The clinical picture is not new. Already in the middle of the 19th century, in the "Fidget Philipp" by Dr. Med. H. Hoffmann described the story of a boy whose behavior reminded of ADHD. The name of the syndrome has undergone some changes over time. Already since 1932 exists the name "hyperkinetic disorder of childhood". The corresponding abbreviation HKS for the hyperkinetic syndrome is still quite common in most of the countries.
Probably the most commonly used term today is attention deficit / hyperactivity disorder with the abbreviation ADHD. If the feature of hyperactivity is missing, it is called Attention Deficit Disorder (ADD).
ADHD is one of the most commonly described today Illnesses in childhood and adolescence. Notes to the Frequencies are very different internationally. You vary between two and 18 percent, depending on the underlying diagnostic criteria. According to recent surveys, just under five percent of children and Adolescents around the world are diagnosed with ADHD, with a further five percent evidence of a disorder. In boys, we found ADHD more frequently than girls.
ADHD is described as a diminished ability to self-regulate in children and adolescents. Disorders mainly occur in three areas, namely when:
As already mentioned in the definitions, can the disease with or without hyperactivity occur? The latter is more common in girls. The diagnosis, However, it is often not posed because of the outside world Early symptom of hyperactivity experienced as "disturbing" is missing. The symptoms inattention and impulsivity are not perceived as expressing a possible disorder.
If ADHD is not detected and treated, then in the further course disturbances in the social behavior so strong come to the fore, that a direct reference to the underlying clinical picture no longer without Further is recognizable.
Timo, 5 years
As soon as Timo wakes up in the morning, he falls already a thousand things he could do today. Immediately he jumps up and races through the Flat. He saw a pirate movie the day before and wants to build a ship. As he climbs on the shelf to get in one fetching sheet for the sail that falls Shelf with noise around and awakens the other family members. Immediately the usual dispute begins. It's not time to build ships, but dressing, having breakfast and kindergarten. The donning lasts forever because he can think of something else every few seconds. Breakfast is a glass Break when Timo jumps up to Sarah, who has a birthday today, still fastA gift to tinker. The way to the kindergarten is torture: Timo has often, despite the strictest admonitions, without looking left or right to run into the street, because he has discovered something incredibly exciting across the street. As Timo's mother, the door of the kindergarten behind him she wants to close, she is actually for the rest of the day already completely done. The governess still wants to be with her Talk: Timo is a big burden for the group. He could not sit still for five minutes and focus on none Concentrate game. He was constantly raging around and disturbing the other children. Timo's mother is desperate: it is not the first time that this is said to her, and slowly knows she really stopped.
Sarah, 5 years
Sarah is called only a dream girl in kindergarten. When the other kids get a picture she sits in front of them, lost in thought blank sheet, and looks out the window, if the other kids already have their pictures proud to show the educators. In group games, Sarah never knows when it's her turn is. She did not pay attention and she is again busy with something else. If her father picks her up from the nursery in the afternoon, the way home will take forever. Sarah stops every few minutes to look at something. She forgot what she was closest to Day for the trip should bring. The note from kindergarten is untraceable. Sarah constantly hears that she should but take better care and concentrate better. But so much Sarah herself tried, somehow it does not succeed.
Ralf, 13 years
Ralf is not really into school. There they only complain anyway around him, as well as at home. Since Ralf can think, all are apparently mad at him. Always everything he does seems to be wrong. He notices it himself: No matter how much he cares endeavors, he can just do not concentrate and lose fast the desire. There they last Homework, of course, forever. What can he do for being math just not got it? He still has never understood how all the others solve the tasks, while he tortures himself and the result is wrong is. The constant arguments with his parents he is also tired. Some time ago he has some guys from the neighborhood met, who also do not feel like school. With he hangs on to them every afternoon now and sometimes even in the mornings. School brings it not.
Children affected by ADHD develop the necessary Ability to self-control much harder than other children. They, therefore, need special support. Psychosocial factors, I. the concrete conditions under which the children grow up, can the course strongly influence the disease. Parents, teachers, and Educators need to learn that kids and teens with ADHD often do not respond as other children do. To cope with everyday needs, such as dressing, eating or doing homework constant control. Due to the high distractibility it if It's hard for children to concentrate on one thing and bring it to a close. Invitations are often disregarded because they are not perceived at all.Especially important for the child are reliable and loving relationships. But they have so to be unique Limits are set. Children with ADHD need low-stimulus, clear structures with manageable rules. The behavior of children often encounters incomprehension and rejection. Conflicts and conflicts are preprogrammed. Since good persuasion, exhortations and appeals or "punishments" no changes are achieved in the parents and other caregivers soon feel with the child no longer "ready". With increasing helplessness, a variety of methods are used but to "penetrate" to the child, but nothing seems to help. Changing educational behavior hinders the child but the necessary orientation and more likely to aggravate the symptoms. Finally, there can be a sustained disruption of the parent-child relationship. The parents are overwhelmed and exhausted, the children feel misunderstood and declined. It creates a vicious circle, which leads to more and more difficulties.Within the family, but also in kindergarten and School, there is an increasing danger that the affected children and adolescents will be labeled as "notorious troublemakers" and as "no longer feasible". The educational achievements decrease and the social one's Exclusion solidifies - the children become Outsiders.The correct diagnosis and the early initiation ofan appropriate treatment for ADHD can help to prevent this vicious circle from developing to break it. As the effects of ADHD can extend to all walks of life and partly persist into adulthood, so can also the probability of far-reaching consequential disorders are decisively reduced. These go up towards drop-outs or even professional and/or social failure.
