Many FAQs about ADHD copied together as one large article

No! Despite clinical research results to the contrary many parents and even some doctors believe that sugar intake is linked to hyperactivity or mood swings in children. A long time ago special diets (Feingold) were used to reduce symptoms of these children. Other parents postulated phosphate or food additives to cause adhd-like-symptoms. They might have some effect for a very short time but cannot influence the outcome of adhd. Actually they are very hard to handle and might cause additional psychological problems because your child will not like them at all.

There might be a small subgroup of adhd-children with a special sensitivity for some food. Trials of sugar restriction or diets should be restricted to 3 or 4 weeks. A subgroup of children (1-3 %) might show limited benefit, so it could be worth a trial. But diets and restrictive eating patterns are a main cause for the development of eating disorders. Since we have no scientific basis for such an attempt you should better use a multimodal treatment approach.

More about sugar

A recent study showed that adults treated for obesity who also had ADHD have significantly more problems achieving weight reduction as well as a worse outcome in standard treatment programs.

If one modifies the diagnostic criteria of ADHD and defines the age of onset of ADHD symptoms at 12 (instead of 7 years), then ADHD is very frequent among obese individuals. 27.4% of all patients with obesity also had ADHD. Severe obesity (BMI over 40) had an even higher frequency of ADHD (42.6% of this treatment group). These patients with both obesity and ADHD had more hospitalisation and longer treatments with lower response rates.

Up to now, very little systematic research is available and only few psychotherapists or doctors will do an evaluation for ADHD in this group of patients with eating disorder.

The reasons why ADHD and obesity often occur together are unknown. There are clues that neurotransmitter changes in the dopamine system and reward centers of the brain are affected.

In a recent study parents of ADHD children were asked to speak about the use of complementary and alternative medicine (CAM). We know, that a lot of parents will try them to make every possible attempt to avoid psychopharmacological treatment with psychostimulants or other forms of multimodal treatment. 62 of 114 (54%) of the parents had experiences with this kind of treatment. Reasons to make a trial of this type of treatment were mainly:

• a "natural" alternative
• having more control over the treatment

One important result of the study was that only 14 % of the parents talked about their treatment approach with their doctor. This might cause severe problems for the children because even "natural" approaches like nutritional supplements or dietary manipulations or even high-dose vitamins can cause severe problems or interactions with medicine.

While scientific results of these "alternatives" are mainly disappointing, doctors usually will accept these trials of the parents. But they might also offer more reliable information about the advantages and possible negative consequences of these treatment approaches.

Up to this point of research there is no alternative or complementary treatment for ADHD that proved any lasting positive results. You should be very careful if advertisements or laymen recommend this type of treatment and promise a "cure" for ADHD symptoms.

More: http://www.chadd.org/fs/fs6.htm

Concerta is a rather new psychostimulant version, containing the known methlyphenidate. But it lasts much longer: between 10 and 12 hours due to a specific transport system (OROS). If your son would take the medicine at noon he might get severe sleeping problems...

And there is another reason why you should stick to the recommended dosage of the clinic: The 36mg dose most properly did the best job to improve the ability to focus and sustain attention. With the lower dose your son will not have the same benefit.

You should talk to your doctor about this issue. He might not be well informed about this new drug but it should be easy for him to get appropriate informations very soon. Maybe one of the members of the self-help group or a local pharmacists could help you and call your doctor to discuss this issue.

If he is not willing to change his opinion you should look for a second opinion.

DAMP = Deficits in Attention, Motor Control and Perception is a descriptive diagnosis which is commonly used in Scandinavian countries. It was introduced by the Swedish professor Gillberg in the 80's.

The core symptoms of attention deficits and impulsive symptoms are common to both descriptions. The main difference is that DAMP also includes deficits in Perception and Motor control.

