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Abstract from ADxS.org

Abstract from ADxS.org

This text is a short version of the ADxS.org project and links to the respective subpages, which present the topics in detail and with over 12,500 links to references1.

This short version of ADxS.org is deliberately formulated in a “popular scientific” way to make it easier for those affected to get started with ADHD and is characterized by our view of ADHD. The more in-depth articles, on the other hand, emphasize a scientific presentation. Our own view is explicitly marked as such in each case.

Short version of the short version ;-)

ADHD is a syndrome. This means that a variety of different diseases / disorders / causes cause the ADHD symptoms. ADHD is dimensional. ADHD is diagnosed by the amount and severity of symptoms. It can therefore be a manifestation of personality traits (fewer and milder symptoms) or a disorder (more and more severe symptoms).
Untreated ADHD has serious consequences and is associated with a shortened life expectancy, an increased risk of other mental disorders and addiction, and impairs education, income and quality of life.
The DSM and ICD criteria for diagnosing ADHD do not cover all the symptoms that can occur with ADHD. Therefore, doctors and therapists should be aware of all possible symptoms of ADHD. ADHD symptoms include motor, drive, attention, memory, thinking, perceptual and emotional difficulties.
ADHD symptoms are caused by a lack of certain neurotransmitters (especially dopamine and noradrenaline) in specific areas of the brain such as the working memory and the reward center.
Although the symptoms of ADHD and chronic stress are similar, they have different causes. Severe chronic stress can also lead to dopamine and noradrenaline deficiency and cause similar symptoms to ADHD.
ADHD can have various causes, including genetic factors (a number of gene variants), environmental influences such as early childhood or chronic stress and epigenetic inheritance of stress. ADHD has a genetic component of about 76% and the heritability of ADHD is higher than that of intelligence.
ADHD is usually diagnosed using questionnaires, interviews and tests, whereby a differential diagnosis must be carried out to rule out confusion with other disorders.
The treatment of ADHD usually involves medication, which can be supported by therapeutic measures such as behavioral therapy, stress reduction, mindfulness training and neurofeedback. Sport is therapeutically helpful for ADHD.
There are different presentation forms (formerly: subtypes) of ADHD, which can differ in symptoms: the pure ADHD-HI type (hyperactive), the pure ADHD-I type (inattentive) and the ADHD-C type (combined).
Treatment should be individualized and includes addressing sleep problems associated with ADHD. Prevention can play a helpful role in ADHD, especially through supportive and warm parenting.

Since mid-March 2023, we have been using the term ADHD (instead of the previously used ADHD) as a generic term. We now refer to the subtypes / manifestations as ADHD-HI (predominantly hyperactive), ADHD-I (predominantly inattentive) and ADHD-C (equally hyperactive and inattentive).

This summary is divided into various sections, which roughly correspond to the chapters of the compendium and whose contents are described in 1 to 2 sentences in the following structure.

1. What is ADHD?
There are very different answers to this, depending on what “is” means:

  • Disorder or manifestation of personality traits?
  • Causes
    • How does ADHD develop?
  • Correlates
    • What is (often) associated with ADHD?
  • Symptoms
    • How does ADHD manifest itself?
  • Symptom mediation
    • What triggers the individual symptoms?
  • Consequences
    • What does ADHD do to those affected?

We summarize these and a few other points in the brief presentation.

2. Consequences of ADHD
ADHD has massive consequences that often last a lifetime. The presentation of the increased mortality rate, the increased risk of further mental disorders or the further consequential risks show a realistic picture of how serious ADHD is.

3. Symptoms of ADHD
Here we describe how ADHD appears externally and what other 35 or so symptoms there are in addition to the diagnostic symptoms listed by the DSM and ICD.
Knowledge of all ADHD symptoms is essential for diagnosis, especially for cases that are borderline according to the DSM or ICD, as well as for any meaningful treatment.

4. Symptom mediation
In our view, ADHD could also be described as chronic overactivity or over-responsiveness of the stress regulation systems, which is more likely to mediate the symptoms. This section describes why ADHD is nevertheless different from chronic (and even more so from acute) stress in non-affected individuals.

5. How does ADHD develop?
What genetic, epigenetic and environmental factors can trigger ADHD?
ADHD is a symptom cluster that can be caused by various factors. ADHD is predominantly caused genetically, whereby a distinction must be made between inherited gene variants, which can be tens of thousands of years old, and epigenetic causes, which are caused by a person’s life experiences and can be passed on over a few generations. A dopamine deficiency caused genetically or otherwise (e.g. by early childhood encephalitis or early childhood stress) in the period between conception and around 3 years of age can cause a brain development disorder or delay, which in turn can cause or mediate AD(H)DS symptoms.

