ADHD: Symptoms, Causes, Therapy

ADHD: Brief overview

• Symptoms: Attention and concentration deficits, hyperactivity (marked restlessness) and impulsivity. Depending on the severity, also dreaminess.
• Causes and risk factors: Probably predominantly genetic, but unfavorable environmental influences as triggers.
• Therapy: Behavioral therapy, possibly in combination with medication (e.g. methylphenidate, atomoxetine). Training of parents.
• Effect of ADHD: Learning or occupational difficulties, behavioral problems, problems in dealing with others.
• Prognosis: Often persists into adulthood as “ADHD” (as with decreasing hyperactivity). If untreated, serious consequences for professional and private life threaten.

ADHD: Symptoms

According to the ADHD definition, the disorder is associated with the following main symptoms:

• attention and concentration deficits
• marked impulsivity
• extreme restlessness (hyperactivity)

ADHD symptoms – Three subgroups

The symptoms of ADHD can vary in severity. Also, not all signs always appear in one patient. Overall, there are three subgroups of ADHD:

• predominantly hyperactive-impulsive type: “fidgety”.
• Mixed type: attention-disordered and hyperactive

In extreme cases of ADHD, a distance/proximity problem can arise. This means that affected individuals cannot strike an appropriate balance between distance and closeness to their environment.

Either the affected person is excessively distant, withdraws, often talks loudly and in mental leaps.

Accordingly, affected individuals may appear either callous or overly sensitive to outsiders.

ADHD symptoms by age group

ADHD is considered a congenital disorder that becomes apparent before the age of six. It often persists throughout life. However, ADHD symptoms manifest differently in infants, toddlers, adolescents and adults.

Early signs in the infant

Babies with regulation disorder cry often and long, sleep poorly and are sometimes difficult to feed. They are also very restless and often appear bad-tempered. Some babies who develop ADHD later in life reject physical contact.

However, such behavior can have entirely different causes. Only about one-third of babies who exhibit such behaviors are later diagnosed with ADHD.

ADHD symptoms in infancy

Social problems: ADHD often burdens the child and its parents in equal measure. Affected children find it difficult to make friends due to their disruptive behavior. They have problems making friends with other children.

Pronounced defiant phase: The defiant phase is also more severe in ADHD children than in other children. Those affected often burst into the middle of conversations. Some also try their parents’ patience by constantly making noises.

Conspicuous language acquisition: Language acquisition in young children with ADHD is either conspicuously early or delayed.

ADHD symptoms at elementary school age.

The most common ADHD symptoms at this age include:

• low frustration tolerance and tantrums when things don’t go one’s way
• Inappropriate facial expressions and gestures
• Talking excessively and interrupting others
• clumsiness and frequent accidents while playing
• low self-esteem
• may have difficulty following rules (at school, affected children are therefore often considered “troublemakers” and “spoilsports”)
• easily distracted
• dyslexia or dyscalculia
• often poorly legible writing and chaotic organizational behavior

All of these symptoms often make elementary school children with ADHD outsiders.

For teachers, ADHD signs such as disrupting class and being highly distractible are challenging. Not every affected child fidgets all the time, but all children with ADHD are out of the ordinary.

ADHD symptoms in adolescence

In addition, adolescents with ADHD tend to engage in risky behavior and are often attracted to marginalized social groups. Alcohol and drugs often play a role. Many suffer from low self-esteem, and some experience severe anxiety and even depression.

However, there are also adolescents in whom symptoms improve – restlessness and impulsivity decrease.

ADHD symptoms in adults

The focus is now usually on scatterbrainedness, forgetfulness or disorganization. Symptoms such as impulsive behavior and rash actions are also still present.

The problem is that ADHD is often not recognized in adulthood. The symptoms have then existed for so long that they are perceived as part of the personality.

Often, additional mental illnesses develop, such as depression, anxiety disorders, substance abuse or addictions.

If they succeed in controlling and using the wealth of ideas typical of ADHD, however, adults with ADHD can also be extremely successful in life.

