Treatment and therapy
ADHD is probably the most treatable mental health problem of all.
Today’s drug and psychological therapy methods for ADHD allow for an extensive to complete resolution of the symptoms. A cure, however, would also require that the symptoms disappear permanently without ongoing further treatment (also not by means of coping strategies).
Long-term behavioral therapy can achieve a comparable effect to medication - but only after years. However, misapplied psychotherapy can cause just as much damage as unsuitable medication.
Unfortunately, there are therapists who do not know all the symptoms of ADHD. Some therapists only know the diagnostic DSM symptoms of ADHD or do not understand that DSM as well as ICD only name those symptoms which are particularly well distinguished from other disorders and that other symptoms can occur which can nevertheless be originally caused by ADHD. We call this totality of symptoms the treatment-relevant symptoms in order to distinguish the subset of diagnostic symptoms.
If this leads to these symptoms being attributed to the individual as personal responsibility rather than as a result of ADHD, the individual may come out of therapy with more feelings of guilt and inadequacy than they went in with. Unfortunately, we know of several such cases, both in outpatient and inpatient treatment.
In addition, 25% of ADHD-HI sufferers (with hyperactivity) showed worsening of symptoms after social skills training.1
Nevertheless, there are methods that can permanently alleviate ADHD symptoms.
ADHD - symptom treatment vs cure
Some evidence suggests that a cure for ADHD may be possible in some areas. Neurofeedback seems to be able to permanently reduce symptoms in some cases or even eliminate them in the best case (although rarely). Similarly, there is tentative evidence that very early medication with methylphenidate, as well as long-term medication, may have measurable curative effects 23
Mindfulness-based treatments consistently show improvements in ADHD symptomatology. If ADHD is completely incurable, the question is why ADHD declines in 20 to 50% of affected children by adulthood, at least to the point where ADHD is no longer diagnosed. Several explanations are conceivable for this, alone or together:
- Lack of knowledge about symptoms changing in adulthood, so that adult ADHD that manifests differently is no longer recognized
- Coping strategies are developed more effectively so that symptoms are better masked
- Change in life circumstances; in particular, discontinuation of school organized mainly by extrinsic motivation and replacement by training or study of a field chosen by oneself (more intrinsic motivation).
- Actual remitting (subsiding) of symptoms, e.g. due to post-maturation of affected brain regions
- Real recovery
In any case, this question, which has not yet been conclusively answered, allows us to retain a little bit of hope.
What is certain is that long-lasting psychotherapy and neurofeedback can develop curative contributions and significantly reduce symptom severity, and that drug treatment can, as a rule, largely eliminate symptoms without burdensome side effects and enable a burden-free life.
Systematic treatment of ADHD not only significantly improves the quality of life for those affected, but also halves the risk of developing an addiction to alcohol, nicotine or drugs compared with untreated patients.4 The risk of developing psychiatric comorbidities (depression, anxiety disorders, compulsions, etc.) is reduced to less than half.4
While untreated children with ADHD show massive impairments in executive functions, treated children with ADHD were found to have executive functions close to those of unaffected children.5
Some people are fundamentally opposed to treating ADHD with medication. This seems to be more a matter of basic attitude than of facts. One study reports that primarily the following factors influence parents’ decision whether children with ADHD receive medication:6
- The degree to which ADHD is perceived as a stigma
- The basic attitude towards medication for ADHD
- The knowledge about ADHD.
Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 79 ↥
Petrovic, Castellanos (2016): Top-Down Dysregulation—From ADHD to Emotional Instability; Front Behav Neurosci. 2016; 10: 70. doi: 10.3389/fnbeh.2016.00070; PMCID: PMC4876334 ↥
Pires, Pamplona, Pandolfo, Prediger, Takahashi (2010): Chronic caffeine treatment during prepubertal period confers long-term cognitive benefits in adult spontaneously hypertensive rats (SHR), an animal model of attention deficit hyperactivity disorder (ADHD). Behav Brain Res. 2010 Dec 20;215(1):39-44. doi: 10.1016/j.bbr.2010.06.022. PMID: 20600342. ↥
Edel, Vollmoeller (2006): Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen, Springer, Seite 108, mwNw. ↥ ↥
Miklós, Futó, Komáromy, Balázs (2019): Executive Function and Attention Performance in Children with ADHD: Effects of Medication and Comparison with Typically Developing Children. Int J Environ Res Public Health. 2019 Oct 10;16(20). pii: E3822. doi: 10.3390/ijerph16203822. n = 150 ↥
Boudreau, Mah (2020): Predicting Use of Medications for Children with ADHD: The Contribution of Parent Social Cognitions. J Can Acad Child Adolesc Psychiatry. 2020 Mar;29(1):26-32. PMID: 32194649; PMCID: PMC7065566. ↥