6. Diagnosis of ADHD
How is ADHD diagnosed?
From which similar disorders should ADHD be distinguished (differential diagnosis)?
Which other disorders often occur together (comorbid) with ADHD?

7. The presentation forms (subtypes) ADHD-HI / ADHD-C / ADHD-I
We describe the differences between ADHD-HI (with hyperactivity), ADHD-I (without hyperactivity) and ADHD-C (with hyperactivity and inattention). SCT is likely to be an independent disorder rather than an ADHD subtype.

8. Treatment of ADHD
How can ADHD be treated? We describe medication, psychotherapy, stress avoidance, stress reduction, nutrition, neurofeedback and other methods.
How effective are these treatment methods (what effect do they have)?
What can be done to prevent ADHD?

9. Neurological mechanisms of action
Which neurophysiological and neurobiological processes mediate which ADHD symptoms?

10. Things to know about ADHD
What else can help you to understand ADHD.

11. Tests and surveys
We offer various free online screening tests that can indicate whether a specialist medical diagnosis might be useful:

  • ADHD symptom test (self-assessment)
  • ADHD external assessment test
  • ADHD reaction test
  • SCT test (Sluggish Cognitive Tempo)
  • High sensitivity test
  • Differential diagnostic test for anxiety
  • Differential diagnostic test for depression
  • Differential diagnostic test autism spectrum
  • ADHD drug effect test
  • We also collect contact details of doctors and therapists with experience in ADHD.

Tests and surveys

12. ADHD FORUM
ADxS.org currently offers the most comprehensive German-language active forum on the subject of ADHD:
ADHD forum at adhs-forum.ADxS.org
Most of the posts can also be read by visitors. Membership is free of charge.

1. What is ADHD?

The question “Is ADHD a disorder* Or a manifestation of personality traits?” can be answered quite simply and succinctly: “Yes!”

*(Strictly speaking, ADHD is a syndrome and not a disorder. But that would be going too far in the short version).

ADHD - like most other mental disorders - is dimensional.23
While pregnancy or a broken bone are categorical (they either exist or they don’t), ADHD (as well as depression, anxiety or narcissism, for example) can only be diagnosed as a disorder by the degree and focus of the symptoms. In milder cases, ADHD is merely a personality dimension.

Almost everyone has a few common ADHD symptoms. Only the number of frequently occurring symptoms distinguishes between personality traits that do not constitute a disorder and ADHD as a stressful disorder. Although this makes a diagnosis complex (ADHD is indistinguishable on brief observation (as a “photo”), it only becomes recognizable on longer observation (as a “film”)), it remains clear enough to be able to clearly differentiate ADHD from mere chronic stress. While unaffected adults frequently exhibit 1 to 2 of 18 symptoms (according to Barkley) or 9 of 35 symptoms (in our online symptom test, version 2), ADHD sufferers frequently exhibit an average of 12 of these 18 symptoms (according to Barkley) or 26 of the 35 symptoms (in our online symptom test, version 2). It is not possible to predict which of the symptoms a particular sufferer will have. It is often, but by no means always, the DSM / ICD symptoms, which are only the symptoms (diagnostic symptoms) that are optimally distinguishable (from other disorders). They are by no means all symptoms that can arise from ADHD itself (treatment-relevant symptoms).

However, there are strong genetic links between those affected by ADHD with disruptive quality and those affected by ADHD without disruptive intensity, i.e. as a mere personality dimension, so that ADHD must be understood as dimensional.4
The dimensional character of ADHD can be described as a continuum:

  • Not present at all, no symptom occurs frequently (this is likely to affect rather few people)
  • Isolated symptoms frequently, without any subjective impairment (this affects most people)
  • Some symptoms common, which become recognizable in individual life situations (many people)
  • Noticeable symptoms that sometimes become stressful in several life situations (but which do not usually constitute a disorder)
  • Clear symptoms that have a stressful effect in a number of life situations (this can already have the character of a disorder)
  • Severe symptoms that have an adverse effect in many life situations (usually of a disruptive nature)
  • Very severe symptoms that make life very difficult in most situations (disorder)

The level at which the personality traits become a disorder must be decided on the basis of individual subjective distress. Subjective distress is the decisive characteristic for speaking of a mental disorder. This is the case with almost all mental disorders, with the possible exception of rare xenophobic disorders and psychopathy.