Diagnostic criteriaThe diagnosis "ADHD" is made according to defined criteria. These are laid down in the ICD 10, one worldwide and the DSM IV, the Diagnostic and Statistical Manual of Mental Disorders of the American Psychiatric Association. The classification schemes mentioned are not completely the same, but they agree in the fundamental aspects.
A. ATTENTION 1. Often ignores details or makes careless mistakes during schoolwork, at work or at other activities.2. Often has trouble maintaining attention for tasks or games for a long time.3. Frequently does not seem to listen when others speak to him.4. Often does not complete instructions from others completely through and can do homework, other work or do not finish duties in the workplace. 5. Often has difficulty, tasks, and activities to organize.6. Often avoids tasks that require longer lasting requiring effort has an aversion to her often or reluctantly deals with them, such as Collaboration in the classroom or at home - gifts.7. Often loses items that he/she for tasks or activities needed, e.g. Toys, homework books, pens, books or tools.8. Can be easily distracted by external stimuli.9. is often forgetful in everyday activities.
B. HYPERACTIVITY 1. Fidgets frequently with hands or feet or slips up around the chair.2. Is often in class or in other situations on, in which sitting is expected.3. Runs frequently or climbs excessively in situations where this is inappropriate.4. Has difficulty playing quietly or wish to engage in leisure activities quietly.5. Is often "on the move" or acts like "driven", or shows a persistent pattern of excessive motor Activity, through the social environment or through Prompts cannot be influenced thoroughly.
C. IMPULSIVITY 1. Frequently pops out with answers before asking the question End is put.2. Cannot wait until he/she plays or games in group situations is the turn. 3. Interrupts and disturbs others frequently, e.g. in conversations or in games of others.4. Often talks too much without proper attention to react to social restrictions.
Important: To put the diagnosis ADHD You may need several of the above-described symptoms
These impairments are often associated with other problems, such. B. oppositional and aggressive disorders of Social behavior, anxiety disorders, depression, tic disorders, learning and part-performance disorders, e.g. Literacy and spelling weakness, and pronounced self-esteem issues. These are described in the chapter "FrequentAccompanying disorders ".All of the behaviors mentioned here can be toned down and in age- and development-dependent form occur with all children and need not necessarily refer to ADHD on their own. In some of the affected people, the symptoms remain more or less persist into adolescence and adulthood. How and with which effects the symptomatology can show in different age groups, is in the next point described in more detail.
Still unclear is whether there are identifiable regularities in the Occurrence of abnormalities in the development of Infants and toddlers who are reliable may indicate ADHD. Professionals say that about from the age of three a distinction between hyperkinetic behavior and "normal variants" in principle possible. Many children, later the Diagnosing ADHD, are or were in first year unobtrusive. Often, however, you can also retrospective abnormalities to the mammal to trace back to age. These children become spirited described as unbalanced and have Problems with the customization. Some fall due to eating and/or sleeping problems so-called "writing babies". You will find it at the beginning difficult to maintain a stable balance in her life are early experienced by parents as "difficult". As a result, the foundation for a difficult parent-child relationship can be laid very early. The first point of contact for parents in such a situation is usually the pediatrician. The doctor the child will examine in detail to organic Exclude diseases. If illnesses could be excluded and usual relief measures should have brought no improvement to the situation the parents turn to professionals who are familiar e.g. on the Specializing in the treatment of "writing babies". For young parents, it is certainly not easy to admit that they are overwhelmed with the behavior of the baby. Nevertheless, it is important to get professional help in good time to try. A stable parent-child relationship is one essential condition for a healthy development of the child and carries the parents through difficult educational periods.
Children affected by ADHD fall in kindergarten due to their inability to do quiet activities and their pronounced hyperactivity. You can Do not focus, are always on the move and climb on tables and shelves. When she started a game break it off within a short time, start another and do not do this to The End. They are easily angry and can only hard to calm down. Consistent friendships are difficult to close because of the irascible and contentious behavior is in the foreground. Admonitions and requests from adults are not heard or disregarded. Borders are not adhered to. Adult behavior can be defiant and aggressive. From kindergarten, parents hear that their child is the Group disturbs, cannot fit in and interrupts other children while playing. At home is the situation despite all efforts also difficult: The common food, games among the siblings, visiting situations, phone calls of the parents, everything is developing a constant cycle of calls and requests Admonitions, without affecting the behavior of the child something changes. Everyday things cannot get in any more Peace be done, every little thing is a "fight" out. The parents of these children often reach the limits of their own Forces, because they have to constantly counteract. From friends, Relatives and the educators in kindergarten come Well-intentioned tips that are usually ineffective are, or allegations and blame, which the additionally burden parents. When the child comes to school, the aggravate Problems continue. Concentrated teaching in the classroom is only possible for short moments; every distraction becomes addressed. The other students are disturbed because the Children cannot sit still, intervene and use every opportunity to "Rumkaspern". Admonitions of teachers lead to no result. Homework is incomplete or not done because the child forgot to write her in the homework book. The problems are more pronounced when children have to deal with tasks they have not chosen freely. On the other hand, they can do things that arouse their interest be much focused and achieve good results. The children stay due to the behavioral problems behind their actual performance. With the Training may involve concomitant disorders, such as a Spelling or reading weakness, become visible. Sometimes this is the reason for a lack of talent adopted and a change of school of the child suggested. For parents, when the child enters the school the nervous stress continues to. They feel responsible for having their child meet the demands of the school but they realize that they are failing again and again with their efforts to change. TheSupervision of homework can be an ordeal for everyone Becoming involved also leads to increased distractibility here to considerable conflicts. The children themselves are through the many experiences of"Want but not knowing" in their self-esteem very impaired. The kids feel unloved and not accepted, although from their point of view very hard. They develop a defiant and aggressive Denial attitude, which in turn reinforces negative feedback. Their suffering also increases increasingly.
