What's the hardest part about ADHD

ADHD> Causes and Diagnosis

1. The most important things in a nutshell

The causes of ADHD * are not clearly understood, but there are some factors that can promote ADHD. The core symptoms of ADHD are hyperactivity, inattentiveness, and impulsivity. Since the demarcation from healthy behavior can often be very difficult, diagnosis and therapy should only be carried out by experienced doctors and psychotherapists.

In Germany, an estimated 500,000 children and young people are affected by ADHD, with the majority of boys. 40-60% of children diagnosed with ADHD retain residual symptoms of ADHD into adulthood.

2. Differences between ADD and ADHD

The following are examples of different symptoms of ADD (attention deficit disorder) and ADHD (attention deficit and hyperactivity disorder) compared:

  • Emotional sensitivity
  • Slow work pace
  • Shy demeanor
  • Anxiety in new situations
  • Distractibility
  • Inner unrest
  • Feeling of "being driven"
  • Aggressive behavior
  • Difficult relationship building
  • frustration
  • Excessive urge to move
  • Difficulty concentrating
  • forgetfulness
  • Problems with motor skills and language
  • Exaggerated emotionality
  • inattention
  • Problems with self-organization


In about half of adolescents with ADHD, the symptoms also persist Adulthood exist in whole or in part. More information under ADHD> Adults.

3. Causes and Risk Factors

The causes of ADHD are not yet clearly understood. It is believed that a metabolic and dysfunctional disorder is a major factor in ADHD. The imbalance of various messenger substances leads to a disruption of signal transmission in the brain. These messenger substances include e.g. Norepinephrine and Dopamine. You are responsible for attentiveness, drive and motivation. In people with ADHD, the concentration of noradrenaline and dopamine in the area between two nerve cells (synaptic gap) is too low. Insufficient stimulus filtering in the brain leads to deficits in concentration, perception and impulse control.

The control of behavior works worse in people with ADHD because they have difficulty filtering, sorting or deleting information. The incoming stimuli can no longer be processed meaningfully and only a blurred picture of the situation emerges. This promotes distractibility, exhaustion, and absent-mindedness.

However, if there is particular interest in something, small things are perceived in great detail and precisely. Further essential information, which is outside of the current focus, is often completely ignored.

The following Risk factors are suspected of promoting the occurrence of the disorder or intensifying the severity of the symptoms:

  • Premature birth, birth trauma
  • Hereditary predisposition
  • Nicotine, Alcohol, and Drugs During Pregnancy
  • Unfavorable external environment, e.g. lack of emotional affection, high media consumption, constant problems with friends or at school

4. Symptoms and forms

The core symptoms can be very different depending on the patient. The intensity and duration can vary greatly. The following signs of the core symptoms are described:

inattention Hyperactivityimpulsiveness
  • lots of careless mistakes
  • Difficulty concentrating on long-term tasks
  • bad listening
  • frequent abandonment or interruption of the task or activity
  • difficult everyday organization
  • frequent loss of items
  • strong distractibility by external stimuli
  • pronounced forgetfulness
  • Fidgeting hands / feet
  • Frequent standing up, walking around, or climbing on objects
  • Feeling of restlessness
  • Difficulty with quiet occupation

  • Frequent interruption or disruption of conversations
  • Those affected cannot wait to be on the line
  • Answering questions before they are finished




4.1. Diagnostic criteria

Both the criteria of the World Health Organization (ICD) as well as the criteria of the American Psychiatric Society (DSM) are used.
The characteristics of the core symptoms of inattentiveness, hyperactivity and impulsiveness (see above) are particularly decisive for an ADHD diagnosis.

4.2. ICD criteria

  • There must be at least 6 signs of inattention, 3 signs of hyperactivity, and 1 sign of impulsiveness.
  • These signs first appeared before the 7th birthday.

4.3. DSM criteria

  • There must be at least 6 signs of inattentiveness and / or 6 signs of hyperactivity / impulsiveness. These signs were noticed before the age of 12.
  • From the age of 17, only 5 symptoms of inattentiveness and / or hyperactivity / impulsivity need to be fulfilled.