A doctor can find characteristic signs of DAMP:

• coordination deficits
• deficits in handwriting and other precise motoric functions
• deficits in sensory perception

Sometimes also "soft signs" are present. These are minor neurological changes that cannot be explained by a severe neurological disorder. This might include differences of sensory perception in distinct areas of the body (or between the right and the left part of the body)

The Diagnostic and Statistical Manual, 4th Edition (DSM-IV) describes three types of ADHD:

• Predominantly Hyperactive-Impulsive Type
• Predominantly Inattentive Type and
• Combined Type.

Children with the mainly Inattentive type of ADHD tend to daydream and have difficulty focusing. The following criteria are used to diagnose children with ADHD, Predominantly Inattentive Type. Symptoms must have been present for at least six months, with onset before age seven:

• often fails to give close attention to details or makes careless mistakes in schoolwork, work, or other activities
• often has difficulty sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly
• often does not follow through on instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behaviour or failure to understand instructions)
• often has difficulty organizing tasks and activities
• often avoids, dislikes, or is reluctant to engage in tasks that require sustained mental effort (such as schoolwork or homework)
• often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books or tools)
• is often easily distracted by extraneous stimuli
• is often forgetful in daily activities

To meet the diagnostic crtieria according to the DSM-IV (Diagnostic and statistical Manual of psychiatric disorders) a couple of aspects have to be considered:

A. Six (or more) of either 1) Inattention, or 2) Hyperactivity/Impulsivity Symptoms must have persisted for at least 6 month to a degree that is maladaptive and inconsistent with developmental level:

1) Inattention

• often fails to give close attention to details or makes careless mistakes in homework, work, or other activities
• often has difficulties sustaining attention in tasks or play activities
• often does not seem to listen when spoken to directly
• often does not follow through instructions and fails to finish schoolwork, chores, or duties in the workplace (not due to oppositional behavior or failusre to understand instructions)
• often has difficulties organizing tasks and aktivities
• often avoids, dislikes or is reluctant to engage in tasks that require sustained mental efforts
• often loses things necessary for tasks or activities (e.g. toys, school assignments, pencils, books)
• is often easily distracted by extraneuous stimuli
• is often forgetful in daily activities

2) Hyperactivity / Impulsivity Hyperactivity

• often fidgets with hands or feet or squirms in seat
• often leaves seat in classroom or in other situations in which remaining seated is extected
• often runs about or climbs excessively in situations in which it is inappropriate (in adolescents or adults, may be limited to subjective feelings of restlessness)
• often has difficulty playing or engaging in leisure activies quietly
• is often "on the go" or often acts as if "driven by a motor"
• often talks excessively

  Impulsivity
  

• often blurts out answers before questions have been completed
• often has difficulty awaiting turn
• often interrupt or intrudes on others (e.g. butts into conversations or games)

B) Some symptoms causing impairment were present before age 7 More.

C) Some impaiment from the symptoms is present in two or more settings (e.g. at school and at home) More.

D) There must be clear evidence of clinically significant impairment in social, academic or occupational functioning More.

E) Occurence is not exclusively during the course of a Pervasive Developmenal Disorder, Schizophrenia or other Psychotic Disorder and are not better accounted for by another mental disorder

Basic information about ADHD by the American ADD organisation

There are no lab-tests that can determine or exclude ADHD. But it might be important to rule out some other relevant causes of hyperactivity or attention problems. So the doctor will do a physical and basic neurological clinical examination of the patient. Using his eyes and ears and doing some basic tests of reflexes, motor functions, coordination and testing the senses of the patient will give a lot of important information.

Then a blood test of the thyroid functions (TSH and maybe thyroid hormones T3, T4) should be considered. This will normally be done within a routine check of the patient.

If the patient (or family) has a history of seizure the doctor will do an EEG. This will not show specific signs of ADHD but might exclude specific forms of seizures. If the doctor and you decide to use psychopharmacological treatment an EKG should exclude significant heart problems.

A scull X-ray (Computer tomography, NMR) can be useful to exclude rare other causes of attention problems (like malformations of blood vessels, tumor, hydrocephalus). But these are very rare conditions!

