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Treatment and therapy

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Treatment and therapy

ADHD is very treatable12 and may be the most treatable psychiatric problem of all.34 The effect sizes of stimulants are the highest ever found for psychiatric medications5

Today’s drug and psychological treatment methods for ADHD make it possible to largely or completely eliminate the symptoms. However, a cure would also require the symptoms to disappear permanently without ongoing further treatment (including coping strategies).
Long-term behavioral therapy can achieve a comparable effect to medication - but only after years. However, incorrectly applied psychotherapy can cause just as much damage as unsuitable medication.

Unfortunately, there are therapists who are not familiar with all the symptoms of ADHD. Some therapists only know the diagnostic DSM symptoms of ADHD or do not understand that the DSM and ICD only list those symptoms that are particularly well differentiated from other disorders and that other symptoms can also occur that can be caused by ADHD. We call this entirety of symptoms the treatment-relevant symptoms in order to distinguish the subset of diagnostic symptoms from them.
If this leads to the affected person attributing these symptoms not as a result of ADHD, but as personal responsibility, the affected person can come out of therapy with more feelings of guilt and inadequacy than they went in with. Unfortunately, we know of many such cases, both in outpatient and inpatient treatment.

In addition, 25% of ADHD-HI sufferers (with hyperactivity) showed a worsening of symptoms after social skills training.6

Nevertheless, there are methods that can permanently alleviate ADHD symptoms.

ADHD - symptom treatment vs cure

There is some evidence to suggest that it may be possible to cure ADHD in some areas. In some cases, neurofeedback appears to be able to permanently reduce or, in the best case (albeit rarely), even eliminate the symptoms. There are also cautious indications that very early medication with methylphenidate as well as long-term medication could have measurable healing effects 78
Mindfulness-based forms of treatment consistently show improvements in ADHD symptoms. If ADHD is completely incurable, the question arises as to why ADHD decreases in 20 to 50% of affected children by adulthood, at least to such an extent that ADHD is no longer diagnosed. There are several possible explanations for this, either alone or together:

  • Lack of knowledge about the changing symptoms in adulthood, so that adult ADHD, which manifests differently, is no longer recognized
  • Coping strategies are developed more effectively so that the symptoms are better masked
  • Change in life circumstances; in particular, discontinuation of school organized mainly by extrinsic motivation and replacement by training or studies in a field chosen by the individual (more intrinsic motivation).
  • Actual remitting (subsiding) of the symptoms, e.g. due to post-maturation of affected brain regions
  • Real recovery

This question, which has not yet been conclusively answered, allows us to retain a little bit of hope.
It is certain that long-term psychotherapy and neurofeedback can have a curative effect and significantly reduce the severity of symptoms, and that drug treatment can generally largely eliminate the symptoms and enable a stress-free life without any burdensome side effects.

Systematic treatment of ADHD not only significantly improves the quality of life of those affected, but also halves the risk of developing alcohol, nicotine or drug addiction compared to untreated patients.9 The risk of developing psychiatric comorbidities (depression, anxiety disorders, compulsions, etc.) is reduced by less than half.9
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.10

Some people reject ADHD treatment with medication as a matter of principle. This seems to be more a question of attitude than a question of fact. One study reports that the following factors in particular influence parents’ decisions as to whether children with ADHD receive medication:11

  • The extent to which ADHD is perceived as a stigma
  • The basic attitude towards medication for ADHD
  • Knowledge about ADHD.

  1. Weiss MD, Gadow K, Wasdell MB (2006): Effectiveness outcomes in attention-deficit/hyperactivity disorder. J Clin Psychiatry. 2006;67 Suppl 8:38-45. PMID: 16961429.

  2. Rivas-Vazquez RA, Diaz SG, Visser MM, Rivas-Vazquez AA (2023): Adult ADHD: Underdiagnosis of a Treatable Condition. J Health Serv Psychol. 2023;49(1):11-19. doi: 10.1007/s42843-023-00077-w. PMID: 36743427; PMCID: PMC9884156.

  3. Barkley (2019): Treatment Matters: ADHD and Life Expectancy; CHADD

  4. Barkley (2018): Health and Life Expectancy in ADHD. Treatment Matters More Than You Think; Youtube

  5. Nageye, Cortese (2019): Beyond stimulants: a systematic review of randomised controlled trials assessing novel compounds for ADHD. Expert Rev Neurother. 2019 Jul;19(7):707-717. doi: 10.1080/14737175.2019.1628640. PMID: 31167583.)

  6. Barkley (2018): Vortrag an der Universität Göteborg, ca. Minute 79

  7. 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

  8. 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.

  9. Edel, Vollmoeller (2006): Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Erwachsenen, Springer, Seite 108, mwNw.

  10. 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

  11. 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.