Attention Deficit Disorder ADHD - Causes, Symptoms and Therapies

Attention Deficit - Causes, Symptoms and Treatment

Increasingly, children in Germany are diagnosed with ADHD and many are being treated with medications such as Ritalin, Medikinet or Straterra. Due to the known side effects, however, warnings about a purely medical therapy and the question of alternative treatment methods are appropriate. How does it look today with the research of alternative therapy methods?

contents

• Attention Deficit - Causes, Symptoms and Treatment
• definition
• Growing number of those affected
• symptoms
• Possible ADHD causes
• diagnosis
• therapy
• Significant increase in drug prescriptions
• Threatening side effects with the ADHD remedies
• Is a herb grown against hyperactivity?

definition

The attention deficit hyperactivity disorder (ADHD) is attributed to the "Classical Behavioral and Emotional Disorders of Childhood and Adolescence" or its subgroup - "Hyperkinetic Disorders" according to the International Classification of Diseases (ICD). The symptoms describe a combination of increased impulsivity, lack of attention or concentration problems and excessive motor activity (hyperactivity), whereby the various aspects can be of varying severity.

Growing number of those affected

In 2008, the Commercial Health Insurance (KKH) announced as a result of a study the fifty percent increase in the diagnosis AD (H) S in the period 2004 to 2007. The surveys of the Scientific Institute of the AOK (WIdO) from the "Supply Report 2015 / 2016 "indicate that children under the age of 18 years have recently had a prevalence of almost five percent for hyperkinetic disorders. By the year 2008, the number of diagnoses has risen sharply and since then a flattening of the curve can be detected here. However, the incidence 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) about 5 percent of children and adolescents in Germany aged between three and 17 years. According to the RKI, boys are significantly more likely to be affected at 8 percent than girls (2 percent), and ADHD is diagnosed more than twice as often among children from low-status families than children from high-social-class families (8 percent vs. 3 percent)..

symptoms

First signs of ADHD usually appear in early life years. For example, affected children are affected by a lack of endurance in cognitively demanding occupations and erratic behaviors. Activities are not completed and instead new ones are started. It shows an excessive motor activity, which is also associated with a tendency to accidents. In addition to limited ability to concentrate and motor hyperactivity, there is an increased impulsivity, which often causes considerable problems in the social environment.

Overall, children affected by ADHD often have difficulty learning and performing tasks, but also within families and when dealing with peers. The extent of the impairments can also be seen as a measure of the need for therapy. While mild ADHD does not require treatment in principle, a moderate and a severe form of the symptoms should be treated to avoid further harm to those affected. ADHD also increases the risk of mental illness such as depression or anxiety disorders. In addition, a 2016 Mayo Clinic Children's Research Center study found that ADHD doubles the risk of obesity in women, which in turn can lead to ill health.

As an ADHD cause also detectable neurobiological changes in the brain of those affected are discussed, however, a causal relationship is not yet clearly proven. (Image: denisismagilov / fotolia.com)

Possible ADHD causes

Regarding the possible causes of ADHD, there is still little clarity. For example, genetic predisposition seems to be an important component, but which sequences of the ergbut are crucial here remains unclear. Other attempts at explanation mainly focus on the social environment of those affected, the pollution (eg passively absorbed tobacco smoke) or the impaired signal transmission in the brain. But clear evidence for one of these theories are pending. Neither are the altered sizes of certain brain areas in ADHD patients as a clear cause of the disease to assess. However, recent studies have increasingly been published that suggest a connection with neurobiological impairments.

A whole package of risk factors is also related to the appearance of the complaint. These include, for example, the intake of paracetamol in pregnancy, which was brought in a study from 2016 in connection with the risk of ADHD in the offspring. In addition, for example, alcohol consumption during pregnancy and diseases of the central nervous system are further risk factors.
In addition, especially for the hyperactivity triggers such as food allergies, heavy metal pollution, environmental toxins, preservatives or Impfunverträglichkeiten are discussed. Last year, a study by British and Dutch researchers concluded that even excessive consumption of fat and sugar in pregnancy increases ADHD risk among offspring.

diagnosis

The diagnosis of ADHD was often made in the past by general practitioners, relying mostly on the statements of parents and teachers. Today, however, the demands on the diagnosis are much higher. So this should in principle be provided by a specialist, detailed surveys of parents, teachers and possibly other family members include and also consider neurological examination or appropriate tests of those affected. Finally, the diagnosis is confirmed if the typical ADHD behavior patterns (see symptoms) can be demonstrated in the investigations and other possible causes such as hyperthyroidism (hyperthyroidism), a liver disease or the Asperger syndrome were excluded differential diagnosis.

