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Attention deficit hyperactivity disorder (ADHD) is a neurobiological developmental disorder that usually manifests itself in childhood and often persists into adulthood. To the technical article →
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Definition and meaning of ADHD
People with ADHD often have difficulty concentrating on a task for long periods of time, have difficulty controlling their impulses and often show motor restlessness. The effects of this symptomatology can be felt in various areas of life and influence the school, professional and social life of those affected.
ADHD is defined and classified internationally by diagnostic systems such as the DSM-5 (Diagnostic and Statistical Manual of Mental Disorders) and the ICD-10 (International Classification of Diseases). Both systems describe ADHD as a disorder characterized by a combination of inattention, hyperactivity and impulsivity. These systems offer specific diagnostic criteria and categories for subdividing ADHD symptoms, which enables a differentiated diagnosis and contributes to the development of targeted therapeutic approaches. The DSM-5 in particular distinguishes ADHD subtypes in order to do justice to the variety of symptom manifestations.
Historical development and recognition of the ADHD diagnosis
The concepts of hyperactivity and impulsivity were already described at the beginning of the 20th century, but the diagnosis of ADHD in its current form only became established in recent decades. Originally, the behavior of affected children was often referred to as „fidgeting syndrome“ or „hyperkinetic disorder“.
With the growing understanding of neurobiological principles and the development of modern psychological diagnostic tools, ADHD became increasingly recognized as a clinical diagnosis in its own right. Today, ADHD is recognized worldwide and is the subject of extensive scientific research.
Origin and multifactorial causal relationships
The etiology of ADHD is complex and is considered to be multifactorial. This view emphasizes that ADHD is not solely due to genetic predispositions or environmental factors, but that a combination of both factors plays a role.
Neuroscientific studies suggest that genetic predispositions, neurobiological deviations and environmental influences such as prenatal stress and early living conditions increase the risk of developing ADHD. These findings enable a holistic view of the disorder and promote the development of specific therapeutic approaches.
Genetic predispositions and heredity
The genetic basis of ADHD is supported by twin studies and familial clustering, which show a significant genetic component. It is estimated that around 70-80% of the risk of developing ADHD is genetic.
Certain genes related to the regulation of neurotransmitters such as dopamine and noradrenaline play a role in this. These neurotransmitters are significantly involved in the control of attention and impulse control. Research into genetic markers and their function in neuronal signal transmission makes a significant contribution to understanding the biological basis of ADHD.
Environmental factors and epigenetics
In addition to genetic predispositions, environmental factors also have an impact on the development of ADHD. Studies show that prenatal and perinatal influences such as the mother's nicotine and alcohol consumption, prematurity or lack of oxygen at birth can increase the risk of ADHD.
In addition, epigenetics is becoming increasingly important as it investigates how environmental factors can influence gene expression and thus promote the occurrence of ADHD. These findings are helping to develop preventative measures and pay attention to risk factors in early childhood.
Neurobiological basics and brain structures
The neurobiological basis of ADHD is characterized by functional and structural deviations in certain brain regions, particularly in the prefrontal cortex, striatum and cerebellum.
The prefrontal cortex is responsible for executive functions such as planning, impulse control and decision-making. Studies using imaging techniques such as fMRI and PET show that these brain regions exhibit reduced activity in people with ADHD, which contributes to the typical behavioral abnormalities. These neuroanatomical abnormalities underline the biological basis of the disorder.
Symptoms
Inattention is a central feature of ADHD and manifests itself in the form of
- Distractibility,
- Difficulties in focusing on tasks and a
- frequent changes between activities.
- Those affected often have difficulty retaining information over a longer period of time and
- tackle tasks in a structured and focused manner.
- The underlying cognitive mechanisms include deficits in executive functions, such as working memory and selective attention, which are necessary for goal-directed behavior.
Hyperactivity symptoms: Expression of motor overactivity
Hyperactivity in ADHD describes excessive motor activity, which manifests itself in constant fidgeting, the urge to move and difficulties in remaining seated.
These symptoms are mainly evident in children, but can also continue into adulthood in the form of inner restlessness and a need for activity.
Neurobiological studies indicate that this motor overactivity is related to a disturbed regulation of neuronal excitation, which leads to the typical hyperactivity.
Impulsivity: risk-taking behavior and decision-making
Impulsivity is another central symptom of ADHD and includes actions that are taken without prior consideration of the consequences.
Those affected tend to behave rashly, which can lead to risks in a social and professional context.
Research shows that this form of impulsivity is linked to a dysfunction in the brain's reward system, which influences decisions and short-term rewards. The resulting difficulties in decision-making represent a major challenge in everyday life.