For more on ADHD in adulthood, see the text ADHD Adults.

Positive symptoms: ADHD can also have advantages

They also have good access to their feelings and are considered very helpful. Their sense of justice is also strong.

Despite the many difficulties people with ADHD have due to their symptoms, they often find amazing ways to cope.

Difference ADHD – ADHD

ADS children are less noticeable than their hyperactive peers. The disorder is therefore often not recognized in them. However, they also have great difficulties at school. In addition, they are very sensitive and easily offended.

ADHD and autism

ADHD: Causes and risk factors

It is not yet clear exactly why some children develop ADHD. What is certain is that the genetic makeup has a major influence. In addition, pregnancy and birth complications as well as environmental factors can play a role.

The decisive mechanism in the development of ADHD is brain-organic changes. With a corresponding genetic predisposition, environmental factors can then become the trigger for ADHD.

Genetic causes

Researchers believe that genes play a 70 percent role in the development of ADHD. In many cases, parents, siblings or other relatives also suffer from ADHD.

The risk for ADHD is significantly increased, especially for boys, if one parent has the disorder.

Signaling disorder in the head

These brain sections are responsible for attention, execution and planning, concentration and perception. In ADHD, the concentration of special neurotransmitters, which are necessary for the communication of the nerve cells, is too low in these brain regions.

These include serotonin, which regulates impulse control, and norepinephrine and dopamine, which are important for attention, drive and motivation.

Missing filters

In ADHD/ADS children, the brain insufficiently filters out unimportant information. The brain of those affected is then confronted with too many different stimuli at the same time and is thus overwhelmed.

As a result, those affected find it difficult to concentrate. The unfiltered flood of information makes them restless and tense. If the teacher shows something on the board, the child is already distracted by the sounds of his classmates.

Environmental influences

Environmental toxins and food allergies are also suspected of contributing to ADHD and ADD. Alcohol and drugs during pregnancy, as well as a lack of oxygen at birth, premature birth, and low birth weight also increase a child’s risk of developing ADHD.

The external circumstances in which a child grows up can affect the course of the disorder. Examples of adverse conditions include.

• accommodation in homes
• cramped living conditions
• constant quarreling of the parents
• incomplete family, i.e. growing up with only one parent or without parents at all
• mental illness of the parents
• negative parenting behavior of the parents, especially the mother
• noise
• missing or not transparent structures
• lack of exercise
• time pressure
• high media consumption

ADHD: Therapy

The following building blocks are fundamentally important for successful ADHD treatment in children:

• Education and counseling of the parents, the child/adolescent and the educator or classroom teacher
• Cooperation with educators and teachers (kindergarten, school)
• Parent training, involvement of the family (including family therapy) to reduce the symptoms in the family environment
• Medication (usually amphetamines such as methylphenidate) to reduce symptoms in school, kindergarten, family, or other settings

A combination of medication, behavioral therapy, and parent training has proven very effective. However, which components are used or combined in individual cases depends on the age of the child and the severity of the ADHD.

ADHD therapy depending on age

Therapy in preschool age

In preschool age, the main focus is on parent training as well as on informing the environment about the disorder. Cognitive therapy is not yet possible at this age.

Experts warn against treating preschool children with ADHD medication. There is little experience to date with the use of methylphenidate in children under the age of six. It is unclear how medications such as methylphenidate affect child development. Some experts fear that ADHD medications may impair brain development.

Therapy in school and adolescent age

An important first measure is the so-called self-instruction training. The children give themselves their next steps in a self-instruction.

The motto “Act first, then think” is thus reversed to “Think first, then act. The ability to give oneself concrete instructions strengthens self-control and helps to rethink one’s own behavior.

Self-instruction for the treatment of ADHD can be learned in five steps:

1. The child acts according to the instructions just heard from the teacher (external behavioral control).
2. The child directs his behavior by his own self-instructions with loud speaking (overt self-instruction) .
3. The child whispers the self-instruction (hidden self-instruction).
4. The child is taught to self-direct by rehearsing the internalized self-instruction (covert self-instruction).