Around 5 to 10 % of people have ADHD symptoms so severe that they suffer considerably from them. ADxS.org deals with ADHD as a disorder and uses the term ADHD to describe a disorder in the sense of a severity of occurrence within the continuum, which is accompanied by subjective suffering on the part of those affected. People who do not suffer from their symptoms on this continuum can nevertheless learn a lot about the correlations and background of their personality traits at ADxS.org.

According to a representative survey, 90% of Germans are familiar with the term ADHD. Of these, 20% believed that ADHD was not an existing clinical disorder and 66% were against drug treatment with stimulants.5 The ADxS.org project is dedicated to creating transparency, increasing understanding and presenting solutions.

2. Consequences of ADHD

ADHD has massive consequences that - if left untreated - often persist throughout life.67 Among other things, life expectancy is shortened by up to 13 years with untreated ADHD, the likelihood of depression, anxiety and eating disorders is greatly increased and the level of education, income and quality of life are reduced. The risk of addiction is almost doubled and the smoking rate more than doubled. People with ADHD are 4 times more likely to get divorced and 7 times more likely to end up in prison.

Detailed information on this can be found at Consequences of ADHD.

ADHD is by no means “merely” stress (even if severe chronic stress and ADHD convey their almost identical symptoms in a very similar neurobiological way), but for those severely affected it is a serious disorder and a heavy burden for those affected, which massively impairs their quality of life if left untreated.

3. The symptoms of ADHD

As a non-affected person, you can clearly understand what ADHD feels like for those affected if you imagine that your own desk is in the middle of a busy pedestrian zone right next to the streetcar tracks instead of in a normal office and try to imagine how much more stressful your day would be and how much more stressed you would be when you got home. Or you can compare it with the life circumstances in which some people who are not affected suffer comparable symptoms at times, such as a war of the roses divorce, bankruptcy or finding out that you have cancer8 - except that in this case your whole life consists of this condition.
Those affected cannot usually tell for themselves whether they have ADHD based on this description. This is because every person perceives their ongoing life circumstances and reactions as the normal measure of things. Only categorical deviations (when something is unacceptable under any circumstances) are recognizable on their own, but not dimensional deviations (in terms of degree), as there is no standard of comparison. The standards, the “normal zero” of a person, are regularly based on their own lifelong experiences - and their own life has always been like this. ADHD sufferers do not know any different and therefore identify with their symptoms as “normal”.
After all, ADHD has one undeniable advantage over all other mental disorders: it is the most treatable mental health problem of all.

As with all mental disorders, a distinction must be made between the smaller number of diagnostically relevant symptoms and the totality of treatment-relevant symptoms.
ADHD can cause many more symptoms than the much-cited DSM or ICD criteria.
DSM and ICD are diagnostic manuals. They aim to identify disorders. For this reason, DSM and ICD only list the diagnostically relevant symptoms, i.e. those that are particularly distinctive from other disorders. Symptoms that also frequently occur in other disorders are not listed in the DSM and ICD. Even the renowned American psychiatrist Allen James Frances, chairman of the DSM-IV, criticizes the fact that diagnoses are far too often based solely on the DSM or ICD criteria.

DSM 5 lists 8 symptoms of ADHD:

  1. Inattention (distractibility and concentration problems, but not task switching problems)
  2. Forgetfulness
  3. Disorganization
  4. Hyperactivity
  5. Impulsiveness
  6. Impatience
  7. Being internally driven
  8. Excessive talking

DSM and ICD - statistical tools, not diagnostic scales

DSM IV (until May 2013) and ICD 10 were still focused exclusively on the symptoms of children and therefore, by their very nature, did not take into account that ADHD symptoms in adults (⇒ ADHD in adults) Change dramatically: motor hyperactivity largely disappears, while inner restlessness and being driven become more visible, emotional problems increase (Emotional dysregulation - mood swings in ADHD). Attention problems can also decrease or even disappear completely (although less frequently than hyperactivity).

The misconception that the DSM or ICD symptoms are the only original symptoms (directly caused by ADHD) is common, even among doctors and therapists. However, knowledge of the totality of all possible symptoms is essential for treatment and therapy. The consequences can be fatal, for example if the dysphoria typical of ADHD is mistaken for depression when inactive and therefore unsuccessful attempts at medication with antidepressants are made. Or if procrastination, mood swings or sickliness (Rejection sensitivity: offendedness / sensitivity to rejection and criticism as a specific ADHD symptom) Should not be considered as an original consequence of existing ADHD, but rather treated as a consequence of negative life experiences or a lack of discipline - which can deepen the impression of being inadequate in those affected.

