How do you deal with ADS of course

ADD and ADHD

ADS (Attention deficit disorder) or ADHD (Attention Deficit Hyperactivity Disorder): Behavioral disorders that focus on non-age-appropriate distractibility.

In ADHD (formerly also as hyperkinetic syndrome There is also an impulsiveness and overactivity that goes beyond the normal. Since normal children are also characterized by these same behaviors (distractibility, impulsiveness and urge to move), drawing the line between normal and abnormal behavior is difficult in individual cases and highly controversial among parents, teachers and paediatricians. About 5% of children are said to be affected, boys much more often than girls (ratio 4: 1). The diagnosis of children has been made more and more frequently for years, but it is unclear whether the number of cases of illness is also increasing or just the number of diagnoses made.

The first signs sometimes appear in babies, but the disease is usually only diagnosed from the age of 7. It is becoming increasingly clear that AD [H] D often persists into adulthood.

Alternative names. In Switzerland the AD [H] S is also known under the (older) term POS (psycho-organic syndrome). The older term minimal cerebral dysfunction (MCD) is no longer used.

Leading complaints

Inattention:

  • The child has trouble keeping their attention on tasks or in play and is easily distracted
  • He finds it difficult to organize activities or tasks
  • The child avoids unpleasant activities such as homework that require constant mental activity
  • He often doesn't seem to hear anyone talking to him
  • The child forgets things and tasks
  • It often does not follow instructions in full and fails to complete games or work
  • The child often loses things like toys or pens that are needed for activities.

Hyperactivity:

  • The child is sliding around on the chair and wriggling with his hands and feet
  • It leaves z. B. his place in school several times
  • The child runs or climbs even when the situation is inappropriate
  • It gets unnecessarily loud while playing.

Impulsiveness:

  • Before a question is fully asked, the child blurts out the answer
  • The child has trouble waiting for their turn
  • It interrupts and interferes with other people's games or conversations or interferes.

When to the doctor

In the next few weeks if

  • You suspect AD [H] D in your child after consulting a carer or teacher and the abnormal behavior does not change over a longer period of time.

The illness

Causes and Risk Factors

The reasons for AD [H] S have not been conclusively clarified; the disorder is probably not due to a single cause.

Inheritance. Today it is certain that a hereditary predisposition plays a role in some children, as AD [H] D occurs more frequently in some families. Most AD [H] S children have at least one affected relative; and approximately 30% of all men who have had AD [H] D later have children with the disorder of their own.

Organic causes. In some children, organic changes in the brain are involved; In AD [H] S children, for example, certain parts of the brain are less sensitive to the reward signals mediated by the messenger substance dopamine. You may therefore need more intense stimuli in order to feel yourself and feel good. Correspondingly, neurological or cognitive abnormalities are also found in about a third of AD [H] S children, such as fine motor skills, partial performance disorders, tics or problems in the area of ​​sensory perception. The fact that premature babies and children of mothers who smoked, drank alcohol or consumed drugs during pregnancy have an increased risk of AD [H] S supports the theory that behind an AD [H] S there is also an disturbed brain maturation or organization is stuck.

Exogenous factors. External factors, i.e. the influence of the environment or society, are also discussed as causes. These include changed family relationships, overstimulation with a simultaneous lack of exercise and a strong focus on performance. In addition, they play Society's expectations a role: Whether a child disturbs others with a certain behavior also depends on how children are supposed to spend their day - keeping still for hours is not part of the normal behavioral repertoire of children.

Temperament. How active children are depends on theirs temperament shaped - and that is at least partially innate. In addition, some children need more exercise than others in order to be emotionally balanced and receptive. In this respect, behind some cases of "hyperactivity" there could also be the built-in brake on movement in today's environment.

Nutrition. Food allergies and intolerance have recently been discussed as a common cause. Despite considerable research efforts, a connection with certain foods, food additives, preservatives (such as phosphates) or sugar could not be confirmed. Sugar does not produce AD ​​[H] S.

clinic

As inconsistent as the definition and causes of AD [H] S are, its manifestations are also inconsistent. Depending on the case, the 3 main characteristics of AD [H] S, i.e. inattentiveness, hyperactivity and impulsiveness, are observed in different degrees. These 3 main features do not have to be present at the same time.

