become necessary because hyperactive children in particular have difficulties in their range of motion. Fine motor exercises can be performed anytime, anywhere. Examples of this are: kneading, cutting out, coloring, plaiting, threading pearls, .... In principle, all “common” exercises for training manual and dexterity are positive. However, any pressure to perform and any form of evaluation should be avoided.

As already mentioned several times, there is no therapy that can cure and remedy ADHD. It has to be started at different points. This means that all areas in which the child is brought up must be addressed first. In addition to the parental home, this is initially the kindergarten or school. But the basic aspects of therapy must also be conveyed to all other contact persons. Counterproductive work, for example by the grandparents, should be avoided.

It usually starts with the Education of parents about ADHD, its symptoms and therapeutic options. It is important to make it clear to parents that dealing with their own child will require more effort, energy and nerves than would be the "normal" rule. As a rule, this also means that you part with old rules and behaviors that you may have grown fond of. The focus must be on establishing or restoring a positive basis for upbringing. Psychological counseling should and in many cases cannot and should not take place once and should not be limited to explaining the disease and its development. In many cases, care during therapy is just as important, possibly more important, as it demands a lot from the parents in terms of rigor and consistency.

As already mentioned, the parents form a unit together with all other children involved in the upbringing of the child and, as such, should also have generally applicable and consistently observed rules. Everyone should "pull together". In addition to educating the parents, it is therefore also important that informed all other groups about the disease become. In addition to forwarding information, the therapy of ADHD of equally great importance: only if everyone observes the rules that have been established can the therapy claim a chance of success.

In summary, it can be said that the therapy of the child tailor-made must become. This means that there is no specific ADHD therapy that is equally applicable and feasible for every child. As individual as the child is, any therapy must be considered as individual. This means that the age and the severity of the symptoms must be taken into account as well as the accompanying symptoms and the child's living environment. Special attention should be paid to the child's environment (see above), so that (therapeutic / psychological) counseling and support for parents and other caregivers can be just as important as the therapy of the child itself.

As a result, therapy should usually include and encompass various measures that should all complement each other in a certain way. These are listed again briefly below.

  1. Advice and support for parents
  2. Cooperation between all adults involved in the upbringing (therapists - school / kindergarten and parental home)
  3. If necessary, educational advice (clear rules and structures (rituals))
  4. Appropriate diagnosis in advance of therapy
  5. Behavior therapy
  6. if necessary, drug therapy
  7. if necessary (and at the appropriate time: therapy of accompanying problems (arithmetic weakness, reading and spelling weakness, dyscalculia, dyslexia ...)

Since first of all certain prerequisites have to be created in order to be able to carry out a therapy in an appropriate and necessary manner, it seems natural that not all measures are started and carried out at the same time. Usually a individual therapy plan created. In general, a start is made at those points where problems arise. Since the behavior then always triggers action and reaction, it quickly becomes clear which points should be further worked on and treated.

ADHD medication

If the diagnosis of ADHD has been made, it must be considered whether either non-drug treatment is started or some well-researched drugs that are used today for the disease are used. Today the active ingredient is used in both child psychiatry and adult psychiatry Methylphenidate used. This active ingredient is under the trade name Ritalin® available. It is administered in tablet form and increases the ability to concentrate. Ritalin® is a drug from the group of so-called Stimulants. It is still not known why a stimulant has the opposite effect, especially in ADHD patients, and leads to an increase in concentration.

Ritalin is used at Children in a dose of 2.5-5 mg a day used and is usually well tolerated. Treatment should initially last for several months. If the symptoms under Ritalin® are significantly reduced or even disappear, an attempt can be made. As a rule, and especially in children and adolescents, the drug is given for at least one year after the diagnosis is made in order to prevent the symptoms from recurring.

In addition to the now older Ritalin®, there has also been a newer drug that contains the active ingredient for some time Atomoxetine includes. The trade name is Strattera®. In addition to improving concentration, the drug also reduces mood swings and impulsiveness. An addictive behavior to the drug has not yet been established.

Parent training

The child's well-being and the prognosis for their attention disorder depend hugely on how parents manage their ADHD. A Training affected parents is therefore an elementary component in ADHD therapy. It creates a basic understanding of the disease in order to better understand the child's behavior.

ADHD makes normal learning difficult and affects social behavior. If these children are treated like everyone else, they experience rejection from an early age and suffer from fear of failure, which disrupts the development of the child and can lead to problems in later life. In addition, with their behavior, the parents also influence the child's image of himself, his illness and his abilities.

Dealing with ADHD is not easy. Affected children are often considered difficult to bring up and parents find it difficult to get through to them. They have to be consistent, but emotional and empathetic, even though they cannot always understand the child's behavior. Praise instead of punish, work solution-oriented, to be patient are challenges for parents, but represent the most effective way to raise children with ADHD.