For a large proportion of children affected by ADHD reduce the symptoms at the onset of puberty. In front all the hyperactivity is hardly noticeable, she, However, it can still be tormenting unrest and inner Being driven. Impulsiveness and attention deficit persists. In the foreground usually stands the problematic school performance. Some adolescents are developing more in this situation antisocial and aggressive behaviors. These show in defiance of social norms, violence, and destructiveness. Some adolescents come into conflict with the law and possibly close outsider groups on. Here they seek the recognition they receive in others Do not find areas of life. A big problem at this time is also often increased susceptibility to alcohol and drug abuse. Also, the risk of further mental disorders, such as Depression or anxiety to develop is increased.
For a long time, it was assumed that ADHD was exclusive a disorder of childhood and adolescence is. Meanwhile, however, it is known that adults are also affected. The course of ADHD after the transition to adulthood can be very different. For some of the patients, there is no restriction in adulthood noticeable. Another part has learned to live well with minor impairments. Some, however, also suffer in the Adults still clearly under their symptoms. The findings on the topic "ADHD in adults" are not that comprehensive and it is still great Research needs. In the fall of 2003 were by the society for psychiatry, psychotherapy and Neurology (DGPPN) first published guidelines for the diagnosis and treatment of adult ADHD released. Basically, the disorder does not start in adulthood but must have existed as a child. For many sufferers, the basic disorder is not he has been known so that later accompanying symptoms such as anxiety, depression or addictive behavior in the foreground Treatment stand. On closer examination, it is found in these cases that affected by those affected the symptoms of ADHD like a red one Thread through life pulls. The school / Career and social relationships are characterized by breaks. The planning of processes or their compliance with the Adult aggravated by inner restlessness, increased distractibility and lack of concentration. Those affected experience themselves as unstructured and forgetful, they can hardly distinguish important from unimportant. Foresighted planning does not succeed because action and thinking are limited to the "Here and now ". Similar to children and adolescents, however, is the Focus on subjectively important things possible. In some professions that require a lot of creativity, vibrancy and spontaneous reactions to hectic work processes, adults with ADHD may well be successful. Usually, however, occupation and social ties require also a considerable degree of continuity and perseverance. This is precisely where ADHD sufferers can fail despite their existing capabilities. Possible accompanying partial performance disorders, such as a reading and writing weakness, can further hinder professional development.
Usually, however, occupation and social ties require also a considerable degree of continuity and perseverance. This is precisely where ADHD sufferers can fail despite their existing capabilities. Possible accompanying partial performance disorders, such as a reading and writing weakness, can further hinder professional development.
Some sufferers suffer from strong mood swings. Emotional reactions are disproportionately intense. Also, angry and aggressive behaviour is common. A constant search for special, interesting experiences and so-called "kicks" can lead to addictive behaviour in different areas. A started in adolescence Dissocial development can also continue and solidify. Those affected often experience failure and failure in different life situations, which are experienced by others as unproblematic. As a result, self-esteem problems develop or increase. Often occur tooDepression and anxiety disorders.
Approximately Two-thirds of children with ADHD show next to the Core symptoms of ADHD further (behavioral) abnormalities. FREQUENT DISADVANTAGES OF ADHESIVE 50% of disorders of social behavior 20-25% anxiety disorders 10-40% depression 30% tic disorders 10-25% partial performance disorders
With a disturbance of social behavior become continuous or repetitive aggressive or defiant behaviors. If ADHD affects these behaviors in addition to actual problem develops, one speaks of a hyperkinetic disorder of social behavior. As with the actual ADHD symptoms persist also with abnormalities of the social behavior depending on age and stage of development of the child or the teenager's flowing transitions. Parents know that nerve-racking defiance phase of the two- to four-year-old in which one's will is recognized and tried becomes. Parents of adolescents know that in adolescence the difficult search for their own point of view in life begins and this once violently Resistance to the parents is connected. Both should next as necessary and "normal" development seen and not overrated. It is important in these phases, to stay as calm as possible and Give children and young people as much freedom as possible and to offer a lot of orientation. In ADHD children with a hyperkinetic disorder of the Social behavior differs the defiant and aggressive behavior of the child in strength, magnitude, and Duration of the peer. In order to make the diagnosis, defined criteria must be fulfilled, which are described in the International Classification Scheme (ICD). These include under others:
> Unusual for the developmental age of the child frequent and severe tantrums,
> Frequent quarreling with adults,
> Frequent active rejection and rejection of Wishes and regulations adults,
> Frequent, an apparently intentional annoyance of others,
> Frequent commencement of physical altercations. The children tend to rebel against rules. They are defiant, quickly angry and react aggressively, both verbally and physically. It succeeds they do not fit into groups, such as the class community, and build friendships. Another consequence is the relationship with the parents more and more difficult. Through the constant arguments, a negative relationship pattern solidifies which is difficult to break. Hyperkinetic disorders of social behavior that not treated in the long term have many unfavorable consequences that can extend to all areas of life. In particular, these can be very problematic effect the school career. In the chapter "How is ADHD treated?" You will find tips on how parents, teachers, and children can break this cycle and where to find help.
