Children with attention-deficit hyperactivity disorder (ADHD) are particularly inattentive, impulsive, and active. ADHD can have a significant impact on the lives of children and their families.
At a glance
- ADHD begins in childhood and often persists into adulthood.
- Children with ADHD are particularly inattentive, impulsive, or “hyperactive”.
- Adults with ADHD often have problems in their relationships or at work.
- It is assumed that the condition is caused by a combination of genetic predisposition and external influences.
- Paediatricians, specialists in child and adolescent psychiatry, and psychotherapists are qualified to diagnose ADHD.
Note: The information in this article cannot and should not replace a medical consultation and must not be used for self-diagnosis or treatment.
What is ADHD?
ADHD is a neurodevelopmental disorder. Children with ADHD are particularly inattentive, impulsive, or “hyperactive”.
But what exactly do these terms mean?
- Children are classified as “inattentive” if they have poor concentration and are easily distracted.
- An “impulsive” child behaves more irresponsibly, carelessly, impatiently, or thoughtlessly than his or her peers.
- A “hyperactive” child is one who is extremely fidgety and restless.
Children with ADHD often stand out as exhibiting behavior that does not conform to the norm. Typically, they also find it hard to focus, which makes learning more difficult. Some children with this condition also have anxiety or depression.
Important: ADHD has been diagnosed with increasing frequency in recent years. However, critics suspect that some of these cases have been misdiagnosed and, for example, that children who are simply restless but otherwise healthy are being regarded as having a brain disorder.
What are the signs of ADHD?
It is normal for children to be occasionally inattentive and impulsive. The critical factor is how extreme and noticeable this behavior is. A potential diagnosis of ADHD is only a possibility if children or adolescents are significantly more inattentive, impulsive, and excessively active than others of the same age.
It is also important to distinguish between different sub-types of this condition. Children may be either predominantly inattentive or predominantly hyperactive and impulsive. If a child is inattentive but not hyperactive, this is known as attention deficit disorder, or ADD for short.
What causes ADHD?
Research into the precise causes of ADHD is still ongoing. It is assumed that the condition is caused by a combination of genetic predisposition and external influences.
Reliable studies on the causes of the condition are still lacking. Consequently, many different possibilities are being discussed among experts.
An indication of genetic predisposition has been established in the nerve cells of the brain in people with ADHD. It appears that a change occurs in how the neurotransmitter dopamine is transported to the areas of the brain responsible for memory and learning. Yet there are other biological factors which contribute to the development of ADHD.
Also, the role of societal developments remains unclear. Some researchers, for example, view ADHD as a consequence of or reaction to modern living, with children’s brains being routinely exposed to an ever-increasing number of stimuli, while their bodies are also moving less – against the backdrop of great pressure to perform and changes in family structures.
Influences during pregnancy are not fully understood either. If an expectant mother smokes, drinks alcohol or uses drugs during pregnancy, this increases the chance of her baby developing ADHD. However, several studies have revealed that only a small proportion of children exposed to these risk factors are affected.
Another possible risk factor is pre-eclampsia – a rare condition in pregnancy, which causes blood pressure to rise and the body to retain water.
Certain types of food are sometimes linked to ADHD. In fact, some research findings indicate that children who frequently consume artificial coloring agents and preservatives are more likely to exhibit more several behavioral issues. However, diet has at most a small role to play. If a connection is suspected, parents can try changing the diet to see if this brings about a positive change.
How common is ADHD?
Attention-deficit hyperactivity disorders are quite common according to statistics. Around 5 percent of children are diagnosed with ADHD. However, it is suspected that some children are being misdiagnosed.
What is the outlook for ADHD?
ADHD normally begins in childhood. Older adolescents and adults with ADHD are often less hyperactive than they were as children but frequently experience a sense of inner unrest or turmoil.
The symptoms are usually milder in adults than in children and adolescents. Around 50 to 80 percent of adults who had ADHD as children continue to have at least some ADHD symptoms. Approximately 15 percent continue to meet all ADHD diagnostic criteria as adults.
How is ADHD diagnosed?
A qualified diagnosis of ADHD can be made by paediatricians, specialists in child and adolescent psychiatry, or psychotherapists for children and young people.
It is important that diagnosis involves an in-depth discussion to identify and exclude other possible reasons for the child’s behavior. After all, difficulties with concentration, mental illness, problems at school and hyperactivity may have other causes, such as sleep disturbances or disorders, impaired vision or hearing, or hypothyroidism.
Adults who suspect they may have ADHD can consult a specialist in psychiatry or psychotherapy.
For more detailed information about the diagnosis of ADHD, visit gesundheitsinformation.de.
How is ADHD treated?
Any type of treatment is preceded by a consultation detailing what exactly ADHD is and how to live with it. Teachers and educators may be involved at this stage too. At that point, it may be determined that there is no great need for treatment.
The discussion should focus on the following questions:
- How severely are the child and parents affected by the behavioral issues?
- To what degree is the child’s development at school impacted?
- How does the condition manifest in daily life, e.g., in terms of sleeping habits?
Important: With mild ADHD, parental training may be sufficient. ADHD training teaches parents how to deal with the condition. Moderate or severe ADHD may lead to social problems or issues with learning. Appropriate measures at school, or family or behavioral therapy may help.
Should ADHD be treated with medication?
The following questions should be considered:
- How old is the child?
- How pronounced is the ADHD?
- Have any psychotherapeutic or pedagogical measures already been implemented?
