ADD - The Attention Deficit Syndrome

• Frequency of occurrence of ADD
• Causes of ADD
• Possible accompanying symptoms of ADD

Synonyms in a broader sense

• Attention deficit disorder
• Attention deficit disorder
• Psycho-organic syndrome (POS)
• Hans-look-in-the-air
• Attention-Deficit-Disorder (ADD)
• minimal brain syndrome

definition

Attention deficit syndrome is a pronounced inattentive, sometimes impulsive behavior that becomes noticeable in several areas of life (kindergarten / school, at home, leisure time) over a longer period of time (about six months). ADD does not necessarily have to be linked to hyperactivity.
Rather, children who appear through dreams or the like also suffer from ADD. The behaviors shown usually do not correspond to the child's level of development, but do manifest themselves, which means that the corresponding behaviors do not occur in phases, but persist. As a result, the problem cannot be overcome without suitable help. There are two forms of attention deficit syndrome: In addition to attention deficit syndrome without hyperactivity (ADD), there is also the hyperactive variant, ADHD (attention deficit disorder with hyperactivity), and the mixed type of both variants.

What both terms have in common is the fact that they are a clearly defined clinical picture acts that through different symptoms of the ADS. Children with ADD or ADHD cannot focus their attention in a targeted manner, so that their ability to concentrate is deficient. These deficiencies usually pervade all areas of the child's life, i.e. kindergarten or school as well as the family and leisure areas. The lack of concentration becomes particularly evident in phases in which children can focus their attention on a certain area over a longer period of time. While the ADD child then begins to dream and otherwise does not necessarily attract negative attention, the hyperactive (ADHD) child can have negative side effects (fidgeting up to refusal to work).

Due to the different external manifestations of the ADHThis is usually diagnosed more frequently, but above all more quickly.

Various series of studies have now confirmed that if AD (H) S is present, the Forwarding and processing of information between different parts of the brain flawed works. In both cases, the ability to concentrate is sometimes considerably impaired. However, this does not mean that children with ADD or ADHD have a Giftedness can be excluded from the outset.
It is noticeable, however, that the symptoms can also have consequences in other school areas. One is not uncommon Reading and writing difficulties or / and a Arithmetic weakness.

Frequency of occurrence of ADD

Since the diagnosis is difficult and, unfortunately, often still incorrect, or depends on the diagnostic criteria used, it is difficult to state the frequency of ADD cases. It is therefore usually limited to representative studies.

It is currently estimated that around 3 to 10% of the population have ADD. Around 3 - 6% of this is in the 6 to 18 age group (3 - 4% children of primary school age, around 2% young people). According to the research results, it is assumed that boys tend to develop ADD or the hyperactive variant ADHD more often. The ratio should be 1: 7 in favor of the girls.
In general, the ratio of ADD to ADHD is estimated to be around 1: 3. Opinions differ on the reasons for this. It is often of the opinion that ADD without hyperactivity does not “stand out” so negatively and is therefore less likely to be advised for clarification and diagnosis.

Due to the fact that twin studies on identical twins have shown that - if ADD / ADHD is present - mostly both children are affected, it is assumed that the symptom - which adults can also suffer from - can be inherited.

history

Historically known is the story of “Hans - look - in - the - air”, written by Heinrich Hoffmann, who also wrote the “Fidgety Philipp”.
In general, the attention deficit without hyperactivity receives significantly less attention, which could be due, among other things, to the fact that calm, attention-deficit children are usually less noticeable. A diagnosis to this end, including the previously noted attention deficit, is much more difficult.

With regard to research into the causes of ADD, it can be said that as early as 1870, the first statements were made that did not rule out heredity and also indicated that the social pressure exerted on children was growing ever greater. The more and more important virtues such as punctuality, order, obedience, ... could not be fulfilled in the same way by all children. This statement should make us sit up and take notice ...
In the further course of research, for example in the early 20th century, there was an increasing tendency to give a high degree of responsibility beyond education. Groups emerged that classified attention-deficient children as difficult to raise. Here, however, it becomes clear again that those children are more likely to be dealing with the hyperactive variant of ADD and that the diagnosis of ADD without hyperactivity would have been much more difficult even then.
Historically, there are parallels not only with regard to the difficulties of diagnosing ADD, but also to the history of dyslexia. Here and there, possible causes were and are assumed, formulated, later revoked and then re-postulated.

In the 1930s, it was found, rather by chance, that special drugs sedate hyperactive children. Since this worked, it was assumed in the 1960s and research results also indicated that a brain disorder was the cause of the development of ADD and treated accordingly. In the further course of research it was believed that there could be no ONE cause for the development of ADD and so the multi-causal approach (= caused by many factors) prevailed: Various factors came into consideration as causes of ADD: Minimal cerebral dysfunction (MCD, a form of brain damage), inheritance (genetic transmission), consequences that arise from the changed society, etc.