Some parents think very specific diagnosis of functional imaging (SPECT, PET) will show specific signs of ADHD. At the moment these diagnostic tools are mainly used for research. You have to consider possible side effects of nuclear medicine especially for children. So these diagnostic tools cannot be recommended for a routine diagnosis of ADHD.

No. But you should always consider all possibilites of improvement depending on the individual domains of impairment and main target symptoms of the kid. To develop an appropriate treatment scheme for ADHD children can only be done by addressing all possible areas of impairment and personal ressources and interests of the children and their enviroment. So a multimodal treatment approach will start by gathering information from the child, the parents, teachers and other relevant persons in contact with the patients. This will help to assess specific presentations of problems or coping facilities of the individual patient in different domains.

Symptoms or behaviors in the context of ADHD (or any other psychiatric diagnosis) will only be treated if they cause problems in the patient«s life or interfere with the individual development. So medication will only be one part of a complete treatment approach to help the client to reach his or her full potential of functioning in all domains of the individual environment. Sometimes this can be done without medication, but very often psychostimulants are the basis of a better awareness and self-controll of the children.

There are very different opinions about the number of adhd children, who need psychostimulants. Some experts think that less than 30 percent of all adhd children might need them. Other experts say, that you should always offer a pharmacological treatment option because it will have the best outcome for the child on the long run. About 80 percent of all adhd-children that get a medication will get significant improvements. Any other treatment approach will not achieve similar benefit for the children.

To define the individual benefits or side effects of the treatment a baseline of specific target symptoms should be defined and a close follow-up (at least once a month in the beginning) should monitor all positive or negative changes.

Impulsiveness is the immediate response to thoughts or deeds without any consideration of the appropriateness or consequences.

People with ADHD tend to speak, act or move without thinking. Typical features of impulsiveness may include:

• rapid decisions without reflecting the consequences
• impulsive buying and horting
• Acting without thinking
• Speaking without any thoughts about the content and appropriate situation
• Interruption of conversations
• lack of ability to check details, making false assumptions

Impulsiveness could be also a positive feature. The ability to make rapid decisions or act can be important for leaders or in a case of emergency. However, it can also cause severe social problems and is one of the most disabling problems of ADHD for many patients.

One very common problem for children, adolescents and adults with ADHD is the problem to adjust to any new situation. While many ADHD people love new things or tend to seek new stimuli they have big problems to adjust to a new enviroment, new homes, teachers at school or any other major changes in their daily routines. Even new clothes or changes of their favourite food or drink can cause severe emotional problems and frustrations.

The pharmacological part of the multimodal treatment of ADHD is not dangerous or you do not have to expect long-lasting or serious side-effects. But you have to be well informed!

Having made an accurate diagnosis of AD/HD as the primary problem, the health care professional should have a therapeutic talk about:

• Patient expectations and goals of the therapy. Sometimes more realistic goals have to be defined.
• It is important to explain the basic effects of psychostimulant medication, but focus on the self-control of the patient. The psychostimulant will not change the behavior or conduct problem. Every child will be able to misbehave or make jokes. But if the medication is correctly working the child should be able to control and inhibit negative behaviors- if she or he really wants to.
• A basic principle of self-monitoring of the symptoms and possible adverse effects should be established
• Information about the risks and benefits of pharmacotherapy
• Likelihood of adverse effects and problems in the titration of the right dose. The patient and/or parents should be familiar with possible symptoms of lack of medication (rebound) and overdoses.

Start the medication only if you and your child are well educated and familiar with the basic principles of medication and agree with this treatment option! If you or your child have any serious concern do not hesitate to ask for further information. You should also try to connect to other parents in a self-help group! More about medication for ADHD

Pharmacotherapy is one option of a multimodal treatment approach of ADHD. While stimulants (methylphenidate or amphetamine) are the treatment of choice some antidepressant medication has also positive effects for the treatment of ADHD .