Subtypes of ADHD and differentiation
| Subtype | Description |
|---|---|
| Predominantly inattentive | Shows concentration problems in particular. |
| Hyperactive-impulsive | Characterized by motor restlessness and impulsive behaviour. |
| Combined type | Includes both inattentive and hyperactive-impulsive symptoms. |
This distinction is clinically relevant because it makes it possible to tailor therapy to the individual symptoms of the affected person. The primarily inattentive type shows primarily concentration problems, while the hyperactive-impulsive type is characterized by motor restlessness and impulsive behavior. The combined type encompasses both symptom groups
Symptoms in childhood and implications for school
ADHD in adolescence and psychosocial challenges
During adolescence, people with ADHD face additional psychosocial challenges. Adolescents not only struggle with the classic symptoms such as impulsivity and inattention, but are also increasingly prone to risky behavior such as drug use or truancy. These behaviors can lead to conflicts in the family and social environment.
In addition, adolescents with ADHD are at an increased risk of developing comorbid mental disorders, including depression and anxiety disorders. Support from specialized professionals and the environment is particularly important at this stage of life.
Symptoms in adulthood: persistence and functional limitations
In a large proportion of those affected, ADHD symptoms persist into adulthood and lead to considerable functional limitations. Adults with ADHD often report difficulties in areas such as time management, organization, occupational performance and emotional self-regulation. Studies show that the symptoms often manifest themselves in adulthood in the form of inner restlessness, impulsive decision-making and problems in interpersonal relationships. It is also known that ADHD sufferers are at a higher risk of burnout and other stress-related illnesses in adulthood.
Diagnostics: Standardized procedures and procedural diagnostics
The diagnosis of ADHD requires a comprehensive clinical examination by experienced specialists. In addition to clinical interviews, in which the behavior and developmental history of the affected person are examined, standardized test procedures are used. These tests aim to assess executive functions, working memory and impulse control. In addition, observations of behavior in various situations and reports from relatives can provide valuable information for making a diagnosis.
Differential diagnosis: differentiation from comorbid disorders
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Therapeutic interventions and treatment strategies
The Treatment of ADHD is typically multimodal in design and combines cognitive behavioral, pharmacological, and psychoeducational approaches. The goal of therapy is to reduce symptoms, promote functional strategies for coping with everyday demands, and improve the quality of life of those affected.
Depending on the age group and severity of the symptoms, different approaches are chosen that are tailored to the specific needs of the patients.
Pharmacotherapy: efficacy and side effects
Drug treatment is one of the key interventions for ADHD. Stimulants such as methylphenidate and amphetamine salts are the most commonly used medications and work by promoting concentration and impulse control.
Despite the proven effectiveness of these medications, possible side effects must be taken into account and the dosage adjusted individually. In addition to stimulants, non-stimulant medications such as atomoxetine are also used, especially if stimulants are not tolerated or if there are contraindications.Pharmacotherapy: efficacy and side effects
Sources
Dilling, H., Mombour, W., Schmidt, H. (2014): International Classification of Mental Disorders. ICD-10.clinical diagnostic guidelines (9th edition). Bern: Hans Huber
How is ADHD tested?
ADHD is diagnosed through a thorough, multi-stage examination that combines various methods. These tests are usually carried out by experienced psychologists, psychiatrists or child and adolescent psychiatrists and include the following steps:
1. detailed anamnesis
The first step is a detailed interview in which the developmental history, current symptoms and everyday life of the person affected are discussed. This will determine whether the symptoms have existed since childhood and are causing impairment in various areas of life (e.g. school, work, family).
2. behavioral observation and external anamnesis
In the case of children, parents, teachers and other caregivers are often interviewed in order to gain a comprehensive perspective on the behavior. In adults, partners or family members can also be consulted in order to better assess the symptoms.
3. standardized questionnaires and checklists
There are specific questionnaires and tests (e.g. Conners’ Rating Scales, SNAP-IV questionnaire, ADHD screening) that are used to assess ADHD symptoms. These help to measure the frequency and intensity of symptoms and compare them with typical ADHD patterns.
4. psychological tests for attention and impulse control
Tests such as the Continuous Performance Test (CPT) or attention batteries check specific executive functions such as responsiveness, impulse control and the ability to concentrate for long periods of time. These tests can indicate whether cognitive impairments typical of ADHD are present.
5. differential diagnostics
ADHD symptoms can be similar to those of other mental or neurological disorders (e.g. anxiety disorders, depression, learning difficulties). It is therefore investigated whether other disorders are present in order to avoid misdiagnosis.
6. medical examination
As physical factors (e.g. thyroid disorders) can cause similar symptoms, a medical examination is often carried out. This is to rule out organic causes that could lead to concentration problems or motor restlessness.
ADHD is diagnosed when the symptoms persist over a longer period of time, have already started in childhood and lead to problems in several areas of life (e.g. school, work, relationships).
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Dr. Katrin Wippersberg is a multi-skilled psychoanalyst and psychotherapist who works with great empathy and extensive experience in the treatment of trauma, anxiety disorders and depression, as well as being a profound couples therapist.
Definition: ADHD (attention deficit hyperactivity disorder) is a neurobiological developmental disorder characterized by inattention, impulsivity and hyperactivity. The causes are multifactorial and include genetic, neurobiological and environmental factors, while the diagnosis is based on standardized criteria such as DSM-5 or ICD-10.
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