At Symptoms of ADHD We have collected all symptoms that can originally result from ADHD and documented them with references from the ADHD specialist literature (as ADHD symptoms):

At ADHD symptoms are stress symptoms We have collected references to where the stress literature refers to these as stress symptoms. At Stress benefits - the survival-promoting purpose of stress we describe the stress benefit for each symptom, i.e. the purpose that the respective symptom has or used to have in combating stressors.

Many specialist books confirm that ADHD sufferers have specific positive character traits (in addition to their specific symptoms). These positive characteristics are largely congruent with the typical character traits of gifted people mentioned in the specialist literature on giftedness. However, this does not mean that all ADHD sufferers are gifted (in fact, a significant lack of giftedness is a known risk factor for ADHD).
Giftedness and ADHD.

4. How ADHD mediates its symptoms

ADHD symptoms are triggered by a lack of certain neurotransmitters (mainly dopamine and noradrenaline) in certain areas of the brain (mainly the working memory and the reward center ).

As severe chronic stress is also associated with dopamine and noradrenaline deficiency, the symptoms of ADHD and severe chronic stress are similar.
ADHD symptoms are stress symptoms

However, even though both phenomena cause similar symptoms in a similar neurobiological way, ADHD is something other than “just” chronic stress: stress goes with the stressor, ADHD stays. This is because the almost identical neurotransmitter deficiency has different causes in ADHD than in stress.
ADHD as a chronic stress regulation disorder

ADHD: The difference between cause level and symptom mediation level

There are many different causes that can trigger a dopamine and noradrenaline deficiency. These include encephalitis (inflammation of the brain) and Parkinson’s disease, but also some rare monogenetic disorders. In addition, a combination of a large number of gene variants, all of which contribute a little something to a dopamine and noradrenaline deficiency, is also cited as a cause.
These individual diseases each have additional, specific symptoms that are not based on dopamine and noradrenaline deficiency.
The dopamine and noradrenaline deficiency is the neurobiological commonality that mediates ADHD symptoms. ADHD can be described as a syndrome (a collection of recognizable symptoms that often occur together). If the dopamine and noradrenaline deficiency is seen as the element mediating the symptoms, it can also be described as a disorder (impairment of normal or regular bodily functions due to a disease).
The dopamine and noradrenaline deficiency that causes ADHD symptoms can be caused by a variety (at least three) of diseases.
This explains why ADHD cannot be cured. It is not possible to permanently increase dopamine and noradrenaline levels. Medication can compensate for the deficiency very effectively, but only for as long as it works. For recovery, the respective cause that triggers the dopamine and noradrenaline deficiency would have to be permanently eliminated. So far, however, too little is known about the exact causes.
New findings always lead to a cause being recognized. Sometimes this can be cured, but usually not.

More on the neurophysiological mediation of individual ADHD symptoms below under 6.

5. How does ADHD develop?

Origin

There are several development paths that work together:

  • Genetic: ADHD can arise through the interaction of a number of randomly created genes (gene variants up to tens or hundreds of thousands of years old) without the need for environmental influences. These gene variants have arisen without the influence of stress. If there are several gene variants with a similar effect at the same time (several genes that all weaken the neurotransmitter dopamine, for example), their influences can add up to such an extent that the balance is disturbed.
    Let’s call it “genetically inherited ADHD” to be able to distinguish it.
    Consequences of these gene variants can already mediate other causes in the first years of life. For example, a dopamine deficiency in the first years of life leads to a developmental disorder of the brain, because dopamine is important for brain development (a so-called neurotrophic factor). ADHD is often described as a brain development disorder.
    Genetic and epigenetic causes of ADHD - Introduction
    Brain development disorder and ADHD
  • Environment: ADHD can be caused by environmental factors (early childhood or chronic severe stress). Stress medicine already describes this as a pathway for depression.
    Early or chronic severe stress can have a neurotoxic effect and change the expression of genes, i.e. their activity (epigenetics). This can also cause the changes in neurotransmitter levels and co. that are typical of ADHD. While active stress increases dopamine and noradrenaline levels, chronic stress is associated with long-term reduced dopamine levels. Chronic stress in early childhood can thus trigger dopamine deficits, which subsequently lead to a brain development disorder. This cause of ADHD is particularly amenable to prevention through caring, warm parental behavior.
    Diseases can also trigger behavioral changes typical of ADHD. Encephalitis, for example, destroys the dopaminergic cells in the brain and can thus trigger a dopamine deficit that causes symptoms typical of ADHD.
  • Let’s call it “acquired ADHD”.
    Environmental factors as a cause of ADHD
  • Epigenetic (Inherited experiences): ADHD acquired through severe or chronic stress can be passed on to one’s own descendants. In contrast to the “genetically inherited” ADHD of the first variant, only the epigenetic changes in gene activity acquired through environmental influences are passed on here. Toxins, severe early or chronic stress or illness can alter the expression of genes. Animal experiments and human studies have demonstrated the inheritance of such acquired gene expression over 2 to 4 generations. Let’s call it “epigenetically inherited ADHD” to differentiate.
    Genetic and epigenetic causes of ADHD - Introduction