  • The predominantly inattentive type ("Hans Guck-in-die-Luft", "Däumerchen"): These children are easily distracted without being hyperactive. Often these are girls.
  • The predominantly hyperactive-impulsive type ("fidgety philippi"): These children have problems with their constant urge to move and their impulsiveness. When they come to rest, they can partially concentrate well.
  • The mixed type: All 3 main features are represented here. Most sick children and almost all severe forms fall into this category.

Influence of age. In addition, the picture of the disorder changes with the age of the child.

  • Infancy: Even as babies, some children are very restless, scream a lot and sleep little. Once they are of the crawling and running age, nothing is safe from them. They investigate their surroundings as if they are excited, but have problems concentrating on something for a long time.
  • Small children: During this time AD [H] D is often difficult to recognize, as healthy small children are constantly on the move. The children fall z. In kindergarten, for example, they fidget in a circle of chairs and do not listen, do not adhere to the rules, do not play constructively (e.g. do not build towers or lay puzzles) and there are very often arguments between them and the other children. In many cases, these phenomena are viewed as bad habits or as an expression of incorrect upbringing - which they can, but do not have to be.
  • School age: The problems become much more apparent here, as the child is now expected to concentrate for a longer period of time. Even after a period of acclimatization of 1–2 months, the children still jump up suddenly from their chair, speak without being called, often react aggressively and bear failure very badly. The parents notice that the child sits endlessly on homework because he is constantly busy with other things. It usually doesn't take too long before school performance leaves something to be desired and other problems such as aggressiveness, depression and family disputes arise.
  • Puberty: During this difficult time, hyperactivity often turns into its opposite, that is, motor restlessness decreases, but adolescents become inactive and no longer feel like doing anything.

course

AD [H] D is usually a "childhood disease", but some of the behaviors still occur in adulthood - albeit much less pronounced than in children. But one thing is certain: Overactive behavior often becomes a problem:

  • On the one hand for the child's environment - the affected child's behavior disturbs classmates, teachers and parents, sometimes considerably.
  • On the other hand for the child himself - z. B. because the school fails despite good talent, because there are constant conflicts with friends, parents and teachers or because it reacts with aggression or depression due to bad experiences.

If the overactivity of a child is so pronounced that its behavior "stands in the way" of both its environment and itself, it is therefore rightly referred to as an overactivity disorder.

Follow-up problems. The unsuitable behavior, which is perceived as "difficult" by the environment, soon leaves the child increasingly sidelined in the circle of friends and in the family. His school performance gets worse and worse sooner or later despite sufficient intelligence - a vicious circle arises from a lack of confirmation or experiences of success, hurt and finally problematic behavior.

AD [H] S in adulthood. Experts assume that childhood AD [H] D very often persists in adulthood. Around half of all those affected have at least some of the symptoms to do later in life. It is estimated that about 3% of adults, v. a. Men who have AD [H] D. While motor overactivity takes a back seat in adulthood, attention disorder and lack of affect control (especially aggressiveness) become the starting point for subsequent psychosocial problems - from unemployment to traffic accidents to risky sexual behavior and crime. A study from 2016 also found a link between AD [H] D and the risk of obesity in women. In addition, the risk of other illnesses increases with AD [H] S, in particular addictions, depression, anxiety disorders and personality disorders.

Diagnostic assurance

The first point of contact in the event of a suspicion is the pediatrician. But many paediatricians then refer the child to a specialist in child and adolescent psychiatry or to a child psychologist, because the diagnosis of AD [H] D requires a lot of experience and is very time-consuming. In addition to a thorough general and neurological examination, it also includes psychological tests and an assessment of the child by other people, e.g. B. Kindergarten teachers (if necessary with the help of standardized observation sheets, the Conners sheets). Other diseases, e.g. B. an overactive thyroid, special forms of epilepsy, giftedness and many forms of other behavioral disorders must be excluded.

When making the diagnosis, the age of the child is always taken into account, because the younger a child is, the more likely it is that "immature" and impulsive behaviors are age-appropriate and therefore normal. The diagnosis AD [H] S is made if

  • the abnormal behavior was observed not only in school but also in at least one other environment (such as at home or among friends).
  • this behavior has persisted for at least 6 months.
  • Other mental illnesses were excluded as causes for the abnormal behavior.
  • in addition, the behavior of everyday life is very hindered, z. B family life, academic performance or friendships.