Two contrary and extreme positions have persisted. On the one hand, there are those who believe that ADD should in principle be treated with medication and, on the other hand, those who are of the opinion that a goal can only be achieved through therapy and changed educational measures and that drug therapy should be avoided. Today most forms of therapy can be found between these two “extreme” views.

All (scientific) attempts at explanation ran through the disciplines of medicine, psychology, but also education. Perhaps, however, it should be borne in mind that there is no classic silver bullet that applies to everyone, especially when it comes to learning problems can. The problems are always of an individual nature and therefore also require individual therapy for ADD.

You will find further information on these subtopics:

Causes of ADD

Even if many factors are still believed to be the cause of ADD today, since the 1990s the neurobiological explanatory approach scientifically established as an explanatory approach for the development of ADD.

Possible causes that try to explain the neurobiological explanatory approach causally can be found under Causes of ADD.

Symptoms

If one speaks of an attention deficit, then everyone immediately has the image of the fidgety philippy in front of their eyes. The fact that there are also very complex main and secondary symptoms can only be seen by those who come into contact with the syndrome in any way.
In addition, different variants of attention deficit syndrome are to be distinguished from one another: ADD and ADS + hyperactivity (ADHD), as well as a mixed type of both variants. People who suffer from a variant of this syndrome find it difficult to distinguish between important and unimportant stimuli. It is assumed that those affected are often in a permanently overstimulated state, and consequently suffer from permanent stress.
According to the different variants, there are symptoms on the one hand that can occur in both main areas - that is, both with ADD and ADHD, but also those that are specific.

Read more on the topic: Symptoms of ADD and ADD symptoms in adults

What can be signs of ADD?

Typical is the dreaminess, which can be noticeable in the child, for example, by staring out the window for a long time or scribbling on the documents. In addition, the ability to concentrate is impaired, so those affected find it difficult to complete tasks, follow instructions incompletely and are easily distracted. They find it difficult to socialize and often isolate themselves. The intelligence is not restricted and those affected often have a flourishing imagination and creativity.

diagnosis

The fact that making an ADD diagnosis is not easy is due, on the one hand, to the fact that ADD-typical symptoms also occur in children and adolescents as well as in adults (ADD diagnosis in adults) without them suffering from ADD themselves. From time to time almost every child experiences a lack of attention and “indolence”.

The difficulty in making a diagnosis is to delineate these cases and to diagnose “real” ADD cases. This can be compared symbolically, for example, with the famous search for a needle in a haystack.

Before a strenuous diagnosis rains down on the child, any “suspicious factors” should have been shown over and over again over a period of about six months - and above all in a similar form.

The following diagnostic measures should be taken into account in order to be able to rule out incorrect diagnostics as far as possible.

1. Questioning the parents
2. Assessment of the situation by the school (Kiga)
3. Preparation of a psychological report
4. clinical (medical) diagnostics

Test for ADD in children

If parents or teachers notice persistent lack of attention, concentration problems, and possibly other ADD symptoms, they can have the child tested for this disorder. As a rule, the pediatrician is responsible for this and carries out various attention and behavior tests. A physical exam and intelligence tests are also part of the diagnosis to rule out other causes of the symptoms. The tests used are those that are also used in typical ADHD. These include, for example, questionnaires for the parents and the child that ask about typical symptoms and accompanying problems, such as the SDQ (Strengths and Difficulties Questionnaire), the Conners scales or the CBCL (Child Behavior Checklist). Computer-aided variants, in which the child's reaction and concentration skills are required, can also be used. Even more important than these tests, however, is the anamnesis, i.e. a detailed discussion with the doctor. These standardized tests often do not capture all symptoms and are not reliable. The diagnosis is only confirmed if the doctor also detects ADD after the examination.

Read more: Therapy and help for children and adolescents with behavioral problems, how to recognize behavioral problems in babies

Test for ADD in adults

In principle, the same tests are possible for adults with ADD as for children, because questionnaires on symptoms and accompanying problems are available for every age group. There are also entire test batteries that the doctor can carry out with the patient for the purpose of checking attention. The difficulty, however, is in becoming aware of ADD as a person affected and in contacting a doctor. Usually, patients are unaware of their disorder and consider the symptoms to be character weaknesses. If ADD is not diagnosed early in childhood, people will find out about it late or never. It is not uncommon for the doctor who treats the patient for accompanying problems such as depression to express the suspicion of an attention disorder. The diagnosis is then made by means of a detailed discussion and working through the years in which the problems have developed. In adults in particular, talking to the doctor is more important than standardized tests, in which many patients who have developed compensation strategies fall through the grid and would not be recognized.

Differential diagnosis

Since an exact diagnosis is necessary with regard to therapy, specific diseases must be differentiated diagnostically. This means that typical examinations exclude diseases that manifest themselves symptomatically similar to ADD.