Behavioral therapy for ADHD

Behavioral therapy involves working with the children, their parents and also the school. The children learn to structure their everyday life and to control their behavior better. In many cases, it makes sense for a professional helper to support the children for some time at school as well.

Parent training for ADHD

An important part of ADHD therapy is parent training. To better support their offspring, parents learn a consistent but loving parenting style. This includes:

providing clear structures, expressing themselves unambiguously

bringing one’s own behavior in line with instructions

avoiding distractions from a task at hand

giving feedback on whether they find the child’s behavior positive or negative

Many parents also seek help from parent initiatives. The exchange with others helps them out of isolation and can reduce possible feelings of guilt. Often, parents of ADHD children only manage to accept their hyperactive child as he or she is thanks to the support provided by the groups.

Medication for ADHD

In less severe cases, ADHD children should only receive medication if behavioral therapy is not sufficient.

It is important to note that medication cannot cure ADHD, but it can alleviate symptoms. For this, they must be taken regularly. Many ADHD sufferers take the medication for years, sometimes even into adulthood.

ADHD medications should not be discontinued on your own!

Methylphenidate

The most commonly used medication for the treatment of ADHD is methylphenidate. It is mainly known under the trade names Ritalin and Medikinet.

Methylphenidate increases the concentration of the nerve messenger dopamine in the brain. This plays a crucial role in controlling movements, but is also important for mental drive and the ability to concentrate.

Rapid onset of action: Methylphenidate acts quickly. Users feel a clear effect after just one hour.

Individually adapted dosage: At the beginning of the therapy, the doctor determines the lowest methylphenidate dose that is effective for the patient. To do this, start with a very low dose and slowly increase it according to the doctor’s instructions – until the desired effect is achieved.

For ADHD children who need all-day stabilization, retard tablets taken once in the morning are suitable. They release the active ingredient continuously throughout the day. Regular tablet intake is not so easily forgotten. Sleep disturbances also occur less frequently.

When used properly under medical supervision, the risks of narcotics or addictive drugs are low. When misused, however, they can endanger health – for example, when methylphenidate is taken for “brain doping” (i.e., to improve brain performance).

Atomoxetine

A newer agent used to treat ADHD is atomoxetine. It tends to work somewhat less well than methylphenidate, but offers an alternative.

Unlike methylphenidate, atomoxetine is not covered by the Narcotics Act. It is approved for the treatment of ADHD from the age of six.

Substance	Methylphenidate	Atomoxetine
Mode of action	Affects dopamine metabolism in brain, increases dopamine concentration	Affects norepinephrine (NA) metabolism, NA is reabsorbed into the cell more slowly and thus acts longer
Efficacy	Helps in the majority of cases
Duration of action	1 to 3 doses per day, newer sustained-release preparations ensure duration of action of 6 or 12 hours	Continuous effect throughout the day
Experience	For more than 50 years	Approved in Germany, Austria and Switzerland since the 2000s. Study experience since 1998
Side effects	In the initial phase for 2-3 weeks: – Headache Frequent: Rarely:	Especially in the early stages: – Headache Frequently: – Decreased appetite Occasional: Rarely:
Late effects	Late effects not yet foreseeable
Danger of addiction	Properly used, no increased risk of addiction; is even reduced in ADHD (progression studies).	No danger of addiction
Contraindications	– concomitant use of drugs from the MAO inhibitor group for the treatment of depression, increased intraocular pressure (narrow-angle glaucoma)
Prescription	Narcotic / addictive drug prescription, for travel abroad confirmation of the attending physician required.	Normal prescription

Other drugs

ADHD therapy on the computer – neurofeedback

Neurofeedback is a method based on behavioral therapy. It teaches you how to positively influence your own brain activities. The method can be used with children over the age of six and adolescents if other, more effective therapies are not delayed or hindered by it.

By concentrating, the patient succeeds in keeping his brain activity at a certain level. With longer training, the learned ability can then be applied in everyday life, at school or at work.

