ADHD/ ADHS/ ADS/ ADD: What's the difference?
ADHD and ADHS are shorthand for the same disorder: Attention Deficit/Hyperactivity Disorder. The abbreviation "ADHD" is primarily used in North America and the English-speaking world, while "ADHS" is the more common abbreviation in Europe.
"ADS/ADD" on the other hand stands for "Attention Deficit Disorder" and is sometimes used to describe a milder form of ADHD in which the hyperactive symptoms are not as pronounced. However, ADD is not an official term in the medical diagnosis of Attention Deficit/Hyperactivity Disorder and is considered by many experts to be outdated or inaccurate.
Collectively, all of these terms refer to the same basic disorder characterized by symptoms such as inattention, hyperactivity, and impulsivity.
ADHD Overdiagnosis - Can ADHD Really Be Diagnosed?
There is a debate about whether ADHD (Attention Deficit Hyperactivity Disorder) is overdiagnosed. Some argue that there is overdiagnosis, particularly in children, since many of the symptoms can also occur with other conditions or simply with normal developmental behavior. However, others emphasize that ADHD is an actual neurological disorder that affects many people and that deficiency can be harmful, as untreated ADHD can lead to problems at school, work, and in relationships.
It's also important to keep in mind that diagnosing ADHD is a complex process that requires careful evaluation of symptoms, history, and other factors. Accurate diagnosis requires that other conditions have been ruled out and that symptoms are significant enough to interfere with daily life.
Despite many years of research, there is no test, no biomarkers that can quickly and unequivocally detect such disorders.
Researchers warn of the potential risk of misdiagnosing ADHD. Because there is no clinical marker for it, diagnosis of the disorder depends on behavioral analysis, and sometimes the child's natural restlessness can be misinterpreted as ADHD symptom. The Diagnostic and Statistical Manual of Mental Disorders sets out the criteria that should be considered in order to diagnose or not diagnose a child with ADHD. However, what experts see in practice is that these criteria are not always taken into account by practitioners in everyday life.
Symptoms of ADHD
The symptoms of ADHD can vary from person to person, but they often include:
- Inattention: Difficulty concentrating on a task or activity, difficulty following instructions or paying attention to details, forgetfulness, being easily distracted.
- Hyperactivity: Excessive physical activity, fidgeting, pacing, difficulty sitting still, talking without pause.
- Impulsiveness: Acting before thinking, difficulty waiting, difficulty controlling one's behavior such as interrupting, responding or acting quickly.
What do supporters say about this?
- More diagnoses reflect increased awareness
- ADHD is a true neurological disorder
- ADHD is associated with abnormal brain structure and activity
What do skeptics say about this?
- Energetic child + boring school = ADHD overdiagnosis
- Children are not made to sit in chairs and indoors for hours at a time.
- The youngest children in a class tend to be more fidgety — and more likely to be diagnosed
- Older students may seek stimulant ADHD medication - "Good-grade Pills" (Schwarz, 2012). Parents sometimes too!
- What are the long-term effects of drug treatment?
- Why the rise in ADHD diagnoses and medications?
Neurotransmitter metabolism in the synaptic cleft
A lack of dopamine is responsible for specific behaviors, perception and cognitive abilities.
ADHD sufferers have a higher number of dopamine transporters at the presynapse. This allows more dopamine to be returned from the synaptic cleft. This condition results in not enough dopamine remaining in the synaptic cleft. This is known as dopamine deficiency.
The causes of ADHD
The causes of ADHD are not fully understood, but there are several factors that can contribute to an ADHD diagnosis:
- Genetics: ADHD can be inherited. Studies have shown that genes may play a role in the development of ADHD. (Nicolas & Burt, 2010)
- Brain development: Research has shown that certain parts of the brain are smaller or less active in people with ADHD than in people without ADHD.
- Environmental factors: Difficulties during pregnancy or childbirth, such as prematurity, low birth weight, alcohol or drug use during pregnancy can increase the risk of ADHD. Unstructured or stressful environments can also promote ADHD. Van der Bergh and Marcoen (2004) report several long-term consequences of maternal stress that appear to be associated with a sensitive period during pregnancy. These include an increased risk of developing ADHD symptoms in childhood and externalizing issues such as temper tantrums and anxiety.
