Which doctor should children or adults with suspected ADHS go to?
The first point of contact is the paediatrician for children and the family doctor for adults. With enough experience, both can make the diagnosis and initiate the treatment. In case of doubt, however, they are dependent on the psychologist or psychiatrist and other specialists, as ADHD is a very complex disease with a wide variety of symptoms. Not only the diagnosis but also the therapy is very diverse and requires the cooperation of different specialists. Early involvement of the various disciplines is therefore advisable.
Frequency of occurrence
Due to the different external, sometimes much more unpleasant manifestations of ADHD, it is usually diagnosed more frequently and, as a rule, more quickly. According to current studies, the frequency of ADHD is assumed to be between 3 and 10% of the population, with 3 – 6% of the population aged 6 to 18 years (3 – 4% children of primary school age, approx. 2% adolescents).
The ratio between ADHD and ADHD is estimated at about 1/3 to 2/3, so that an ADHD frequency of 2 to about 7% can be assumed. Studies have also shown that boys are affected by AD(H)D about 7 times more often than girls. Even in adults, AD(H)S is not to be discounted.
It is assumed that about 1% of the adult population suffers from AD(H)S, although the studies and investigations show country-specific differences. However, it is not possible to determine why there are country-specific differences, since not only actual differences but also the different state of scientific research play a role. Twin studies could confirm that a genetic component of AD(H)S cannot be discussed away and that identical twins are usually affected together by the corresponding symptomatology.
Historical view of ADHS
Historically known is the history of the fidgeting philipp, which was first published in 1846 by Heinrich Hoffmann, a doctor from Frankfurt. It is often said that Hoffman himself suffered from the fidgeting syndrome or at least wanted to draw attention to it. This may be true, but it should also be remembered that perhaps he simply wanted to achieve an entertainment factor with his book.
This could be confirmed by the fact that Hoffman was not yet a neurologist at the time of writing his book. While in the children’s book the bad habits were still smiled at, in the following years the search for the causes began. Similar to the history of dyslexia, there are different directions that were taken, different opinions and views.
Parallels to the history of dyslexia become apparent: possible causes are accepted, revoked, postulated anew. In the 30’s it was found out rather by chance that special drugs sedate hyperactive children. Wilhelm Griesinger, a Berlin psychiatrist, explained in 1845 that hyperactive children cannot process the external stimuli in the brain appropriately and therefore problems/deviations from the norm must be present in the brain area.
Since even then there was controversial discussion, counter-opinions quickly developed. Thus one tried to relativize Griesinger’s statements and attributed the problems to a hasty development (“hypermetarmorphosis”). In the early 20th century, education was given a great deal of responsibility.
Groups arose which classified overactive children as difficult to educate. In the 60’s, a brain disorder was assumed to be the cause of ADHD and treated accordingly. As early as 1870, inheritance was not excluded, but increasing social pressure was also pointed out.
The increasingly important virtues like punctuality, order, obedience, … could not be fulfilled by all children in the same way. Later the multi-causal approach (= caused by many factors) became more and more popular: Various factors were considered as the cause of its development: minimal cerebral dysfunction (MCD, a form of brain damage), heredity (genetic transmission), consequences resulting from the changed society. Since the 90’s, the neurobiological explanatory approach, which is described below, has emerged as another possible cause.
However, it can also be assumed that several factors play a role in its manifestation. First and foremost, the changed childhood, but also the changed family situation. The scientific attempts to explain this were made in all fields of medicine, psychology, but also pedagogy.
Perhaps it should be remembered, however, that there can be no such thing as the classic ideal solution that is valid for everyone. The problems are very individual and therefore require an individual therapy for ADHD. Until today two contrary and extreme positions have been maintained in principle. These are on the one hand those who believe that AD(H)S should in principle be treated with medication and on the other hand those who believe that a goal can only be achieved through therapy and changed educational measures and that medication should be avoided. Most forms of therapy today can be found between these two views.