For many children and adolescents, neurofeedback is an effective method for increasing concentration. It involves at least 25 to 30 sessions with reviews of success by the child/adolescent and parents.

Homeopathy in ADHD therapy

ADHD diet

The situation is different for children who suffer from both ADHD and a food intolerance or allergy. In these cases, a low-allergen diet improves the symptoms of ADHD in many children. Nutrition can then make a positive contribution. In addition to standard treatment, doctors therefore often recommend a change in diet. Some foods that frequently trigger allergies are, for example, dairy products, eggs, nuts, and colorants and preservatives.

ADHD: Course of the disease and prognosis

Attention deficit disorder, also called hyperkinetic disorder, is sometimes difficult to distinguish from other behavioral disorders. That is why there are no exact figures on the frequency of ADHD. It is estimated that in Germany about five percent of children and adolescents between the ages of three and 17 suffer from ADHD. Boys are affected four times more often than girls. The gender difference evens out again with increasing age.

ADHD untreated – the consequences

For people with ADHD, the correct diagnosis and appropriate treatment are essential, otherwise they will have serious problems at school or at work, as well as in social contact.

• Some do not succeed in school or learn a profession that does not match their mental abilities.
• It is harder for some to establish and maintain social relationships.
• The risk of becoming delinquent in adolescence is higher.

People with ADHD are also at high risk of developing other mental disorders. These include.

• Developmental disabilities
• Learning disorders
• Social behavior disorders
• Tic disorders and Tourette’s syndrome
• Anxiety disorders
• Depression

So far, there are no comprehensive studies on the prognosis of ADHD. It is important that ADHD is recognized and treated in good time. Professional support enables children to lay the foundations for their professional careers.

Homeopathy for ADHD

There are also alternative attempts to treat ADHD. They can complement conventional medical therapy.

The selection of homeopathic remedies that can be considered here is large. Depending on the symptoms, one uses globules based on Kalium phosphoricum (to promote the ability to concentrate) to Sulfur (to help with impulsivity and excess energy).

Nutrition for ADHD

Avoiding artificial colors and other food additives can be helpful for some ADHD sufferers.With the help of a food log, where you also note any ADHD symptoms that occur, you can confirm or disprove an existing connection with the diet.

Food allergy or intolerance

Some children suffer from both ADHD and a food intolerance or allergy. In these cases, a low-allergen diet often improves the symptoms of ADHD. The individually adapted diet can then make a positive therapeutic contribution.

According to the latest findings, the administration of omega-3 and omega-6 fatty acids cannot be recommended for the treatment of ADHD in children or adolescents, nor in adults.

ADHD: Diagnosis

ADHD can manifest itself in different ways. This makes diagnosis more difficult. Not all signs of the disorder are always present. Also, ADHD symptoms are often difficult to distinguish from age-appropriate behaviors.

ADHD diagnostic criteria

For the diagnosis of ADHD, certain criteria according to the ICD-10 classification system must be met. Typical of ADHD is an unusual degree of inattention, hyperactivity and impulsivity.

With an ADHD diagnosis, children are merely inattentive, but neither hyperactive nor impulsive.

Criterion inattention

• do not pay close attention to details or make careless mistakes
• have difficulty concentrating for long periods of time
• often do not seem to listen when spoken to directly
• often do not carry out instructions completely or do not finish tasks
• have difficulty completing tasks and activities in a planned manner
• often avoid or refuse tasks that require sustained concentration
• frequently lose things such as toys or homework books
• are easily distracted by non-essential stimuli

Criterion Hyperactivity, Impulsivity

In addition, ADHD manifests itself in at least six of the following ADHD-typical hyperactivity-impulsivity symptoms. These also occur for at least six months and are not due to an age-appropriate developmental phase. Those affected

• fidget or squirm in the chair
• dislike sitting and often leave the seat, even when sitting is expected
• often run around or climb up everywhere, even in inappropriate situations
• are usually very loud when playing
• often talk excessively
• often blurt out answers before questions are completely asked
• often have trouble waiting for their turn to speak
• often interrupt or disturb others during conversations or games

In children with ADHD, these symptoms are typically observed before the age of seven. The signs do not occur only at home or only at school, but in at least two different environments.

