ADHD

ADHD: brief overview

• Symptoms: Common symptoms include poor attention and concentration, pronounced restlessness (hyperactivity), impulsiveness, and, in some cases, daydreaming
• Causes and risk factors: ADHD is primarily believed to be influenced by genetics, with unfavourable environmental factors potentially acting as triggers
• Therapy: Behavioural therapy is a common treatment approach, often combined with medication such as methylphenidate or atomoxetine. Parent training can also be beneficial
• Diagnosis: Diagnosis involves assessing typical characteristics, observing behaviour, and ruling out other mental and physical disorders as the cause of the symptoms
• Impact of ADHD: ADHD can lead to difficulties in learning or work, behavioural problems, and challenges in interpersonal relationships
• Prognosis: ADHD often persists into adulthood, with a transition to “ADD” (Attention Deficit Disorder) as hyperactivity diminishes. Without treatment, it can have significant consequences on both professional and personal aspects of life

ADHD: Symptoms

When children or adults display restlessness, lack of focus, disorganization, uncontrollable impulsiveness, or persistent daydreaming, it could indicate the presence of Attention Deficit Hyperactivity Disorder (ADHD). This condition is colloquially referred to as “Zappelphilipp.”

As per the definition of ADHD, the disorder is characterized by the following primary symptoms:

• Poor attention and difficulty concentrating
• Pronounced impulsiveness
• Intense restlessness and hyperactivity

ADHD Symptoms – Three Subgroups

ADHD symptoms can vary in severity. Not all signs are always present in one patient. Overall, there are three subgroups of ADHD:

• Predominantly hyperactive-impulsive type: “Zappelphilipp”
• Mainly attention-deficient type: “Hans-look-in-the-air” or “dream girl” (attention deficit type, ADD)
• Mixed type: attention deficit disorder and hyperactive

In severe cases of ADHD, individuals may struggle with a distance-proximity issue. This means they have difficulty finding the right balance between being too distant or too close to their surroundings.

On one hand, affected individuals may appear distant, withdrawn, frequently speaking loudly and with scattered thoughts. On the other hand, they may seek excessive closeness, exhibiting high levels of empathy or becoming engrossed in a lecture to the point of forgetting their surroundings.

Consequently, individuals with ADHD may come across as either emotionally detached or overly sensitive to outsiders.

ADHD symptoms by age group

ADHD is recognized as a congenital disorder that typically becomes evident before the age of six and often persists throughout a person’s life. However, the symptoms of ADHD manifest differently in babies, toddlers, adolescents, and adults.

Early Signs in Infants

Diagnosing ADHD in infants is challenging. However, long-term studies have identified a connection between ADHD and regulatory disorders, which include difficulties in eating, digestion, and sleep problems. Babies with regulatory disorders often cry frequently and for extended periods, experience sleep disturbances, and may exhibit restlessness and irritability. Some infants who later develop ADHD may display an aversion to physical contact. It’s important to note that such behaviours can have various causes, and only around one-third of infants displaying these behaviours are eventually diagnosed with ADHD.

ADHD symptoms in infancy

Detecting ADHD in young children is also challenging. Toddlers with ADHD tend to cry excessively, show little interest in playing, and struggle with attention. Restlessness and hyperactivity are common ADHD symptoms at this age.

• Social Issues: ADHD can significantly impact both the child and their parents, as affected children may struggle with disruptive behaviour and have difficulties socializing and making friends
• Poor Concentration: Toddlers with ADHD find it challenging to concentrate on quiet activities for extended periods. They often switch quickly from one game to another, and their unpredictable behaviour may lead to more frequent accidents
• Defiant Behaviour: Children with ADHD often exhibit more intense defiant behaviour compared to their peers. They may interrupt conversations and constantly make noises, testing their parents’ patience
• Language Development: Language acquisition in young children with ADHD may occur earlier than average or be delayed
• Poor Motor Coordination: Many children with ADHD struggle with fine and gross motor coordination, making tasks involving crafts or precise movements difficult for them

ADHD symptoms in elementary school age

Some of the most common ADHD symptoms at this age include:

• Low tolerance for frustration and tantrums when things don’t go your way
• Inappropriate facial expressions and gestures
• Excessive speaking and interrupting others
• Clumsiness and frequent accidents while playing
• Low self esteem
• Can have difficulty following rules (at school, affected children are therefore often seen as “nuisances” and “spoilsports”)
• Slow and unsystematic task solving
• Fast distractibility
• Difficulties in reading, spelling or arithmetic
• Often poorly legible writing and chaotic order behaviour

All these symptoms often make grade school kids with ADHD misfits.