ADHD has a strong genetic component of around 76%. The heritability of ADHD is therefore greater than that of intelligence. Up to 90 % of ADHD cases with clinical intensity are genetic.9 However, individual genes are not the cause, even if certain gene variants are more frequently involved. Many hundreds of candidate genes are known. It would not be surprising if there were thousands. We have more than 300 of them at Candidate genes in ADHD Named.

More on this in the article How ADHD develops: genes or genes + environment

Incidentally, dopamine is closely linked to the regulation of the circadian rhythm. Dopamine and the sleep-promoting melatonin are antagonists. Around 75% of ADHD sufferers have a delayed circadian rhythm (or would have one if they were allowed to. This explains the close connection between ADHD and sleep problems.
Sleep problems and ADHD are mutually reinforcing. Sleep problems with ADHD.

6. The diagnosis of ADHD

We present the diagnostic procedures for ADHD and explain which similar disorders ADHD must be distinguished from (differential diagnosis) and which disorders often occur together with ADHD (comorbidities).
Diagnostics

ADHD is primarily diagnosed using questionnaires (self-assessment and parent/teacher assessment). However, these alone are not sufficient for a solid diagnosis.
Interviews by experienced diagnosticians have the advantage that they can better assess and compare the severity of a symptom.
Tests appear to be more objective in terms of assessing the test results - but only in terms of the test results.
ADHD - Diagnostic methods.

Interviews, questionnaires and tests can also lead to falsified results if the subjects have a very high personal interest in the investigation and are motivated accordingly. With correspondingly high (and personally interesting) rewards, which succeed in overcoming the motivational deficit typical of ADHD, the attention performance of ADHD sufferers can no longer be distinguished from that of non-affected persons.
Smoking can also falsify test results, as nicotine, like methylphenidate, increases dopamine levels and is often used as self-medication.
Diagnostic methods: Problems with ADHD-HI tests - ADHD-HI symptoms are not consistently present
Therefore, there is no one universal test that alone could provide a reliable objective diagnosis.
Apart from that, performance tests can only ever confirm the momentary stress symptoms, but not the duration of their existence and their origin.
Stress damage - effects of early childhood and/or prolonged stress

A careful diagnosis includes:
ADHD - Diagnostic methods

  1. A clear differential diagnosis Differential diagnosis of ADHD
    • Exclusion of organic causes
      This is impossible without blood tests (for vitamin deficiency, thyroid hormones, etc.).
      A number of other differential diagnoses must also be clarified.
    • Exclusion of mere stress symptoms caused by acute stress-inducing life circumstances (duration of existence of symptoms and occurrence in different areas of life)
    • Exclusion of other psychological causes that can better explain the symptoms
  2. Thorough recording and analysis of symptoms
    • Complete symptom query Symptoms of ADHD
      • DSM/ICD are important points of reference, but only contain those symptoms that are particularly well differentiated from other disorders and not the totality of all symptoms that can result from ADHD. The symptoms present in individual cases therefore do not necessarily have to correspond to DSM/ICD and in almost all cases go far beyond this.
      • Self-perception questionnaires
      • Interviews with affected persons
      • External assessment questionnaires and interviews with parents/confidants
    • Test psychological performance diagnostics

Once again, because it is of particular importance: The DSM and ICD symptom catalogs are not exhaustive, complete lists of all ADHD symptoms. DSM and ICD are diagnostic aids, statistical and billing tools that contribute significantly to medical quality assurance. However, it would be malpractice to use them as the sole standards for diagnosis. Diagnostic ADHD symptoms according to DSM, ICD, Wender-Utah and others

Only an overall view of the results leads to a reliable diagnosis.

