ADHD in children: what it is

Everything you need to know to support your child with ADHD as effectively as possible—with empathy, practical everyday advice, and a sound evidence base.

Energetic and impulsive children who are constantly on the move can pose a real challenge for parents and teachers. In many cases, this is simply their temperament, which changes as they grow older. Sometimes, however, the conspicuous behavior is caused by attention-deficit/hyperactivity disorder (ADHD).

The essentials at a glance:

How can I tell whether my child has ADHD?

Typical signs of ADHD include severe restlessness, impulsivity, and difficulty concentrating. Only a specialist medical diagnosis can determine whether it is actually attention-deficit/hyperactivity disorder.

What are the causes of ADHD?

ADHD usually results from an interaction of genetic factors and environmental influences, such as family stress or certain adverse experiences in early childhood. Nutrient deficiencies have also been linked to ADHD. In this article, based on studies, we explain in greater detail which factors may promote the development of ADHD.

Does my child with ADHD need medication?

In some cases, medically supervised drug treatment may be appropriate when symptoms are severe. At the same time, there are many complementary approaches—such as exercise, nutrition, clear daily routines, and targeted support—that can help strengthen the child in everyday life.

We have researched the most important topics related to ADHD in children on a scientific basis and compiled them for you in detail.

What do medical professionals mean by ADHD?

Attention-deficit/hyperactivity disorder is one of the most common chronic conditions diagnosed by psychiatrists in children and adolescents in Germany. According to the criteria of the American Psychiatric Association (Diagnostic and Statistical Manual of Mental Disorders, DSM-5), doctors classify patients with ADHD into three subgroups:

• Impulsive-hyperactive type
• Predominantly inattentive type
• Mixed types with varying proportions of inattention, impulsivity, and hyperactivity

Because the terms hyperactive, impulsive, and inattentive form the basis for diagnosing ADHD, they are precisely defined.¹ Put simply, inattention means poor concentration; impulsivity involves thoughtless, spontaneous actions. A hyperactive child is the classic fidgety child.

If you want to explore the diagnostic criteria for ADHD in greater depth, you will find easy-to-understand explanations here.

Adolescents and children with ADHD are quick to

• frustrated when people do not understand them immediately
• discouraged and give up when something does not work right away
• offended when they are confronted with criticism or someone shows too little interest
• anxious and worried when they encounter a new situation

If the symptom of increased physical activity is absent, medical professionals refer to the disorder as attention deficit disorder (ADD). Those affected withdraw into themselves and appear to outsiders like daydreamers (daydreamers).

Important note:

In Germany, some doctors use the ICD-10 criteria catalog to diagnose ADHD in children. At international scientific conferences, experts repeatedly emphasize that the ICD-10 can be used to identify ADHD only in boys between 6 and 12 years of age. The ICD-10 does not apply to boys under 6 or over 12, or to girls of any age!

How does ADHD develop?

Doctors and scientists assume that the predisposition to ADHD is inherited from parents by their children. Current studies show that the disorder occurs more frequently within families.

In other words: If a child or adolescent is diagnosed with ADHD, a parent may also be affected without being aware of it.

According to current knowledge, patients with ADHD have a functional disorder in the brain. The reason is an insufficient supply of the neurotransmitters (neurotransmitters) serotonin, noradrenaline, and above all dopamine.

This leads to impaired transmission of external stimuli between nerve cells (neurons). Information is filtered inadequately, resulting in constant sensory overload in the brain.

Because of the faulty processing of external stimuli, a child with ADHD perceives reality differently from a healthy child of the same age. This results in typical behavioral abnormalities such as inattention, hyperactivity, and impulsivity.

Statistical data on ADHD in children in Germany

According to current data from the German Local Health Insurance Funds (AOK), 6.1 percent of children and adolescents between the ages of 1 and 17 in Germany have ADHD. Among 9-year-old boys, nearly one in seven (13.9 percent) is affected. Compared with statistical surveys from 2009, this represents an increase of more than 20 percent.²

Psychiatrists make this diagnosis more than four times as often in boys as in girls.³ One to two thirds of affected children still have ADHD symptoms in adulthood.⁴

The diagnosis of ADHD has a high error rate

The enormous increase in ADHD diagnoses over recent decades prompted numerous critics to speak out. If ADHD is frequently misdiagnosed, are we more likely to help or harm those affected? Scientists now openly discuss questions like these in renowned specialist journals.^{5, 6}

In a 2012 study, researchers from the University of Basel and Ruhr University Bochum demonstrated that child and adolescent psychiatrists are apparently often wrong. The researchers sent fictional case reports about boys and girls with ADHD-like symptoms to 1,000 psychiatrists and psychotherapists and asked them to provide a diagnosis.

According to the applicable criteria and guidelines, only one-quarter of the case reports could be diagnosed as ADHD. In fact, many ambiguous cases were also given this label. The study's conclusion: One in six ADHD diagnoses is incorrect.⁷

Alarmingly, in completely identical case reports, lively boys were diagnosed with ADHD twice as often as girls. Apparently, some psychiatrists are influenced too much by subjective criteria and do not adhere strictly to the official guidelines. It is no wonder that the number of ADHD cases among children in Germany is rising rapidly.