For teachers, ADHD signs such as being disruptive in class and highly distractible are challenging. Not every affected child is constantly fidgeting, but all children with ADHD syndrome are out of the ordinary.

ADHD symptoms in adolescence

During adolescence, individuals with ADHD often remain inattentive and may develop a “don’t care” mentality. They may refuse to perform tasks and adopt an aggressive anti-attitude. While some of these behaviours are common during puberty, they are more pronounced in individuals with ADHD. Adolescents with ADHD are also prone to risky behaviours, often gravitate towards socially marginalized groups, and may be vulnerable to substance abuse. Many experience low self-esteem, anxiety, and depression. However, some adolescents may see a decrease in restlessness and impulsivity over time.

ADHD Symptoms in Adults

Hyperactivity tends to diminish after puberty, and ADHD in adulthood is often referred to as Attention Deficit Disorder (ADS). Adults with ADHD primarily exhibit symptoms such as clumsiness, forgetfulness, and disorganization. Impulsive behaviour and ill-considered actions may still be present. Unfortunately, ADHD often goes undetected in adulthood, as the symptoms may be perceived as part of the individual’s personality. If left untreated, ADHD can have significant effects on social relationships, career, and overall life satisfaction. Adults with ADHD are more prone to taking unnecessary risks due to impulsiveness, which can lead to harm. Additionally, comorbid mental illnesses such as depression, anxiety disorders, substance abuse, and addiction may develop. However, with proper management, adults with ADHD can harness their characteristic creativity and thrive in various aspects of life.

Positive Symptoms: ADHD can also have benefits

ADHD can present positive aspects as well. Individuals with ADHD often possess great mental flexibility and demonstrate exceptional creativity. When engaged in a task that inspires them, they exhibit high levels of motivation and remarkable productivity. During such instances, they can concentrate their full attention on the task at hand and achieve significant success.

People with ADHD also tend to have a strong connection to their emotions and are often perceived as highly helpful individuals. Their sense of justice is notably pronounced. Despite the numerous challenges brought about by their symptoms, individuals with ADHD often discover remarkable coping strategies to navigate their daily lives.

Difference ADD – ADHD

While individuals with Attention Deficit Disorder (ADD) struggle with inattention and difficulties in concentration, they do not display hyperactivity. They fall under the “dreamy” subtype of ADHD. Consequently, there is no fundamental distinction between ADD and ADHD.

Children with ADD may be less noticeable compared to their hyperactive counterparts. As a result, the disorder often goes unrecognized in them. However, they still encounter significant challenges in school. Additionally, they tend to be highly sensitive and easily affected by emotional stimuli.

ADHD and Autism

ADHD and autism commonly coexist, posing challenges in distinguishing between the two diagnoses due to their overlapping symptoms. It can be challenging to determine whether a particular symptom specifically aligns with ADHD or serves as evidence supporting an autism diagnosis.

ADHD: causes and risk factors

The precise reasons why some children develop ADHD remain unclear. However, it is well-established that genetic factors play a significant role. Complications during pregnancy and childbirth, as well as environmental influences, may also contribute to its development.

Organic changes in the brain serve as the pivotal mechanism in the onset of ADHD. When combined with a genetic predisposition, environmental factors can act as triggers for the condition.

Contrary to past assumptions, ADHD is not a modern ailment linked to civilization. Improper upbringing, poor diet, or excessive media consumption do not cause ADHD, although they can potentially exacerbate the condition. These factors have an adverse impact, but they are not the primary cause.

Genetic causes

Researchers hypothesize that genes contribute to approximately 70 percent of ADHD development. It is often observed that parents, siblings, or other family members of individuals with ADHD also have the condition. The risk of ADHD is notably heightened, particularly among boys, when a parent has been diagnosed with the disorder.

Signal interference in the head

Scientists suspect that malfunctions in the brain are the primary underlying cause of ADHD. Certain regions of the brain exhibit inadequate activity, akin to being in a dormant state. These regions include the frontal lobes, as well as specific areas of the basal ganglia and cerebellum.

These brain regions play crucial roles in attention, execution and planning, concentration, and perception. In ADHD, there is a deficiency in the concentration of specific neurotransmitters, which are vital for communication between nerve cells in these brain regions.

These neurotransmitters include serotonin, which regulates impulse control, as well as norepinephrine and dopamine, which are essential for alertness, drive, and motivation.

Missing filters

Our brains constantly receive an abundance of information, but not all of it reaches our conscious awareness. A filtering mechanism serves as a protective barrier against sensory overload and helps us discern the important from the unimportant. In children with ADHD/ADD, this filtering process is insufficient. Their brains struggle to effectively filter out irrelevant information. Consequently, they are confronted with a multitude of stimuli simultaneously, leading to a sense of overwhelm.

