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Abstract of

Abstract of

This text is an abridged version of the project and links to the respective subpages, which present the topics in detail and with over 10,000 directly linked sources1.

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

Contrary to professional convention, we use the term ADHD as a generic term for all subtypes in order to enable non-specialists to distinguish the subtype ADHD-HI (predominantly hyperactive) at any time. We refer to the other subtypes / manifestations as ADHD-I (predominantly inattentive) and ADHD-C (equally hyperactive and inattentive). We assume that professionals can translate this at any time and ask them for their indulgence that sometimes makes such compromises to keep the texts more understandable for non-specialists.

This executive summary is divided into several sections that roughly correspond to the chapters of the compendium and whose contents are described in 1 to 2 sentences in the following outline.

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

  • Disorder or expression 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?
  • Follow
    • What does ADHD do to those affected?

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

2. ADHD consequences
ADHD has massive consequences that are often lifelong. The presentation of the increased mortality, the increased risks for further mental disorders or the further consequential risks show a realistic picture of how serious ADHD is.

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

4. Symptom Mediation
ADHD, in our view, could also be described as chronic overactivity or overreactivity of stress regulatory systems, which is more likely to mediate 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 circumstances can trigger ADHD?
ADHD is a symptom cluster that can be caused by various causes. ADHD is predominantly genetically caused, although a distinction must be made between inherited gene variants that can be tens of thousands of years old and epigenetic causes that can be caused by a person’s life experiences and 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 about 3 years of age may cause a brain developmental disorder or delay, which in turn may cause or mediate AD(H)DS symptoms.

6. ADHD diagnosis
How is ADHD diagnosed?
From which similar disorders is ADHD to be distinguished (differential diagnosis)?
What other disorders often occur together (comorbid) with ADHD?

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

8. ADHD treatment
How can ADHD be treated? We describe medications, psychotherapy, stress prevention, stress reduction, nutrition, neurofeedback and other methods.
How effective are these treatments (what is their effect size)?
What can be done to prevent ADHD?

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

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

11. Tests and surveys
We offer several free online screening tests that can provide clues as to whether a medical professional diagnosis might be appropriate:

  • ADHD symptom test (self-assessment)
  • ADHD Foreign Assessment Test
  • ADHD reaction test
  • SCT Test (Sluggish Cognitive Tempo)
  • High sensitivity test
  • Differential diagnostic test anxiety
  • Differential Diagnostic Test Depression
  • Differential Diagnostic Test Autism Spectrum
  • ADHD Drug Efficacy Test
  • In addition, we collect contact data of doctors and therapists with experience in ADHD.

Tests and surveys

12. ADHD FORUM currently offers the most comprehensive German-language active forum on the topic of ADHD:
ADHD forum at
Most of the contributions are also readable for 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 abstract).

ADHD, like most other mental disorders, is dimensional.23
Whereas pregnancy or a broken bone are categorical (they either exist or they do not), ADHD (like 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 represents only one personality dimension.

Almost everyone has a few ADHD symptoms frequently. Only the set of frequently occurring symptoms distinguishes between personality traits that are not a disorder and ADHD as a distressing disorder. While this makes diagnosis laborious (on brief observation (as a “photo”) ADHD is indistinguishable, only on longer observation (as a “movie”) does it become recognizable), it remains far clear enough to cleanly distinguish ADHD from mere chronic stress. While unaffected adults have 1 to 2 of 18 symptoms (according to Barkley) or 9 of 35 symptoms (in our online symptom test, version 2) frequently, ADHD sufferers have on average 12 of these 18 symptoms (according to Barkley) or 26 of the 35 symptoms (in our online symptom test, version 2) frequently. Which of the symptoms a particular sufferer has is unpredictable. It is often, but by no means always, the DSM / ICD symptoms that represent only the symptoms (diagnostic symptoms) that are optimally distinguishable (from other disorders). It is by no means all the symptoms that can arise from ADHD itself (treatment-relevant symptoms).

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

  • Not present at all, no symptom occurs frequently (this should affect rather few people)
  • Isolated symptoms frequently, without any subjective impairment (this affects most people)
  • Some symptoms common, recognizable in individual life situations (many people)
  • Noticeable symptoms, which sometimes become stressful in several life situations (but which usually do not yet 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 are disruptive in many life situations (usually this has disorder quality)
  • Very strong symptoms that make life very difficult in most life situations (disorder)

At what stage the personality traits become a disorder must be decided on the basis of the individual subjective distress. Subjective distress is the decisive characteristic for speaking of a mental disorder. This is the case for almost all mental disorders, except perhaps for rare other-dangerous disorders and psychopathy.

