Attention deficit disorder can occur in the context of mental and neurological disorders. Attention deficit disorder is one of the central features of attention deficit disorder with or without hyperactivity (ADHD or ADD).
What are attention deficit disorders?
Attention is a cognitive performance that consists of different parts. In an attention disorder, at least one of these functions is impaired. Vigilance or wakefulness is also called sustained attention. It is not focused on a specific task, but describes a basic state of the nervous system. In the case of a vigilance disorder, the affected person is unable to maintain his or her attention for a prolonged period of time. Vigilance also plays an important role in connection with other aspects of attention. Alertness, or attentional activation, serves to put the psyche in a general “state of alert” in which the person can respond quickly to relevant stimuli. Executive attention represents another facet. It is consciously controlled and serves, for example, to specifically block out unimportant stimuli or to direct attention to a specific object. In everyday life, many people understand an attention disorder to mean that the person affected is easily distracted. This is a disorder of selective attention. With the help of selective attention, a person chooses relevant stimuli and reacts to them appropriately. If, on the other hand, divided attention is disturbed, the affected person can only process one task at a time. When confronted with at least two tasks, on the other hand, his performance drops significantly.
Causes
Attention deficits may result from neurological diseases. They may occur after a stroke or be triggered by a brain tumor. Attention deficits may also result from traumatic brain injury, inflammation of the central nervous system, or dementia-related syndrome. Many mental illnesses are accompanied by attention and concentration disorders. This is true, for example, of depression, schizophrenia, and autism. Various causes are discussed for attention deficit hyperactivity disorder (ADHD). Genetic factors probably influence the development of ADHD. Researchers also found structural differences in the brain that distinguish people with ADHD from others. Measurements of brain activity also show differences. Psychological and social factors also play a role in the development of ADHD. Among experts, however, it is disputed whether the family and the social environment actually cause ADHD or whether they merely intensify the symptoms. Boys are more often affected by ADHD than girls. The gender difference is greater in the predominantly hyperactive and impulsive type of ADHD.
Symptoms, complaints, and signs
Attention deficit disorder typically affects many cognitive performances. The patient often feels that he cannot concentrate. He may appear “scatterbrained” and distracted. Tasks that require attention are difficult for the affected person and he performs worse than would be expected. This is true even if intelligence is unchanged. However, especially in the case of a stroke, other partial performances of intelligence may also be impaired. A vigilance disorder manifests itself in the patient’s ability to maintain attention for less than half an hour. In other attention disorders, affected individuals may have trouble following a conversation or driving a car. ADHD is characterized by three central symptoms: Attention Deficit Disorder, Impulsivity, and Hyperactivity. For attention deficit hyperactivity disorder to be diagnosed, symptoms must last longer than six months. In addition, they must not be due to another cause. The symptoms of ADHD appear before the age of seven. If the symptoms begin only by the time the child starts school and there were no signs of ADHD before, other explanations than the syndrome must be considered. In ADHD, the cardinal symptoms are present not only qualitatively, but also quantitatively. Every child is occasionally inattentive and hyperactive. Since children have yet to learn to control themselves, they are more impulsive than adults.However, in ADHD, these signs are much more pronounced than in other children who are the same age and have the same level of mental development.
Complications
Attention deficit disorder affects all areas of life. Even the ability to work can suffer. People with attention disorders are often underestimated by others or labeled as “stupid.” As a result, various psychological complications can develop: Depression is a common reaction to continuous put-downs. The attention deficits may also cause the patient to feel inferior. He may even blame himself for his performance deficits. Anxiety is another possible complication. If the attention deficits result from a neurological disease or an event such as a stroke, other cognitive performances may also be affected. If so, speech disorders, memory problems, perceptual problems, and orientation problems, among others, are possible. ADHD may be associated with other mental illnesses and problems. In children, oppositional behavior disorder or aggressive-dissocial behavior disorder often occurs. One-third to one-half of children with ADHD exhibit such a behavioral disorder. Learning disorders are somewhat less common. Children with ADHD are more likely than other children to have dyslexia or dyscalculia. They suffer more often from tic disorders such as Tourette syndrome. Other possible complications include anxiety disorders and depression. In some cases, an eating disorder may develop as a complication. Some teens and adults with ADHD use drugs and alcohol as self-medication. This can lead to substance dependence. Harmful use of drugs and alcohol is also more common than average in this group of people. Possible complications include poisoning, delirium, or traffic accidents.
When should you see a doctor?
Mild attention deficits are not always a reason to go to the doctor. They can also occur as a result of a cold or other mild infection. In addition, attention fluctuates throughout the day, which is perfectly normal. However, a visit to the doctor is advisable if attention worsens and no cause is apparent. If symptoms occur that indicate a stroke, a doctor should be consulted immediately or an emergency physician should be called. If symptoms are unclear, a general practitioner or pediatrician is often the first point of contact. Depending on the cause, further treatment can be provided by a neurologist, psychiatrist, psychotherapist or child and adolescent therapist. The diagnosis of ADHD should always be carried out by a specialist. Some patients suffer predominantly from psychological complaints, while the attention disorder accounts for only a small proportion. This may apply to depression, for example. In this case, those affected can also turn directly to a psychotherapist. A referral is not necessary for this in Germany.