As a result, individuals with ADHD/ADD find it challenging to maintain focus. The unfiltered influx of information contributes to their restlessness and tension. Even seemingly subtle distractions, like the sounds of classmates, can divert their attention from the teacher’s instruction.

While children with ADD, without the hyperactivity component, may exhibit quieter behaviour, they encounter similar difficulties in sustaining attention as their more visibly restless counterparts.

Environmental influences

Environmental factors, including toxins and food allergies, are suspected to contribute to the development of ADHD and ADD. The consumption of alcohol and drugs during pregnancy, as well as conditions like oxygen deprivation during birth, premature birth, and low birth weight, can increase the risk of ADHD in children.

Moreover, the circumstances in which a child grows up can impact the course of the disorder. Unfavourable conditions may include:

• Insufficient emotional attention or extreme neglect
• Residing in institutional care
• Living in cramped conditions
• Witnessing constant parental conflicts
• Growing up in an incomplete family structure, such as with a single parent or without parents altogether
• Presence of parental mental illness
• Negative parenting behaviours, particularly from the mother
• Excessive noise exposure
• Absence or incomprehensibility of structures
• Limited opportunities for physical exercise
• High levels of time pressure
• Excessive media consumption

These environmental factors can potentially influence the manifestation and progression of ADHD and ADD.

ADHD: Therapy

While ADHD cannot be cured, there are various therapy methods that can significantly alleviate or stabilize its symptoms, enabling individuals to lead a life with minimal long-term restrictions. An individually tailored combination of different therapeutic approaches is key to achieving positive outcomes.

The following components form the foundation for successful ADHD treatment in children:

• Providing education and guidance to parents, the child/adolescent, and educators or class teachers
• Collaborating with educators and teachers in settings such as kindergarten or school
• Parent training and involvement of the family, including family therapy, to reduce symptoms within the family environment
• Cognitive-behavioural therapy for children/adolescents (typically starting from school age), which focuses on developing impulse control, improving organization, and fostering self-management skills to address problematic behaviours
• Medication (usually amphetamines like methylphenidate) to alleviate symptoms in school, day-care, family, or other settings

The combination of medication, behavioural therapy, and parent training has proven to be highly effective. However, the specific combination and utilization of these approaches may vary based on the child’s age and the severity of their ADHD symptoms.

ADHD therapy according to age

ADHD treatment is adjusted to suit the age of the individual receiving treatment. This is necessary because certain medications may only be approved or effective for specific age ranges. Additionally, younger children are still undergoing mental maturation, so doctors need to consider their ongoing developmental needs.

Therapy in preschool

During the preschool years, the focus is primarily on parent training and educating the child’s environment about the disorder. Cognitive therapy is typically not applicable at this stage. If children struggle with sustaining attention for extended periods, play-based training can help develop this ability. Some clinics offer specialized programs like mother-child therapy, combining learning training and relationship work as part of ADHD treatment. However, caution is advised when considering medication for preschool children with ADHD. There is limited experience with using medications such as methylphenidate in children under six, and the impact of these drugs on child development remains unclear. Some professional’s express concerns about potential interference with brain development.

Therapy in school and youth

Education, guidance, and parent training form the foundation of therapy for individuals with ADHD in school and adolescence. An important first measure is the so-called self-instruction training. In a verbal self-instruction, the children specify their next steps.

An important technique introduced at this stage is self-instruction training. In this approach, children learn to give themselves specific instructions, reversing the “act first, think later” approach to “think first, then act.” Self-instruction training is typically taught in a series of five steps, progressing from external behavioural control to internalized self-instruction. If children or adolescents continue to experience significant restlessness or aggression despite therapy and training, additional medication may be considered as a supplementary option.

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

1. The therapist or educator speaks the “self-instructions” as a model and acts accordingly
2. The child acts according to the instructions just heard from the teacher (external behavioural control)
3. The child steers its behaviour through its own self-instructions by speaking out loud (open self-instruction)
4. The child whispers the self-instruction (hidden self-instruction)
5. The child should learn to control itself by practicing internalized self-instruction (covert self-instruction)

By tailoring ADHD therapy according to age, healthcare professionals can provide targeted interventions that consider the unique needs and developmental stage of each individual. If children / young people are extremely restless or aggressive despite therapy and training, additional medication can be useful.

Behavioural therapy for ADHD

Behavioural therapy for ADHD involves collaboration between the children, their parents, and the school. The aim is to help children establish structure in their daily lives and improve their behavioural control. In some cases, it can be beneficial to have a professional helper provide support to the children at school for a period.