Anxiety disorders occur in up to a quarter of ADHD affected children. Sometimes it is hard, to detect these accompanying fears as the disturbing, so-called "external" abnormalities are in the foreground. The experience of failure and increasing social problems prevent the build-up of a healthy self-confidence of those affected by ADHD. These Experiences can lead to disturbances because the kids are constantly experiencing them certain things despite great efforts not succeed. Success stories and praise stay away. By experiencing their failure and the negative feedback from her in the environment, they develop the conviction that they are a "loser". This favors that Occurrence of depressive development.
10-25% of children have partial performance disorders in addition to ADHD. By this one understands learning disturbances like reading and/or spelling weakness or calculation weakness.
About one-third of children with ADHD have in addition a tic disorder. With tics involuntary, repeated "twitches" or movements (motor tics) or sudden sound production (vocal tics). Often these appear in the face, e.g. as Blinking or Grimacing. Vocal tics can be common Express like throat clearing. Tics are common in children, and in boys much more common than girls. Have simple tics usually a good prognosis and usually disappear after a while again. To distinguish from this is the rare syndrome of generalized tic disease (Tourette syndrome).
Many ADHD children are in their movements disturbed. Problems in the coarse and fine motor skills can show themselves in uncoordinated movements and a marked awkwardness or in an illegible, scrawny typeface. Some of the children are often in Accidents and falls involved. If the mentioned faults are detected, they must be treated separately. Even though the symptoms of ADHD are with most of those affected Decrease greatly as they grow older, the accompanying disorders may persist and require further treatment.
There is not one cause for ADHD. Professionals go today assume that neurobiological and psychosocial Factors must work together so that it can come to the disease. Various investigations prove right now sure that inherited biological factors play a big role play. In the context of the twin research it was found that identical twins with identical Genetics come into the world, much more often both Children are affected by ADHD, as in dizygotic twins, who have different genetic make-up. Also, It has been shown that ADHD is more common in the family and partly also the parents are affected or were.
The existence of an inherited predisposition means that the appropriate children are at increased risk to develop ADHD. But if symptoms are so obvious to be that talked of a real disorder and how it will continue in the future significantly influenced by which learning and Environmental conditions meet these kids and whether theirs "Specificity" is adequately addressed. The neurobiological changes mainly affect a decrease in the messenger dopamine in the brain. Messengers regulate the exchange of information between the nerve cells. Dopamine is responsible for coordinated movement, emotional control and targeted attention in certain areas of the brain. At ADHD is not enough dopamine for a variety of reasons available. This results in a stimulus-open, in which the Attract stimuli unfiltered to the children and cannot be processed properly. This leads to it being Difficult for children, their urge to move, their feelings and to control their attention. For this Reason, one speaks of a diminished ability to Self-control. To be able to compensate for this deficiency, the children in the social environment need concreteSupport and help, i.e. in particular clear, manageable and predictable structures and rules.
For a long time was discussed whether certain foods and additives changes in balance cause the messenger substances and so cause ADHD with could. In particular, sugars, phosphates, and foods that can cause allergic skin reactions were considered as possible triggers. Sugar and phosphates can now largely be excluded as polluters. However, it has been shown that about 5-10% of children with ADHD respond to different foods with an increase in symptoms. In these children may possibly the so-called oligoantigenic diet (outlet diet) to a reduction of Symptoms lead. More about this in the chapter "How to become ADHD treated?"
Social changes and the conditions under which children grow up, can the course strongly influence ADHD. Today is fast moving. TV, video, mobile devices, and computers are part of everyday life. Already for children, it is becoming increasingly difficult to process the wealth of recorded information.
They need to be able to process external stimuli be integrated into a perceived inner world. This succeeds when experimentation, imagination, and Creativity has the necessary space. If these areas are neglected, this can lead to feelings emptiness and boredom occur as soon as external stimuli absence. This, in turn, means that more external stimuli are sought and again only "consumed". All teachers know the catastrophic start of the week, as many children after hours of watching TV on Weekend are over-excited and restless. In principle Irritable over-stimulation and physical inactivity harm all children, but especially children with ADHD. Because of their open-mindedness, they are particularly susceptible to the corresponding negative effects. Therefore it is important for them to develop leisure activities that correspond to their abilities and limitations and also meet their high urge to move. The high rating of performance in our society presents a particular problem for children with ADHD. They experience themselves when compared with other children often as a "loser." Much of what the school friend and the School friend easily falls, they do not succeed or only with the greatest effort. If only looking at performance the skills and gifts that ADHD children often have are often under-appreciated and promoted. The children themselves take off one certain age as "different" true, they suffer from it, to be marginalized and to have no friends. The parents, in turn, fear that poor school performance of their child may affect the future career opportunities and therefore exert appropriate pressure on them, to encourage them to good academic performance. This leads to defiance, especially in ADHD children Resistance or resignation, as they realize that they are the one they cannot meet the requirements. Often the parents themselves are having significant professional or personal burdens and problems and in this situation can not sufficiently meet the special needs of the children. The parents are irritated and are not transparent or predictable in their behavior for the children. Especially children with ADHD need a lot of orientation and clear structures. That's why can be a persistent problematic family situation negatively influence the course of the disease.