About 5 to 10% of people have ADHD symptoms so severe that they suffer significantly. 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 of the respective affected person. People who do not suffer from their symptoms from this continuum can nevertheless learn a lot about the correlations and backgrounds of their personality traits at

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

2. ADHD consequences

ADHD has massive consequences that - if left untreated - often persist throughout life.67 Among other things, untreated ADHD shortens life expectancy by up to 13 years, greatly increases the likelihood of depression, anxiety and eating disorders, and reduces educational attainment, income and quality of life. Risk of addiction is nearly, and smoking rates more than doubled. ADHD sufferers are 4 times more likely to get divorced and 7 times more likely to end up in prison.

Detailed 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 neurobiologically quite similar way), but for those affected accordingly severely, it is a disorder to be taken seriously and a heavy burden for those affected, which massively impairs the quality of life if left untreated.

3. The symptoms of ADHD

As a non-affected person, you can vividly understand what ADHD feels like if you imagine your desk in the middle of a busy pedestrian zone next to the streetcar tracks instead of in a normal office and try to feel how much more strenuous a day it would be and how much more stressed you would be when you got home. Or one compares it with the life circumstances under which some non-affected people suffer comparable symptoms at times, such as a crisis divorce, an insolvency or learning that one has cancer8 - only that here the whole life consists of this condition.
Affected persons usually cannot recognize for themselves whether they have ADHD on the basis of this description. This is because everyone perceives their ongoing life circumstances and reactions as the normal measure of things. By themselves, only categorical deviations are recognizable (when something is not acceptable under any circumstances), but not dimensional deviations (according to the measure), because the standard of comparison is missing for this. The standards, the “normal zero” of a person, are regularly based on one’s own life-long experiences - and one’s own life has always been like this. ADHD sufferers do not know themselves differently 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. Therefore, DSM and ICD list only the diagnostically relevant symptoms, i.e., those that have a particularly high discriminatory power to other disorders. In contrast, symptoms that also frequently (co-)occur in other disorders are not listed in DSM and ICD. Even the renowned American psychiatrist Allen James Frances, chairman editor of the DSM-IV, criticizes that diagnoses are far too often based on the DSM or ICD criteria alone.

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. Impulsivity
  6. Impatience
  7. inner drive
  8. excessive talking

DSM and ICD - statistical tools, not diagnostic scales

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

The misunderstanding that the DSM or ICD symptoms would be the only original (directly caused by ADHD) symptoms is common even among physicians 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 ADHD-typical dysphoria during inactivity is mistaken for depression and therefore unsuccessful medication attempts with antidepressants are made. Or if procrastination, mood swings, or sickliness (Rejection Sensitivity: sickliness/sensitivity to rejection and criticism as a specific ADHD symptom) Not be considered as an original consequence of an existing ADHD, but be treated as consequences of negative life experiences or lack of discipline-which may deepen the impression of being insufficient in the affected person.

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

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

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

4. How ADHD mediates its symptoms

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

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

But even though both phenomena cause similar symptoms in a similar neurobiological way, ADHD is nevertheless something different 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 chronicized stress regulation disorder

ADHD: The difference between cause level and symptom mediation level

There are many different causes that can trigger dopamine and norepinephrine deficiency. These include encephalitis (inflammation of the brain) and Parkinson’s disease, but also some rare monogenetic disorders. In addition, a confluence of a variety of gene variants, all of which contribute a little bit to dopamine and norepinephrine deficiency, has been implicated as a cause.
These individual diseases each have other specific symptoms that are not due to dopamine and norepinephrine deficiency.
Dopamine and norepinephrine deficiency is the neurobiological commonality that mediates ADHD symptoms. ADHD can be referred to as a syndrome (collection of recognizable symptoms that often occur together). Insofar as dopamine and norepinephrine (effect) deficiency is seen as the element mediating the symptoms, it can also be referred to as a disorder (impairment of normal or regular bodily functions by a disease).
The dopamine and norepinephrine deficiency that causes ADHD symptoms can be caused by a variety (at least three digits) of conditions.
This explains why ADHD is not curable. It is not possible to permanently increase dopamine and norepinephrine levels. Medications can compensate for the deficiency very effectively, but only as long as they work. For recovery, the particular cause that triggers the dopamine and norepinephrine deficiency would have to be permanently eliminated. So far, however, too little is known about the exact causes.
Every now and then, new findings lead to a cause being identified. Sometimes this is curable, but usually not.

