Attention Deficit Hyperactivity Disorder (ADHD)

ADHD: causes & diagnosis

The mechanism by which attention deficit hyperactivity disorder develops is not yet fully understood. Among other things, a dysregulation of the metabolism of the messenger substances dopamine, serotonin and norepinephrine is assumed. Genetic predisposition is likely to play an important role. Oxygen deficiency around birth and risk factors to which the child was exposed in the womb (such as infections) are also discussed. Premature birth, excessive consumption of licorice, food intolerance and drug / nicotine abuse could also be contributory factors. Inconsistent parenting behavior can negatively affect ADHD.

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• Core symptoms of ADHD
• Careful diagnosis
• Diagnosis in young children
• From the anamnesis to game observation
• Psychological examination
• Whom can I ask?
• Who pays the costs?

Core symptoms of ADHD

The main symptoms of ADHD are inattention, impulsiveness and overactivity - beyond what is appropriate for a child's developmental phase. In diagnostics, criteria according to ICD 10 (International Classification of Diseases) are used to classify diseases. ADHD shows up individually in each child. Diagnostics should be made easier on the basis of so-called core symptoms. These are divided into three main areas: inattention, hyperactivity and impulsivity.

Core symptoms of inattention:

• Trouble holding sustained attention
• Difficulty paying attention to details and careless mistakes
• Listening and following instructions are difficult
• Difficulty completing or organizing tasks / activities
• prolonged mental exertion is difficult
• frequent misplacement of objects, forgetfulness
• easy distraction by external stimuli

Core symptoms of hyperactivity:

• constant restlessness in hands and feet
• Trouble sitting or playing quietly
• Feeling of being "driven internally as if by a motor"

Core symptoms of impulsivity:

• Torrent of speech
• Difficulty waiting until it's your turn to talk
• disruptive behavior towards others

Source: adapted from ADHD Consensus Statement - State of the art 2012, CliniCum, April 2012

Careful diagnosis

The diagnosis of ADHD is made in a social context: only if the child's behavior is significantly impaired and at least six of the above symptoms are present. Symptoms must also first appear before the age of seven for ADHD to be diagnosed. In many cases, ADHD persists into adulthood.

The symptoms must express themselves clearly and sustainably hinder the child's development and persist for at least six months in several areas of life (school, leisure time, at home, etc.). The child's environment is carefully examined in order to identify framework conditions that can contribute to the disorder.

Often, children with ADHD also suffer from other mental disorders such as social behavior, depression, anxiety disorders, partial performance disorders, an autistic disorder or tics. If the restlessness and hyperactivity are caused by a disorder other than ADHD (eg an anxiety disorder), the diagnosis “attention deficit hyperactivity disorder” is not made.

Diagnosis in young children

Symptoms are not as evident in young children as they are in school children. Being hyperactive or impulsive is part of development at this age to some extent. Small children with ADHD have difficulty accepting a “no” or observing rules, and are conspicuously defiant - even outside of the “defiant phase”. In addition, it is more difficult for them to assess dangers, which means a higher risk of accidents.

From the anamnesis to game observation

At the beginning of the diagnosis there is a detailed survey of the medical history (anamnesis). Medical, social, psychological and family factors are taken into account, as are the course of pregnancy and child development. The child's behavior and play are observed. Not only the weaknesses, but also the strengths should be considered, as these can be used helpful for therapy. Parents are also asked about their reaction to the behavior of their offspring (e.g. punishment) and what feelings are associated with it (e.g. helplessness or anger).

A physical examination as well as a measurement of length and weight complete the diagnosis. If necessary, a blood sample (e.g. to determine the thyroid hormone) as well as an EKG, EEG or imaging examinations (e.g. MR) are necessary. Additional clarifications, for example by an occupational therapist, can also be helpful.

Psychological examination

An ADHD diagnosis in childhood always includes a psychological test. Depending on the age, suitable tests are selected that are helpful for the diagnosis. In addition, there is a development and talent diagnosis. In selected cases, videos make it possible to view family dynamics (e.g. parent-child bond) from a different perspective. If required, partial performance diagnostics are also used.

Whom can I ask?

If you suspect that your child suffers from ADHD, contact a child psychiatrist or a pediatrician specializing in psychosomatic medicine or one of the specialized ADHD outpatient clinics. The latter then initiates further necessary examinations or therapies.

Who pays the costs?

The costs for the medical examination and treatment are normally covered by the social insurance institutions. For more information, see Costs and deductibles and prescription fee & Co. The clinical-psychological diagnosis is a social security service. Information on occupational therapy can be found under occupational therapist.