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Free AccessÜbersichtsarbeit

ADHS – an der Nahtstelle von Medizin und Pädagogik

Published Online:April 10, 2014https://doi.org/10.1024/2235-0977/a000060

Abstract

Die Aufmerksamkeitsdefizit-Hyperaktivitätsstörung (ADHS) ist eine der häufigsten kinder- und jugendpsychiatrischen Diagnosen. Die Kernsymptome Hyperaktivität, Impulsivität und Konzentrationsstörung führen zu schulischem Leistungsversagen, sozialer Ausgrenzung und familiären Konflikten. Der Verlauf der ADHS ist gekennzeichnet durch eine hohe Persistenz ins Erwachsenenalter, aber auch durch eine zunehmende Entwicklung komorbider Störungen wie Depression, Sozialverhaltensstörungen und Suchterkrankungen. Die Ursachen der ADHS sind in erster Linie genetisch. Umweltfaktoren wie Alkohol oder Nikotin in der Schwangerschaft nehmen eine untergeordnete Rolle ein. Die Therapie besteht aus Psychoedukation, Verhaltenstherapie und Pharmakotherapie. Um eine optimale Versorgung der Betroffenen zu gewährleisten ist eine intensive Zusammenarbeit der Familien, den Therapeuten und der Schule notwendig. Angesichts kontroverser öffentlicher Debatten um ADHS ist es notwendig, die wissenschaftlichen Fakten und Hintergründe zu kennen, um bagatellisierenden und für die Betroffenen schädlichen Berichterstattungen entgegentreten zu können.


ADHD – at the Intersection of Medicine and Pedagogics

Background: Attention-deficit/hyperactivity disorder (ADHD) is a highly prevalent childhood onset disorder characterised by the core symptoms inattention, impulsivity and motor hyperactivity. Although the disorder is impairing in family and peer settings, it is the poor performance and social integration deficits at school, which are frequent reasons for referral, diagnosis and therapy. ADHD is controversly discussed in the media and there is an ongoing debate about the validity of the disorder as well as the proper diagnosis and therapeutic approach. In general, the public discussion suffers from a lack of knowledge about the current evidence in regard to the aetiological background and the available therapies.

Aims: The aim of this article is to provide an overview on the current scientific knowledge of aetiology, diagnosis, course and therapy of ADHD for physicians, psychologists, pedagogues and associated therapeutic workers.

Methods: A selective review of the literature with focus on meta-analyses and systematic reviews was performed.

Results: The aetiology of ADHD is multifactorial, yet the genetic contribution is relevant with heritability estimates up to 80 %. Although there has been substantial improvement in the research on the genetic factors underlying ADHD, the polygenetic aetiology hampers the identification of single genetic variants with high contribution. Environmental factors associated to ADHD are largely restricted to pregnancy such as maternal alcohol consumption or nicotine use. Neurobiological correlates of ADHD in the brain have been identified on both structural as well functional levels. Several pathophysiological hypotheses have been in discussion in recent years, yet those have proven to be non-exclusive and most probably overlapping due to the aetiological heterogeneity of ADHD. The clinical diagnosis of ADHD is well defined in the existing classification systems and careful diagnostic procedures applying validated instruments is the prerequisite for avoidance of false diagnoses. ADHD in childhood is associated to high psychosocial impairment and psychiatric comorbidity in adolescence and adulthood. Although there is a wide variety of therapeutic approaches, only medication with psychostimulants provides sufficient evidence for high efficacy. A recent comprehensive meta-analysis demonstrates the lack of evidence for most non-pharmacological interventions. This may be interpreted as indication that behavioural therapy affects comorbid symptoms rather than ADHD core symptoms.

Discussion: ADHD is characterised by high psychosocial impairment. Although effective treatment strategies exist for ADHD and comorbid conditions, the complexity of the disorder, the development of comorbid disorders and the heterogeneous trajectories and outcome require increasingly individualized therapeutic approaches. There is an unmet need for intensified collaboration between families, therapists and schools in order to implement comprehensive setting-spanning manualized treatment strategies.

The public discussion surrounding ADHD requires to be oriented and directed to the needs of the affected individuals and their families. In order to adequately evaluate differing opinions on the adequate approach towards ADHD und the associated sociological, medical and pedagogical fields it is necessary to gain knowledge on the current state of science on the topic. A public discussion doubting the validity of the diagnosis per se and toning down the problems of affected families does not adequately handle the topic and is harmful for the patients and their families.

ADHD has become a relevant and complex problem for the whole society that needs to be addressed by joint efforts from medical, psychological, pedagogical and further therapeutic services.

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