Practicing in simulated situations can also be valuable. Through role-playing activities, such as interacting with peers, children with ADHD can practice specific behaviours in practical scenarios that they can later apply at home or in school. If they receive recognition during this process, they are more likely to integrate the new behavioural patterns into their repertoire effectively.

Parent training for ADHD

Parent training is a crucial component of ADHD therapy, aiming to equip parents with effective strategies to support their children. Parents learn to adopt a consistent yet nurturing parenting style, which includes the following approaches:

• Establish clear structures and communicate with clarity
• Align their own behaviour with the provided instructions
• Minimize distractions when the child is engaged in a task
• Provide feedback to the child regarding their behaviour, indicating whether it is positive or negative
• Implement a system of clear rewards for desired behaviour

Many parents also find support through parent initiatives or support groups. Sharing experiences with others helps them overcome feelings of isolation and can alleviate potential feelings of guilt. By receiving support from these groups, parents of children with ADHD can better accept and understand their hyperactive child for who they are.

Medication for ADHD

Medication is prescribed for ADHD to address severe symptoms that significantly impact daily functioning. These medications are generally fast-acting and effective. In cases of severe behavioral problems, medication can often create a foundation for behavioral therapy.

For less severe cases, medication should be considered only if behavioral therapy alone is insufficient in managing the symptoms of ADHD.

It is important to understand that medication does not cure ADHD, but rather helps alleviate symptoms. To achieve this, medication needs to be taken consistently. Many individuals with ADHD take medication for several years, and sometimes into adulthood.

Regular check-ups with the treating doctor should occur at least once a year to assess the progress of the disorder and determine whether the prescribed medication and dosage remain optimal. If ADHD symptoms have significantly improved over an extended period, it may be possible, in consultation with a doctor, to discontinue medication.

Note: ADHD medication should not be discontinued on your own!

Methylphenidate

The most commonly prescribed medication for ADHD is methylphenidate, which is widely recognized under the trade names Ritalin and Medikinet.

Methylphenidate is not a sedative but belongs to the group of psychostimulants known as amphetamines. Despite the initial contradiction, as children with ADHD are already hyperactive, its use is meaningful. Methylphenidate works by increasing the concentration of the neurotransmitter dopamine in the brain. Dopamine plays a crucial role in regulating movement, mental drive, and concentration.

By increasing dopamine levels, methylphenidate reduces inattention and restlessness while enhancing concentration in the majority of ADHD children. It allows some children to participate in classroom activities and facilitates easier social interactions.

Quick onset of action: Methylphenidate takes effect rapidly, with noticeable results within one hour of consumption.

Individualised dosage: When starting treatment, the doctor determines the lowest effective dose of methylphenidate for each patient. The dosage begins with a very low amount and is gradually increased according to the doctor’s instructions until the desired effect is achieved.

The target dose varies from person to person. Some individuals with ADHD may only require a single low-dose tablet per day, while others may need to take up to three high-dose tablets daily.

Sustained-release tablets, taken once in the morning, provide continuous stabilisation throughout the day for ADHD children who require it. These tablets release the medication gradually, ensuring regular intake and reducing the likelihood of insomnia.

Legal regulations: Methylphenidate is classified under the Narcotics Act (Germany, Switzerland) or the Narcotic Drugs Act (Austria). To prevent misuse, doctors may only prescribe these medications for a limited duration and using special prescription forms designated for controlled substances. However, methylphenidate does not have physically addictive effects.

When used appropriately under medical supervision, the risks associated with narcotics or controlled drugs are low. Nevertheless, improper use, such as taking methylphenidate for “brain doping” to enhance cognitive performance, can pose health risks.

Atomoxetine

Atomoxetine is a more recent medication used for the treatment of ADHD, offering an alternative to methylphenidate. Although it may be slightly less effective than methylphenidate, it still serves as a viable option.

One of the primary mechanisms of atomoxetine is increasing the concentration of the neurotransmitter norepinephrine in the brain. It achieves this by slowing down the breakdown of norepinephrine, allowing the messenger to remain active for a longer duration and thereby improving signal transmission in the brain.

Unlike methylphenidate, atomoxetine does not fall under the Narcotics Act. It has received approval for the treatment of ADHD in individuals from the age of six.