- Chemical imbalances in the brain: ADHD is sometimes linked to a dysfunction of certain neurotransmitters in the brain, particularly dopamine and norepinephrine.
- Lifestyle: Irregular lifestyles, such as poor diet, lack of sleep, lack of physical activity, and excessive media consumption can increase the risk of ADHD.
It's important to note that not all people with these factors will develop ADHD, and that ADHD is usually caused by a combination of factors. An “accurate” diagnosis can only be made by an ADHD specialist.
Treatment:
Treatment for ADHD can vary depending on the patient's age, severity of symptoms, and individual needs. In general, treatment for ADHD involves a combination of drug therapy, behavioral and psychosocial therapy, and targeted interventions at school or in the workplace.
Drug Therapy: Drugs that relieve symptoms such as impulsivity, inattention, and hyperactivity. The most common medications used to treat ADHD are stimulants such as methylphenidate (e.g. Ritalin) or amphetamines (e.g. Adderall). These drugs work by affecting activity in the brain and reducing symptoms of ADHD.
Ritalin is a prescription drug typically prescribed to treat attention deficit/hyperactivity disorder (ADHD) and narcolepsy. As with many other medications, Ritalin can be abused, particularly by people who want it for better academic or professional performance, or for its recreational use. This has raised concerns among scientists and families around the world. Ritalin abuse can lead to a number of undesirable effects. The increase in consumption can be observed not only among children, but also among adolescents and adults (in Brazil, the increase was 775% between 2003 and 2012, according to a study by the Universidade do Estado do Rio de Janeiro).
Although it has been used since the 1960s, the cellular mechanisms of this substance are still unknown.
Ritalin and Cocaine: Chemical Similarities
Both substances are stimulants and work in a similar way in the brain. Here are some similarities:
- Mechanism of action: Both Ritalin and cocaine increase the levels of dopamine in the brain by inhibiting the reuptake of dopamine in nerve cells. As a result, dopamine stays longer in the synaptic cleft and increases signal transmission between nerve cells.
- Pharmacological Effects: Both substances can induce euphoria, increased alertness, increased self-confidence and increased physical performance. They can also suppress appetite and interfere with sleep.
- Risks and side effects: Both Ritalin and cocaine can lead to addiction if consumed in excess. Both substances can also cause undesirable physical and psychological side effects, such as rapid heartbeat, high blood pressure, anxiety, insomnia and psychosis.
While there are similarities between Ritalin and cocaine, there are also important differences between the two substances. Ritalin is a prescription drug used to treat ADHD, while cocaine is an illegal drug. Ritalin is less potent and wears off more quickly than cocaine.
Why is Ritalin prescribed so quickly and so often?
There is also criticism of the frequency with which Ritalin is prescribed. Some argue that it is overprescribed and that there are better alternative treatment options. Others question whether ADHD is overdiagnosed and whether Ritalin might be prescribed too quickly and carelessly, particularly to children and adolescents. The consumption of methylphenidate in Germany, known primarily as Ritalin, ultimately increased more than tenfold from 1990 to 2000, and tripled again from 2000 to 2010, which is a strong indication of medicalization and overtreatment.
It is therefore important that doctors prescribing Ritalin exercise caution and consider alternative treatment options before resorting to any medication.
Ritalin is often prescribed because it is effective in many people with ADHD and can result in rapid, significant improvement in symptoms in many cases. Doctors and patients, parents and children, everyone wants a quick solution that works. However, it is important to note that Ritalin is a drug with side effects.
Ritalin - effects and long-term consequences
Some of the consequences of Ritalin can include:
- Most often, children suffer from loss of appetite and (falling) sleep disorders. However, nausea also occurs, blood pressure and heart rate increase, and the liver is put under strain. There is also a risk of tics, psychoses or mental disorders such as depression.
- Dependence: When Ritalin is taken for a long period of time, dependency can develop, especially in people who abuse the drug.
- Growth retardation: Growth retardation may occur in children who take Ritalin for a long time.
- Mood changes: Ritalin can cause mood changes in some people, especially when the drug is stopped abruptly.
