What is ADHD and how does it manifest itself? Explained by experts

ADHD is one of the most common psychiatric disorders in children and adolescents. Boys are three to six times more likely to have ADHD than girls. However, it is also more difficult to diagnose ADHD in the latter.

In girls, the syndrome often manifests itself in insecurity, inability to make decisions, and a lack of self-esteem instead of the “fidgety” that is typical in boys with ADHD.

Affected women are at increased risk of depression and anxiety. However, some girls and women with ADHD also have the tendency to always be the center of attention and want to have the last word.

ADHD is an attention deficit hyperactivity disorder with serious consequences.

Learn how it manifests itself and whether it can be treated.

What is ADHD: Meaning of the Abbreviation and Definition

By definition, ADHD is a disease, more precisely: a neurobiological disorder that can occur in all age groups. The term ADHD is an abbreviation. ADHD written out means attention deficit/hyperactivity disorder or attention-deficit / hyperactivity disorder.

It typically manifests itself in symptoms such as hyperactivity, a lack of impulse control, and the ability to concentrate. And this is exactly how ADHD differs from ADD. In contrast to ADHD, the latter is a form of autism. This means that those affected tend to withdraw into themselves, appear withdrawn. Often ADD and ADHD are associated with giftedness, which, however, often goes undetected due to the typical symptoms.

From a certain degree of severity, ADHD can be considered a disability. Namely, when the disorder “seriously impairs social and economic participation for those affected”.

ADHD: symptoms of the disease

The activity and attention disorder ADHD is characterized by three main symptoms:

Attention disorders: Affected people are easily distracted and find it difficult to concentrate. People with ADHD often stop doing something in the middle of it. Children often make careless mistakes with their homework or have no patience to do handicrafts or play. They often don’t seem to hear what parents or teachers are telling them, are poorly structured, and don’t pay too much attention to details or lose things.
Impulsiveness: This sign of ADHD is often expressed as impatience, such as being B. if the person concerned has to queue and wait. Strong mood swings or great irritability are also typical – especially in children, outbursts of anger over small things are possible. They feel provoked quickly. Children in particular often do not know when to hold back. You burst into conversations, talk a lot, often change the subject and have difficulty assessing the gestures and facial expressions of other people.
Hyperactivity: moving, moving, moving – even if it’s just waving your hands or shaking your legs. Children, in particular, find it difficult to just sit quietly. They slide around on the chair, play very loudly and sometimes get into dangerous situations because they are poor at assessing risks. In contrast to the other two ADHD characteristics, hyperactivity often decreases in adolescence.

The symptoms of ADHD can usually be recognized early, i.e. in the first five years of life. It is typical that they occur in different areas of life, so the child doesn’t just run around wildly at home and not in kindergarten. However, the signs of ADHD can vary in severity, depending on where the child is.

For example, they are often stronger when the child is supposed to be occupied with something that requires concentration (homework, painting, etc.) and weaker when they are in an unfamiliar environment or are allowed to devote themselves to their favorite activity.

It is therefore sometimes difficult for doctors to clearly determine ADHD in children or the symptoms in examination situations. For example, ADHD in babies cannot be diagnosed with certainty, although symptoms such as constant crying, poor sleep, and trouble feeding can indicate the disorder.

Even when it comes to diagnosing ADHD in young children, the doctor and the environment have to look very carefully. Signs can be when the child screams a lot, barely makes friends with people of the same age, but is also unable to keep himself busy for a long time.

Sometimes ADHD expresses itself differently in girls than in boys. They are less aggressive and hyperactive, but rather restless inside, talk constantly, are fearful and not very self-confident, daydream a lot and work slowly. They usually try very hard to adjust and be unnoticed in school, which is why they can be exhausted and very impulsive at home.

In adulthood, the symptoms are often less pronounced, but still present. For example, ADHD in adults shows up when they talk a lot and interrupt others. They cannot concentrate on their work – at least not for a long time – they are disorganized in everyday life and forget, for example, to pay bills. It is also typical to act rashly, with adults with ADHD suddenly ending a relationship or quitting their job.

Treating ADHD: These are the options

There is no cure for ADHD. However, there are various therapy options that can be used to treat ADHD well. Which ADHD therapy is suitable – or a combination of different (multimodal treatment concept) – always depends on how the ADHD expresses itself, how severe the symptoms are and whether there are accompanying disorders. In any case, the treatment must always be individual and also include the environment.