Not always when a child is particularly lively or Shows abnormal behavior, ADHD is present. Temperament characteristics and certain, difficult stages of development such as puberty must be taken into account. Also, special cuts in the life situation can lead to disturbances and abnormalities in behavior. Only a change of location or school is for children and Teenagers a huge burden. Other difficult ones or even traumatic situations can get through separation of the parents or the death of a family member. Since parents also new situations only the children will have to deal with these times sometimes not sufficiently supported. Mood swings, retreat, but also oppositional behaviour, lack of concentration and performance degradation are clear signals. Unlike the symptoms In ADHD, however, the disorders often occur only in the Connect with certain events and usually reduce again, if it manages to solve the problems to edit. Here can be the support of an educational counseling center, a doctor or psychotherapist be helpful. If a child suffers from anxiety, his / her ability to concentrate may also be reduced or it may show increased restlessness. The kids are so focused on their fears - the fixes that everything else is hidden. Mostly, however, the fears remain limited to certain areas and diminish over time as the child learns to cope better with these situations. Some fears are age-typical and go back by themselves. But when the fears intensify or more Expand areas, there may be a treatment-related anxiety disorder. Continuous overworking or undercharging can also be the cause of behavioral difficulties. Then it must be checked whether the school form is suitable for the child, school subsidies necessary or possibly a change of school must be considered. To assess a child's intellectual abilities, psychological testing may be helpful. When it comes to clarifying the question with a child "ADHD" is, in principle, a physical examination (height, body weight, heart rate, blood pressure) should be performed. Also a laboratory diagnostics (Differential blood count, electrolytes, liver status, thyroid, and renal function values, blood sugar levels) is important. The goal is to rule out physical illnesses. Because some organic impairments or illnesses can also be the basis for behavioral problems. These include hearing and vision problems, an overactive thyroid and certain types of epilepsy. Such diseases have to be excluded before getting the diagnosis ADHD poses. If a child has to take medication for a disease, it is also possible to think about possible side effects, which may also show up as attention and concentration problems. For this, you consult on best the attending physician.
How is ADHD treated?
Before the question of treatment, it is important to special take care of the position of the correct diagnosis. A hasty determination that it is at a certain Constellation "only to act ADHD" can be as problematic as a very late or under circumstances not asked diagnosis of
Many parents report that it is a great relief have felt, if - often after a long odyssey -The correct diagnosis ADHD has been made in her child. Finally, there is a conclusive explanation for the behavioral problems of your child. They now know that you Child does not simply "do not want" or even she as a parent not simply "failed", but that their child is temporarily not in the Able to react like other children. A comprehensive consultation on causes, course, and treatment can contribute to significantly reducing the pressure on parents. There are now different treatment options which can significantly improve the symptoms. A Timely and appropriate treatment also helps to avoid consequential damage.
After the diagnosis of ADHD treatment should be on several interlinked planes take place. This is implemented in a so-called "multimodal treatment concept". It refers in addition to a careful Diagnosis also the advice of parents, relatives and other caregivers as well as psychotherapeutic and psychosocial treatment and care measures on. Different approaches, such as psychotherapy, drug therapy, educational measures and psychosocial assistance interlocks with each other. Cooperation with the kindergarten or the school is an important part. Special promotion in different problem areas requires Collaboration between different professionals, e.g. from Child and adolescent psychotherapists, occupational therapists, Physiotherapists, and teachers. Children with ADHD may have different degrees of severity and different problems and concomitant disorders. Therefore, an individual treatment plan must be created. The treating Doctor should discuss this treatment plan in the context of detailed consultation with the parents.
ADHD Training programs
One of the most important building blocks in the treatment of ADHD is the advice and support of parents. To the one needed the child by the parents in many everyday situations special Help, on the other hand, is through the difficult behavior of the child often a negative parent-child relationship emerged. As part of therapy programs Teach parents how to target the behavioral problems of the child Reduce measures. For this special parent training has been developed. By way of example, a therapy program for children with hyperkinetic and oppositional problem behavior (THOP) is mentioned Here University of Cologne was created. This program is by many professionals with behavior-prone children work, used.
Part of this program is the so-called parent guide. (See bibliography in the appendix). In a 14-step program, parents learn step by step how the difficult family situation changed and solutions for special problem behaviour of the child are developed can. Typical application examples provide very concrete assistance in order to enable parents to be able to influence difficult situations in a targeted manner. To achieve a lasting change, these programs must have a longer duration Period to be carried out consistently. The importance of clear rules and limits plays an important role in the mentioned parents' guide. Reliable and predictable processes help children with ADHD, with their charm to cope better. The rules should be with the parents set up and discuss with the children. It precisely determines what consequences follow if the rules not be complied with. The Agreements should be simple and be comprehensible. Very important is that agreed consequences really happen and that the parents here "at pull together and do not react differently. It is equally important to praise the child if rules have been met. In the beginning, parents should too with small advances signal her child directly, that his effort was seen. The child learns that way also considers positive and not only negative behavior becomes. In many families, a cycle has solidified, in which reacts mainly to disturbing behaviors becomes. "Normal" or desired behavior is called of course provided and hardly leads to one special feedback. A consistent reinforcement the positive behaviors through appropriate attention and praise will result in the child also showing this behavior more often. Very successful may also be point plans in which the child points by meeting certain requirements collects, which will later be exchanged for rewards can.