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

5. How does ADHD develop?


There are several paths of origin that act in concert:

  • Genetic: ADHD can result from an interaction of a plurality of randomly evolved genes (up to tens or hundreds of thousands of years old gene variants) without the need for environmental influences. These gene variants have developed without the influence of stress. If several gene variants with a similar effect exist at the same time (several genes which, for example, all weaken the neurotransmitter dopamine), their influences can add up in such a way that the balance is disturbed.
    Let’s call it, to be able to distinguish it, here “genetically inherited ADHD”.
    Consequences of these gene variants can mediate other causes already in the first years of life. For example, a dopamine deficit 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 ADHD-typical changes in neurotransmitter levels and the like. While active stress increases dopamine and norepinephrine levels, chronic stress is associated with long-term decreased dopamine levels. Early childhood chronic stress can thus trigger the dopamine deficits that subsequently cause brain developmental disorder. This ADHD cause is particularly amenable to prevention through caring, warm parenting behaviors.
    Furthermore, diseases can also stimulate behavioral changes typical of ADHD. For example, encephalitis destroys the dopaminergic cells in the brain and can thus trigger a dopamine deficit that causes ADHD-typical symptoms.
  • 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, here only the epigenetic changes in gene activity acquired through environmental influences are passed on. Toxins, severe early or chronic stress, or disease can alter gene expression. Animal experiments as well as studies in humans have demonstrated inheritance of such acquired gene expression over 2 to 4 generations. Let’s call it “epigenetically inherited ADHD” to distinguish it.
    Genetic and epigenetic causes of ADHD - Introduction

ADHD has a strong genetic component of about 76%. The heritability of ADHD is thus greater than that of intelligence. Among ADHD cases with clinical intensity, up to 90 % are genetically caused.9 However, single genes are not causative, although 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 identified 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 related to the regulation of the circadian rhythm. Dopamine and the sleep-promoting melatonin are antagonists. Around 75 % of ADHD sufferers have a retarded 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 in ADHD.

6. The diagnosis of ADHD

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

ADHD is primarily diagnosed using questionnaires (self-report 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 degree of severity of a symptom.
Tests are seemingly more objective in terms of assessing test results - but only in terms of 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 ADHD-typical motivability deficit, the attentional performance of ADHD sufferers can no longer be distinguished from that of non-affected persons.
Smoking can also skew test results because nicotine, like methylphenidate, increases dopamine levels and is often used as a self-medication.
Diagnostic methods: problems with ADHD-HI testing - ADHD-HI symptoms do not consistently occur
Therefore, there is no one universal test that alone could provide a reliable objective diagnosis.
Apart from that, performance tests can always confirm only the momentary stress symptomatology, but not the duration of its existence and its origin.
Stress damage - effects of early childhood and/or prolonged stress

A careful diagnosis includes:
ADHD - Diagnostic Methods

  1. A clean differential diagnosis Differential diagnosis in ADHD
    • Exclusion of organic causes
      This is impossible without blood tests (for vitamin deficiency, thyroid hormones, etc.).
      In addition, several other differential diagnoses must be clarified.
    • Exclusion of mere stress symptoms due to acute stress-causing life circumstances (duration of the existence of the symptoms and occurrence in different areas of life)
    • Exclusion of other psychological causes that may better explain the symptoms
  2. Thorough recording and analysis of symptoms
    • Complete Symptom Query ADHD symptoms
      • DSM/ICD are important clues, but contain only those symptoms that are particularly well differentiated from other disorders and not the totality of all symptoms that can result from ADHD. The symptoms existing in the individual case therefore do not necessarily have to correspond to DSM/ICD and in almost all cases go far beyond it.
      • Self-awareness questionnaires
      • Interviews with affected person(s)
      • Third-party assessment questionnaires and interviews with parents/guardians
    • Test psychological performance diagnostics

Again, because of special importance: The symptom catalogs of DSM and ICD are not final, complete lists of all ADHD symptoms. DSM and ICD are diagnostic tools, statistical and billing instruments that contribute significantly to medical quality assurance. However, to use them as the sole standards for diagnosis would be malpractice. Diagnostic ADHD symptoms according to DSM, ICD, Wender-Utah, et al.

Only the overall view of the results leads to a definite diagnosis.