7. The difference between ADHD-HI and ADHD-I - the subtypes

In ADHD, a distinction is made between the subtypes ADHD-HI (predominant hyperactivity), ADHD-I (predominant inattention) and ADHD-C (attention problems and hyperactivity).
SCT (sluggish cognitive tempo) does not appear to be an ADHD subtype, but a disorder in its own right. This is consistent with the fact that high SCT scores were found by our ADxS-SCT online test in both ADHD-HI and ADHD-I sufferers.
The pure ADHD-HI type is predominantly found in children up to the age of 15. This is probably due to the fact that inattention symptoms are very difficult to diagnose at the age of less than 6 years. A reliable diagnosis is only possible at an age of more than 15 years. ADHD-C is therefore often likely to be the later developmental form of the ADHD-HI subtype. However, there is still a proportion of around 10% of ADHD sufferers - even in adults - with the pure ADHD-HI subtype with minor attention problems.

A detailed description of the differences between the subtypes of ADHD can be found at ⇒ The subtypes of ADHD: ADHD-HI, ADHD-I and others.

8. Treatment of ADHD

Our guide presents an ADHD treatment that makes sense from a scientific point of view.
We present many suitable and less suitable medications for ADHD as well as possible non-drug treatment options. It is particularly important to compare the effect sizes of the different treatment options.
Treatment and therapy

There is no one-size-fits-all treatment for ADHD. Each treatment must be tailored to the individual manifestation of symptoms and the personal circumstances and personality traits of those affected. Therefore, an individual medical history and case-by-case assessment is always required.

From a scientific point of view, the approach described below makes sense in most cases and thus forms a basic conceptual framework.
ADHD treatment guide

The first step Requires a reliable diagnosis using a questionnaire AND tests, a family history with a complete differential diagnosis and the identification and differentiation of comorbidities.
Differential diagnosis for ADHD and ⇒ ADHD - Comorbidity

The second step Is to take the first treatment steps. As a rule, this is primarily an appropriate and carefully adjusted medication. The acute medication allows the affected person to experience what a symptom-free life feels like, in order to anchor this as the target state over several months, which is the aim of the therapeutic measures in the third step. As a rule, only normalization of dopamine levels through stimulants leads to an appropriate learning and therapeutic ability. Dopamine is neurotrophic, i.e. necessary for the anchoring of learning experiences.

If children up to the age of 6 are affected, therapeutic measures for parents and caregivers are indicated as a second treatment measure. In young children, parental work reduces the stressors and protects against a deepening of the ADHD disorder at a still vulnerable age. Therapeutic measures for children up to the age of 6, on the other hand, tend to be ineffective. ADHD - Prevention and screening - What parents can do.

The third step Involves various therapeutic measures aimed at making medication unnecessary. In the short term, stressors in the environment should be reduced and sleep problems tackled head-on.
Sleep problems with ADHD. In the medium term, mindfulness-based forms of therapy such as mindfulness-based behavioral therapy (MBCT) and mindfulness-based sleep training (MBSR) are recommended. In the long term, neurofeedback, trauma therapies such as EMDR or DBT may be useful. In addition, there are environmental interventions, psychoeducation and group experiences.
Neurofeedback is particularly fascinating because the treatment successes are permanent - although unfortunately only in rare exceptional cases are they completely curative.
Neurofeedback as ADHD therapy

Medication for ADHD is a highly complex issue. In ADHD, dopaminergic, noradrenergic and other neurotransmitter systems are involved in mediating the symptoms. Detailed information can be found in the individual articles on the respective medications.
When fine-tuning the medication, it should be noted that a healthy state is not the absence of all ADHD symptoms, but that in healthy people (and optimally medicated) an average of 20 to 25% of possible symptoms occur frequently (instead of an average of 75% of symptoms in affected people). Medication should therefore only reduce the number of frequently occurring symptoms to the level of those not affected and not completely eliminate all possible symptoms. Otherwise, there is a risk of overdosing, which in extreme cases leads to a restriction rather than an improvement in enjoyment of life.

Particular attention should be paid to the treatment of sleep problems. Sleep problems (like all ADHD symptoms) can be symptoms of stress. As sleep is one of the most important factors in reducing stress, sleep problems can lead to an ADHD vicious circle. Around 3/4 of all ADHD sufferers have a chronorhythm that is shifted backwards, meaning that the circadian system is affected. Particularly in children who have to get up (often far too) early for school reasons, bringing forward the time at which they fall asleep (e.g. with unretarded melatonin) can be helpful.
For more details, visit Sleep problems with ADHD And the interesting topic ⇒ Binaural music as therapy for ADHD and sleep problems has its own article.