The severity of the disease (mild, moderate, severe) is also determined by the severity of the condition in order to determine the need for therapeutic care.

Symptoms can be used to determine the severity of attention deficit hyperactivity disorder (ADHD) and the need for therapy. (Image: simoneminth / fotolia.com)

therapy

As mentioned earlier, not every attention-deficit hyperactivity disorder requires therapy. The decisive factor is 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, first of all an intensive education takes place, which is aimed directly at those affected and their parents and also includes teachers and / or educators. Possible assistance in everyday life are an important part of the therapy here. The further steps are individually very different and are usually based on a combination of different measures.

Basically, psychotherapeutic procedures such as cognitive behavioral therapy for ADHD treatment are relatively well suited, but need this time and they are compared to the medication relatively expensive. Also, recent studies suggest that psychotherapy (without drugs) can only help to a limited extent, as the cause of the disease in neurobiological changes in the brain is suspected. To date, therefore, the drug treatment in ADHD remains widespread. In particular, the active ingredients metylphenidate (for example, contained in Ritalin) and atomoxetine (contained in Statera) are used. They show in many patients quite remarkable treatment success, however, the side effects are not to be underestimated and the drug therapy is now considered much more critical than a few years ago.

Significant increase in drug prescriptions

Already in 2009, a study commissioned by the DAK showed a nationwide increase of the drug prescription in AD (H) S by 4.1 percent compared to the previous year. In regional distribution, Baden-Württemberg and North Rhine-Westphalia were the leaders. On average, therefore, one child per school class was affected by the intake. The drugs are the active ingredients Atomoxetine (in Straterra) and especially Metylphenidat (in Ritalin, Equasym, Concerta, Medikinet). The Federal Institute for Drugs and Medical Devices (BfArM) reported a tripling in the consumption of methylphenidate between 2002 and 2012. According to the Scientific Institute of the AOK (WIdO), in 2013 at least one prescription of a corresponding drug was reported by 40.2% of all six- to 17-year-olds diagnosed with hyperkinetic disorder.

Often, ADHD is treated with the active ingredient methylphenidate (included in Ritalin). However, the long-term effect of the drug therapy remains controversial and the drugs can bring significant side effects. (Image: Zerbor / fotolia.com)

Threatening side effects with the ADHD remedies

The high prescription rates of ADHD remedies have been increasingly critically evaluated in recent years, as not infrequently massive side effects show up, especially in continuous use, whose adverse effects outweigh the positive effect in part. Frequently, for example, an appetite reduction during the action time, which is accompanied by true binge eating when the effect wears off - that is usually in the later evening hours. This can lead to an increase in weight, which especially strains obese children.

Possible side effects of ADHD medications include:

• a headache,
• stomach pain,
• inner excitement,
• slight to strong increase in heart rate and blood pressure,
• weight loss,
• dizziness,
• nausea,
• increased hyperactivity with decreasing effect,
• cognitive impairment,
• depressive mood, tearfulness and social withdrawal,
• vegetative paleness with red rings around the eyes,
• Triggering and strengthening existing tics,
• Psychotic reactions in overdose as well as various interactions with other drugs.

Not only parents are worried about the development of prescribing practice in view of the threat of side effects. The Federal Institute for Drugs and Medical Devices (BfArM) has limited the approval for metylphenidate for a good reason. Close physical check-ups and special knowledge about behavioral disorders are linked to the regulation, additional psychological care and body-oriented offers are strongly recommended by health policy-makers and experts. It stands to reason that the prescription of drugs no longer has to be done by general practitioners, but especially by child psychiatrists with social psychiatry agreement. Because these are bound to provide additional psychological, educational and curative (or occupational therapy) offers by the employment of members of appropriate occupational groups.