Substance	Methylphenidate	Atomoxetine
Mode of action	Acts on dopamine metabolism in the brain, increases dopamine concentration	Affects norepinephrine (NA) metabolism, NA is reabsorbed more slowly into the cell and thus acts longer
Effectiveness	Helps in most cases	Effectiveness rather lower than that of methylphenidate, may be effective in patients not responding to methylphenidate
Duration of action	1 to 3 doses per day, newer slow-release preparations ensure a 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:	Especially in the early stages:
	– headache	– headache
	– stomach upset	– dry mouth (adults)
	– increased irritability	– abdominal pain
	– nausea and vomiting	– decreased appetite
	Common:	– nausea and vomiting
	– loss of appetite	– constipation
	– weight loss	– tiredness
	– drowsiness	– mood swings
	– muscle twitching / tics	Frequently:
	– allergic skin reactions	– decreased appetite
	Rarely:	– weight loss
	– increase in blood pressure and pulse	– slight increase in blood pressure and heart rate
	– rare reports of an increase in liver values ​​or inflammation of the liver (hepatitis)	Uncommon:
	– slows down growth and weight gain in children	– allergic reactions
		Rarely:
		– additional behavioural disorders with an aggressive component
		– very rare reports of an increase in liver values, jaundice or liver inflammation (hepatitis)
		– slows down growth and weight gain in children, probably only temporarily
Late Effects	No increased rate of late effects, fears of Parkinson’s disease or brain damage cannot be proven.	Late consequences not yet foreseeable
Addictive	If used correctly, no increased risk of addiction; is even reduced in ADHD (history studies).	No risk of addiction
Contraindications	– epileptic seizure disorders	– concomitant use of medicines from the drug group MAO inhibitors used to treat depression
	– anxiety and tension	– increased pressure in the eye (narrow-angle glaucoma)
	– increased intraocular pressure
	– Tourette’s syndrome
	– simultaneous use of drugs from the drug group of MAO inhibitors for the treatment of depression
	– hyperthyroidism
	– severe angina pectoris
	– cardiac arrhythmias
	– severe high blood pressure
	– severe depression
	– anorexia
	– psychoses
	– tic – Disorders
	– drug abuse
	– alcohol or drug abuse
	– pregnancy and breast-feeding
	– prostate enlargement
	– recent onset stroke
Regulation	Narcotic / narcotic drug prescription, confirmation from the treating doctor required for trips abroad.	Normal recipe

More medication

If methylphenidate and atomoxetine are not effective enough, healthcare professionals may consider prescribing various alternatives such as neuroleptics, antidepressants, tranquilizers, other amphetamines, as well as fenetylline and pemoline.

ADHD therapy on the computer – neurofeedback

Neurofeedback is a form of therapy rooted in behavioral techniques. It involves learning how to positively influence one’s own brain activity. This method is suitable for children aged six and above, as well as adolescents, as long as it does not hinder or delay more effective therapies.

During neurofeedback sessions, electrodes are attached to the patient’s scalp to measure and display their brain waves on a monitor. This measurement technique is known as electroencephalography (EEG).

Through concentration and focus, the patient learns to regulate their brain activity within a specific range. With continued training, this learned skill can be applied in everyday life, such as at school or work.

Neurofeedback has been found to be an effective method for improving concentration in many children and young people. Typically, it involves a series of at least 25 to 30 sessions, with regular reviews of progress involving the child and their parents.

Recent studies indicate that the benefits of neurofeedback training persist even after six months.

Homeopathy in ADHD therapy

In ADHD therapy, alternative approaches are sometimes explored to complement conventional medical treatments. One such approach is homeopathy, which some parents and patients believe may help alleviate symptoms. There is a wide range of homeopathic remedies available, with options like globules containing potassium phosphoricum believed to enhance concentration abilities, and sulphur used to address impulsiveness and excessive energy, depending on the specific symptoms experienced.

Diet for ADHD

A balanced and nutritious diet should be prioritized for individuals with ADHD. While some parents have observed that fast food and a high-sugar diet can exacerbate their children’s hyperactivity, the scientific evidence linking such diets to ADHD is inconclusive. However, eliminating artificial colours and other food additives may be beneficial for certain individuals. Keeping a diet journal to track ADHD symptoms can help determine if there is a correlation with diet. Consulting a nutritionist is advisable to prevent nutrient deficiencies and potential harm.

For children with both ADHD and food intolerance or allergies, a low-allergen diet has been found to improve ADHD symptoms in many cases. Dietary changes are often recommended by doctors in addition to standard treatment in such situations. Common allergenic foods to consider avoiding include dairy products, eggs, nuts, as well as foods containing colouring and preservatives.

Regarding the use of omega-3 and omega-6 fatty acids, current findings do not support their recommendation for children, adolescents, or adults with ADHD.

ADHD: disease course and prognosis

The attention disorder, also known as hyperkinetic disorder, can be challenging to differentiate from other behavioral issues, making it difficult to determine its exact prevalence. However, it is estimated that approximately five percent of children and young people in Germany, aged three to 17, experience ADHD. Boys are four times more likely to be affected than girls, although this gender difference tends to diminish as they grow older.