Through the constant clashes between Parents and children are often disturbed by the emotional relationship within the family. The lovable one's Characteristics of the child are almost completely out of sight devices. Everything is just about the "wrongdoing". It is all the more important to bring the strengths and abilities of the child back into focus move. To "like each other" more again and to create a good family feeling, it also becomes with the aid of the therapy program worked on how the family climate can be improved again. The parenting guide may be from the parents be used under the guidance or alone. The latter may not always work. Sometimes they are Disturbances so pronounced and is the Situation so "proceed" that it better is to get professional support. Even for children, there are special training programs that are specifically tailored to specific problem areas. Examples include:
> Attention and concentration training here, The children learn in several sessions, as theirs Increase attention, control their behaviour better and plan actions better. Step by step then the techniques acquired under instruction become transferred to everyday situations. The method has changed proved to be effective when e.g. for the settlement the homework goes.
> Self-management programs Self-management methods can help to better control one's own behavior and develop more appropriate ways of dealing with others. Here is the child initially supported in it, own reactions and behaviors, but also others more accurately to perceive and to play. Possibilities of a Reaction control or reaction delay taught. By the child trying to get to specific to keep up rules and for a successful coping with the situation positively strengthened, it should learn in the "critical" situations alternative, appropriate Show behavior. Also, strategies for coping with distractions, mistakes, and frustration can be conveyed. With the help of role-plays and other methods, the new behavior is practiced. Over time, the children can better assess situations in everyday life and respond more appropriately. The training programs are part of an overall treatment e.g. from social pediatric centers, specialized outpatient departments in clinics, educational counseling centers, child and adolescent psychiatrists and child and adolescent psychotherapists.
Children who have marked accompanying disorders in the emotional Have area, e.g. Fears and depression, need further psychotherapeutic treatment. This is used by the child and adolescent psychiatrists as well as by Child and adolescent psychotherapists performed. The offered procedures can be very different because the range of suitable therapies is large. When choosing a child and adolescent psychotherapist if necessary, it should be paid attention to whether this has a cash register approval. Corresponding addresses can be obtained from the Health insurances or the organizations listed in the Annex. The cost of the mentioned treatment methods are usually taken over by the health insurance companies.
Educational and other aids
Learning difficulties related to the reduced concentration and attention deficit of a child with ADHD are improving often under appropriate treatment. But if, how described above, e.g. accompanying a partial performance disturbance present, the children should have a special promotion on getting in the respective area. Here are various learning programs offered. In disorders of the motion, coordination should be tried to be, through appropriate training the motor Improve skills. Often this also becomes one Improvement of self-confidence achieved. Specially trained specialists such as physiotherapists, occupational therapists or motor therapists offer various treatments.
Sometimes it can also be helpful to choose sports that match their abilities with the child. These may be sports, e.g. gross motor requires procedures. Some children also have great success with sports such as karate, judo or taekwondo.
Social educational family help or other aids to Relief of the family as educational assistance, social Group work etc. can be considered as additional help offers for families with a child affected by ADHD or Young people are eligible. These varied services of a child and youth welfare are regulated by the Social Security Code VIII (Child and Youth Welfare Act). A claim to such assistance expressly exists when children are emotionally disabled or mentally disturbed Disability are threatened. Children with ADH need family and school Area a unified orientation. That's the only way they learn over time to change their behavior. To be able to support the children and adolescents effectively, it is therefore important to work together with caregivers in kindergarten or school. This is an essential component of the entire treatment. Parents should talk to educators and teachers search, inform them about the situation and the respective therapy program and discuss possibilities of mutual support. In consultation with the Parents are useful conversations between therapists or practitioners and teachers or educators.
If the child is addicted to treating ADHD Gets medication (see chapter "Medicaments Treatment "), this should be communicated to the teachers become. These can be all the better on students and Pupils with ADHD, the more comprehensive they are informed and the more confident the cooperation designed with parents.
It is also important to talk to teachers about issues such as general over- or under-demands to discuss with the child. Considerations for a possible change of school, the handling of possible partial disabilities and possibilities of special support of the child can be clarified in a trusting conversation. In many schools and kindergartens are meanwhile Training programs on ADHD offered to enable employees to focus on the cease the special needs of children with ADHD and to provide them with more targeted support. In some states, there are special decrees in which the procedure in case of difficulties with students Disabilities and special needs also for Behavioural students is described. Information on this can be obtained from the responsible Education offices. Some points should be given to teachers who have a child with ADHD have their class, especially note:
> Because the children open up very easily because of their stimulus any distraction, it can be helpful if they are sitting in front and next to a quiet child. So can too the teacher can quickly grasp problematic situations and react accordingly. Sometimes it helps Look or a quick note to signal to the child that it is not alone in a difficult situation is. The support of the teacher can provide security and be a sign of acceptance for the other students. This is important because the children through their behaviour and their performance problems easily it may be an outsider role and not participate more in the classroom.