- What are the benefits and drawbacks of the medication?
The most frequently prescribed medications contain the active ingredient methylphenidate. Alternative active ingredients are atomoxetine, dexamphetamine, guanfacine, and lisdexamfetamine.
For adults with ADHD, the treatment will depend on the individual’s personal situation and the problems they are experiencing. If a person finds it difficult to manage the illness with their own strategies, psychotherapy or medication may help.
When is treatment as an in-patient or day patient helpful?
For hyperactive and impulsive children and adolescents who find it difficult or impossible to manage daily life, a temporary stay in a psychosomatic or psychiatric clinic may be beneficial.
What can make everyday life with ADHD easier?
A child with ADHD may present a challenge for the entire family. It is not only during school and leisure-time activities that problems occur, including conflict with other children. Within the family environment, parents are continually faced with the difficult task of supporting the child affected while also ensuring that siblings do not feel neglected.
Most parents develop their own strategies to deal with this situation over time. Having certain routines and clear rules in place has been shown to help. Contacting and exchanging information with other families in a similar situation may also provide relief, e.g., in the context of a support group. It is important to remember that the child’s behavior is not intentional. Children with this condition also suffer the consequences of their behavior.
Where can I find support for ADHD?
A wide range of personalized advice and support is available throughout Germany for those with ADHD. These are organized differently, depending on the region. For a list of contacts, visit gesundheitsinformation.de.
- Catalá-López F, Hutton B, Núñez-Beltrán A et al. The pharmacological and non-pharmacological treatment of attention deficit hyperactivity disorder in children and adolescents: A systematic review with network meta-analyses of randomised trials. PLoS One 2017; 12(7): e0180355. doi:10.1371/journal.pone.0180355.
- Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie (DGKJP), Deutsche Gesellschaft für Psychiatrie und Psychotherapie, Psychosomatik und Nervenheilkunde (DGPPN), Deutsche Gesellschaft für Sozialpädiatrie und Jugendmedizin (DGSPJ). Aufmerksamkeitsdefizit- /Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter. S3-Leitlinie. AWMF-Registernummer 028-045. 05.2017.
- Döpfner M, Breuer D, Wille N et al. How often do children meet ICD-10/DSM-IV criteria of attention deficit-/hyperactivity disorder and hyperkinetic disorder? Parent-based prevalence rates in a national sample - results of the BELLA study. Eur Child Adolesc Psychiatry 2008; 17 Suppl 1: 59-70. doi: 10.1007/s00787-008-1007-y.
- Häge A, Hohmann S, Millenet S et al. Aufmerksamkeitsdefizit/ Hyperaktivitätsstörung im Kindes- und Jugendalter. Aktueller Forschungsstand. Nervenarzt 2020; 91(7): 599-603. German. doi: 10.1007/s00115-020-00904-1.
- Kazda L, Bell K, Thomas R et al. Overdiagnosis of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents: A Systematic Scoping Review. JAMA Netw Open 2021; 4(4): e215335. doi: 10.1001/jamanetworkopen.2021.5335.
- Kemper AR, Maslow GR, Hill S et al. Attention Deficit Hyperactivity Disorder: Diagnosis and Treatment in Children and Adolescents. (AHRQ Comparative Effectiveness Reviews; No. 203). 2018.
- Kim JH, Kim JY, Lee J et al. Environmental risk factors, protective factors, and peripheral biomarkers for ADHD: an umbrella review. Lancet Psychiatry 2020; 7(11): 955-970. doi: 10.1016/S2215-0366(20)30312-6.
- Richardson M, Moore DA, Gwernan-Jones R et al. Non-pharmacological interventions for attention-deficit / hyperactivity disorder (ADHD) delivered in school settings: systematic reviews of quantitative and qualitative research. Health Technol Assess 2015; 19(45): 1-470. doi: 10.3310/hta19450.
- Rimestad ML, Lambek R, Zacher Christiansen H et al. Short- and Long-Term Effects of Parent Training for Preschool Children With or at Risk of ADHD: A Systematic Review and Meta-Analysis. J Atten Disord 2016; 23(5): 423-434. doi: 10.1177/1087054716648775. Epub 2016 May 14.
- Storebø OJ, Krogh HB, Ramstad E et al. Methylphenidate for attention-deficit/hyperactivity disorder in children and adolescents: Cochrane systematic review with meta-analyses and trial sequential analyses of randomised clinical trials. BMJ 2015; 351: h5203. doi: 10.1136/bmj.h5203.
- Storebø OJ, Ramstad E, Krogh HB et al. Methylphenidate for children and adolescents with attention deficit hyperactivity disorder (ADHD). Cochrane Database Syst Rev 2015; (11): CD009885. doi: 10.1002/14651858.CD009885.pub2.
- Thomas R, Mitchell GK, Batstra L. Attention-deficit/hyperactivity disorder: are we helping or harming? BMJ 2013; 347: f6172. Erratum in: BMJ. 2014;348:g4377.
- Uchida M, Driscoll H, DiSalvo M et al. Assessing the Magnitude of Risk for ADHD in Offspring of Parents with ADHD: A Systematic Literature Review and Meta-Analysis. J Atten Disord 2021; 25(13): 1943-1948. doi: 10.1177/1087054720950815. Epub 2020 Aug 24.
In cooperation with the Institute for Quality and Efficiency in Health Care (Institut für Qualität und Wirtschaftlichkeit im Gesundheitswesen) (IQWiG).As at: