ADHD - Facts

Dr. med. Katharina Larisch Translation from German - Evgeny Sheronov

Dr. med. Katharina Larisch

 

One condition – many terms

ADHD is short for Attention Deficit Hyperactivity Disorder. Attention deficits, exuberant impulsivity and extreme restlessness (hyperactivity) are symptomatic for this disorder. However, the disorder is also known as hyperkinetic syndrome or Attention Deficit Disorder (ADD). Usually, the symptoms occur in (young) children, but they can often persist far into adulthood.

ADHS is no modern civilization disease but dates back more than a hundred years. In 1848 the German neurologist Heinrich Hoffmann described what he called the “Zappel-Philipp-Syndrom” in “Struwwelpeter”: “He won’t sit still; He wriggles; He giggles; And then I declare, swings backwards and forwards and tilts up his chair…”. The English pediatrician George Still talked 1902 in his lectures about a “defect of moral control in children”.

 

More boys than girls

According to estimates, about two to six percent of all children in Germany suffer from ADHD. Boys are in general more prone to the disorder and ADHD shows different symptoms for each gender: Boys tend more to show hyperactivity, whereas girls have more problems with their attention. This might be a reason why ADHD in girls is not as often diagnosed as it is in boys. Around 60% of the affected carry their symptoms until far into adulthood.

Filtering is impaired

Scientists believe that impaired signal transmission in the brain is the cause of ADHD. More precisely it seems to be a malfunction in the metabolism of certain messenger substances such as dopamine and noradrenaline. Both are essential for attention, drive, and motivation. In children suffering from ADHD, the information transmitted by these neurotransmitters from brain cell to brain cell is incomplete or disturbed.

Patients with ADHD continuously receive new, unfiltered information, because the signals in their brains cannot filter them sufficiently. That is why those affected by ADHD find it hard to concentrate and lack motivation. Furthermore, matching new, incoming information with already existing experiences is difficult. Therefore, ADHD patients have a hard time with forward planning.

ADHD is also affected by the patients’ environment. Restricted housing conditions, parenting styles (lack of affection or lack of consequences), hectic surroundings, lack of space to move or time pressure have a negative impact and can even worsen ADHD symptoms.

ADHD – Yes or no?

Not every “little whirlwind” suffers from ADHD. There precise criteria for diagnosing ADHD. It is crucial to preclude other diseases, such as epilepsy or depression. Furthermore, clear boundaries between ADHD and age-appropriate behavior in certain stages of the patients’ development need to be drawn. Accordingly, at least six of the following symptoms need to have occurred for at least six months:

  • Neglects details or make careless mistakes
  • Has difficulties to concentrate for a longer period of time
  • Seems not to be listening when being talked to directly
  • Does not completely perform tasks or does not finish given tasks
  • Has difficulties to systematically finish tasks
  • Is reluctant, avoids or refuses to accept tasks that require constant concentration
  • Loses things such as toys or exercise books that are necessary for certain tasks
  • Is easily being distracted by minor stimuli
  • Is forgetful during everyday activities

ADHD is also very likely when at least six of the following symptoms for hyperactivity/impulsivity have been occurring often for at least six months and if they cannot be attributed to age-appropriate development:

  • Fidgets and wriggles on his/her chair.
  • Does not like sitting in general and leaves seat even if sitting is demanded
  • Runs around and climbs things all the time – also in inappropriate situations
  • Is often quite loud at play
  • Is always on the go
  • Talks too much
  • Blurts out answers before questions have been completely formulated
  • Has difficulties to wait for his/her turn
  • Interrupts or disturbs others while they are communicating or playing

Further indications for ADHD are:

  • Some symptoms have been present before the age of seven
  • Symptoms don’t exclusively occur at home or in school, but at least in two different environments
  • Symptoms cause considerable impairment in social and professional areas and also in terms of learning performance

Dreamy or fidgety

ADHD affects people in different ways. Some are more agitated, some are more inattentive. In principle ADHD is divided into three different subgroups:

  • Mainly hyperactive-impulsive
  • Mainly attention deficit  (more common in girls)
  • Mixed type: attention deficit and hyperactive

ADHD symptoms vary with age. So it might be completely normal for a three-year-old child to have problems concentrating, where the same problem in a seven-year-old would be conspicuous.

ADHD in infancy: Inexplicably long lasting phases of screaming, motoric restlessness, problems with eating and sleeping, refusing physical contact, ill temper

ADHD in early childhood(incl. kindergarten age): haphazard and restless activity; activities change quickly, frequently, and unpredictably; low perseverance in single, or group-activities, pronounced acts of defiance; unpredictable social behavior; partial disturbance of performance in terms of seeing, hearing as well as fine and gross motor skills; raised danger of accidents; strikingly early language acquisition or delayed language acquisition, no stable friendships

ADHD in primary-school-age: lack of acceptance for rules in the family, play-groups, and class; disturbs lessons; low perseverance; easy to distract; emotional instability; low tolerance of frustration; tantrums; aggressive behavior; sloppy handwriting; chaotic sense for tidiness; constant talking;  constant noise-making; speaks hastily; inept facial expressions, gestures and body-language; clumsy; accident-prone; dyslexia; dyscalculia; learning performance problem that results in having to repeat school-years; retraining; no lasting social relationships; outsider; low self-esteem

ADHD in adolescence: lack of attention; “can’t be bothered”-attitude; performance refusal; oppositional-aggressive behavior; strongly lowered self-esteem; anxieties; depression; contacts to social fringe groups; prone to traffic accidents; tendency to become criminal, consume alcohol and drugs

ADHD in adults: clumsiness; forgetfulness; difficulties with planning and finishing tasks; volatile professional and social relationships; anxieties; depression, violent temper; tendency to become criminal, consume alcohol and drugs

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