17. March 2022
Unfocused? Restless inside? Impatient? – It is a misconception that ADHD is an issue that only affects children. Because ADHD can also lead to a number of restrictions and problems in everyday life, work and private life in adults. This type of disorder now affects around 4.5% of all adults in Germany and is therefore not uncommon. ADHD is easily treatable today. With the right therapy, those affected can learn to cope with ADHD and increasingly focus on their strengths. Coming to terms with the symptoms and the dimensions of the disorder is an important first step in this direction.
When we speak of ADHD, we mean the so-called attention deficit hyperactivity syndrome. The disorder is based on a genetically determined, neurobiological developmental delay that involves altered brain connectivity. The three core symptoms include the following:
Disturbance of attention: increased distractibility; forgetfulness; difficulty following conversations and focusing on tasks; losing or misplacing objects of use.
Hyperactivity: feelings of inner turmoil; nervousness; difficulty relaxing; inability to perform prolonged activities while seated
Impulsivity: speaking, acting and deciding without considering consequences; impatience; interrupting others in conversation; difficulty managing money.
In addition to the core symptoms mentioned above, many affected persons describe themselves as particularly empathetic. They quickly pick up on the moods of their fellow human beings, which enables them to deal with them empathetically. At the same time, however, it becomes more difficult to distance oneself from negative moods in one’s environment. In the course of this, many patients report rapidly changing moods, which can only be triggered by small occasions. Likewise, there is often an increased irritability in those affected. Even a visit to a shopping mall or a ride on the subway with many people, smells and the noise can lead to aggressiveness or an inner withdrawal. Frequent conflicts with partners, friends or family, failures, the permanent feeling of not being able to realize one’s performance potential and being considered lazy, superficial or choleric often results in a lowered self-esteem. ADHD patients also often live in an altered day-night rhythm and describe themselves as more efficient at night. This may have biological causes or may be due to the fact that there are fewer distracting stimuli at night.
As already mentioned, ADHD can cause considerable impairment in various areas of everyday life
In the context of vocational training, studies or further education, attention problems can lead to a lack of ability to listen or learn, which brings with it the risk of failure. Students with ADHD in particular have problems organizing their own learning material or meeting deadlines due to the low structural framework.
Likewise, conflicts can arise in the workplace if work is too slow or mistakes are made due to inaccuracy. However, if those affected try to compensate for these deficits through increased effort, sooner or later there will be persistent exhaustion. If the loss of the job threatens, a great discouragement arises.
Many sufferers have problems organizing official and financial matters. For example, they forget to pay bills despite repeated reminders.
Conflicts can easily arise in social contacts due to increased impatience and low frustration tolerance. Impulsive statements and actions offend those around them and cause the person affected to feel misunderstood. The increased withdrawal can be seen as rejection and unsettle the environment. Disorganized behavior, which includes not keeping appointments or breaking off activities, also harbors potential for conflict.
Looking beyond all the challenges, it is important to emphasize that ADHD can bring not only limitations but also special abilities. Hyperactive people in particular often possess a great deal of charisma and can captivate others with their spontaneity and energy. Affected people also often have a tendency to creativity and question rigid views. These skills can be an advantage in the profession, for example, many people with ADHD are active in artistic professions as writers, actors or in science, where they can introduce new ideas through their innovative thinking and convince with their great enthusiasm.
The diagnosis of ADHD is complex. To date, there are no known standardized laboratory tests or specific procedures that can be used to make a reliable diagnosis. The assessment of the symptoms therefore takes place step by step on several levels and requires the cooperation of various specialists and specialist groups.
Exploration: Here, the disease-specific symptoms in the various areas of life with the corresponding limitations should be addressed. It is important that the typical symptoms have already existed before the age of 12 and that they are not only present in a certain phase, but persist over time. Structured interviews, questionnaires, testimonies or an external anamnesis by the partner, family or friends come into play here.
Clinical observation: Here, the various symptoms can be observed in a fixed framework. Patients with hyperactivity may be observed sitting in a chair, which is often accompanied by a shaky leg or drumming fingers. Hyperactive-impulsive patients are observed here as being particularly noisy, while inattentive patients are distracted, scattered or lose the thread of conversation.
Important: The aforementioned behaviors can also appear when the patient is nervous. Likewise, ADHD patients may succeed in suppressing their symptoms for the duration of the examination
Neuropsychological test diagnostics: Since a disturbance of attention in ADHD patients is mostly observed in routine activities, especially sustained attention tests and working memory should be checked
Differential diagnoses and comorbid disorders: Symptoms of AHDS coincide with or may be additional to many other mental health disorders. However, it is often unclear whether comorbid disorders are promoted by the often unfavorable life course of ADHD patients or whether another biological cause underlies them. For example, depression could be a consequence of failures in private and professional life, or it could be triggered by ADHD-related neurobiological deficits.
Somatic differential diagnoses: Physical diseases can also lead to ADHD-like symptoms. An internal and neurological examination can exclude differential diagnoses such as epilepsy, narcolepsy or hyperthyroidism and hypothyroidism.
Even though some adults have already been diagnosed with ADHD in childhood, there is a large percentage who have not yet been diagnosed with the disorder. Not infrequently, the diagnosis in precisely these cases creates a great relief and the cornerstone for a new beginning and new treatment paths.
As soon as the diagnosis of ADHD has been made, it should be checked whether the patient’s symptom spectrum requires treatment at all. Only when several areas of life are affected by the disorder and there is a high level of suffering can an individual therapy concept be created with the help of psychoeducational, psychosocial, psychotherapeutic and pharmacological components. Comorbid disorders should also be included in the treatment concept.