In addition to the drugs, which influence the brain metabolism for a limited time, the ADHD sufferers are mainly offered concentration therapies and social skills training, which may be supplemented by a behavioral-oriented parent training. Learning disabilities, negative social interactions, and family causes and enhancers should be reduced or eliminated.

Is a herb grown against hyperactivity?

Although the sufferers are often offered therapies from the field of experience healing individually. However, despite the observation of positive developments in the treatment of medicinal plants, dietary supplements, homeopathic remedies, Bach flower remedies, craniosacral therapy and the therapeutic use of alternative body-oriented procedures, so far no general recommendations could be made because the proof of efficacy was lacking according to scientific criteria.

ADHD children need special support and care to avoid possible impairments. A simple immobilization with medicines is - especially in view of impending side effects - the wrong way. (Picture credits: Dieter Schütz /pixelio.de)

However, for several years, efforts to scientifically investigate alternative ADHD treatment approaches have been progressing steadily:

• For example, in the Department of Child and Adolescent Psychiatry at the University Hospital Mainz scientists under the direction of Prof. Michael Huss are trying to investigate the efficacy of a combination of St. John's wort and valerian extract (Sedariston concentrate) for hyperkinetic symptoms. Clinical observations suggested a clear effect.
• Regarding the triggers, British researchers found a link between combinations of artificial colors (including the red food color 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 summed up several studies as the scientific director of the magazine "ADHS Report", which investigated the effect of omega-3 and omega-6 fatty acids on brain metabolism in general and in connection with AD (H) S , Accordingly, the children affected by symptoms actually have low levels of polyunsaturated fatty acids in the body that can be compensated by dietary supplements, which has a positive effect on milder symptoms. However, if AD (H) S is strong, this effect is unlikely to be sufficient.
• According to a controlled pilot study of the University of Heidelberg from the year 2006, a yoga training adapted to child needs is clearly superior to the conventional exercise training as intervention or accompanying AD (H) S therapy.
• A special neurofeedback has also been shown in a study by the TU Dresden in 2016 as a promising treatment approach. The results were published in the journal "Nature".
• Furthermore, a study under the auspices of the Frankfurt University Hospital is currently investigating whether exercise programs and light therapy in adolescents and young adults can reduce or prevent the complications of ADHD.
• Regarding prevention, scientists from the University of Southern Denmark found out last year that vitamin D intake during pregnancy protects the offspring from the risk of hyperactivity.

The exemplified studies illustrate the scope of the various research approaches. Hope for further progress in treatment seems justified, but traditional psychotropic drugs are thought to remain a widely used option until then. And this despite the fact that a study at the Ruhr-Universität Bochum (RUB) made it clear last year that no lasting relief from the psychotropic drugs is to be expected. These show therefore only temporary effects and after weaning return the symptoms. In addition, there is the risk of serious side effects while taking.

Until scientists succeed in replacing Ritalin & Co with more general research results by using gentler treatment methods, it remains to be hoped that many brave parents and children will find alternative ways to help their families make their own individual lives. (jvs, fp, last updated on 18.04.2017)
Specialist supervision: Barbara Schindewolf-Lensch (doctor)

Swell:
Haffner, Roos, et al .: "On the Efficacy of Body-Oriented Therapeutic Procedures in the Treatment of Hyperkinetic Disorders" in: Zeitschrift fur Kinder- und Jugendpsychiatrie und Psychotherapie, 34 (1), Hogrefe 2006

Döpfner, M .: "Alternative therapies: polyunsaturated fatty acids", ADHS Report, 7th year, May 2006

Warnke, Walitza: "Methylphenidate in the treatment of Attention Deficit Hyperactivity Disorder (ADHD), in: Schulte-Markwort M, Warnke A (Hg.): Metyhlphenidate. Stuttgart: Thieme 2004; 14-33.

Resonanzen, German Society for Alternative Medicine, Issue 8, 07/2002