4.4. Additional criteria according to ICD and DSM

  • The conduct disorder was observed for at least 6 months.
  • The symptoms go hand in hand with impairments in social relationships, performance, activities or participation (= being involved in society).
  • They occur in several areas of life (e.g. in the family and in school).
  • Other mental illnesses can be ruled out as the cause of the behavior.

4.5. Division into types

The DSM criteria differentiate between the following types of ADHD:

  • ADHD mixed type: Noticeable through hyperactivity, impulsiveness and inattentiveness
  • Mostly inattentive ADHD type: Conspicuousness mainly due to strong inattentiveness
  • Predominantly hyperactive-impulsive ADHD type: Abnormalities mainly due to strong impulsiveness and hyperactivity
  • ADHD residual type: The symptoms are no longer all fully developed, but existed earlier

4.6. Classification according to degrees of severity

In addition, ADHD can be divided into different degrees of severity:

  • Mild form: There are few or no symptoms in addition to those needed to establish a diagnosis. The symptoms only slightly impair the social, school or professional functional areas.
  • Moderate form: The number and severity of symptoms and the resulting impairments lie between the mild and severe forms.
  • Heavy form: There are significantly more symptoms than would be necessary to establish a diagnosis, or several symptoms are particularly pronounced, or the symptoms are significantly impaired in social, academic or professional functioning.

5. Diagnosis

In children, adolescents and adults, it makes sense to clarify an ADHD if

  • you Development, learning, performance or behavior problems to have,
  • them to others mental disorders Suffer,
  • your attention and concentration are impaired or
  • they very much restless or impulsive are.

A diagnosis of ADHD should not be made before the age of 3 years. Even in preschool age, ADHD should only be diagnosed if symptoms are very severe. In general, the younger the child, the more difficult it is to make a diagnosis.

Diagnosis and therapy should always be done by an experienced person Specialist or psychotherapist be performed.

At Children these are usually:

  • Specialist in child and adolescent psychiatry and psychotherapy
  • Child and adolescent psychotherapist
  • Psychological psychotherapist with additional qualification for children and adolescents
  • Pediatrician with experience in relation to ADHD


At Adult:

  • Specialist in psychiatry and psychotherapy
  • neurologist
  • Specialist in psychosomatic medicine
  • Medical or psychological psychotherapist

If the diagnosis is made by a psychotherapist, a physical examination be done by a doctor.

5.1. History and diagnosis

To diagnose ADHD, an extensive anamnesis (= collection of information on the medical history) and various examinations are carried out in accordance with the guideline "ADHD in children, adolescents and adults":

  • Information through the parents (in older children / adolescents / adults also by themselves) on the occurrence, frequency and intensity of the symptoms and the development of the child
  • Information from kindergarten or the school the occurrence, frequency and intensity of symptoms and the development of the child
  • information about restrictions e.g. social relationships, performance, participation
  • Information about the beginning and course of the symptome
  • examination for additional psychological symptoms / disorders and physical illnesses
  • Clarification of the previous and current Framework in the family, in kindergarten / school or at work
  • Physical examination of the child (internal, neurological, possibly others) and psychological Testing
  • Behavior observation of the child and the parent-child interactions

5.2. Demarcation

The Demarcation Behaving in a healthy, normal manner can be very difficult, especially in pre-school children. Other causes such as tics, obsessive-compulsive disorders or metabolic disorders must be ruled out and any accompanying illnesses such as depression or anxiety disorders must not be disregarded.

6. Practical tips

  • The ADHD info portal of the central ADHD network, the Federal Ministry of Health and the Federal Center for Health Education offers detailed and helpful information for children, adolescents, adults, educators and parents at www.adhs.info.
  • The current knowledge on diagnosis and therapy of ADHD is summarized in a medical guideline. The guideline "ADHD in children, adolescents and adults" can be downloaded from the website of the Working Group of Scientific Medical Societies (AWMF) at www.awmf.org> search term: "ADHD".


* For the sake of simplicity, ADHD is used as a collective term for ADS (attention deficit disorder) and ADHD (attention deficit and hyperactivity disorder).

7. Related links

Attention Deficit Disorder (ADD) and Attention Deficit and Hyperactivity Disorder (ADHD)

ADHD> Treatment in Children

ADHD> Diet

ADHD> adults

ADHD> school

ADHD> Sports and Recreation

ADHD> studies and work

ADHD> Housing

ADHD guide