11. September 2019
“ADHD? That’s something in kids, isn’t it, when they can’t concentrate properly and fidget and disrupt at school?”
You would probably hear this answer more often if you asked the general public what is behind the two abbreviations. This is because most people associate the disorders ADHD and ADD with children. But the disorder persists beyond childhood and adolescence and can cause enormous distress in adults.
ADHD stands for attention deficit hyperactivity disorder. ADD stands for attention deficit disorder. The disorders are similar, but ADD lacks hyperactive behavior (American Psychiatric Association, 2013).
In an ADHD problem, the attention of the affected person is disturbed. This is required whenever a specific task is to be processed or a goal is to be pursued. Patients with ADHD cannot maintain their attention for as long as healthy individuals. They are quickly distracted by external stimuli and therefore cannot concentrate well. For ADHD sufferers, attentional performance requires significantly more effort and mental control than for healthy individuals.
One speaks of hyperactivity when there is an excessively high urge to move and motor impulses can only be suppressed with difficulty. The physical activity is then excessive and thus often not appropriate to the situation. Those affected suffer from excessive restlessness.
Although the term does not appear in the abbreviation, increased impulsivity is one of the main symptoms of ADHD/ADD. In impulsive behavior, there is a lack of action planning. While healthy individuals can plan through their actions step by step, individuals with ADHD are overwhelmed with this cognitive task.
Good to know: In German-speaking countries, ADHD/ADD is also referred to as hyperkinetic disorder (ICD 10 according to Dilling et al., 2012).
Pronounced ADHD/ADD symptomatology can make life quite difficult. All areas of life can be affected by the disorder:
It happens that ADHD or ADD is diagnosed only in adulthood, although it always develops in childhood and adolescence (more on this later). Sometimes those affected just “somehow” fought their way through it or were optimally supported by their environment. Some people with ADHD/ADD are also particularly creative and innovative, so that one cannot really speak of a disorder, but rather of a special feature. In that case, ADHD/ADD is not diagnosed at all, even if it is actually present. The rule of thumb is always: A diagnosis is only made when there is suffering.
If ADHD/ADD is diagnosed at a late stage, it is often not the main reason why the person concerned seeks treatment. For example, there may be depression, anxiety disorder, or addiction, and ADHD/ADD may not be recognized until the causes are looked at closely. The diagnosis of ADHD/ADD can then even be relieving. It explains why those affected encounter so many more difficulties in life than their peers and opens up new treatment options.
There are several explanatory models for the development of ADHD/ADD. Basically, it can be assumed that no model in isolation is sufficient to explain the development and maintenance of the disorder. It must be assumed, as with any mental disorder, that there is a coincidence of many factors. Factors that have been scientifically investigated and supported by studies are:
Over time, the conspicuousness of hyperactivity diminishes in many ADHD patients. By comparison, people not affected by ADHD/ADD also become more motor calm with age. Attention disorders, on the other hand, are more persistent. Scientists make the following basic assumption: If ADHD/ADD exists in childhood, it is 75% likely to persist into adolescence and 50% likely to persist into adulthood.
Important: If ADHD/ADD is suspected only in adulthood, it is mandatory for a reliable diagnosis that in retrospect the impairments were already present in childhood.
People with ADHD/ADD may not cope as well with some of the developmental hurdles that we inevitably encounter in life. For example, social skills, self-control, and self-image may not develop as well because the calm to do so is simply lacking. The school and professional development suffers from this and so an ADHD/ADD can pull a real mountain of problems with itself.
The treatment of ADHD/ADD in adults is composed of several components (Riechmann et al., 2017):
Psychotherapy in individual and group settings
In psychotherapy What to expect in psychotherapy?, mechanisms for dealing with the disorder can be learned. Psychotherapists often refer to this as coping strategies. The English word coping stands for the use of one’s own resources to deal with personal and interpersonal problems in a solution-oriented manner (Solanto et al., 2008). In group therapy, there can be an exchange of experiences with other affected persons, which can have a very relieving and strengthening effect.
Drug treatment is similar to that used in childhood. Particularly well known and widespread is the administration of the active substance methylphenidate – better known as Ritalin. Ritalin normalizes brain metabolism and ensures that those affected have more dopamine available (Döpfner, 2004). As a result, people with ADHD/ADD become calmer and can concentrate better, since they do not have to drive up the dopamine concentration through their own activity. In addition, after thorough medical clarification, medications are used to treat mental disorders that occur as a complication of ADHD/ADD, e.g., depression and anxiety disorders.
Neurofeedback is a computer-based method designed to train attention and self-control. The idea is that the computer provides feedback whenever attention goes down, and individuals receive a signal reminding them to self-regulate attention. Part of the process also involves measuring brain activity and teaching patients how to influence their brain’s electrical activity.
If you or a loved one has a diagnosis of ADHD/ADD in adulthood, the good news is that awareness and research of this disorder has improved greatly over the past two decades (review in research by de Zwan et al, 2012). Well-tested concepts are available on how to treat such a disorder in a meaningful way.
Many behaviors that make living with ADHD/ADD easier can be learned with help and long-term training. Solanto et al (2008) indicate areas where small tricks and exercises can make everyday life easier: Time management, “procrastination,” distractibility, and organizational skills are just a few. Setting priorities, keeping a calendar, and dividing larger tasks into subgoals – all of these can be practiced specifically! Living well is possible even with ADHD/ADD. Do not be afraid to seek external help and get advice – for this I wish you success and the necessary portion of calm at this point!