English: ADHD – What Is It About?

The Attention Deficit Hyperactivity Disorder (ADHD), earlier usually referred to as ADH, is characterized by diminished attentiveness, hyperactivity, and impulsiveness. A malfunctional information processing in cerebral regions responsible for controlling behaviour and feeling is suspected to be the causal disorder of those predominant symptoms.

One knows by now that the disease which starts in childhood and adolescene continues in approximately 50 % of cases into adulthood, changing according to age.

Studies have shown a rate of about 4% developping the disease. Only a minority of those affected is looking for and receiving appropriate help. Thus the development of ADHD in adulthood is not adequately diagnosed and treated.

Most adults affected with ADHD have quite a long history of suffering. During all their life they were often facing problems, knowing that something was wrong but being unable to name it. As children they were often called ‘lazybones’ or were told: ‘If you only wanted to, you could do it’. Later in life adverse effects in various areas turned up. In many cases school or training were not brought to a close, partnerships were considerably endangered, or broke down time and again. Those affected suffer from mood swings, minor self-esteem, and major frustrational pressure as they find themselves constantly faced with the feeling of not being successful and, despite all their efforts, falling short of their own potentialities. The intensity of ADHD may vary from one person to some other as well as in regard to the degree to which symptoms become manifest. Thus there does not exist a ‘On-Off-symptom complex’ but a variety of transitions and different stages, from minor symptoms to major ones. These are for the most part very stable and are experienced since childhood as known and familiar.

Often the symptom complex is characterized by the difficulty to stay attentive for longer periods, or to regulate and control emotions. Frequently there is a feeling of permanent strain and being pushed.

When only the symptom complex attentiveness disorder is to be found the diagnosis is ‘inattentive type of ADHD’; in case of additional hyperactivity and impulsiveness it is called ‘combined type’.

Whilst the manifestation of the main symptoms changes with the transition from childhood to adulthood, the attentiveness disorder often remains very consistent, hyperacitivity and impulsiveness however are decreasing. Quite often a reversal to the inner being takes place showing up as increased inner restlessness and hyperkinesia.

The life stories of those affected with ADHD show one third of them not suffering from substantial impedings; two thirds however have difficulties with regard to the main symptoms attentiveness, hyperkinesia, impulsiveness as well as to social interactions. This causes problems in the areas training, choice of career, and partnership.

In case of a major manifestation about 10 to 15 % of those affected show mental problems and even antisocial behaviour.

In this case there is an increased risk of developping psychiatric concomitant disorders like depression, anxiety, personality disorders, and addiction to drugs and/or alcohol.

ADHD — How Does It Come About?

ADHD is a neurobiological malfunction, a result of genetic and environmental factors, the genetic component being extraordinarily distinct, especially in those patients in which AHDA continues into adulthood. In most cases the disease affects several members of a family, only rarely it shows up as an isolated disease.

First relatives run an at five times increased risk to develop ADHD. In most cases a larger number of genes seems to be involved in causing ADHD. Specific genes are not always to be found in this cases; some genes were detected in connection with other psychic disorders as well. Nowadays one assumes specific ADHD-subtypes, for example combinations of ADHD and malfunctional social behaviour or ADHD in connection with depressions.

Studies have revealed genes as affecting neuronic systems, especially the transmission systems dopamine and noradrenaline (norepinephrine). Thereby it is established that it is a disorder of equilibrium and of the interaction of several neurotransmitters.

What about ADHD-related diseases in grown-up age? A diagnosis of ADHD in grown-ups involves discovering any correlated disorders.

Establishing ADHD in grown-ups is an extensive clinical diagnosis to be achieved by a psychiatrist or a neurologist, and requires clinical expertise as well as an exaxt knowledge of the syndrome in grown-ups, because the central syndrome — characterized by inattentiveness, hyperactivity, and impulsiveness — is speficic only in a restricted sense. It occurs in connection with other serious disorders as well.

Assessment by oneself as well as by others may help to get the right diagnosis. Thus the Wender-Utah-Ratings-Scale for diagnosing retrospectively ADHD-symptoms in young age has proved successful. On further assessment sheets the patient and people close to him can provide additional information to what extent diagnostic criterions according to ICD-10 are to be found.

Repeatedly using those scales in order to check the course of the disorder proves quite helpful for ascertaining wether the treatment is successful or not.

Just as ADHD-affected run a higher risk to develop additional psychic disorders, children as well may show learning ability disorders, tics, and malfunctional social behaviour. Problems connected with alcohol and drugs may show up in young persons; grown-ups quite often develop a disturbed personality, anxiety disorders, depressive and bipolar disorders. In those cases the need for therapeutic help increases significantly. In many affected particularly the abuse of nicotine may cause additional grave health hazards.

Domestic, work, school, and leisure-time accidents hit much more often persons affected with ADHD, and often cause severe health problems.

Moreover grown-ups change jobs much more often. Partnerships as well are more often conflict-ridden and instable, and don’t last long. Divorce rates are higher, bringing up children causes additional tensions. As children frequently develop the disorder as well, an ever-increasing range of conflicts putting strain on families arises.

