Attention deficit hyperactivity disorder

Attention deficit hyperactivity disorder (ADHD) belongs to the group of behavioural and emotional disorders with onset in childhood and adolescence. It manifests itself through problems with attention, impulsivity and self-regulation; sometimes strong physical restlessness (hyperactivity) is added.

The disorder used to be seen as a pure behavioural problem, whereas today it is increasingly understood as a complex developmental delay of the self-management system in the brain. ADHD can also be seen as an extreme behavior that shows a smooth transition to normality. The abnormalities must be very pronounced for the age and consistently present in most situations since childhood. Symptoms alone, however, do not have the value of a disease: Only if they additionally strongly impair the way of life or lead to recognizable suffering, an ADHD diagnosis is justified.

The worldwide frequency of ADHD among children and adolescents is estimated at about 5.3%. The frequency of ADHD in Germany is about 4.4%. Today, it is considered the most common psychiatric disorder among children and adolescents. Boys are diagnosed noticeably more often than girls. Follow-up studies have shown that in 40 to 80 % of diagnosed children the disorder persists into adolescence. Finally, in adulthood, at least one third of the cases still show impairing ADHD symptoms (see ADHD in adults).

ADHD as a neurobiological disorder has largely genetic causes. However, it can have very different consequences depending on the person, as the individual course is also influenced by environmental factors. In most cases, those affected and their relatives are under considerable pressure: failures at school or work, unplanned early pregnancies, drug use and the development of further mental disorders have often been observed. In addition, there is a significantly increased risk of suicide, accidents and unintentional injuries. However, these general risks may not be relevant in each individual case. Treatment therefore depends on the severity, the level of suffering, the respective symptoms and problems, and the age of the person concerned.

Research to elucidate causes and improve treatment has been ongoing for decades. Today (as of 2018), the benefits of individually tailored treatment have been clarified; as have the disadvantages of missed or incorrect treatment. Signs of long-term recovery of altered brain functions through appropriate (pharmacological) treatment have already been demonstrated many times with modern imaging techniques.

Designations and abbreviations

In addition to ADHD, many alternative terms and abbreviations exist. Some of these describe consistent clinical pictures (e.g. hyperkinetic disorder (HKS) or attention deficit/hyperactivity syndrome), while others sometimes refer to specific manifestations. Internationally, ADHD is now usually referred to as attention deficit hyperactivity disorder (ADHD) or attention deficit/hyperactivity disorder (AD/HD).

The term attention deficit syndrome or attention deficit disorder (ADS) is still widely used colloquially - although it is no longer in use in the more recent specialist literature. The abbreviations ADS and AD(H)S are used especially by those affected with predominant attention deficit disorder without pronounced hyperactivity. They are used to express that hyperactivity is not always necessarily present as a symptom. The terms minimal cerebral dysfunction (MCD) or hyperkinetic reaction of childhood are obsolete; the diagnosis psychoorganic syndrome (POS) is only used in Switzerland.

Differential Diagnosis

Mental disorders sometimes confused with ADHD include, in particular, chronic depressive mood (dysthymia), persistent and disabling mood swings (cyclothymia or bipolar disorder), and borderline personality disorder.

Differentiation from autism spectrum disorders can be difficult if the attention disorder occurs without impulsivity and hyperactivity, and there are additional social deficits arising from it. In Asperger's syndrome, however, the impairments in social and emotional exchange, special interests, and detail-oriented perceptual style are more pronounced. Conversely, in ADHD, strong disorganization with jumpiness in thinking and acting are often observed, which are rather not typical for autism.

Other medical conditions that can cause ADHD-like symptoms and must also be ruled out before an ADHD diagnosis are: Hyperthyroidism, epilepsy, lead poisoning, hearing loss, liver disease, sleep apnea, drug interactions, and traumatic brain injury.