Methylphenidate is the name of the most commonly used medication for the psychopharmacotherapy of ADHD. Brandnames of drugs with Methylphenidate are Ritalin, Ritalin-SR, Ritalin LA or Concerta and Metadate. There are also some generic medication with Methylphenidate (Equasym, Medikinet). Methylphenidate is a central nervous system stimulant, or a CNS stimulant.

To achieve positive effects for ADHD patients the main target of the medication is the dopamine system of the brain. The most relevant neurobiological problem of ADHD can be explained as a malfunction of the dopamine transporter system. These transporters are responsible for the reuptake of dopamine from the synaptic gap into the nerve cells. If the activity (or number of transporters) is too high, the available dopamine is too low.

Are parents doping their children?

Myth: PARENTS WHO GIVE THEIR KIDS ANTI-ADHD DRUGS ARE DOPING UP PROBLEM CHILDREN.

Some people claim that medicating ADHD children is only a frustrated attempt to explain failures in parenting and to explain inattention, incompetence and inability of adults (or teachers) to control these children. These people say parents try to mask their own failings and use medicine to calm children down.

This is unfair because most of these people never got contact with any ADHD children or the parents for a longer period. People without such children have no idea what it's like.

They very often rely on wrong information which is influenced by authors like Breggin or even misinformation posted by Scientology church. There are strong interests for such wrong information and emotional discussions concerning ADHD and stimulant medicine in the public media. But they are not talking to selfhelp-organisations or parents but only to authors with no experience in the field of ADHD who try to get publicity for their own books or institutes.

Randomized, controlled studies in both the United States and Sweden have tried combining medication with behavioural interventions and then dropped either one or the other. For those trying to go on without medicine the behavioural interventions maintained nothing. Only the combination of pharmacotherapy with psycho-social intervention and behavioural interventions for ADHD can achieve better results. Behavioural therapy is of special importance if comorbid disorders like conduct disorder or symptoms of secondary depression or anxiety are present. Myth and Scientific Evidence

More information from the American CHADD organisation
Medication for ADHD treatment

A negative self-esteem with self-destructive beliefs and feelings of despair is very common among children and adolescents with ADHD. This can be a consequence of failures caused by disturbed attention, impulsive reactions and behaviour and rejection by classmates or even their teachers.

ADHD patients are prone to a variety of other impulse control disorders. Rates of impulse control disorders usually do not differ in gender but the "choice" of impulsive behaviours may be different. Some experts of gambling addiction report a very high co-occurence of ADHD and pathologic gambling and say that up to 20% of the patients with gambling addiction show traits of ADHD. Another impulsive disorder can be diagnosed in 35 % of pathologic gamblers (compulsive buying or compulsive sexual disorders) compared to 3% prevalence in the control groups.

Most therapies of pathologic gambling will not handle this topic because the knowledge is still limited. But it might be worse to look for traits of ADHD and make a multimodal treatment approach including psychopharmacotherapy.

To make the diagnosis of ADHD symptoms must have persisted for at least six months. There a normal fluctuations of the presentation of symptoms or changes within different environments. But the impairments have to meet the criteria of pervasiveness and severity and may not be caused by intermittent changes of the social environment or due to other acute problems.

During the diagnostic process other possible causes of hyperactivity, attention deficits or distractibility or problems of impulse control have to be excluded. Important other causes of these symptoms could be:

• organic disorders
• recent trauma (but also early sexual abuse or other traumatic experiences)
• substance abuse
• onset of an other psychiatric disorder (depression, anxiety disorder)
• social problems or severe interpersonal problems at home

If problems are only present at school but everything is fine during holidays, one should be very careful to consider ADHD.

Some parents or teachers try to make a diagnosis after reading a book with ADHD-checklists. Simply knowing the symptoms of ADHD or having problems in distinct areas of behaviour or school performance is not enough to consider a clinical diagnosis. You need to refer to an expert to rule out other possible disorders and find the best help for your child.

While diagnostic criteria and treatment plans focus on negative aspects of hyperactivity, impulsive problems or attention deficits, there are a lot of positive aspects of ADHD children, adolescents or adults. Not all ADHD people will have all these positive traits or qualities but usually you will find a broad variety of strenghts.