In traffic ADHD-affected persons attract attention by exceeding the speed limit, driving without driving license, or under the influence of alcohol, briefly: by a general tendancy to committing irregularities. Those affected by ADHD in connection with dysfunctional social behaviour or specifically disturbed personalities run a higher risk to behave antisocially. Thus the rate of ADHD-affected persons is much higher in men taken into custody.

Because of the distinctly greater hazards to develop psychic disorders, related health problems and subsequent social restrictions, and because of the additional social tensions and problems arising at the workplace, in marriage and family life or in interaction with other spheres of the personal environment, the additional strain in mastering their own life is significantly increased in persons developping ADHD.

I Am Affected With ADHD — What Now?

A diagnosis of ADHD does not imply a specific series of treatments; it merely represents a diagnostic evaluation supplying for he first time an explanation for certain symptoms and problems.

Once the diagnosis ADHD in a grown-up is established the question arises which therapies would be adequate?

Psychoeducation, psychiatric drugs as well as psychotherapy, applied separately or combined (multimodal therapy) represent appropriate possiblities, and aim at reducing the symptoms, improving the self-esteem, and increasing the quality of life.

Within the framework of the so-called multimodal therapy concept a successful treatment should be obtained, by means of advising, psychotherapy and coaching as well as by treating any correlated disorders. As to medication, stimulants are of great significance. They usually enhance concentration, and reduce impulsiveness and hyperactivity. In this case the basic substance is methylphenidate which in different preparations is released partly immediately, partly retardedly. Often those substances are needed if a psychotherapy aiming at overcoming problems and difficulties is to be successful.

Since the ‘off-label’-instruction applys to using methylphenidate in grown-ups most insurers refuse at the time being to take over the costs.

ADHD And Grown-Ups

Persons affected with ADHD are often thought to be “lively, very creative, distinctly fair and helpful, imaginative and sensitive, charming and always openminded to new ideas; moreover they like taking risks.”

The biography of Hermann Hesse shows quite clearly the other side of the coin. Already at the age of one he climbed boldly on small benches and tables, and “caused the little angels a lot of trouble to watch over him”. At he age of four, when he was visiting nursery school, his hot temper worried his mother greatly. On the other hand he was so cute and delicate that he meant a lot to her. He was constantly babbling about this and that, and was always energetic enough tocommit good as well as bad acts. When he was five his mother said that merely the mentioning of his name frightened her, and made her think: ‘So what has happened now?’ When he was six, the situation was to her feeling so humiliating that she was thinking seriously about sending him to a home or to foster parents, that they were to nervous and weak to be up to him.

When he was twelve his mother prayed to god that his diligence and his behaviour might improve. Sometimes it got so bad, that again she asked herself what to do about him. During the following years his life is marked by praying therapy in order to exorcise the demon, suicide attempts, several stays in mental institutions, short-term school attendances, and fruitless efforts to take school-leaving exams. He dropped out of an apprenticeship in book trading as well as in a clock factory and once more in book trading. Finally he was made out to be a lazybones, a good-for-nothing, and a warning for everybody.

When he attained his majority, his mother wrote: “With some of our children we had to go through deep below. God and solely those who experience something similar know what a parents heart has to go through.”

Today many grown-up patients diagnosed as ‘depressive’, ‘antisocial’ or ‘addicted to drugs and alcohol’ are treated more or less unsuccessfully because the underlying disorder, namely ADHD, is not recognised.

Even today the syndrome is often thought to be a disorder of childhood and adolescence. Considering the prevalence in grown-up age of 1 to 6 % as compared to 5 to 9% in childhood and adolescence this means that two thirds of the children ‘take their disorder with them into grown-up age’.

As the syndrome is often barely known and therefore overlooked, one can observe a change in the chronology. As most of those affected become calmer on the surface, and attract less attention, it is assumed that the disorder is overcome. Thus one misses that the basic problems remain just as they were: problems concerning order and organisation, a lacking ability to concentrate; frequently relational problems in private as well as in professional life.

Typical symptoms of ADHD in grown-ups are attentiveness and concentration disorders as well as readiness to be diverted; those affected frequently change from one activity to some other, and their learning ability is timewise restricted. Already after short-time efforts the patients have to get up. At longer lectures or presentations they frequently grasp cognitive contents only incompletely. The inability to concentrate if things are not really interesting causes frequent mental leaps and careless mistakes. Often they leave behind things, and their household as well as their workplace is in complete disarray and sort of chaotic.

Distinct symptoms — in correlation with hyperactivity and impulsiveness — are drumming one’s fingers or jiggling one’s feet; when conversing or phoning they constantly wander around, frequently very fast. They find it disagreeable to sit still for a good while, are chased by a permanent feeling of inner restlessness, and tend to act spontaneously. Frustration tolerance is distinctly restricted, and quite often those affected throw unbridled tantrums.

In meetings the patients tend to burst in conversations, and to cut short other people; in traffic they quickly become impatient and tend to undertake risky manoeuvers.

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