ADHD is not a condition that simply disappears with time. While some children may see a reduction in symptoms as they age, around 60 percent of individuals continue to experience ADHD throughout their lives.

ADHD untreated – the consequences

Without the proper diagnosis and appropriate treatment, individuals with ADHD can face significant challenges in various aspects of their lives, including school, work, and social interactions. The consequences of untreated ADHD can be severe:

• Some individuals may struggle to complete their education or pursue a career that aligns with their cognitive abilities
• Forming and maintaining social relationships can be more difficult for some
• There is an increased risk of engaging in delinquent behaviour, especially during adolescence
• Individuals with untreated ADHD are more prone to accidents, including serious ones

Moreover, people with ADHD are at a higher risk of developing other mental disorders, such as developmental disabilities, learning disabilities, social behaviour disorders, tic disorders, Tourette’s syndrome, anxiety disorders, and depression. The symptoms of ADHD may change as individuals progress through different stages of life. While children with ADHD are often noticeable due to their hyperactivity and impulsivity, adolescents may exhibit more inattentive and daydreaming behaviour. Hyperactivity typically decreases in adulthood.

Comprehensive studies on the long-term prognosis of ADHD are still lacking. However, it is crucial to recognize and treat ADHD in a timely manner. Professional support enables children to lay the foundations for their professional careers.

Homeopathy for ADHD

There are alternative approaches to treating ADHD that can complement traditional medical therapy. One such alternative method is homeopathy, which is used to address ADHD symptoms by some individuals or their parents. They report experiencing improvements in symptoms when using homeopathic remedies.

The range of homeopathic remedies available for ADHD is extensive. Depending on the specific symptoms, globules containing substances like potassium phosphoricum (which is believed to enhance concentration) or sulphur (which is thought to address impulsiveness and excessive energy) are commonly used.

Diet for ADHD

A well-balanced and nutritious diet is generally recommended for individuals with ADHD, as well as for those without the disorder. Some parents have reported that their children’s hyperactivity increases when consuming fast food and a high-sugar diet. However, scientific evidence linking an unhealthy diet to ADHD is currently lacking.

For some individuals with ADHD, avoiding artificial colours and other food additives may be beneficial. Keeping a dietary log that includes tracking ADHD symptoms can help determine if there is a correlation with specific foods.

If certain foods are suspected to worsen ADHD symptoms and are being eliminated from the diet, consulting a nutritionist can be beneficial to ensure that any potential nutritional deficiencies are addressed and to prevent any harm resulting from a restricted diet.

In cases where individuals have both ADHD and a food intolerance or allergy, a low-allergen diet has shown to improve ADHD symptoms. A customized diet plan can have a positive impact on the overall therapy. Alongside standard treatment, doctors often recommend dietary changes. Common allergenic foods and additives include dairy products, eggs, nuts, as well as colours0020and preservatives.

Recent research suggests that the use of omega-3 and omega-6 fatty acids is not recommended as a treatment for ADHD in children, adolescents, or adults.

ADHD: Diagnosis

ADHD can express itself in different ways. This makes diagnosis difficult. All signs of the disorder are not always present. ADHD symptoms are often difficult to differentiate from age-appropriate behaviour.

That is why only experienced specialists can make the diagnosis of ADHD, for example specialists in child and adolescent medicine or child and adolescent psychiatry.

ADHD diagnostic criteria

To receive a diagnosis of ADHD, specific criteria outlined in the ICD-10 classification system must be met. ADHD is characterized by a significant level of inattention, hyperactivity, and impulsivity. In contrast, a diagnosis of ADD is given when children display primarily inattentive symptoms without hyperactivity or impulsivity.

Criterion of inattention

To meet the criteria for ADHD, at least six of the following symptoms of inattention should be present for a minimum of six months, and they should not be attributed to age-appropriate development. Individuals with ADHD often:

• Fail to pay close attention to details or make careless mistakes
• Struggle to sustain attention for extended periods
• Seem to not listen when directly spoken to
• Have difficulty following through with instructions or completing tasks
• Encounter challenges in organizing tasks and activities
• Avoid or dislike tasks requiring sustained mental effort
• Frequently lose things necessary for tasks or activities
• Become easily distracted by external stimuli
• Forgetful in daily activities

Criterion hyperactivity, impulsivity

In addition, ADHD is characterized by the presence of at least six of the following symptoms of hyperactivity and impulsivity, lasting for a minimum of six months and not attributed to an age-appropriate developmental phase. Individuals with ADHD often:

• Fidget or squirm in their seats
• Struggle to remain seated and frequently leave their seat when expected to stay seated
• Run around or climb excessively in inappropriate situations
• Feel restless, constantly on the go, or act as if driven by a motor
• Tend to be excessively noisy during play
• Engage in excessive talking
• Blurts out answers before questions have been completed
• Have difficulty waiting for their turn
• Interrupt or intrude on others in conversations or activities

These symptoms typically manifest before the age of seven in children with ADHD. It is important to note that these signs are observed in at least two different settings, not solely at home or school. Additionally, for an ADHD diagnosis, there must be clear evidence of distress, difficulties in social interactions, learning, or occupational functioning.