This is one of the reasons why many parents do not want their children to be changed by psychopharmacotherapy or behavioural treatment. Some positive aspects of ADHD can be:

• creativity
• charming personality, warmheartedness
• good judge of character
• sense of humor
• quick to grasp essentials
• flexibility
• intuitiveness
• sensitive to surrounding environment
• enthusiastic, passionate
• forgives mistakes
• tries to do better next time
• willing to take risks

Myth: ADHD ISN'T A REAL DISORDER.

Wrong! All paediatric and psychological or psychiatric organisations accept ADHD. In fact, it is the most common mental disorder of children and adolescents.

Some people say, ADHD is not a real disorder because scientists cannot identify a cause of ADHD. The hyperactive behaviour of the children should be more or less "normal" like "ants in the pant" or signs of bad parenting or lack of motivation at school. These children could be stimuli driven due to a change of the environment like too much TV or a lack of attention of their parents.

One of these opponents is Thomas Armstrong. He says: "ADHD is a disorder that cannot be identified in the same way as polio, heart disease or other legitimate illnesses." But the diagnosis or psychological problems or psychiatric diseases like depression, anxiety disorders or dementia is not based on lab tests. Dr. Russel Barkley, a famous ADHD expert, explains that we do not have such tests for headaches, multiple sclerosis or Alzheimer. We would eliminate nearly all mental disorders, if we would only diagnose or treat "diseases" with a single lab test for diagnosis.

However, there is convincing evidence for a biological vulnerability of ADHD. Epidemiological evidence indicates that ADHD has a powerful genetic component. University of Colorado researchers have found that a child whose identical twin has the disorder is between eleven and 18 times more likely to also have it than is a non-twin sibling. Genetics is a special area of interest in the area of ADHD research. Scientists have identified several possible genes that influence the symptoms and severity of the disorder. Additional functional anatomy with SPECT or PET diagnosis can show distinct changes in the blood flow of ADHD adults and changes in the dopamine system (Dopamine transporter DAT) which are typical for ADHD. But this of course is not a method to diagnose ADHD in a clinical setting due to extreme high costs and possible adverse effects of the diagnostic tools (low radiation) for children.

Yes. But you must have a prescription of the psychostimulants of your doctor. Otherwise a drug test of your urine might show the psychostimulants and you can get serious trouble with the police.

There is ongoing research in the area of driving performance and ADHD. Up to now most scientist have no doubt that you will show a better driving performance if you take medicine. But you should also consider that your attention and awareness can differ extrem. If you are not used to the "new" perceptions of your enviroment (at the very beginning of a psychopharmacological treatment) you should not drive a car.

Any emergence of mood changes (irritability or dysphoria) or agitation is very relevant and should be reported to the doctor! There a many possible causes that could contribute to this change.

• Titration of the right dose

  The medication needs to be monitored and adapted to the personal needs. So the child might need a higher dose of the medication or might be very sensitive to psychostimulants. This should be evaluated!

• Rebound

  Normal methylphenidate pills work for about 3 to 4 hours. After that time a "rebound" of the old symptoms can occur. The patients feel very uncomfortable with this. Adaption of the right dose and intervall is necessary or you might try long-acting psychostimulants instead.

• Change stimulant preparation

  Some children do not respond to methylphenidate but do fine with amphetamines.

• Evaluate comorbid disorders like depression or anxiety disorders!!!
• Assess sleep.

  Many adhd children have severe problems at night. If they cannot sleep they might feel irritable and dysphoric.

Sleep deprivation will influence the cognitive function of the brain! So it is very important to rule out sleep problems or lack of sleep due to TV or other activities during nightime. Sleep research showed that 11 and 12 year olds, who get less than 6.5 hours of sleep per night had similar attention and behaviour problems that mimicked ADHD. These kids are often irritated and defiant and had additional problems at school. It is very important to get enough sleep! One night of sleep loss can reduce the brain processing capacity by 30 to 40 %! Two nights without sleep will reduce the attentive and cognive functions by 60-70%!