Diagnosis
Attention can be measured with neurocognitive tests. Such tests are usually guided and evaluated by a psychologist, psychotherapist, or psychiatrist. Different aspects of attention should be assessed. The everyday complaints that the patient describes are also included in the diagnosis. A well-known test that measures concentration is Brickenkamp’s “d2”. The patient is given a worksheet on which rows of letters with and without dashes are shown. Within a given time, he or she ticks all the “d “s that have two dashes. The worksheet also contains other letters such as “b” and letters with different numbers of dashes. To make a neurological diagnosis or to rule out such a cause, an EEG, CT or MRI is often performed. These procedures show brain activity or make the structure of the brain visible. Doctors can use them to assess whether abnormalities are present. A brain tumor or advanced dementia-like syndrome can usually be seen on these images. ADHD diagnostics are very complex. Different perspectives should be taken into account for children and adolescents, e.g. from parents and teachers, if possible also from different teachers. Standardized questionnaires are used to record the child’s behavior.One example is the “Strengths and Weaknesses Questionnaire” by Klasen, Woerner, Rothenberger and Goodmann. For adults, there is the “ADHD Screening for Adults” by Schmidt and Petermann or the “Adult Self-Report Scale” of the World Health Organization. In this questionnaire, the affected person indicates which of the described symptoms he recognizes in himself. The “ADHD Screening for Adults” is only the beginning of the diagnostic process. A screening basically only records rough characteristics. This allows a doctor or psychologist to decide whether a detailed ADHD diagnosis is worthwhile or whether the cause of the attention deficit disorder is probably something else. Necessary differential diagnoses of ADHD include childhood behavior disorders, impulse control disorders, tic disorders, epilepsy, and other neurological disorders. In adolescents and adults, differentiation from emotionally unstable personality disorder is also necessary.
Treatment and therapy
Treatment of attention deficit disorder depends on the underlying cause. A stroke must be treated promptly to increase the likelihood of survival and minimize the consequences. This is often followed by neurological rehabilitation. Surgery may be considered after a traumatic brain injury or for a brain tumor. In the case of a brain tumor, radiation and/or chemotherapy may also be used. Treatment is always individualized to the patient. Neurological and psychiatric disorders may be treated with medications. One known agent used for ADHD is methylphenidate. However, AHSD and ADHD should also be treated psychotherapeutically. Especially in children, social therapeutic or (professional) educational approaches may also be used. It is important that parents are also involved in the treatment. Various trials with neurofeedback have also been successful in ADHD. Co-therapies such as occupational therapy can be useful in attention deficit disorders, as they train attention and contribute to a comprehensive treatment. Occupational therapy is a component of neurologic rehabilitation after stroke and may also be considered for dementia or ADHD.
Outlook and prognosis
The prognosis for attention deficit disorder is particularly favorable when the cause is treatable. In other cases, symptoms can be alleviated. There are major differences between different disorders, as well as between individuals. In scientific studies, the best effects for ADHD therapy are shown with medication and cognitive behavioral therapy. Both can also be used together. In most cases, symptoms decrease in adulthood. Adults with ADHD may have more nonspecific symptoms – so it is controversial whether these cases are still ADHD in the disease sense.
Prevention
Only indirect prevention is possible for attention deficit disorders that are neurologically based. A healthy lifestyle helps reduce the risk of stroke. Overweight individuals should reduce their weight to normal levels. Elevated cholesterol and smoking increase the risk of stroke and should therefore be avoided. Sufficient physical activity is also useful in preventing stroke. Lifestyle factors could also play a role in the development of brain tumors and other cancers. For example, various studies point to the importance of a healthy diet with plenty of vegetables and fruit. Targeted ADHD prevention is not possible because psychosocial factors are probably not the cause of the disease. They only seem to intensify the symptoms. However, good parenting behavior may be able to reduce the intensity of ADHD.
Here’s what you can do yourself
Ease of distractibility is a fundamental problem in many attention deficit disorders. It can be taken into account when designing the environment. Work spaces such as the office, home office, or sitting area at school should be free of distracting stimuli. A tidy desk and low noise level also help people without attention deficit disorder to concentrate better on their tasks. In many cases, attention can be trained by those affected constantly challenging themselves and being challenged by their environment. However, this is not always possible.In any case, excessive demands should be avoided, as this leads to frustration. Attention can be trained in many everyday activities:
- Reading (calms, organizes and structures thoughts and nerves).
- Watch a movie and then summarize
- Hold a longer conversation (also trains social skills, reasoning skills and logical thinking).
- Solve puzzles (e.g. Sudoku or crossword puzzles).
- Assemble a puzzle
- Crafting
- Write a letter
- … and much more
People with ADHD often helps to give themselves more space. Some do a lot of sports to live out the increased urge to move, while others consciously meditate or practice deep relaxation. Both together are also possible. However, these measures are no substitute for medical or psychotherapeutic treatment. In particular, neurological diseases such as tumors, strokes or dementia require medical treatment.