A differential diagnostic differentiation may also be necessary if, in addition to ADD, other diseases are suspected that make it more difficult.

For further and more detailed information on differential diagnosis, please click on Diagnosis of ADS: Diagnosis of ADS.

What is the difference to ADHD?

In typical ADHD, the symptom complexes hyperactivity and impulsivity are in the foreground. Those affected often show the typical image of a "Fidget-Philipps“Who cannot sit still and interrupts others. In these forms of ADHD, the symptoms become noticeable in childhood and the child's parents and teachers consult a doctor. Even in ADD without hyperactivity, the symptoms have existed since childhood, but are very often overlooked. These children experience a sensory overload similar to that in ADHD, where it is difficult for them to separate the important from the unimportant and therefore absorb far too many stimuli from their surroundings. This excessive demand results in the attention and concentration disorder, as simply too much information rains down on them at the same time. Hyperactive children compensate for this with movement, abnormal behavior and impulsive reactions. Hypoactive, ie “underactive” ADD children try to isolate themselves from the outside world and take refuge in their imaginations. This creates the image of the typical "Dreamer“, Who can also concentrate poorly and therefore also has problems at school. However, this dreamy absenteeism is often interpreted as normal shyness and introversion, and the difficulties in school as a lack of intelligence.

This can have serious consequences, because the failures and social problems are then attributed to one's own character and put an enormous strain on self-esteem. This then favors the associated problems later in life, such as depression and social isolation. Because the disorder is more difficult to recognize, ADD has a higher risk of psychological problems and behavioral problems than ADHD. In addition, it more often lasts into adulthood, which is not only due to the lack of therapy and must have other reasons.
It is still unclear what cause the symptoms and where the difference between the hyper- and hypoactive forms of ADHD comes from. Some mechanisms, such as impaired signal transmission in the brain, are common to both types, while the differences that lead to the different appearances have not yet been fully explored. However, the following applies to all ADHD types: early detection and treatment of symptoms lowers the level of suffering in almost all patients and enables them to lead an unrestricted life.

ADD and Asperger's Syndrome

Many symptoms of ADD are similar to Asperger's Syndrome, which is a disorder of the autism spectrum. Social isolation, psychological abnormalities and inappropriate behavior are particularly common in both disorders. Some patients actually have both diseases, but most of the time there is only one condition to identify. When diagnosing ADD-typical attention deficits should be differentiated from autism-like symptoms.

Read more on the subject at: Asperger syndrome

therapy

The therapy must be designed as individual as the symptoms of ADD. As a result, each therapy should be individually tailored to the child's deficits and, if possible, should be holistic (multimodal). The child has to be “picked up” where it is currently located. This means: the pedagogical and therapeutic work must begin with the individual learning status and in the area of ​​the individual learning conditions and work opportunities of a child and be oriented towards them in a special way.
“Holistic approach” also implies a collaboration between therapist - parents - school. It must be made clear to all those involved in upbringing (especially grandparents) that only cooperation with one another can achieve success.
In addition, “holistic” always implies a combination of the social-emotional area with the psychomotor and the cognitive area in the context of a therapeutic approach.

Further information is available at: Therapy ADD.

Among other things, there are specific therapeutic approaches that we have specifically developed. These are:

1. the drug therapy of ADD: ADD drugs, including methylphenidate and antidepressants,
2. the psychotherapeutic approach of ADD therapy: psychotherapy in ADD,
3. the curative educational approach: ADS curative education,
4. the nutritional approach: nutrition in ADD, as well
5. family support: ADD and family

Medication for ADD

ADD is also treated with drugs against the hyperactive forms of ADHD. A cure is not achieved by this, but the symptoms are reduced and thus the suffering is reduced. The most commonly used preparation is the so-called methylphenidate (e.g. in Ritalin ®), an amphetamine-like substance that improves signal transmission in the brain and thus increases performance. In ADD, this substance does not work quite as often as in typical ADHD, but the patients often manage with lower doses or with other therapies without any medication. Other substances such as atomic exetine (e.g. in Strattera ®), which are often insufficient in hyperactive ADHD, are used more in ADD.
Homeopathic and herbal alternatives are also available to the patient. Which substance works best in individual cases or shows the least side effects varies from person to person and therefore requires detailed advice and patient testing. In almost all cases, however, drug therapy alone is not sufficient and should be supplemented by psychotherapy and behavioral therapies.

Read more on the subject at: ADD medication

Methylphenidate

Methylphenidate is the most common substance in ADD and ADHD therapy and can be found in drugs such as Ritalin® or Medikinet®. It is an amphetamine-like substance from the group of psychostimulants that improves signal transmission in the brain via the messenger substance dopamine by increasing the concentration of this substance in the synapses. Therefore, methylphenidate does not eliminate the cause of the disorder, which has not yet been clarified, but rather alleviates the symptoms. Unfortunately, side effects of Ritalin® are very common, especially in the gastrointestinal tract and the psyche. The use of this drug is therefore controversial nowadays.