Note: Almost all children exhibit one of these behaviors from time to time. For the diagnosis of AD [H] D, however, these complaints must have persisted for the past 6 months to an extent that is incompatible with the child's level of development and inappropriateness and in different environments, e.g. B. in kindergarten and family, school and circle of friends. All signs of AD [H] S occur temporarily in children who are not affected by it, e. B. after special burdens (divorce of parents).

treatment

The therapy starts on several levels:

  • In family therapy, parents learn how to best deal with a child affected by AD [H] D, as these are very exhausting and often push their parents to their limits. In self-instruction training, older children learn to control themselves to a certain extent. Above all, behavioral therapeutic procedures are used, in which parents and the affected child should systematically learn more favorable behaviors. Play and occupational therapy are often recommended for children, but their additional benefits have not been proven.
  • Medicines come into question if there is no improvement due to changes in the home and school environment as well as behavioral therapy measures.

Pharmacotherapy

For the drug treatment of an AD [H] S patient, not soothing substances are used, but - apparently contradicting - stimulating substances. So the hyperactivity is not dampened, rather the controlling influences of the brain on both movements and attention are intensified.

These preparations have a stimulating and mood-enhancing effect on healthy people; therefore the use of some of these drugs is also subject to the Narcotics Act. In children with AD [H] D, it is the other way round: After taking it, the children become calmer, less impulsive and can concentrate better.

Active ingredients. In the German-speaking countries, methylphenidate is mainly used, better known under the trade names Ritalin®, Medikinet®, Concerta® and Equasym®. 4% of US school children take methylphenidate regularly, in Germany it is likely to be less, but exact data are not available. Other active ingredients in AD [H] S treatment are dexamfetamine and lisdexamfetamine. Recently, with atomoxetine and guanfacine, two preparations have become available that do not have a stimulating effect. They are indicated when stimulants are not tolerated or do not work.

Treatment with all the drugs mentioned requires constant specialist medical checks by a pediatrician or child psychiatrist.

Rating. Of course, drugs should only be used after careful diagnosis and only in those children for whom the non-drug measures have not been sufficient. When used in a targeted manner, the balancing effects of the drugs mean that they do not allow drug treatments at all, which would have been impossible until then. This means that the vicious circle of behavioral problems and subsequent social problems is interrupted and the child is socially integrated.

The drugs are controversial less because of their short-term side effects (mainly a lack of appetite, weight loss or insomnia) than because of their possible long-term effects, such as the resulting risk of addiction (from drug addiction to alcohol addiction). So far, however, there are no conclusive scientific studies on this.

Many children take the medication throughout their school years. If the child is making good progress, elimination attempts are made to determine whether the (drug) treatment is still required.

Conservative treatment

Biofeedback describes the feedback of body signals via sound or screen, for example in the context of breathing training or muscle relaxation exercises. Biological processes that are not directly accessible to the senses are made accessible to one's own consciousness using electronic aids. Affected people learn to understand their body signals better and thus to control their behavior. In detail, the following processes are used in biofeedback:

  • Breathing patterns such as breathing rate or breathing amplitude
  • Blood pressure and its change
  • Pulse rate, amplitude and variability
  • Skin temperature and resistance.

Neurofeedback is a biofeedback method in which the electrical brain waves are measured in real time using electroencephalography (EEG) and displayed on a monitor in order to train the generation of certain frequency ranges. About half of the children with AD [H] D benefit from neurofeedback therapy. Attention improves with the number of sessions. An important prerequisite for a successful treatment is that the child concerned and his or her parents are sufficiently motivated and are willing to train outside of the sessions.

Therapy of AD [H] D after puberty

More than half of the children and adolescents affected by AD [H] S take the disease partially or completely with them into adulthood. Those affected respond well to specialist psychiatric and psychotherapeutic treatment; improvement rates of around 70% are given.

A combination of pharmacotherapy and psychotherapy as well as social psychiatric support has proven successful. In psychotherapy, behavior-oriented group therapy seems to be particularly promising.

Pharmacotherapy. Methylphenidate is primarily used to treat AD [H] D after puberty. It is prescribed to patients over the age of 18 who have had AD [H] S since childhood and who do not respond adequately to other therapeutic measures. If methylphenidate does not help, treatment with atomoxetine is an option.