Questionnaires

Specialists utilize specific questionnaires to assess ADHD, allowing them to systematically capture various behaviours associated with ADHD.

These questionnaires focus on identifying behavioral difficulties and specific characteristics that may impact learning, performance, and future employment. The family environment and any family history of illnesses are also important topics of inquiry.

Additionally, specialists inquire about any notable factors during pregnancy, birth, and development, as well as previous medical conditions and current complaints.

For adult patients, relevant questions encompass nicotine, alcohol, and drug use, as well as psychiatric disorders. Gathering this information helps in comprehensively evaluating and diagnosing ADHD.

Preparation for the doctor’s visit

Parents can take the following steps to prepare for their child’s visit to the doctor for a potential ADHD diagnosis:

• Observe and carefully note their child’s behaviour: Parents should pay attention to any specific events or situations that may be associated with the restless behavior. It is helpful to document when the attention difficulties occur, such as certain times of the day or specific school days.
• Communicate with other caregivers: Parents should have conversations with other individuals who regularly interact with their child, such as grandparents, kindergarten teachers, school teachers, or after-school care providers. Gathering their insights and observations about the child’s behaviour can provide valuable information for the doctor’s evaluation.

Survey of parents, caregivers and teachers

During the assessment process for diagnosing ADHD in children, the specialist conducts interviews with parents, caregivers, and teachers to gather information about the child’s social interactions, learning abilities, performance, and personality. The initial discussion may cover the following questions:

• Is your child able to sustain concentration on a single activity for an extended period?
• Does your child display restlessness or fidget when expected to remain seated?
• Does your child frequently interrupt or intervene in conversations or activities?
• Is your child easily distracted or prone to losing focus?

Teachers play a crucial role in providing valuable insights into the child’s intellectual capacity and attentional behaviour. Information obtained from exercise books, such as organization, handwriting, and task completion, can offer indications of potential difficulties. School certificates also serve as documentation of academic achievements.

Conversation with the child

Engaging in a conversation with the child is beneficial in the process of assessing possible ADHD. Gathering information directly from the child can provide valuable insights. Some relevant questions to ask the child include whether they find it easy to concentrate, if they ever feel left out from social groups, or if they generally feel like they don’t fit in.

Considering the sensitivity of these questions, it may be helpful for parents to have a discussion with their child before the doctor’s visit to create a comfortable environment for open communication.

Physical exams

During the physical examination, the doctor evaluates the child’s motor coordination and observes their behaviour. This includes assessing their level of cooperation, gestures, facial expressions, language usage, and vocalizations.

In certain cases where there is a suspicion of epilepsy or other related conditions, an electroencephalogram (EEG) may be conducted to measure the electrical activity in the brain. However, this is only necessary when such conditions are suspected.

Behaviour observation

During the consultation and examinations, the doctor carefully observes the child’s behaviour to identify any potential behavioral issues.

Video recordings can sometimes be used to validate the diagnosis of ADHD. These recordings allow doctors to demonstrate to parents any abnormalities in the child’s facial expressions, gestures, body language, or attention span. They also provide insight into the parents’ reactions and interactions with the child.

Furthermore, conducting repeated video recordings during individual appointments helps document the progress and course of therapy over time.

Distinguishing ADHD from other disorders

Differentiating ADHD from other disorders that present similar symptoms is crucial. At a psychological level, it is important to consider factors such as low intelligence or difficulties in reading and spelling (dyslexia), which can resemble ADHD. Hyperactivity can also be observed in individuals with obsessive-compulsive disorder (OCD).

ADHD specialists strive to compare their examination results with previous assessments of the child, such as the school enrolment examination, to gather comprehensive information. It is worth noting that in certain cases, hyperactivity may be attributed to physical causes. Conditions such as metabolic disorders, epilepsy, tic disorders, Tourette’s syndrome, pathological itching, as well as vision or hearing problems, should be taken into consideration.

Lots of misdiagnoses

Many experts believe that ADHD is often diagnosed prematurely in children. It is important to note that not every highly active or energetic child necessarily has ADHD. In some cases, children may simply require more physical activity to channel their energy effectively.

Furthermore, some children may require more downtime and moments of relaxation compared to others, leading to feelings of overexcitement. In such cases, making lifestyle changes often proves sufficient in improving the situation.