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

ADHD is divided into 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 by our ADxS-SCT online test were found equally in ADHD-HI and ADHD-I sufferers.
The pure ADHD-HI type is predominantly found in children up to 15 years of age. This is likely due to the fact that inattention symptoms are very difficult to diagnose at ages less than 6 years and can only be reliably diagnosed at ages greater than 15 years. ADHD-C is therefore often likely to be the later developmental form of the ADHD-HI subtype. However, there is still - even in adults - a proportion of about 10% of ADHD sufferers with the pure ADHD-HI subtype with minor attention problems.

For a detailed discussion of the differences among the subtypes of ADHD, see ⇒ ADHD-HI, ADHD-I, and others The subtypes of ADHD: ADHD-HI, ADHD-I, and others.

8. ADHD treatment

Our guide presents ADHD treatment that makes sense from a scientific point of view.
We present many appropriate and less appropriate medications for ADHD, as well as possible non-drug treatment pathways. Particularly important is the comparison of effect sizes of the different treatment options.
Treatment and therapy

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

From a scientific point of view, the procedure described below makes sense in most cases and thus forms a basic intellectual framework.
ADHD Treatment Guide

The first step Requires a definite diagnosis by questionnaire AND tests, family history with complete differential diagnosis and identification and differentiation of comorbidities.
Differential diagnostics in ADHD and ⇒ ADHD - comorbidity

The second step Is to take acute measures. As a rule, this is primarily an appropriate and carefully adjusted medication. The acute medication enables the patient to experience what a symptom-free life feels like, so that this can be anchored for several months as the target state, which is aimed for with the therapeutic measures in the third step. Usually, it is only when dopamine levels are normalized by stimulants that adequate learning and therapeutic ability is achieved. Dopamine is neurotrophic, i.e. necessary for the anchoring of learning experiences.

If children up to 6 years of age are affected, therapeutic measures for parents and caregivers are indicated as a second acute measure. In young children, parental work causes a reduction of stressors and protects against a deepening of the ADHD disorder at a still vulnerable age. In contrast, therapeutic measures for children up to 6 years of age themselves tend to be ineffective. ADHD prevention and screening - What parents can do.

In the third step, various therapeutic measures are taken with the aim of making medication dispensable. In the short term, stressors in the environment should be reduced and sleep problems aggressively addressed.
Sleep problems in ADHD. In the medium term, mindfulness-based therapies such as mindfulness-based behavior therapy (MBCT), mindfulness training (MBSR) are recommended. In the long term, neurofeedback, trauma therapies such as EMDR or DBT may be useful. In addition, environmental interventions, psychoeducation and group experiences occur.
Neurofeedback is particularly fascinating in this context because the treatment successes - although unfortunately only completely curative in rare exceptional cases - are permanent.
Neurofeedback as ADHD therapy

Medication in ADHD is a highly complex topic. In ADHD, dopaminergic, noradrenergic and other neurotransmitter systems are involved in mediating symptoms. Detailed information can be found in the individual articles on the respective medications.
When fine-tuning medication, it should be kept in mind that a healthy state is not the absence of all ADHD symptoms present, but that healthy individuals (and those optimally controlled with medication) have an average of 20 to 25% of possible symptoms occurring frequently (instead of the average of 75% of symptoms in affected individuals). Medication should therefore only reduce the number of frequently occurring symptoms to the level of non-affected persons and not completely eliminate all possible symptoms. Otherwise, an overdose is risked, which in extreme cases leads to a restriction instead of an improvement in the enjoyment of life.

Special attention should be paid to the treatment of sleep problems. Sleep problems (like all ADHD symptoms) can be symptoms of stress. Since sleep is one of the most important factors in reducing stress, sleep problems can lead to an ADHD vicious cycle. About 3/4 of all ADHD sufferers have a chronorhythm that is shifted backwards, so the circadian system is affected. Especially for children who have to get up (often much too) early due to school, an advance of the time of falling asleep (e.g. by unretarded melatonin) can be helpful.
Detailed at Sleep problems in ADHD and The interesting topic ⇒ Binaural Music as Therapy for ADHD and Sleep Problems Binaural music as therapy for ADHD and sleep problems a separate article is dedicated.

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 in sufferers who have such mild ADHD that it is not disruptive without additional stressors (keyword: dimensional disorder), shift it into the pathological range. This is not a pattern that applies to ADHD alone: eliminating food intolerances can also reduce or eliminate symptom intensity in other mental disorders.
For example, early or prolonged stress can impair the barrier function of the intestinal mucosa and thereby promote chronic intestinal inflammation - especially in people who externalize stress rather than bottling it up, as this stress phenotype is associated with a flattened cortisol stress response and therefore often increased inflammatory problems. Cortisol immunologically inhibits inflammation and instead promotes foreign body clearance (TH1/TH2 shift). Too little cortisol leads to inadequate inflammatory shutdown.
Further, (especially early or chronic) stress can alter the expression of genes responsible for providing 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.
See more at Nutrition and diet in ADHD.