Your pharmacy recommends

What you can do as a parent

Even if every child is different, some principles always apply:

  • Your child is difficult - stick with them! A child with AD [H] D suffers from being "offended" so often. Take away the all-too-obvious feeling of being "bad" or "bad". The best thing to do is to regularly schedule times in your daily schedule when you only have time for the affected child.
  • Clear rules, boundaries and structures. Children with AD [H] D need a regular daily routine with fixed meals and adequate sleep. It is important to avoid inconsistent parenting rules. Instead of ranting and debating, rules and consequences laid down in advance should apply.
  • As much praise as possible. The child should be consistently praised for successful behavior. The children suffer from being different, they have to take a lot and therefore need praise and recognition even more than healthy children.
  • Calm environment. Children with AD [H] D process information particularly poorly when they are exposed to many stimuli at the same time. Homework should therefore be done in a quiet room, with no radio or siblings. TV and computer time should be allocated in moderation. Free access to these media is counterproductive. Meals should also take place without sources of interference such as radio or even television.
  • Don't ask too much, don't ask too much. Find out whether your child may be gifted or gifted and choose a school that suits his or her ability. Long work is overwhelming for most children, while limited, short tasks tend to give them a sense of achievement.
  • Sufficient exercise. You should definitely give your child enough "exercise", not just once a day, but also in between. Creative leisure activities are also beneficial, e.g. B. painting or dancing.
  • Nutrition or diet. Whether diets make a difference is a matter of belief. There is no evidence of this. There is no stopping many parents from trying any of the "conjured up" diets. Since dieting may increase the child's social isolation, it should only be maintained if a really positive reaction has been observed, not just by a family member but also by teachers.
  • Contact with educators and teachers. You should definitely inform the caregivers of your child so that their abnormalities are not seen as a bad habit, but as an illness and the expectations of the child are adjusted accordingly. Some of the above rules should also be implemented at school. B. get the quietest possible seat within the classroom. Unfortunately, however, in German schools there is a pronounced "attention deficit" when dealing with AD [H] S (and other "difficult" children).

Complementary medicine

Unfortunately, so far there is no reliable evidence that medicinal plants and co. Help with AD [H] S. Even if the scientific evidence is still lacking, the alternative treatment approaches for some accompanying symptoms such as sleep disorders and restlessness are definitely helpful and worth trying.

Valerian.

For the tea, add 1/4 l of cold water to 1 teaspoon of dried valerian root, leave to stand overnight and then strain. Let your child drink ½ or 1 cup of this before bed. A valerian tincture from the pharmacy is suitable for longer use. Give your child 10 drops on a lump of sugar three times a day after meals for 3 months.

Johannis herbs.

A tea is ideal for general nerve disorders and against internal discrepancies. To do this, take 2 parts of St. John's wort, 2 parts of lemon balm, 2 parts of lavender flowers and pour ½ l of boiling water over this mixture. Let it steep for 10 minutes, strain and give a cup to drink once throughout the day. Regular rubbing with St. John's wort oil also has a balancing effect. Either rub it all over your body once or twice a week, or just your chest and back in the morning and evening.

Lemon balm and St. John's wort tea.

If your child sleeps poorly for a long time, a tea made from lemon balm and St. John's wort will help. To do this, take 1 teaspoon at a time, pour ¼ l of boiling water over the mixture and let everything steep. Then strain and give to drink during the day.

Hop tea.

For tea, pour 2 teaspoons of hops with ½ l of boiling water. Then let it steep for 5 minutes and strain. If necessary, sweeten the tea with honey and drink it warm 1 hour before going to bed.

Aromatherapy.

Scented oils made from orange blossom, lavender, jasmine and lemon balm are suitable here.

Further information

  • www.ag-adhs.de - Website of the ADHD working group of paediatricians (Forchheim), an association of paediatricians interested in ADHD.
  • www.bvah.de - Website of the Federal Association of Attention Disorders / Hyperactivity e. V., Forchheim: With diverse (but unfortunately not always well sorted) information.

Authors

Dr. med. Herbert Renz-Polster in: Gesundheit heute, edited by Dr. med. Arne Schäffler. Trias, Stuttgart, 3rd edition (2014). Revision and update of the sections "Description", "Symptoms and complaints", "When to see the pediatrician", "The disease", "Confirmation of diagnosis", "Treatment", "Prognosis" and "Your pharmacy recommends": Dagmar Fernholz | last changed on at 17:32


Important note: This article has been written according to scientific standards and has been checked by medical professionals. The information communicated in this article can in no way replace professional advice in your pharmacy. The content cannot and must not be used to make independent diagnoses or to start therapy.