Food, food additives and ADHD

ADHD is not caused by food or food additives alone. However, food or food additive intolerances can act as stressors to increase the intensity of ADHD, or shift it into the pathological range in sufferers who have ADHD that is so mild that it is not disruptive without additional stressors (keyword: dimensional disorder). This is not a pattern that only applies to ADHD: eliminating food intolerances can also reduce or eliminate the intensity of symptoms in other mental disorders.
For example, early or prolonged stress can impair the barrier function of the intestinal mucosa and thus promote chronic intestinal inflammation - especially in people who externalize stress rather than internalize it, as this stress phenotype is associated with a flattened cortisol stress response and therefore often with increased inflammatory problems. Cortisol immunologically inhibits inflammation and instead promotes the fight against foreign bodies (TH1/TH2 shift). Too little cortisol leads to insufficient inhibition of inflammation.
Furthermore, stress (especially early or chronic stress) can alter the expression of genes that are responsible for the provision of certain enzymes in the digestive tract. Oxidative stress (which is promoted less by psychological stress than by suboptimal nutrition and toxins such as smoking) can also cause digestive problems and food intolerances.
Find out more at Nutrition and diet for ADHD.

Prevention:
Based on the understanding that inherited stress experiences can cause a risk of ADHD (disposition) and that particularly warm and caring parental behavior can help to prevent such a disposition from developing into actual ADHD (manifestation), it is very important for us to present the possibilities for ADHD prevention for parents and caregivers. These principles should also apply to other multi-factorial mental disorders.
Prevention

9. Neurophysiological mechanisms of action in ADHD

Every thought, every feeling, every action has a neurophysiological correlate. This means that everything we do is represented by specific processes in the brain. This correlation is reciprocal. Depending on its neurophysiological state, the brain influences what we think, do and feel, while everything we think, do and feel in turn influences neurophysiological changes in our brain. Similarly, the brain influences the body and the body influences the brain. Here, too, there are cycles of perception and consequences that influence each other.
Neurophysiological correlates are thus merely a momentary image of the brain state that occurs simultaneously with a certain state or behavior and do not mean that there is a one-way causality (i.e. that brain states are always only the cause and behavior is always only the consequence). Neurological aspects

Examples of neurophysiological influences and correlations in ADHD

The number of dopamine transporters is halved in adults (50 years) compared to children (15 years). Adults therefore require (in some cases significantly) lower doses of dopaminergic medication than children.
ADHD in adults

Inhibition and impulse control problems have their own neurological correlates.
Neurophysiological correlates of inhibition problems and impulsivity in ADHD

Motivation problems arise from a different evaluation of expected rewards. Rewards are only interesting for ADHD sufferers (and just as interesting as for non-affected people) if they are immediately available. The further in the future an expected reward lies, the less interest ADHD sufferers have in it compared to non-affected people. Important things, on the other hand, must happen immediately (impatience).
Neurophysiological correlates of drive and motivation problems in ADHD

Aggression and social disorders often occur comorbidly, especially in ADHD-HI sufferers, but are not an original symptom of ADHD.
Neurophysiological correlates of aggression in ADHD

ADHD sufferers (especially ADHD-HI and also procrastination sufferers) often have a deep-seated aversion to relaxation and mindfulness.
Where does aversion to mindfulness in ADHD and procrastination come from? This aversion is also a healthy stress benefit: Anyone who is exposed to an acute danger should not relax until this danger has been eliminated. Stress benefit - the survival-promoting purpose of stress As with all ADHD symptoms, the problem is not the symptom itself, but the fact that the person affected is subject to other leitmotifs in stress mode.

Many people with ADHD suffer from an inability to enjoy. As with attention, it is not the ability to enjoy in itself that is impaired, but the self-directed ability to allow and experience pleasure in a self-determined way. This is a serious problem because the ability to enjoy is closely linked to the ability to recover. Those who cannot enjoy themselves sufficiently usually also have the problem of not being able to recover sufficiently. This can be seen, for example, in the frequent aversion to mindfulness exercises, meditation, yoga or other relaxation techniques. This leads to a vicious circle that exacerbates the symptoms further and further.
Neurophysiological correlates of delay aversion, inability to enjoy and inability to recover in ADHD
However, the inability to enjoy is also a stress benefit, as it encourages us not to be distracted from fighting the stressor until it is defeated.