Parent training is recommended for ADHD, as offered by specialist clinics, psychotherapeutic practices or (online) health insurance companies. Siblings, relatives, friends, teachers, etc. should also know what the disorder means and how they deal with an ADHD patient. Because only then can you help him cope with his everyday life, support and encourage him – without taking away his independence.

Therapy of ADHD with medication

Drug treatment for ADHD is usually either in addition to other therapeutic measures or to make other measures possible in the first place. The guidelines of the professional associations recommend them for children from the age of six with ADHD only after detailed advice and with severe symptoms that greatly impair the child’s everyday life or that behavioral therapy cannot improve the symptoms sufficiently.

Adult ADHD patients are given medication when other strategies do not work (sufficiently) to cope better with the disorder in everyday life. The doctor regularly checks whether the medication is bringing about the desired improvement and whether the dosage is optimal for the patient in question.

Most patients are given drugs containing the active ingredient methylphenidate to treat ADHD (e.g. Ritalin, one of the best-known ADHD drugs that has also been approved for adults for several years). The active ingredient that the patient takes in the form of tablets in ADHD, for example, ensures that the brain can better filter external stimuli by increasing the concentration of the neurotransmitters dopamine and norepinephrine, which are important for memory function. So it regulates the imbalance of the messenger substances in the brain. The patient becomes more balanced and can better process external influences.

The doctor can also prescribe agents containing the active ingredient atomoxetine. This has a different mechanism of action than methylphenidate (not classified as an anesthetic, no potential for dependence), but it also increases the concentration of norepinephrine in the brain.

Note: As with all medications, ADHD drugs can also have side effects, such as insomnia or loss of appetite. Ritalin can also cause stunted growth in children if they take it for a long time.

Therapy for ADHD without medication

For those affected with less pronounced symptoms as well as for emotional or psychological problems, (supplementary) psychotherapy can be useful. There are special group therapies for young children that aim to improve concentration and social skills, and which help children better manage their hyperactivity and impulsiveness.

Older children and adolescents are given behavioral therapy without a group for ADHD. The individual therapy should support them in approaching and solving tasks in a structured manner (self-instruction training). If there are interpersonal problems in the family, family therapy can be an option.

Psychotherapy can help adult ADHD patients if they do not want to take medication or if it does not work. Or even if they are only diagnosed with ADHD in adulthood and would like to learn through therapy to understand the disorder and how to deal with it. There are also numerous regional ADHD self-help groups, where those affected can exchange information, receive tips and, above all, get the feeling: “You are not alone.”

Other ways to treat ADHD

In the case of ADHD, sport and physical activity can help to increase mental performance; adult sufferers in particular often find exercise a helpful compensation and use it consciously.

Others rely on relaxation techniques such as autogenic training or yoga. Still others swear by homeopathy for ADHD. According to a study by the University of Bern from 2005, therapy with homeopathic drugs in high potencies should be able to alleviate symptoms such as restlessness in children. However, the scientific evidence on the effectiveness of homeopathic remedies is generally thin.

According to the current state of knowledge, a dietary supplement with the fatty acids omega-6 and omega-3 is not recommended for ADHD. It is not finally clear how ADHD and diet are generally related. So far, only the oligoantigenic diet (with foods such as rice, lamb, turkey, pears, bananas, various types of cabbage and potatoes) is recommended for a period of a few weeks. However, not to treat ADHD in general, but only if those affected have symptoms of an allergy or food intolerance.

ADHD: causes and risk factors

How and why ADHD occurs has not yet been conclusively clarified. The scientific explanation is that in ADHD the information processing in the brain or between certain brain areas is faulty, which controls concentration, impulse control and perception. As a result, dopamine and norepinephrine are imbalanced in ADHD. In other words, messenger substances that play an important role in brain function.

This imbalance can affect the neural control loops that control the interplay of emotion, movement behavior and motivation.

Science assumes that there are always different influencing factors that work together to create ADHD. These include:

Genetic factors: Many studies suggest that ADHD is hereditary. For example, twin studies show that around 80 percent of identical and 30 percent of dizygotic twins show the same symptoms. In addition, scientists were able to identify individual regions in the human genome that show a typical change in ADHD patients. However, these can only explain to a very limited extent why ADHD develops. Experts suspect that various genes, as well as hereditary and environmental factors, must interact for the disorder to occur.
Complications During Pregnancy and Childbirth: It is suspected that the child’s risk of ADHD if the mother smokes, drinks, or uses drugs during pregnancy. Central nervous system infections or traumatic brain injuries during pregnancy and childbirth can also increase the likelihood of ADHD. However, they do not necessarily lead to ADHD.
Environmental Influences: There are various psychosocial factors that can exacerbate symptoms in ADHD. If the upbringing is not consistent, if the parents have psychological problems, if the financial burden on the family is great or if parents and/or teachers often abuse and punish the child, this can intensify the signs of the disorder.

