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Attention Deficit - Causes, Symptoms, and Treatment
Attention deficit disorder ADHD is diagnosed with increasing frequency in children in Germany and many sufferers are treated with medications such as Ritalin, Medikinet or Straterra. However, due to the known side effects, warnings against purely medicinal therapy and the question of alternative treatment methods are appropriate. What about researching alternative therapy methods today?
Attention deficit hyperactivity disorder (ADHD) is classified according to the international classification of diseases (ICD) as “behavioral and emotional disorders beginning in childhood and adolescence” or their subgroup - “hyperkinetic disorders”. The symptoms describe a combination of increased impulsivity, lack of attention or concentration problems and excessive motor activity (hyperactivity), whereby the different aspects can be present in different degrees.
Growing number of people affected
In 2008, as a result of a study, the commercial health insurance company (KKH) announced the 50 percent increase in the diagnosis of AD (H) S between 2004 and 2007. The surveys by the AOK Scientific Institute (WIdO) from the “Supply Report 2015 / 2016 “show that the prevalence of hyperkinetic disorders among children under the age of 18 was just under five percent. The number of diagnoses rose steeply until 2008 and since then the curve has flattened out. However, the disease rate continues to increase.
The Robert Koch Institute (RKi) also reports on the basis of the "Study on the Health of Children and Adolescents in Germany" (KiGGS) that the disease rate is around five percent among children and adolescents in Germany between the ages of three and 17 years. According to the RKI, boys are affected significantly more often at eight percent than girls (two percent) and ADHD was diagnosed more than twice as often in children from families with low social status than in children from families with high social status (eight percent compared to three percent). .
The first signs of ADHD usually appear early in life. For example, affected children stand out due to a lack of endurance in cognitively demanding occupations and through erratic behavior. Activities are not completed and new ones are started instead. There is an excessive motor activity, which is also associated with a tendency to accidents. In addition to the limited ability to concentrate and motor hyperactivity, increased impulsivity can be observed, which often leads to considerable problems in the social environment.
Children affected by ADHD generally have difficulties in learning and doing tasks, but also within families and when dealing with peers. The extent of the impairments can also be seen as an indicator of the need for therapy. While mild ADHD does not require any treatment in principle, a moderately severe and a severe form of the symptoms should be treated in order to avoid further impairment of those affected. Because ADHD also increases the risk of mental illnesses such as depression or anxiety disorders. In addition, a Mayo Clinic Children's Research Center study in 2016 found that ADHD doubles the risk of obesity in women, which in turn can lead to health problems.
Possible causes of ADHD
To date, there is little clarity about the possible causes of ADHD. For example, genetic predisposition seems to be an important component, but which sequences of the genetic make-up are decisive remains unclear. Other attempts to explain focus primarily on the social environment of those affected, the pollution (e.g. passively ingested tobacco smoke) or the impaired signal transmission in the brain. So far, however, there is no clear evidence for any of these theories. The changes in the size of certain areas of the brain in ADHD patients should also not be assessed as a clear cause of the disease. However, studies have recently been published that suggest a connection with neurobiological impairments.
A whole package of risk factors is also related to the appearance of the symptoms. This includes, for example, the intake of paracetamol during pregnancy, which was brought up in a study from 2016 in connection with the ADHD risk in the offspring. In addition, alcohol consumption during pregnancy and diseases of the central nervous system are further risk factors.
In addition, triggers such as food allergies, exposure to heavy metals, environmental toxins, preservatives or vaccine intolerances are also discussed, especially for hyperactivity. Last year, a study by British and Dutch researchers found that even excessive consumption of fat and sugar during pregnancy increased the risk of developing ADHD in the offspring.
In the past, the diagnosis of ADHD was made by general practitioners in most cases and was mostly based on the statements of parents and teachers. Today, however, the demands on the diagnosis are significantly higher. In principle, this should be provided by a specialist, include extensive surveys of legal guardians, teachers and, if applicable, other family members, and also take into account neurological examinations or corresponding tests of those affected. Ultimately, the diagnosis is confirmed if the typical ADHD behavioral patterns (see symptoms) can be demonstrated in the course of the examinations and other possible causes such as an overactive thyroid (hyperthyroidism), liver disease or Asperger's syndrome have been excluded by differential diagnosis.