So it is very important to make sure your child (and you) gets enough sleep!

How much sleep is enough?

• infancy/toddler: 17-18 hours
• 4 year old: 10-12 hours
• 10 year old: 9-10 hours
• 18 year old: 8-9 hours
• 30 year old: 7-8 hours
• 60 year old: less than 6-7 hours

No.

ADHD children usually show some delay of the personal development, including a different growth pattern. The neurotransmitter Dopamine plays an important role in the regulation of the growth hormones and prolactine. Recommended doses of stimulants do not influence the hormone levels, but due to loss of appetite a slight delay of weight gain could occur.

The optimal medication dose should be adapted on a regular schedule at least every 6 months. Very often older children need LOWER stimulant doses.

Usually children with ADHD will reach a normal growth and weight in late puberty, sometime 1 or 2 years later than their classmates. Only a very small number of children will remain a little bit smaller than expected. This will not be caused by the medication but could be a result of additional hormonal disturbances.

Typical side effects of psychopharmacotherapy with stimulants like methylphenidate (Ritalin, Concerta) or amphetamines are usally mild and restricted to the first days or weeks of therapy. Typical adverse effects can be explained by the stimulation of the autonomic nervous system (sympathetic and parasympathecic).

The activation of the sympathetic nervous system can cause a mild increase of the pulse. But some patients report palpitations or tachycardia (trembling or fast, irregular heartbeat). Usally this will not cause any severe problems. The blood pressure might increase a little bit, usally not more than 5 mm Hg. This is relevant for patients with hypertension problems.

Sometimes this can also cause symptoms of dizziness. The most common side effect due to the activation of the sympathetic nervous system are sleep problems (insomnia). So usally stimulants will not be given in the late afternoon or evening. (But some patients have less sleeping problems if they take a low dose of stimulants in the late afternoon because their brain calms down). Typical reaction on the parasympathic system are:

• low appetite and stomach problems
• sometimes headaches Severe or long-lasting side effects are extremly rare! However every medication could cause an allergic reaction. Usally these are not caused by the stimulant but by additional substances of the tablet
• Severe toxic effects of methylphendiate have not been described in literature. An older other psychostimulant called Pemolin (Cylert) has rare liver complications, so that a special monitoring is required if the doctors uses this stimulant. However methlphenidate causes no damages or alterations of this kind.
• Neurotoxicity Some people are afraid of possible alterations of nerve cell groth or brain development using methylphenidate. Actually a German neurobiologist tried to get attention in the media saying methylphenidate might cause Parkinsonism. Yes, dopamine is of special importance for ADHD. Yes, psychostimulants act on the dopamine transporter in the brain. But NO: There is no connection between ADHD and Parkinson. There is not a single case where any ADHD child developed symptoms of Parkinson in later life.
• Growth Supression

More.

The common psychostimulants for the treatment of ADHD in children, adolescents and adults (methylphenidate and amphetamines) have no (or extremely rare) toxic effects.

Any medicine could cause allergic reactions or sometimes alterations of the number of red or white blood cells. However, this is extremely rare. The doctors usually make some blood tests at routine visits once or twice a year.

One older psychostimulant (Pemolin) had rare toxic effects on the liver, so a close monitoring of the liver enzyme was necessary.

Methylphenidate (Ritalin, Concerta) does not cause these alterations!

Sleeping problems seem to be closely related to ADHD. Many children, adolescents or adults have problems to calm down in the evening and fall asleep or report disturbed sleeping patterns or nightmares.

Psychostimulant medication can cause insomnia in some patients. However there is a significant group of patients that will even benefit from low dose psychostimulant in the afternoon or before bedtime to calm down!

To find out whether the psychostimulant medication is responsible for the sleeping problem you could try to administer the medication earlier and to reduce or avoid medication after 2 pm.

If you administer sustained release medication (e.g. Concerta) with a very long duration you might consider to change the tablet or dose.