Questionnaires

In order to identify ADHD, specialists use special questionnaires with which various ADHD-typical behaviors can be recorded in a structured manner.

Important here are behavioral abnormalities and peculiarities that affect learning, performance or later the profession. Further topics are the family situation and illnesses in the family.

Especially for adult patients, questions about nicotine, alcohol, drug use and psychiatric disorders are also relevant.

Preparation for the doctor’s visit

Parents can prepare for the doctor’s visit, where a possible ADHD in their child is to be clarified, in the following way:

• Talk to your child’s caregivers (e.g., grandparents, caregivers at daycare, school, or after-school care) about his or her behavior.

Interviewing parents, caregivers, and teachers.

For an ADHD diagnosis in children, the specialist asks parents and other caregivers about the child’s social, learning, performance behavior and personality structure. The following questions could be part of the initial interview:

• Can your child concentrate on one activity for a long time?
• Does your child often interrupt or talk a lot?
• Is your child easily distracted?

Teachers can provide valuable information about the young patient’s intellectual performance and attention behavior. School exercise books also provide clues to a possible disorder based on order, guidance, writing and division. Report cards document academic performance.

Conversation with the child

Since these are very sensitive issues, it may be useful for parents to discuss such topics with their child before the doctor’s visit.

Physical examinations

The doctor examines the child’s motor coordination skills and assesses his or her behavior during the examination. To do this, he or she observes the child’s ability to cooperate, gestures, facial expressions, speech and vocalizations.

Behavioral observation

During the interview and examinations, the doctor observes the child and watches for behavioral abnormalities.

Sometimes video recordings help to confirm the diagnosis of ADHD. Using such recordings, medical professionals can demonstrate to parents afterwards their child’s abnormalities in facial expressions, gestures and body language, or attention lapses.

In addition, the recordings show the parents’ reaction in dealing with the child.

Differentiation of ADHD from other disorders

It is important to differentiate ADHD from other problems with similar symptoms. On a psychological level, this may be reduced intelligence or dyslexia, for example. Obsessive-compulsive disorder can also cause ADHD-like hyperactivity.

Many misdiagnoses

Experts believe that ADHD is often diagnosed prematurely in children. Not every particularly active or lively child has ADHD. Some children may simply not get enough exercise to get their energy out.

Others need more withdrawal and recovery moments than other children and are therefore over-excited. In that case, lifestyle changes are often enough to ease the situation.

ADHD: Giftedness is rare

When children fail at school, it is not necessarily due to a lack of intelligence. Some children with ADHD have above-average intelligence and yet have great difficulty in class. However, the combination “ADHD + giftedness” is rather rare.

Children are considered highly gifted if they score above 130 on an intelligence test. Such children are usually characterized by a particularly good ability to concentrate, which does not exist in ADHD.

ADHD: Course of the disease and prognosis

ADHD is not a disorder that simply “grows out”. In some children, the symptoms disappear over the years, but in about 60 percent they persist throughout their lives.

By the way: ADHD has no effect on life expectancy. This corresponds to that of people without attention deficit hyperactivity disorder.

ADHD prognosis – consequences without treatment

For people with ADHD, the correct diagnosis and appropriate treatment are essential, otherwise they can have serious problems at school or at work, as well as in social contact.

• Some do not succeed in school or learn a profession that does not match their mental abilities.
• The risk of delinquency in adolescence is higher for ADHD.
• They are more likely to have accidents, including serious ones.
• People with ADHD are also at high risk of developing other mental disorders. These include
• Developmental disabilities
• Learning disorders
• Social behavior disorders

• Tic disorders and Tourette syndrome
• Anxiety disorders
• Depression

So far, there are no comprehensive studies on the prognosis of ADHD. It is important that ADHD is recognized and treated in good time. Professional support enables children to lay the foundations for their professional careers.