10. Things to know about ADHD

At ADHD - literature for beginners, sufferers, experts and specialists You will find some books on the subject that are well worth reading.

After some consideration between the deeply felt reluctance to expose third parties and the advantage of showing many sufferers that ADHD is nothing to be ashamed of and that very successful careers are possible with it, references to prominent people with ADHD who have self-published their diagnosis and people in contemporary history who are thought to have ADHD can be found at ⇒ Prominent ADHD sufferers.

The typical terms on this topic are explained in the articles ⇒ Glossary Glossary And Other and older names for ADHD. In all articles on the website, underlined technical terms are also explained by a mouseover text (a text that appears when you point the mouse at the word).

A few comments on the question of how misleading some scientific studies are and how to recognize scientifically reliable studies can be found at Studies prove - often enough - nothing at all.

11. Tests and surveys

We offer various free online screening tests in our test area:

Tests and surveys

These are unvalidated screenings that are not used for medical diagnosis, but are intended to give an idea of whether medical diagnostics might be useful.
The tests are completely free of charge. It is necessary to create an account, the sole purpose of which is to ensure that several test results can be assigned to the same test person and that the results are permanently available to the test person.

Our data protection concept is extreme: we do not want to know who is behind an account. Therefore, no personal data is requested, in particular no e-mail address, name or other data. We also do not store any IP data or other information about test subjects.
On the contrary, it is not permitted to use names or e-mail addresses in the account name or password you choose yourself. The test account is therefore completely separate from the two accounts for the forum and newsletter.

12. ADHD forum, virtual self-help groups

ADxS.org offers a free forum on the topic of ADHD:
ADHD forum at adhs-forum.ADxS.org

The forum can also be used to participate in virtual self-help groups or to set up your own virtual self-help group (possibly on specific topics for which there are not enough people interested in a face-to-face group in your region).

13. Newsletter

Our newsletter informs you about new or significantly changed articles as well as new tests or updated test evaluations.

Subscribe to our newsletter

The newsletter account (with e-mail address) is completely separate from the test account (without e-mail address) and the forum account for data protection reasons.


  1. This is a sample link: This article is an extremely abbreviated summary of the ADxS.org compendium and therefore contains (almost) no references. The more in-depth chapters and articles contain a total of over 12,500 footnote links that refer to almost 9,000 different sources, around 90% of which are primary literature (research articles).

  2. McLennan (2016): Understanding attention deficit hyperactivity disorder as a continuum. Can Fam Physician. 2016 Dec;62(12):979-982. PMID: 27965331; PMCID: PMC5154646.

  3. Rafi H, Delavari F, Perroud N, Derome M, Debbané M (2023): The continuum of attention dysfunction: Evidence from dynamic functional network connectivity analysis in neurotypical adolescents. PLoS One. 2023 Jan 20;18(1):e0279260. doi: 10.1371/journal.pone.0279260. PMID: 36662797; PMCID: PMC9858399.

  4. Faraone, Larsson (2019): Genetics of attention deficit hyperactivity disorder. Mol Psychiatry. 2019 Apr;24(4):562-575. doi: 10.1038/s41380-018-0070-0. PMID: 29892054; PMCID: PMC6477889.

  5. Speerforck, Hertel, Stolzenburg, Grabe, Carta, Angermeyer, Schomerus (2019): Attention Deficit Hyperactivity Disorder in Children and Adults: A Population Survey on Public Beliefs. J Atten Disord. 2019 Jul 4:1087054719855691. doi: 10.1177/1087054719855691. n = 1.008

  6. Steinhausen, Sobanski in Steinhausen, Rothenberger, Döpfner (2010): Handbuch ADHS, Kohlhammer, Seite 158 ff und 165 ff mit etlichen Nachweisen

  7. Leffa, Torres, Rohde (2018): A Review on the Role of Inflammation in Attention-Deficit/Hyperactivity Disorder. Neuroimmunomodulation. 2018;25(5-6):328-333. doi: 10.1159/000489635. mit etlichen Nachweisen

  8. Miller, Ancoli-Israel, Bower, Capuron, Irwin (2008): Neuroendocrine-Immune Mechanisms of Behavioral Comorbidities in Patients With Cancer; J Clin Oncol. 2008 Feb 20; 26(6): 971–982. doi: 10.1200/JCO.2007.10.7805, PMCID: PMC2770012, NIHMSID: NIHMS147295

  9. Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 75