Experts warn against generation ADHD

Experts warn „Generation ADHD“

11/02/2013

Nearly 20 percent of boys and 7.8 percent of birth year 2000 girls were diagnosed with ADHD between 2006 and 2011. That resulted „Doctor Report 2013“ the health insurance Barmer GEK, in which of the „Generation ADHD“ the speech is.

ADHD diagnoses should not get out of hand. Pills against education problems are the wrong way, Dr. Rolf-Ulrich Schlenker, Deputy CEO of Barmer GEK, the result of the investigation. Especially in Würzburg, according to the 2013 Physician Report, ADHD diagnoses are frequently made. Professor However, Marcel Romanos, director of the Department of Child and Adolescent Psychiatry, Psychosomatics and Psychotherapy at the University of Würzburg, warns against premature conclusions. The results are not fully generalizable. The ADHS expert also sees a danger in blaming parents for incompetence as the cause of their children's problems. Investigations have shown that ADHD is primarily genetic.

ADHD - that „Hyperactivity syndrome“
Attention Deficit / Hyperactivity Disorder (ADHD) is one of the most common childhood psychiatric disorders, with attention, impulsivity, and hyperactivity issues. Affected children can not concentrate well, often do not finish tasks, often change jobs, suffer from nervousness and anxiety, and fall asleep in the classroom „Zappelphilipp“ on. Children with ADHD may also experience developmental learning or social behavior. ADHD is classified by psychiatrists as incurable.

The exact causes of ADHD have not yet been conclusively clarified. Beneficial factors of ADHD include exposure to alcohol and nicotine during pregnancy, pregnancy and birth complications, decreased birth weight, infectious diseases, various pollutants and environmental toxins, and diseases and injuries affecting the central nervous system. Experts talk about multifactorial causes of ADHD, in which biological, psychological and social factors interact. Genetic causes also play an important role.

Cause of ADHD mainly genetic
Back in 2010, scientists from Cardiff University in Wales identified the origins of ADHD and genetic makeup. For their study, the researchers compared the genome of 366 children with an ADHD diagnosis to the DNA of 1047 healthy humans. It turned out that twice as many ADHD children (15 percent) had significant and rare changes in their DNA compared to healthy children (7 percent). Anita Thapar, Professor of Neuropsychiatric Genetics at Cardiff University and head of the study, said that ADHD often occurs not only to a family member, so suspicion that hereditary cause of ADHD was also responsible. The study confirmed this assumption.

The difference in the genetic make-up of healthy children and ADHD patients essentially consists of deviations in the so-called copy number variants (CNV), the scientist explained. ADHD children are more likely to have defective DNA structures. Some parts are duplicate or missing completely. Experts have long suspected an association between CNV and a predisposition to certain diseases such as schizophrenia.

Doctor Report: Children of the unemployed are more likely to have ADHD
According to the medical report of Barmer GEK, there is a dramatic increase in ADHD diagnoses. In the period from 2006 to 2011, the number of cases is said to have increased by 42 percent. Especially children from families with low income are affected. The risk is even higher if the parents are unemployed, according to the report. In addition, the risk for ADHD decreases, the better the education level is. „We need to be careful that ADHD diagnostics are not getting out of hand and we are making an ADHD generation. Pills for education problems are the wrong way, "warns Dr. Rolf-Ulrich Schlenker, Deputy Chairman of the Barmer GEK.

Professor Marcel Romanos criticizes statements like these sharply. In conversation with the „Main Post Office Würzburg“ he reports that unfortunately it is often doubted, „that ADHD is a disease“. Educational mistakes are often cited as a cause of ADHD in public discussion.

„The frivolous accusation that ADHD is due to the incompetence of parents, however, does not do justice to the situation in any way. Families have a great deal to do to help their affected children, often reaching the limit of their capacity. Many families even break this problem“, so the expert.

Overburdened teachers, too little exercise and excessive media consumption are also often cited as causes. Above all, however, Romanos sees a genetic predisposition as the trigger of ADHD. Studies on monozygotic and dizygotic twins have unequivocally proven the link between the genetic material and the disease. In 80 percent of identical twins with identical genetic material both children are affected, in dizygotic only 30 percent. In about one third of ADHD children, one parent is also affected.

ADHD research at the University of Würzburg for child and adolescent psychiatry
The University of Würzburg had put a focus on ADHD research, reports the clinic director. On the one hand, it is about researching the causes of the disorder, which include not only genetic but also environmental factors. Second, focus on the treatment of those affected and their family members. Also called biomarkers, biological factors, would be explored to provide a better diagnosis and prognosis. Added to this were the psychological factors that would also be examined in Würzburg. Only recently has a large psychological study been completed. As a preliminary result, according to Romanos, could be called the realization that affected families will be helped particularly effectively, even if their environment will be discussed. Therefore, it is not enough to limit the treatment to the affected child. It must also be examined whether there are other mental illnesses within the family. It is not uncommon that the mother is also affected by ADHD, the expert said. Therefore, it is currently being investigated whether the children also benefit from treating the symptoms of the mothers. That was the first such study worldwide.