- Behavior Changes: Ritalin may cause behavior changes in some people, especially at higher doses or with prolonged use.
- According to a Danish study, ADHD medication has a low but statistically relevant cardiovascular side effect profile. The working group around Søren Dalsgaard at Aarhus University published the results of their cohort study in the Journal of Child and Adolescent Psychopharmacology ( http://dx.doi.org/10.1089/cap.2014.0020 ).
- Treatment with methylphenidate, in a randomized controlled trial in Radiology (2019; DOI: 10.1148/radiol.2019182528) in boys but not in male adults, resulted in changes in magnetic resonance imaging (MRI) that indicate structural changes in the brain . The clinical significance of the findings is unclear.
- 08/14/2020 - Researchers analyze the effects of Ritalin on the developing brain — UFRGS | Universidade Federal do Rio Grande do Sul ( http://www.ufrgs.br/english/the-university/news/researchers-analyze-the-effects-of-ritalin-on-the-developing-brain). To mimic the situation of chronic use in childhood, scientists injected methylphenidate into rats from 15 to 45 days of age. This period would be humanely equivalent to that of children taking Ritalin. What did they observe? An increase in inflammatory parameters, changes in oxidative stress and amino acid profile, and a decrease in ATP levels - molecule known as the cells' energy currency, responsible for storing energy. There was also a loss of astrocytes and neurons in the hippocampus.
- There are also other indications on the package insert: Ritalin and depression – what scientists say (zentrum-der-gesundheit.de)
Non-drug treatments for ADHD:
There are various treatments that can be used individually or in combination. Here are some examples:
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Behavior Modification: This involves the use of strategies such as positive reinforcement to encourage desired behavior, time management and organizational skills to structure everyday life.
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Behavioral and psychosocial therapy: One form of psychotherapy that can be helpful for ADHD sufferers is cognitive behavioral therapy. This focuses on identifying and managing thoughts and behaviors that make ADHD symptoms worse. Behavioral therapy, family therapy, and cognitive-behavioral therapy can help reduce symptoms of ADHD and teach the patient strategies for self-regulation. These therapies can also help resolve issues related to interpersonal relationships and workplace issues.
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Diet : Eating a balanced diet can help relieve ADHD symptoms. This includes getting plenty of protein, fiber and healthy fats, and avoiding processed foods and sugary drinks.
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Exercise: Regular exercise can help reduce stress and improve focus. Sports such as yoga, Pilates or Tai Chi can be particularly helpful.
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Occupational Therapy: This type of therapy can help develop everyday skills and improve fine motor skills. This can help patients organize themselves better and get their tasks done.
- School or Workplace Interventions: Involving teachers and employers in treating ADHD can help reduce symptoms and improve the patient's performance at school or work. For example, schools can create IEPs (Individual Education Plans) or plans to provide additional support and adjustments for students with ADHD. For example, in the workplace, employers may offer flexible working hours or work adjustments to accommodate the patient's symptoms.
It is important to note that non-drug treatments for ADHD are not equally effective for every patient.
Would you rather have "sick" children, than unhappy, overwhelmed or unsuccessful children?
The high consumption of Ritalin becomes an issue for the UNO. The UNO is therefore likely to recommend that Switzerland draw up stricter rules for Ritalin consumption by children.
Swiss UNO adviser Pascal Rudin criticizes ADHD and its medication: “So the key question is: What is our understanding of disruption? It is clear that a child can become disruptive relatively quickly in the school environment. But that doesn't mean that it has a disorder in the medical sense. The attention deficit disorder ADHD is defined as a disease, but can hardly be measured medically. So children are stigmatized just because Ritalin works in the short term and is efficient. In this context, the UNO is likely to refer to fundamental ethical principles: Doctors should treat us, not improve our performance.”
"Rudin further points out that "Ritalin" is only justified if you have a real biological-medical basis for the prescription. However, this applies to at most 5% of the children who are currently taking the corresponding medication, so that 95 % of children – almost always – these psychotropic drugs are superfluous."
Many children no longer want to take Ritalin and Co. when they get older. What bothers them the most: that the hunger disappears. And they're kind of not themselves while the drug works. That they can work very focused, but at the same time feel like a machine and hardly notice what is happening around them.