> Also in kindergarten and school applies: simple, clear rules and clearly formulated requests are important. If it is the child manages to implement this, it should be praised. As within the Family should also be in kindergarten and school trying to break the solidification of a pattern in which only the disturbing Behaviour of a child is in the foreground. If possible, should e.g. minor disturbances as possible not considered. The more important is to positively emphasize constructive and desired behaviour.
> Since children find it hard to plan well and concentrate, concrete ones can be used Help can be very useful, such as the Entry of important points in homework booklet. In addition to the child itself, the parents can
The question of drug treatment is one of the most controversial issues in the discussion about ADHD. There the main focus is on the drugs most commonly used with methylphenidate (e.g. Ritalin and Medikinet) and since 2005 also with the active ingredient atomoxetine (e.g., Strattera). Here it is particularly important to put factual considerations in the foreground. As a general rule, the decision on the need for drug treatment of ADHD can only by the attending physician be taken in an individual case after the diagnosis was carefully made. Only if the diagnosis is ADHD assured should these drugs be given. And: not every child or teenager with ADHD requires treatment with medication. Deciding on the use of drugs ADHD should be between the attending physician and the Parents and - as far as possible according to age – with agreed to the affected child or adolescent become. In particular, for methylphenidate-containing medicines, other than before their application Treatment options should be exhausted. This sees also the technical and usage information of these medicines and the Pharmaceuticals Directive of the Joint Federal Committee (G-BA). Some Children also want it without medication create - this should be taken into account. However, the disorder may also be so pronounced that it is withoutaccompanying medication is hardly possible to carry out training programs or other measures. Here -In individual cases, only the doctor can decide. If the diagnosis is confirmed, this is the minimum standard every drug treatment a detailed consultation and intensive support. Mostly it is desirable and meaningfully carry out accompanying psychotherapy. Before the treatment, the child should be thoroughly examined be, as the drugs mentioned in certain Diseases should not be given. Parents should have an effect, possible side effects, dosage and duration of ingestion. Based on Conversations and assessment sheets should be effective be checked regularly. Likewise is in meaningful Intervals to check whether the dose is appropriate or whether continuation of drug administration is required. This should be checked at least once a year. So it is also in the Pharmaceuticals Directive of the Common Federal Committee (G-BA). Most methylphenidate-containing medicines work after taking for about three to four hours. The children must, therefore, take two or even three tablets a day to obtain the desired effect. For some time there are also long-term preparations, of which the only one to two tablets are taken have to daily. Drugs with the active ingredient Atomoxetine need also be taken 1-2 times a day. However, it takes about 4-6 Weeks after taking it for the first time until the full effect occurs.
The child should be taught that the tablets are him help to better control one's own behaviour and develop one's own abilities better. Clear But it should also be that the tablets are not "all right can do. Tablets do not solve all the problems with Children, adolescents and their caregivers ADHD are confronted. You can but conditions create under which existing difficulties better and can be tackled more successfully. The medicines are supported. That is precisely why it is so important to the treatment with drugs ADHD is embedded in an overall concept. In about 85% of the children shows taking of methylphenidate a significant reduction in Symptoms. You can focus better and it works better with the school. They can also do their Control excessive urge to move better. These changes often make the relationship with peers and parents even more relaxed.
Some parents are concerned that their child may become dependent on the drugs that contain methylphenidate, or that it is generally more potent when ingested could be in danger of addiction. These fears are fortunately unfounded. The current state of research suggests that the opposite is the case is: children and adolescents with ADHD, the drug even fewer seem to have been treated later being at risk of being a child with ADHD that is not be treated. However, in adolescents and adults who should be treated with this drug, one should Addiction disease be excluded. If there are indications that the tablets are different than for the intended use could be used, the doctor should not prescribe. There are other medicines used in ADHD, e.g. Means that were originally developed for depression, but have also been proven in ADHD. To illustrate this in detail, would be the scope of Brochure the brochure. Your doctor may be here if interested sure to give more information.
Efficacy of diets in ADHD has increased in the Most studies do not show. For the oligoantigenic diet is considered that a total of about 5-10% of children with ADHD benefit from it. It is an individualized diet. It starts with a so-called basic diet in which various foods are left out, which cause more allergic reactions. If this is followed by an improvement of ADHD symptoms, individual foods are gradually added and it is observed whether the symptoms return strengthen. So possibly food can be identified after their consumption in each individual case the symptoms occur more frequently. The diet is very elaborate, expensive and requires a lot a lot of discipline from the children and the parents. The risk malnutrition is to be considered. Children with ADHD are often overwhelmed with adhering to the diet plans. When regular treatment, the diet is not recommended become Some parents express concerns about traditional medicine Treatments and look for so-called "natural" alternatives. In this context will also be discussed the use of AFA algae.
AFA algae, colloquially blue or blue-green primeval called algae, belong to the cyanobacteria. A variety of different diseases should be with these Algae can be treated in addition to ADHD here also flu, chickenpox, mumps, and depression specified. The effectiveness of AFA algae in the treatment of However, these diseases are not scientifically busy. Cyanobacteria containing preparations are also in some countries are not approved as a medicinal product. Certain Strains of these bacteria can affect the nervous system and damage the liver. For this reason, the Federal Institute for Drugs and Medical Devices and the Federal Institute for Health Consumer Protection and veterinary medicine in a joint press release of 21 March 2002 expressly warned against treatment with AFA algae.