Treatment for ADHD consists of combining psychotherapeutic measures
In order to give the best possible advice to the affected children and their families, after the diagnosis has been made, intensive information about the symptoms of ADHD will first be provided. Then follow various behavioral therapy measures, reports Romanos. A drug treatment, for example, with psychostimulants such as methylphenidate (Ritalin) come only in severe cases of ADHD in question. Children who did not need Ritalin would not get one either. However, the remedy works the most against the core symptoms of ADHD children.

The best results were obtained when children who received a drug were given a behavioral therapy in parallel. Especially in those affected by ADHD and other mental illnesses such as depression, a strong effect of behavioral therapy was observed. Psychiatric comorbidities are not uncommon in ADHD. However, the children who only had ADHD had no additional noticeable effect from behavioral therapy, the clinic director said. Although there is little scientific evidence for the efficacy of behavioral therapy in a pure ADHD disorder, it is recommended in the guidelines. In contrast, the efficacy of Ritalin is clearly demonstrated.

Ritalin in ADHD is controversial
According to the Physician Report 2013 of the health insurance company Barmer GEK, the prescription frequency of methylphenidates (Ritalin) has increased in a similar way as increasing numbers of ADHD diagnoses, with the amount of daily doses decreasing after 2010 for the first time. In 2011 alone, Ritalin was prescribed 336,000 times. Children were most often given the drug at age eleven. At least 10 percent of boys and 3.5 percent of girls take at least once in their lives a remedy for ADHD. The box office sees this development highly critically. „Ritalin should not be the means of first choice per se“, warns the Deputy CEO of Barmer GEK.

Romanos speaks expressly „against a non-indicated Ritalin regulation“ out. A diagnosis must be made clearly and unequivocally. In a mild form of ADHD, a psychotherapeutic treatment without medication is often sufficient. In severe cases, however, Ritalin is necessary. The discussion and, above all, the rejection of the drug would primarily affect people who have never treated an ADHD child and are not themselves affected. However, this one-sided view goes past the interests and needs of those affected. Even self-help groups would advocate Ritalin, reports the physician.

The reproach of the Barmer GEK that in the „ADHD stronghold Würzburg“ Romanos may well be back too fast to Ritalin. He sees a high level of medical competence in Lower Franconia. A negligent action of doctors excludes the physician. Despite good care of ADHD patients, there are long waiting times. So there is no need, „unnecessarily make an ADHD diagnosis“. In Lower Franconia, Ritalin is not prescribed more frequently than in other regions of Germany. The show also the doctor's report. The prescription frequency of Ritalin did not increase between 2011 and 2012. However, the number of diagnoses for ADHD and the drug prescription in adults has increased.

„ADHD stronghold Würzburg“ is internationally in midfield
The hospital director is annoyed by the report by Barmer GEK. The diagnostic rate of ADHD of 4.14 percent among children and teenagers ranks Romanos in the international comparison in midfield. It was not clear that doctors would be too lazy to make a corresponding diagnosis. In Würzburg, the number of cases of diagnosis would increase, because the university hospital and the established child and adolescent psychiatrist form a specialist center for ADHD, which could possibly make a diagnosis that would otherwise not be recognized. Many families from other states would even come to the clinic. Although these would not appear in the doctor's report, but also missing the private insurance and the data of other statutory health insurance. The report is only a secondary data analysis and neither a scientific study nor an epidemiological study. Romanos sees the report as possibly a political instrument that generally calls into question mental illnesses.

Occupational therapy in ADHD does not make sense
When looking at the costs of treating ADHD, the doctor's report shows that Ritalin costs about 10 percent of the treatment. Psychotherapy and ergotherapy are significantly more expensive, explains Romanos. It is already known that occupational therapy has no effect on ADHD. Other countries would therefore have deleted from their treatment catalog. Alternatives to a drug therapy such as neurofeedback would have to be further explored. There, the data is still very bad.

According to Romanos, the discussion about Ritalin has to do first and foremost with the evaluation of mental illnesses in our society. Patients with biliary colic who got them from high-fat food and too much alcohol would not be stigmatized. However, the question of guilt would be asked in the case of mental illnesses such as depression, which sufferers would have suffered through no fault of their own. It was not accepted, „that mental illnesses can affect anyone and are thus part of our society“, criticizes the doctor. It was important to counteract this development. Often, in the context of ADHD, allegations would be made to parents for not caring for their children, watching too much TV or lacking the movement. Prejudices such as these, however, would contribute to the de minimization of ADHD and defame the affected families. (Ag)

Also read:
ADHD genetically conditioned?
Doctor Report 2013: More and more children with ADHD?
ADHD: Many adults unconsciously suffer from it
Study: ADHD is often misdiagnosed
ADHD: Physiotherapy instead of psychostimulants?
More and more children are receiving ADHD medication
Trend reversal in ADHD therapy?
ADHD: concentration through noise
Environmental factors hardly investigated in ADHD

Picture: Nicole Celik