BAG Switzerland also takes the problem seriously and monitors developments in connection with the topic of Ritalin /ADHS: https://www.bag.admin.ch/bag/de/home/gesund-leben/gesundheitsfoerderung-und-praevention/praevention- for-children-and-adolescents/adhs.html
Developmental psychology has contributed a great deal to the understanding of ADHD in recent years. For example, studies have shown that ADHD symptoms decrease over time in many children, while others have a chronic disorder. There is also evidence that certain factors such as family circumstances, genes, and environmental conditions can influence the development and progression of ADHD.
We should not forget that our children are developing. Everyone has their own colourful, unique personality, their own pace and needs. There are specific phases in life that play an important role in the development. A plant needs the environment to manifest itself. Each development phase has a meaning in and of itself.
Nowadays we just want to be faster, better and perform everywhere. We don't want to show weakness or make mistakes. Not our children anyway. Frustration tolerance is also getting smaller, which is why people are looking for faster, simpler solutions. But such solutions usually have painful long-term consequences.
Shouldn't we rather reflect and treat our everyday social and family stresses empathetically?
Credentials:
https://ruor.uottawa.ca/handle/10393/34386
https://www.tandfonline.com/doi/abs/10.1080/00754179808414817
https://www.sciencedirect.com/science/article/abs/pii/S1568997219302502
https://www.tandfonline.com/doi/abs/10.3109/10401230009147088
https://psycnet.apa.org/record/1993-10736-001
https://pubmed.ncbi.nlm.nih.gov/19202072/
https://connect.springerpub.com/content/sgrehpp/24/1/41
https://www.paracelsus-recovery.com/de/blog-de/ritalin-zuchtung-zukunftiger-suchtiger/
https://konferenz-adhs.org/de/presse/pressemitteilungen/137-adhs-forschung-in-der-sackgasse
https://www.sciencedirect.com/science/article/abs/pii/S0149763420305923
https://www.sciencedirect.com/science/article/abs/pii/S0149763420305923
https://www.sciencedirect.com/science/article/abs/pii/S0304383505000376
https://onlinelibrary.wiley.com/doi/abs/10.1111/and.14594
https://www.tandfonline.com/doi/full/10.1080/15376516.2020.1805665
Ritalin - Breeding Future Addicts? | Paracelsus Recovery (paracelsus-recovery.com)
https://www.sueddeutsche.de/wissen/adhs-medikamente-kinder-ritalin-1.5132811
19.4283 | ADHD. Integrating the results of the Focus project into training | business | The Swiss Parliament
SCHMITZ, Felipe; CHAO, Moses V; WYSE, Angela TS Methylphenidate alters Akt-mTOR signaling in rat pheochromocytoma cells. International Journal of Developmental Neuroscience, 2018.
CDC, 2019a; Simon et al. 2009; MacDonald et al., 2019; Smith, 2017; Martel et al., 2016; Kofler et al., 2016; Chen, M et al., 2016; Black, 2012; Ellison, 2015; Hales et al., 2018; Sayal et al., 2017; World Federation for Mental Health, 2005; Ball et al., 2019; Hoogman et al., 2015; Nikolas & Burt, 2010; Poelmans et al, 2011; Volkow et al., 2009; Williams et al. 2010; Barbaresi et al., 2007; Cerillo-Urbina et al., 2015; Pelham et al., 2016; Fabiano et al., 2008.
Status of research on methylphenidate:
The Cochrane Society, an independent, international network of scientists and health professionals, has evaluated a large number of studies on the active ingredient methylphenidate. The scientists also found that a number of the available studies have qualitative deficiencies. The conclusion of the systematic review states: "Due to the quality of the available evidence, we cannot currently say with certainty whether methylphenidate improves the lives of children and adolescents with ADHD. Methylphenidate is associated with a number of less serious side effects, such as sleeping problems and decreased appetite. Although we found no evidence that the risk of serious side effects is increased, studies with longer follow-up are needed to assess this risk in people who are taking methylphenidate over a long period of time. For more information, visit www.cochrane.org