The discussion about ADHD The topic of ADHD has been heavily debated in recent years, the positions are very contradictory and the Discussion is often done very emotionally. In addition to the Question, if it is at all a disease, are also the most diverse causes of occurrence responsible for the disruption? The general social development, media overstimulation, a lack of exercise, parenting style, eating habits and much more are used to explain.Equally contradictory is the discussion about the correct treatment. As shown, except Psychotherapeutic, pedagogical and drug treatment approaches also certain Diet forms, the intake of algae preparations and other therapeutic approaches to solving the problems recommended, depending on the underlying explanatory approach for ADHD.
These different views or recommendations complicate the already often difficult search after competent and experienced contact persons and lead to great irritation in parents and caregivers. Was particularly controversial and is the question of one Use of drugs in ADHD. The fact that the consumption of the active substance methylphenidate used for the treatment of ADHD in recent years had risen sharply, sparked a very violent, often unobjective discussion about the use of Methylphenidate. The problem ADHD appeared at times the question "Methylphenidate - yes or no?" limited his.
Standards in diagnostics and treatment
Based on the dramatically increased consumption figures for the drug methylphenidate, at the initiative of the Federal Government Drug Commissioner, BMG deals extensively with the subject of ADHD set. Through various activities became one Objectification of discussion and improvement contributed to the information situation. A central point in these activities was one in October conducted in 2002 under the direction of the BMG "consensus conference ADHD". She found with the participation of various specialist and other professional groups as well as Self-help associations, representatives of the Medical Associations and others instead. The main results were End of 2002 published by the BMG as a key issues paper. For the first time in this broad form, they became common Positions on various issues of diagnostics and Therapy as well as other aspects.
Where Can I Get Help?
The diagnosis of ADHD should be comprehensive Examination by doctors or psychotherapists experienced in the examination and treatment. Especially because of the fluid transitions from difficult to disease-conspicuous behavior is often prematurely suspected that it is ADHD must, although other problems are the cause. An Extensive diagnostics are important to rule out other conditions and to detect concomitant disorders. Just so can one specific to the overall problem of the child tailored individual treatment concept to be developed. In the beginning, the detailed conversation with the parents and children or adolescents. Here are the carefully considered, i.e. since when and in which situations these occur. What matters is how the problems have developed and what has already been done to cope with it and what these attempts at a solution have brought. Often additional questionnaires are used. Through this in a structured form, other aspects can be recorded quickly and clearly and the disturbance can be narrowed down more precisely. Teachers and/or educators may also be asked to consider the behaviour and performance of the child using questionnaires. Teachers and Educators are not required to fill in the often extensive questionnaires, but they are often willing to do so. Furthermore, it is asked what diseases it is in the family gave as pregnancy and childbirth go and what other illnesses have occurred in the child.In addition, the child is physically examined. Here also neurological examinations are carried out and the hearing and sight are tested. Around to exclude a brain organic disease is sometimes additionally made an EEG.
To developmental problems, partial performance weaknesses and accidentally detect accompanying disorders can additionally psychological tests are necessary. So Intelligence tests are used to the intellectual Level of achievement of the child. Specific performance tests provide information about possible partial power disturbances, such as reading or writing weakness. Concentration tests show the ability to short-term and targeted attention. Personality questionnaires that are used in older children can first indications of a self-esteem problem, anxiety disorders or give depression. Only after careful investigation can reliable the Diagnosis ADHD be made. Doctor in charge will be after detailed information and advice develop an individual treatment concept together with the parents.
Where do parents find help?
The first contact for help-seeking parents is in usually the pediatrician. Many children and Youth doctors have been specially trained and qualified on this topic.If necessary, however, this is for further diagnostics and treating a child and adolescent psychiatrist and/or Involve child and adolescent psychotherapists. At psychotherapeutic measures, behavioural therapy concepts have proven particularly useful. That's why you should ask the attending physician or psychotherapist if he can perform and bill for appropriate behavioural programs. Depending on existing concomitant disorders it can be necessary to include other treatment approaches Diagnosis and treatment can also be carried out in a social pediatric center in which different disciplines work together. In some children and youth, hospitals have special ambulances for children with ADHD.
Since ADHD is a disease, it will be the cost of the examination and treatment of the Taken over health insurance. If the incidence of ADHD constitutes a disability, it threatens those affected by disability or impaired in their psychosocial development are, come according to the Child and Youth Welfare Act (Social Security Code VIII) and the Law on the Rehabilitation and Participation of Disabled Persons (Social Code IX) Social assistance, which, in consultation with the Cause the necessary action to be taken. Here the youth welfare office can be an important contact person. In cooperation with professionally trained teachers here are offered many aids from curative day groups to socio-educational family help. Other contact persons may also be an educational counseling center or the school psychology service. In some schools, the School Psychology Service offers special counseling and training for parents and children.Diagnosing an ADHD, creating an individual Therapy plan and the coordination of the measures are Task of the doctor. Increasingly there are interdisciplinary regional networks, which work in the team around the therapy to strive for children and adolescents.
Parents of children with ADHD are special burdens exposed. Many doubt about the difficulties their educational skills, withdraw from social Contacts back and get so more and more in the Isolation. In such a situation it can be pronounced be helpful in communicating with other concerned parents. The realization that it is the same for many others the suggestions, information, and tips out of personal concern can be very relieving and encouraging for the parents. There are now in whole web self-help groups, in which one can find such mutual support.