ADHD: diagnosis by the doctor

The sooner a doctor diagnoses and treats ADHD, the greater the chances that the affected child will develop positively. Parents who suspect that “something is wrong” with their kids should therefore definitely see a pediatrician. In order to diagnose ADHD, a lot of experience on the part of the doctor and a thorough investigation are required.

Interview/questionnaire/tests: The diagnosis of ADHD often begins with a test. There are various questionnaires that the doctor can use to get an initial picture. The doctor will also speak to the parents to find out something about the child’s medical history and life situation. If necessary, they can conduct intelligence and attention tests or check the child’s reading, writing and arithmetic skills.
Physical examination: In this, the doctor checks gross and fine motor skills, tests coordination of movements, eyesight and hearing. If necessary, he can measure the brain waves (EEG) and heart activity (EKG) or do a blood test.
Behavior observation and evaluation: The doctor relies on descriptions of the parents and the extended social environment with regard to everyday behavior and possibly also on video recordings in order to determine weaknesses, strengths, skills and deficits.

Important: The doctor must always clarify whether there are accompanying problems or diseases. Depression, anxiety, etc. can not only accompany ADHD, but also be the clinical picture that triggers the symptoms. Diseases such as epilepsy, thyroid disorders, psychoses, compulsions or traumatic brain injuries can trigger symptoms similar to ADHD, so the doctor must absolutely rule them out before making a diagnosis.

ADHD diagnosis in adults

Diagnosing adults with ADHD is even more difficult than diagnosing children. This is because over the years they have learned to adapt, the symptoms have shifted or changed as a result and can be very diverse.

In order to be able to make a diagnosis, the doctor will speak to the people around him as well as to those affected. In addition, he can ask the patient to fill out a special questionnaire with which the affected person can assess himself more easily and specifically. In addition, the doctor must rule out other (mental) illnesses.

ADHD: course and prognosis

ADHD often shows up in infancy or toddlerhood. The offspring cries a lot, has difficulty eating and sleeping. The symptoms often worsen towards kindergarten age, and ADHD children are then hyperactive, cannot play calmly and persistently or establish contact with their peers.

The affected children are often aggressive or irritable, some show developmental disorders and lag behind in their gross and fine motor skills, which can be seen, for example, in difficulties with coloring. If the children come to school, have to sit still in class and concentrate on homework at home, the difficulties often become even greater. In many cases, motor restlessness decreases in adolescence.

For some, attention deficit and impulsiveness remain, and with the school problems. In adolescents with a favorable course, however, there is sometimes no longer any difference to their peers without ADHD.

Problems organizing and controlling one’s impulses can drag on into adulthood. Hyperactivity as a symptom, on the other hand, hardly plays a role anymore, it often gives way to a feeling of inner restlessness and difficulties in being able to wait for a little quietly. Adults with ADHD, for example, often interrupt conversations when a thought occurs to them that they want to get rid of.

ADHD can take very different courses. Whether and how well those affected can cope with their everyday life despite the disorder always depends on when (and whether) the disease was recognized and appropriate treatment was given.

ADHD: Consequences for Everyday Life

ADHD is a serious disorder that can have a huge impact on people’s daily lives – in a number of areas.

ADHD and Kindergarten: Young children with ADHD often have difficulty interacting with other children, play persistently, and often react impulsively.

ADHD and school: Everyday school life is difficult for ADHD children to cope with without treatment. Sitting quietly and listening, concentrating on tasks – all of this is a great challenge. Sometimes there is also a partial weakness (reading, spelling or arithmetic weakness).

ADHD in a relationship: Entering into and maintaining a relationship with ADHD can pose major problems for those affected (and their partners). ADHD patients are often impulsive and disorganized, there is chaos at home, those affected forget appointments and appointments – which complicates everyday life together. It can also happen that a person with ADHD ends the relationship completely unexpectedly.

ADHD and concomitant diseases: In addition to the main symptoms, other disorders can occur in ADHD, including depression, motor, and language development disorders and partial performance disorders (e.g. reading and spelling weaknesses), anxiety disorders, tic disorders (Tourette) or, especially in girls, also eating disorders.

Image Credit: Getty

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