The severity of the disease (mild, moderate, severe) is determined based on the severity of the symptoms in order to determine the need for therapeutic care.
As mentioned earlier, not every attention deficit hyperactivity disorder requires therapy. The decisive factor is above all the extent of the complaints, but also the impairments in the social environment can play a role in the decision. In the course of the treatment, there is first an intensive education, which is aimed directly at those affected and their parents, and also includes teachers and educators. Possible help in everyday life is an important part of therapy. The further steps are very different individually and are mostly based on a combination of different measures.
Basically, psychotherapeutic procedures such as cognitive behavior therapy for ADHD treatment are relatively well suited, but this takes time and they are relatively expensive compared to medication. Recent studies also suggest that psychotherapy (without medication) can only help to a limited extent, since the cause of the disease is suspected to be neurobiological changes in the brain. To this day, drug treatment for ADHD remains widespread. The main active ingredients are methylphenidate (e.g. contained in Ritalin) and atomoxetine (contained in Statera). They show remarkable treatment successes for many of those affected, but the side effects should not be underestimated and drug therapy is viewed much more critically today than a few years ago.
Significant increase in drug prescriptions
Already in 2009, a study commissioned by the DAK showed a nationwide increase in the drug prescription for AD (H) S by 4.1 percent compared to the previous year. In terms of regional distribution, Baden-Württemberg and North Rhine-Westphalia were the leaders. On average, one child per school class was affected by the intake. The drugs are the active ingredients atomoxetine (in Straterra) and especially methylphenidate (in Ritalin, Equasym, Concerta, Medikinet). The Federal Institute for Drugs and Medical Devices (BfArM) tripled the consumption of methylphenidate between 2002 and 2012. In 2013, according to the AOK Scientific Institute (WIdO), 40.2 percent of all six- to 17-year-olds who were diagnosed with hyperkinetic disorder received at least one prescription of a corresponding drug.
Impending side effects with ADHD drugs
The high prescription rates of ADHD medicines have been assessed increasingly critically in recent years, since massive side effects often occur, especially when taken continuously, the negative effects of which outweigh the positive effects. Often, for example, there is a reduction in appetite during the period of action, which is accompanied by true bouts of eating when the effect wears off - i.e. usually in the late evening hours. This can lead to weight gain, which is particularly stressful for children who are already overweight.
Possible side effects of ADHD medication are:
- A headache,
- Stomach pain,
- internal excitement,
- slight to strong increase in pulse and blood pressure,
- Weight loss,
- increased hyperactivity with diminishing effects,
- cognitive impairment,
- depressed mood, tearfulness and social withdrawal,
- vegetative pallor with red circles around the eyes,
- Triggering and reinforcement of existing tics,
- psychotic reactions to overdose and various interactions with other medications.
It's not just parents who are concerned about the development of prescription practice given the impending side effects. The Federal Institute for Drugs and Medical Devices (BfArM) has restricted the approval for methylphenidate for good reason. Tight physical check-ups and special knowledge of behavioral disorders are linked to the regulation, additional psychological care and body-oriented offers are strongly recommended by health politicians and experts. It is obvious that the prescription of medication no longer has to be done by general practitioners, but above all by child and adolescent psychiatrists with a social psychiatry agreement. Because these are bound to provide additional psychological, pedagogical and curative education (or occupational therapy) offers through the employment of relatives of corresponding professional groups.
In addition to the medication that affects the brain metabolism for a limited time, ADHD sufferers are primarily offered concentration therapy and social skills training, which may be supplemented by behavioral therapy-oriented parent training. Learning disorders, negative social interactions and family causes and reinforcements should be reduced or eliminated.
Has an herb grown against hyperactivity?
Often, those affected are offered therapies from the field of experiential medicine individually. However, despite the observation of positive developmental developments under the treatment with medicinal plants, dietary supplements, homeopathics, Bach flowers, craniosacral therapy and the therapeutic use of alternative body-oriented procedures, no general recommendations have been able to be made so far, since the proof of effectiveness according to scientific criteria was lacking.
But in recent years, efforts to scientifically research alternative approaches to ADHD treatment have been increasingly advanced:
- In the Department of Child and Adolescent Psychiatry at the University Clinic in Mainz, scientists headed by Prof. Michael Huss are trying to investigate the effectiveness of a combination of St. John's wort and valerian extract (sedaristone concentrate) for hyperkinetic symptoms. Clinical observations suggested a clear effect.