Sometimes comedication with sedating antihistamine medication or Clonidine can be helpful.

However, it is important to establish sleeping routines and stick to defined times to go to bed. Try to reduce TV times or too much computer games in the late afternoon or evening because this can be a source of overstimulation of the brain.

Targets of Psychostimulant Pharmacotherapy

Psychostimulants like Methylphenidate (Ritalin, Concerta) are known for treating "hyperactivity". However, this is only one symptom of ADHD that can be altered by this medication. In a multimodal treatment approach of ADHD stimulants positively affect not only the core symptoms of ADHD (hyperactivity, attention deficits and impulsivity) but proved to have lasting effects on:

• Specific cognitive functions of learning, working memory and other attention functions.
• Improved social functioning with better peer interactions, more friends and prosocial behaviours.
• Better classroom behaviour and academic functioning with reduction of off-task behaviour, disruptive behaviour and following directions of the teachers.
• Relationships with the parents and siblings improves. Fewer anger outbursts or off-task behaviour.
• Mood improvement with less aggressive and disruptive behaviours.

This can have a big influence on the development of self-esteem and social interaction. While children with ADHD have a higher risk for substance abuse or addiction the treatment with psychostimulants prevents this bad outcome for them.

For children with additional Oppositional Defiant Disorder or Conduct Disorder psychostimulants proved to have a benefit as well. Aggression, lying, stealing or other conflicts with the law are influenced. Usually these kids are less prone to severe accidents if they are treated with psychostimulants within a good medical and psychosocial setting.

Children, adolescents and adults with ADHD are easily distracted by stimuli in their environment. This can be any other important or irrelevant accustic or visual stimuli. So ADHD is characterized by the inablity to control what one pays attention to. The children with ADHD are not able to inhibit other stimuli or to stay focused to one task. Actually many ADHD children can focus on a very interesting task (hyperfocussing), but are not able to shift their attention focus in an appropriate way.

A typical problem for adhd children are "boring" tasks like doing homework or cleaning up their room. Usally any other stimuli (e.g. a bird outside the window, a dog barking next door, or a toy) will distract the child. Now the attention focus has complety changed, the old task is "off mind".

Our doctor told us that there is no need for further medication or treatment for adolescents. Do adolescents eventually outgrow ADHD?

No. ADHD is a neurobiological based disorder. We know that at least 60 % of all children with severe ADHD will continue to show severe symptoms as adults. But symptoms might change: Hyperactive movements or impulsive behaviours might be reduced. So some children do no longer meet the diagnostic criteria for the hyperactive-impulsive type. But normally they will still have attentional problems and even more problems due to deficits of their executive functions and self-organisation.

So they might "outgrow" diagnostic criteria, but will still have the neurobiological vulnerability of ADHD.

This can cause different kinds of problems in later life due to maladaption at work, partnership or secondary problems of substance abuse or impulsive behaviours.

Many ADHD-adolescents are especially prone to substance abuse problems or problems with discipline at school or work due to their deficits in impulse control and self-organisation. However, many adolescents or adults develop positive traits and can use positive aspects of this "disorder". They learn to adapt in every day life and will no longer feel handicapped by ADHD-symptoms. But the biological vulnerability is still present.

ADHD characteristics in the Infancy, Toddler and Preschool Stages

It is very difficult to make a proper diagnosis for very young children. Normal development has to be carefully evaluated. Most of the research has focused on children with conduct problems and is mostly retrospective. But if a genetic predisposition or siblings with ADHD are present, the following symptoms might also be related to ADHD-traits:

• Excessive crying
• Difficulties to be soothed
• Hypersensitivity for touching or certain clothes
• Feeding problems, irregular eating
• Sleep disturbances
• colics

Theses symptoms can cause severe mother-child difficulties with stress and lower self-esteem of the parents. Especially excessive crying and sleeping problems can cause additional psychological problems for the mother. Very often they try every tip of friends of relatives, but they do not work! So the mother thinks, the symptoms might be due to bad parenting.