Herbal medications

Many ADD patients use herbal medicines for only mild symptoms or for supportive treatment. Examples are the extracts of the gingko tree to improve the ability to concentrate or Bach flower preparations to increase mental well-being. However, herbal substances can also have side effects and not all of them are compatible with conventional drugs, so it is advisable to seek advice from a doctor or pharmacist.

Homeopathy for ADD

Another therapeutic approach are homeopathic remedies, which are increasingly being used to treat ADD. In many cases, with better tolerability, similar successes can be achieved as with conventional medication, but the effect is different for each patient and less researched than with methylphenidate. According to the principle of homeopathy, a substance is administered in low concentration that is based on the severity of the symptoms. For typical ADD “dreamers” substances such as sulfur or agaricus would be possible therapy options.

Possible accompanying symptoms of ADD

On the following pages you can find out more about accompanying problems. In the school sector, these are the ones Reading and writing difficulties and the Arithmetic weakness.
Since ADD children also have trouble getting their attention focused, you can rely on the Poor concentration - Learn more about the problems and symptoms on this page.

• Reading and spelling weaknesses / dyslexia
• Arithmetic weakness / dyscalculia
• Poor concentration
• Giftedness

ADD in adults

Attention deficit disorder without hyperactivity is more likely to persist into adulthood than the other types of ADHD. This means that the first symptoms appear in childhood and change, but do not “grow together”, but can affect the person affected throughout their school days and into everyday working life. So while the hyperactive form of ADHD mostly remains a children's disease, ADD is often a cross-age disorder. The reasons for this have not yet been clearly clarified.
Since this form is significantly less noticeable than the typical impulsive, hyperactive ADHD, it is not diagnosed in childhood in many of those affected and is therefore not adequately treated. Even patients with hyperactive ADHD can have problems into adulthood if they did not learn how to deal with their symptoms as a child. The lack of recognition of the disease or the incorrect handling of it can therefore be one of the reasons that an above-average number of people affected by this subtype suffer from the disorder for decades. With the duration of the disease, however, the severity of ADD symptoms in adults also changes. While children mainly appear dreamy and absent-minded, the adults' difficulty concentrating and paying attention are less noticeable. Often they are forgetful, easily distracted and overwhelmed, but usually develop compensation strategies that hide their symptoms. They often avoid situations that cause them difficulty, e.g. at work or in the social environment. They usually find it difficult at work and in everyday life if they have not received adequate therapy.

In adults, for example, the psychological and social problems that arise from frequent failures and a lack of self-esteem and cause the patient's suffering are more in the foreground. They usually do not perceive the symptoms as illness or disorder, but as their own weaknesses and faults. In addition to performance problems, ADD patients therefore also suffer from depression more than average. Appropriate therapy with psychological training and, if necessary, medication can reduce the level of suffering and prevent these accompanying disorders from occurring. Recognizing and treating the disorder is therefore essential to ensure the patient's well-being.

Read more on the subject at: ADD in adults

What is the relationship between depression and ADD?

Due to poor performance and social problems, many ADD patients experience failures and disappointments in childhood that they attribute to themselves. If their special talents are not encouraged and how to deal with their attention disorder is not learned, the self-esteem of most of those affected suffers enormously. The above-average incidence of depression in ADD patients is therefore not surprising. The exact numbers vary depending on the study, but it can be assumed that at least every 5th ADD patient has gone through at least one depressive phase.

What is the connection between giftedness and ADD?

The data on the frequency of giftedness combined with ADHD or ADD is unclear.What is certain, however, is that both conditions make the diagnosis more difficult, so that either giftedness or ADD is often not recognized. However, since people with high intelligence perceive their attention deficit much more clearly, they usually suffer more from it than others. Highly gifted ADD patients are therefore under enormous stress and have a higher risk of accompanying psychological problems.

What is the relationship between alcohol and ADD?

Addictive behavior is a major problem in related ADHD. Nicotine and alcohol come first. However, since impulsiveness in particular can be viewed as a trigger of harmful behavior, the frequency of nicotine and alcohol abuse is estimated to be less high in pure ADD, although the study situation is poor. So how high the risk is for the individual to develop alcoholism is presumably dependent on the individual psychological state and the level of suffering caused by the symptoms.

What effects can ADD have on a partnership?

People with ADD find it harder to have interpersonal relationships. It is not easy for them to listen attentively and react appropriately to their counterpart. In addition, they quickly feel misunderstood and are often rejected. So the problem is communication, which is difficult in an ADS relationship. There are various therapy options for both partners in which they learn to respond to the other and to make their needs understandable.