Dossier: Strong mind

ADHD: a blessing and a curse

Children who in the past would have been told off for having ants in their pants or for day dreaming are today often diagnosed with ADHD. We take a look at how and when attention deficit hyperactivity disorder (ADHD) should be treated and how to manage it in adulthood.

Text: Katharina Rilling; photo: iStock

They are easily distracted, appear absent-minded and their mind often seems to be elsewhere. They find it hard to concentrate and like to put work off until the last moment. Some are physically restless or find it difficult to socialise. Many break the rules and are bullied. Not all children are made for sitting quietly at school – are they? Their parents often ask themselves whether their child’s behaviour is normal or if they have ADHD.

Only doctors and psychologists can diagnose attention deficit hyperactivity disorder. But it is sometimes said that they may have been too free with their diagnoses in recent years, with talk of misdiagnoses, handing out the trendy drug ritalin willy nilly, and even an entire ADHD generation. This observation is shared by Stephan Kupferschmid, head of psychiatry for adolescents and young adults at Integrierte Psychiatrie Winterthur - Zürcher Unterland (IPW): “I’ve been working in this sector for 16 years and have noticed that the diagnosis of ADHD has always been in flux and is sometimes controversial. In recent years, people have often wondered whether the mental disorder was diagnosed too often.”

What causes ADHD? 

In people with ADHD, the balance of messenger substances in the brain (neurotransmitters) is altered, with dopamine and noradrenaline in particular playing a significant role. This makes it harder for them to control themselves and concentrate. According to Kupferschmid, it is generally believed that biopsychosocial-cultural factors are involved. There is no single cause of ADHD and it is a field in which a lot still remains unexplained. Genetic predisposition and pre, peri and early postnatal environmental influences play a decisive role.

ADHD: Different symptoms in children and adults

In the beginning, this behavioural disorder was typically attributed to boys. It was – and still is – rare for girls to be diagnosed with ADHD or ADD. This is mainly because the symptoms often show themselves differently in boys. Girls tend to day dream and be quiet, they are less impulsive and hyperactive and therefore attract less attention. The latest findings show that ADHD doesn’t stop when a person turns 18. Most people become less hyperactive over the years, but the attention problems continue. “That’s why the topic has been picked up in adult psychiatry,” explains Kupferschmid.

Should we treat ADHD with medication like ritalin?

Today, experts are more careful about diagnosing ADHD straight away. Observation is key to the diagnostic process. Parents and teachers are asked about the child’s behaviour and they examine how the child is affected. The diagnosis is rounded off by psychological and neurological examinations such as attention tests. Medication, such as the now well-known drug ritalin, is no longer prescribed automatically. “Medication is a controversial topic, particularly with children. We look at each case individually,” says Kupferschmid. After taking ritalin, some children suddenly suffered from depressive moods. “In this case, the medication intake is checked and adjusted, if necessary, to counteract side effects such as a deterioration in mood,” says Kupferschmid.

The good news is that ritalin is broken down very quickly by the body. And if the diagnosis of ADHD proves to be not entirely correct, in most cases the medication simply has no effect and can be discontinued immediately. Most recently, amphetamines  are being prescribed more often. Common side effects include problems sleeping or loss of appetite.

However, Kupferschmid believes that the benefits of drug treatment usually outweigh the disadvantages. “In my opinion, ADHD medication is safe, well-documented, not addictive and usually well-tolerated.” You also have to consider the consequences if the disorder goes untreated. Boys in particular are proven to be involved in more traffic accidents, perform less well at school and often fall into drug use when they get older. And there are more divorces seen in adulthood. So ADHD can remain a big issue throughout a person’s lifetime.

“What is often forgotten is that there are many positive sides to ADHD.”
Dr Stephan Kupferschmid, head of psychiatry for adolescents and young adults at IPW

Focus on the positives of ADHD

In addition to medication, ADHD is also often treated with psychotherapy and learning support at school (see Tips for parents). Good results have also been achieved with occupational therapy. Neurofeedback can also help to improve older children’s concentration. But the aim is not to cure ADHD. “What is often forgotten is that there are many positive sides to ADHD. Those affected who know their strengths and weaknesses and can adjust their life accordingly, benefit greatly from these advantages,” says Kupferschmid. People with ADHD are often creative and fast-thinkers, they are often inquisitive and open to new ideas, particularly when it comes to new technology. They are less resentful and more willing to experiment and are happy to try new things. If they find an area that interests them and matches their skillset, they are happy to explore it in-depth. So perhaps they are more suited to an apprenticeship that allows them to work creatively and where they don’t necessarily have to follow precise instructions. Or a course of study that coincides with their favourite topic but leaves time for physical activity. 

Kupferschmid’s oldest patient is 60 years of age. He was only diagnosed with ADHD ten years ago. “He worked well when he had an administrative job, but when he become self-employed and had to organise everything himself, he started having real problems. His disorder started to show itself,” says Kupferschmid. Finding their own way can be a lifelong task for people with ADHD. And one that has every chance of success.

ADHD – a family topic: Tips for parents

School and parents: working together 
It is important to talk to teachers early on, because topics such as attention and impulsiveness can really start to be noticed at school. “Often, little changes can have a big impact,” says Dr Stephan Kupferschmid. “For example, if a girl who day dreams is allowed to sit at the front of the class so the teacher can talk to her more often. Or if a boy with behavioural problems is entrusted with an important job to boost his self-esteem.” In addition, there are often good solutions for targeted support for common symptoms of ADHD, such as motor difficulties or reading and spelling disorders, and later also treatment options for new-onset depression and anxiety. 

Rules and structure
“Many families with children affected by ADHD benefit from having a structure with clearly-defined routines. Family rituals are often a good idea and help bring a feeling of calm to everyday life,” says Kupferschmid  

Avoid downward spirals 
“There is a great risk of getting stuck in a vicious circle if you have children who aren’t so easy to manage and don’t fit in everywhere,” says Kupferschmid. Punitive parenting and education methods aren’t a good solution. It’s better to highlight the positive sides of a child with ADHD, such as creativity and openness, and to give them the confidence that they will find their own way.

Self-help groups
In addition to educational support, self-help groups are also useful. They can help you learn to deal with ADHD as a family.

Further information is available from the ADHD organisation elpos and SFG-ADHS