ADHD is a genetically based disorder. So the mother or father (and often both) might also be affected by ADHD. So they might have additional problems with organizing and impulse-regulation. Up to now there is very little help for these families. The best thing is to seek professional help by a doctor or psychotherapist. Psychostimulants are not recommended for very young children before preschool.

While the core features of ADHD have to be prolonged and present in different situations there can be marked changes of the visible symptoms or adaption to a specific situation as a consequence of the specific situation or individual interests and coping facilities. Usually ADHD children do better in one-to-one situations, in new or competitive situations (like video games, sports competition) or if they can get immediate rewards for their efforts.

Many parents say that their children have less problems to complete their tasks (homework), if someone is in the room to supervise them. This could help the children to focus and reduce the risk of daydreaming.

Some children need rather specific situations, like background music, or have less problems if they get help from a friend who takes notes of the school day.

Controversially those with ADHD manifest more problems in group settings because they have problems to track conversations. Any boring work will not be completed in a reasonable time span if not supervised and rewarded in an appropriate way.

• Dietary Intervention. The changing of a child's diet to prevent ADHD. Conclusion: No scientific evidence of effectiveness
• Megavitamin and Mineral Supplements. The use of very high does of vitamins and/or minerals to treat ADHD. Conclusion: No scientific evidence of effectiveness.
• Anti-Motion Sickness Medication. Conclusion: No scientific evidence of effectiveness.
• Candida Yeast. Those who support this model believe that toxins created by the yeast overgrow and weaken the immune system making the individual susceptible to many illnesses including ADHD. Conclusion: No scientific evidence of effectiveness.
• Algae. Those who support this treatment believe blue-green algae to be a nutritional supplement for ADHD. Potential liver damage and no proof for effectiveness.
• Applied Kinesiology (Chiropratic approach). This theory believes that Learning Disabilities are caused by 2 specific bones in the skull. Conclusion: No scientific evidence of effectiveness.
• Optometric Vision Training. This proposes that reading related Learning Disabilities are caused by visual problems. Conclusion: No scientific evidence of effectiveness.
• EEG Biofeedback. Proponents of this approach believe that ADHD children can be trained to increase the type of brain-wave activity associated with sustained attention. Conclusion: No scientific evidence of effectiveness.

Their are many possible causes, why people have problems to track relevant information in a conversation.

Possible causes are:

• hearing problems / tinnitus / hyperacusis
• lack of concentration due to sleep problems
• chronic worrying about problems (e.g. work related problems)
• depressive symptoms
• daydreaming
• low interest in the topic of conversation

Try to find out what might contribute to your problem. Some people have severe problems in group settings due to social anxiety or fears. This might cause high tension and reduced ability to focus on conversation.

If you have a history of attentional problems, distractibility and / or hyperactive symptoms (or children with these problems) you should also consider an residual form of ADHD (Attention Deficit Hyperactivity Disorder).

ADHD has to be considered as a chronic conditition, that might interfere with the further development and quality of life of the children. Studies indicate that persistence of ADHD into adolescence and adulthood will affect at least 60 to 80% of the ADHD children. It is important to develop an ongoing partnership among clinicians, parents, teachers or any other person who is relevant for the child and the further development.

Therefore special efforts for a long-term management of ADHD are recommended:

• Appropriate information about the condition and possible individual problems.
• Focus on individual strengths and resources of the child and the family!!!!
• Update and monitoring of the family knowledge and understanding of ADHD and any treatment options. Also alternative treatment methods should be considered, because more than 60% of all parents will at least try one or more methods.
• Counselling about the possible reactions of the family, friends, teachers...
• Developmentally appropriate education of the child about ADHD. Again: Consider resources and strengths of the child!
• Availability to any kind of questions, problems or crisis intervention.
• Offer additional support for coaching or explain the ADHD symptoms at school.
• Connect to other ADHD-families (self-help-groups, internet).
• Monitoring of any positive or negative changes and adjustment of the treatment plan/medication.