Conventional medical treatment for ADHD

Doctors primarily treat ADHD with medications containing the active ingredient methylphenidate. These include products such as Ritalin, Equasym, Medikinet and Concerta. In addition, the medications Attenin (active ingredient: dexamfetamine sulfate) and the norepinephrine reuptake inhibitor Strattera (active ingredient: atomoxetine) are also used.

Methylphenidate and dexamfetamine sulfate act as stimulants by releasing the neurotransmitters dopamine and noradrenaline in the brain.

What happens if ADHD remains untreated?

If ADHD is not recognized or is treated incorrectly, behavioral problems increase over time. The disorder often has an enormous impact on family life, school performance, and later on working life.

Children with ADHD quickly become outsiders whom no one wants to play with. Since their classmates also do not like inviting them to birthday parties, their self-esteem suffers.

Typical secondary disorders resulting from untreated ADHD include:

• Delayed emotional development
• Problems integrating into a community
• Learning, memory, and cognitive performance are impaired
• Difficulty planning the day and allocating time appropriately
• Problems managing financial matters
• Their own potential is not fully realized

As pedestrians or cyclists, adolescents with ADHD are involved in accidents significantly more often than healthy peers.⁸ Adults with behavioral problems take greater risks as drivers.

In a study involving 71 participants, American scientists demonstrated that ADHD patients had more car accidents during the same period and sustained more severe injuries than healthy people in the control group.⁹

When children with ADHD do not receive adequate treatment, their parents face an increased risk of developing depression. In addition, alcohol consumption in affected families is significantly higher than in households with children who do not exhibit behavioral problems.¹⁰

What promotes the development of ADHD?

According to the renowned Mayo Clinic, several factors may contribute to the development of ADHD. These include, in particular:¹¹

1. A parent or one of the siblings has ADHD or another mental illness.
2. Exposure to environmental toxins such as lead. This heavy metal is found primarily in paints and water pipes in older buildings.
3. Using drugs, alcohol, or nicotine during pregnancy increases the risk of the children developing ADHD.
4. Premature birth

Children who grow up as orphans or with only one parent are more likely to exhibit psychological problems than children raised in a family with both a father and a mother.¹²

In a recent study involving 1,384 children and adolescents, scientists at the University of Hamburg demonstrated that social influences affect the severity of ADHD symptoms. At the beginning of the study, the researchers found that the most noticeable behavior occurred among younger male children who were aggressive and whose parents suffered from a mental illness.

Over the course of the two-year study, ADHD symptoms increased most among aggressive girls with a migrant background who had anxiety disorders and whose parents had a pronounced mental disorder. Conversely, symptoms decreased over time in all children when the family environment improved.¹³

What role does diet play in ADHD?

Even though ADHD is genetic, studies show that certain micronutrients such as vitamin D3, omega-3 fatty acids, and iron can positively influence behavior. A balanced Mediterranean diet rich in fruit, vegetables, whole grains, and fish may also reduce the risk of ADHD symptoms.

For the results of these studies, we recommend our article What role do vitamins, minerals, and omega-3 fatty acids play in ADHD?.

Conclusion

ADHD is a mental disorder inherited by children from their parents. Current scientific research shows that several factors influence the course of the disorder.

Without appropriate treatment, serious secondary disorders may develop. Those affected may then have great difficulty integrating into working life and building collegial relationships with other employees.

In addition to conventional medical treatment with Ritalin & Co., there are other important approaches that we explain in detail in the following articles:

• ADHD in children—what can affected parents do?
  
• Why omega-3 fatty acids are so important for children
• How children's concentration can be supported
• The benefits of omega-3 algae oil for children

FAQ: ADHD in children

What exactly is fidgety Phil syndrome?

The so-called fidgety Phil syndrome is a colloquial term for attention-deficit/hyperactivity disorder (ADHD). The abbreviation ADHD refers to a disorder characterized by restlessness, impulsivity, and concentration difficulties.

Typical core symptoms often appear as early as kindergarten or elementary school. Children with this disorder often find it difficult to concentrate on a task and show a strong need for movement.

It is important to correctly classify these behaviors as part of a professional assessment—for example, by a pediatrician—as many children at this age naturally display differences in temperament.

What role do schools & teachers play in ADHD?

Teachers and educators play a central role in dealing with attention-deficit/hyperactivity disorder (ADHD). They are often the first to notice signs such as restlessness, concentration difficulties, or impulsive behavior during elementary school or even kindergarten.

Close contact between the school and the family is essential to support the child in various areas of life. Understanding, clear structures, and a supportive environment can help prevent overwhelming the child and provide the best possible support despite their impairments.

How do I deal with frustration or feeling overwhelmed?

Parents of children with ADHD often experience emotional strain in everyday life—whether due to conflicts, constant restlessness, or the feeling of being alone with the situation. The important thing is: You are not alone! Connecting with other affected families, for example in support groups, can provide relief.

Professional advice from a pediatrician or specialized professionals can also help you better understand the causes of feeling overwhelmed and find new ways to cope with the condition. A structured daily routine can also help reduce frustration at home.

References