- Regarding the triggers, British researchers were able to demonstrate a connection between combinations of artificial colors (e.g. the red food coloring Azorubin E122 and the yellow tartrazine E 102) with the preservative sodium benzoate and hyperactivity in children. Several other dyes are suspected to trigger the symptoms.
- Professor Manfred Döpfner from the University of Cologne, as the scientific director of the "ADHD Report" magazine, summarized several studies that examined the effects of omega-3 and omega-6 fatty acids on brain metabolism in general and in connection with AD (H) S . Accordingly, there are actually lower concentrations of polyunsaturated fatty acids in the body in the children affected by symptoms, which can be compensated for by dietary supplements, which has a positive effect on lighter symptoms. If the AD (H) S is pronounced, this effect is probably not sufficient.
- According to a controlled pilot study carried out by Heidelberg University in 2006, yoga training tailored to children's needs is clearly superior to conventional exercise training as an intervention or accompanying AD (H) S therapy.
- A special neurofeedback was also shown in a study by the TU Dresden in 2016 as a promising treatment approach. The results were published in the specialist magazine "Nature".
- Furthermore, a study led by the University Hospital Frankfurt is currently investigating whether exercise programs and light therapy in adolescents and young adults can reduce or prevent the secondary diseases associated with ADHD.
- Regarding prevention, scientists from the University of Southern Denmark found last year that taking vitamin D during pregnancy protects the offspring from the risk of hyperactivity.
The studies listed as examples illustrate the range in which the various research approaches operate. Hope for further progress in treatment seems to be justified here, but the conventional psychotropic drugs will probably remain a widely used option until then. And this despite the fact that last year a study at the Ruhr University Bochum (RUB) made it clear that no lasting relief can be expected from the psychotropic drugs. These only show their effects for a limited period of time and the symptoms return after discontinuation. There is also the risk of serious side effects while taking it.
Until scientists succeed in replacing Ritalin & Co with gentler treatment methods with generally valid research results, it remains to be hoped that many courageous parents and children will take alternative paths that make life easier for their families. (jvs, fp)
Author and source information
This text corresponds to the requirements of the medical literature, medical guidelines and current studies and has been checked by medical doctors.
Jeanette Viñals Stein, Barbara Schindewolf-Lensch
- Professional associations and specialist societies for psychiatry, child and adolescent psychiatry, psychotherapy, psychosomatics, neurology and neurology from Germany and Switzerland: What is Attention Deficit Hyperactivity Disorder or ADHD? (Accessed: August 12, 2019), neurologen-und-psychiater-im-netz.org
- Professional Association of Pediatricians e. V .: ADHD / Attention Deficit Hyperactivity Disorder (accessed: August 12, 2019), kinderaerzte-im-netz.de
- Federal Ministry of Health: Attention Deficit Disorder (accessed: August 12, 2019), bundesgesundheitsministerium.de
- Institute for Quality and Efficiency in Health Care (IQWiG): Attention Deficit Hyperactivity Disorder (ADHD) (accessed: August 12, 2019), gesundheitsinformation.de
- German Society for Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy (DGKJP) / German Society for Psychiatry and Psychotherapy, Psychosomatics and Neurology (DGPPN) / German Society for Social Pediatrics and Adolescent Medicine (DGSPJ): S3 guideline ADHD in children, adolescents and Adults, as of May 2017, detailed view of guidelines
- Federal Center for Health Education: Information brochure adhs ... what does that mean? As of November 2014, bzga.de
- Brakemeier, Eva-Lotta / Jacobi, Frank: Behavioral Therapy in Practice, Beltz, 2017
- Cologne University Hospital (AöR): Preschool ADHD (access: August 12, 2019), Zentrales-adhs-netz.de
- Warnke, Walitza: "Methylphenidate in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), in: Schulte-Markwort M, Warnke A (ed.): Methylphenidate. Stuttgart: Thieme 2004; 14-33.
- Haffner, Roos, et al .: "On the effectiveness of body-oriented therapy methods in the treatment of hyperkinetic disorders" in: Journal of Child and Adolescent Psychiatry and Psychotherapy, 34 (1), Hogrefe 2006
ICD codes for this disease: F90ICD codes are internationally valid encodings for medical diagnoses. You can find e.g. in doctor's letters or on disability certificates.