To ensure an accurate diagnosis, it is crucial to consult with an experienced paediatrician or a child and adolescent psychiatrist who can provide a precise evaluation.

ADHD: Giftedness is rare

The lack of academic success in children does not necessarily indicate a lack of intelligence. Some children with ADHD may possess above-average intelligence but still face significant challenges in the classroom. However, it is relatively rare to find the combination of “ADHD + giftedness” in individuals.

In fact, doctors sometimes misdiagnose ADHD in gifted children. These children are often restless and disruptive at school because they are not adequately challenged due to their high level of intelligence.

Children are considered gifted when they score above 130 points on an intelligence test. Gifted individuals typically exhibit a strong ability to concentrate, which contrasts with the difficulties in concentration commonly associated with ADHD.

ADHD: disease course and prognosis

ADHD is not a condition that simply disappears with time. While symptoms may diminish in some children as they grow older, approximately 60 percent of individuals will continue to experience symptoms throughout their lives. ADHD is not curable, but with appropriate therapy, individuals affected by the disorder can lead normal lives and experience healthy development. However, managing ADHD requires patience and effective collaboration among all parties involved.

It is worth noting that ADHD does not have an impact on life expectancy. Individuals with ADHD have a similar life expectancy to those without the condition.

ADHD prognosis – consequences without treatment

The right diagnosis and appropriate treatment are essential for people with ADHD, as the absence of proper management can lead to significant challenges in various aspects of life, including school, work, and social interactions.

Here are some potential consequences that may arise without adequate ADHD treatment:

• Some individuals may struggle to complete their education or pursue careers that align with their cognitive abilities
• Establishing and maintaining social relationships can be more difficult for some individuals with ADHD
• There is an increased risk of delinquency during youth for those with ADHD
• Accidents, including serious ones, are more likely to occur among individuals with ADHD
• People with ADHD face a higher risk of developing other mental disorders, such as developmental disabilities, learning disabilities, social behaviour disorders, tic disorders, Tourette’s syndrome, anxiety disorders, and depression

Symptoms of ADHD may evolve as individuals progress through different stages of life. While hyperactivity and impulsiveness are prominent in children with ADHD, adolescents with the condition often exhibit more dreaminess and inattention. Hyperactivity tends to decrease in adulthood.

Comprehensive studies on the long-term prognosis of ADHD are currently lacking. Therefore, it is crucial to recognize and treat ADHD promptly. Professional support plays a vital role in helping children establish a strong foundation for their future careers.

ADHD is recognized as a global issue, and various countries have implemented strategies to tackle the diagnosis, treatment, and support for individuals with ADHD. Here are some approaches and initiatives taken in different countries:

• United States: In the United States, the management of ADHD involves a multimodal approach. This typically includes a combination of medication, behavioral therapy, and educational support. The American Academy of Pediatrics (AAP) provides guidelines for the diagnosis and treatment of ADHD in children.
• Canada: In Canada, there are national and provincial guidelines for the assessment and treatment of ADHD. These guidelines focus on a comprehensive assessment process, including input from multiple sources, and evidence-based interventions such as behavioral interventions, psychoeducation, and medication when necessary.
• United Kingdom: The National Health Service (NHS) in the UK provides guidelines for the diagnosis and management of ADHD. These guidelines emphasize a stepped-care approach, starting with parent and teacher training programs and gradually progressing to medication if needed. The UK also has dedicated ADHD clinics and support services for individuals with ADHD.
• Australia: Australia has established resources and support networks for individuals with ADHD. The Australian ADHD Professionals Association (AADPA) provides guidelines, professional development, and a directory of healthcare professionals specializing in ADHD. There are also organizations such as ADHD Australia that offer support and information to individuals with ADHD and their families.
• Norway: Norway has implemented a comprehensive national ADHD program called the “ADHD Norway” initiative. This initiative focuses on early identification, diagnosis, and intervention for individuals with ADHD. It involves collaboration between healthcare professionals, educational institutions, and parents to provide coordinated support and treatment.
• United Arab Emirates: In the UAE, there is an increasing recognition of ADHD, and healthcare professionals are becoming more aware of the disorder. The diagnosis and management of ADHD in the UAE typically involves qualified healthcare professionals, such as psychiatrists or pediatricians. Treatment approaches may include a combination of medication, behavioral therapy, and educational support.

It is important to note that the approaches to tackling ADHD can vary across countries depending on their healthcare systems, cultural factors, and available resources. However, the common goal is to provide accurate diagnosis, appropriate treatment, and support to individuals with ADHD, as well as to raise awareness and understanding of the disorder among healthcare professionals, educators, and the general public.