Based on the understanding that inherited stress experiences can cause an ADHD risk (disposition) and that especially warm and caring parenting behavior can contribute to the fact that such a disposition does not develop into an actual ADHD (manifestation), the presentation of ADHD prevention options for parents and caregivers is very important to us. These principles are likely to apply to other multigene mental disorders as well.

9. Neurophysiological mechanisms of action in ADHD

Every thought, every feeling, every action has a neurophysiological correlate. This means: everything we do is represented by specific processes in the brain. This correlation is reciprocal. The brain, depending on its neurophysiological state, influences what we think, do and feel, while everything we think, do and feel in turn influences neurophysiological changes in our brain. Likewise, the brain influences the body and the body influences the brain. Again, there are cycles of perception and consequences that influence each other.
Neurophysiological correlates are thus merely a momentary reflection of the brain state that occurs simultaneously with a particular state or behavior and do not imply that there is unilateral causality (that is, 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). Therefore, adults require (sometimes significantly) lower doses of dopaminergic drugs 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 result from a deviant evaluation of expected rewards. Rewards are only interesting for ADHD patients (and just as interesting as for non-affected persons) if they are available immediately. The more distant an expected reward is in the future, the less interest ADHD sufferers have in it compared to non-ADHD sufferers. 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 in ADHD-HI and likewise Procrastination sufferers) often have a deep-seated aversion to relaxation and mindfulness.
Where does aversion to mindfulness come from in ADHD and procrastination? This aversion is also a healthy stress benefit: Anyone facing an acute danger should not relax until that danger is removed. Stress benefits-the survival-promoting purpose of stress As with all ADHD symptoms, it is not the symptom itself that is the problem, but that the person in stress mode is subject to other guiding principles.

Many ADHD sufferers suffer from an inability to enjoy. As with attention, it is not the ability to enjoy per se that is disturbed, but the self-directing ability to allow and experience enjoyment 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 sufficiently usually also have the problem of not being able to recover sufficiently. This is reflected, for example, in the frequent aversion to mindfulness exercises, meditation, yoga or other relaxation techniques. This leads to a vicious circle that aggravates the symptoms more and more.
Neurophysiological correlates of delay aversion, pleasure inability, and recovery inability in ADHD
However, inability to enjoy is also a stress benefit, in that it drives one not to be distracted from fighting the stressor until it is defeated.

10. Things to know about ADHD

At ADHD - Literature for Beginners, Affected Persons, Professionals and Specialists You will find a number of books on the subject that are well worth reading.

After some balancing between the heartfelt reluctance to expose third parties and the benefit 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 believed to have ADHD are ⇒ ⇒ ⇒ ⇒ Prominent ADHD sufferers.

The typical terms on the topic are explained in the articles 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 remarks on the question of how misleading some scientific investigations are, and how one can recognize scientifically reliable investigations, can be found at Investigations prove - often enough nothing at all.

11. Tests and surveys

In our testing section, we offer several free online screening tests:

Tests and surveys

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

Our data protection concept is extreme: We do not want to know which person is behind an account. Therefore, we do not ask for any personal data, in particular no mail address, no name details or other data. We also do not store any IP data or other information about test persons.
On the contrary, it is consequently not allowed to use names or mail addresses in the self-selected account name or password. Therefore, the test account is completely separate from the two accounts for the forum and newsletter.

12. ADHD forum, virtual support groups offers a free forum on the topic of ADHD:
ADHD Forum at

Via the forum, it is also possible to participate in virtual self-help groups or to found one’s own virtual self-help group (if necessary, on specific topics for which there are not enough interested parties regionally for a face-to-face group).

13. Newsletter

Our newsletter informs about new or heavily modified articles as well as about new tests or updated test evaluations.

Subscribe to newsletter

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

  1. Dies ist ein Beispiellink: Dieser Artikel ist eine extrem verkürzte Zusammenfassung des und enthält daher (fast) keine Quellenangaben. Die tiefergehenden Kapitel und Beiträge enthalten insgesamt über 10.000 direkt verlinkte Fußnoten auf 7.000 unterschiedliche Quellen, davon rund 90 % Primärliteratur (Forschungsartikel).

  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 with several references

  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. with several references

  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