German Law on ADHD

Under German law, ADHD affects narcotics law due to stimulants, driver’s licenses, labor law, professions with specific health requirements, civil service employment, school, vocational training and exams, laws governing persons with severe disabilities, social welfare and tax laws, criminal law, insurance law, and sports. Barely any law explicitly mentions ADHD. In most cases, general provisions regarding illness, mental disorders, disability, or medication apply. For example, ADHD is explicitly mentioned in the Ordinance on Medical Care (Degree of Disability), the Ordinance on Maritime Medical Requirements (Fitness for Naval Service), the Federal Subsidy Regulation, the Bundeswehr’s regulations on fitness for military service, and in guidelines from individual federal states regarding the mitigation of disadvantages in school.

In Germany, an ADHD diagnosis alone almost never rules anything out. Courts generally require a case-by-case assessment of whether and to what extent ADHD has a concrete impact. Well-managed ADHD without current limitations is usually assessed differently than untreated ADHD with noticeable symptoms. Conversely, ADHD does not automatically lead to accommodations. For example, courts have so far consistently denied requests for extended testing time based on ADHD.

Stimulants (methylphenidate, lisdexamfetamine, dexamfetamine) are classified as controlled substances in Germany. Anyone who is prescribed them is permitted to possess and take them. Passing them on to others constitutes a criminal offense. Passing them on to others is punishable by law. While driving, the proper use of prescribed medications is permitted as long as safe driving is possible. However, the use of non-prescribed substances can result in the loss of one’s driver’s license upon the first instance of detection.

Duty of disclosure is important. When hiring, employers are subject to restrictions on asking about medical conditions. In contrast, during the medical examination conducted by a public health officer for civil service positions, during police background checks, on insurance applications, and during medical examinations for truck, bus, and taxi driver’s licenses, questions about mental health conditions and medications are explicitly asked. Providing false information in these contexts can lead to the loss of one’s position or insurance coverage even years later. 

This page does not constitute legal advice. It reflects the situation as of October 2026. Rules and case law are subject to change. For information on traveling abroad with stimulants, see Taking Stimulants Abroad. Information on prescriptions, coverage of costs, recourse, and questions regarding narcotic prescriptions can be found on the page Restrictions on Treatment and Medication Choices in Germany. The approval of medications is covered on the page Approval Status of ADHD Medications, and the topic of medical cannabis is covered on the page Medical Cannabis for ADHD.

 

1. Stimulants as Narcotics¶

Methylphenidate, dexmethylphenidate, amphetamine, dexamphetamine, and lisdexamfetamine are listed in Schedule III of the Narcotics Act (narcotics available for sale and prescription). Atomoxetine and guanfacine are not listed in Schedule III. (Legal provision.)¹ Atomoxetine and guanfacine are also not listed in Schedules I and II. (ADxS assessment.) Narcotics listed in Schedule III may only be prescribed if their use on or in the human body is justified. (Legal provision.)²

No permit is required for anyone who “acquires” narcotics listed in Schedule III “based on a medical … prescription …” (Section 4(1)(3a) of the German Narcotics Act (BtMG)). (Legal provision.)³ Under Section 29(1) of the BtMG, a prison term of up to five years or a fine may be imposed, among other things, on anyone who: (Legal provision.)⁴

• Illegally “sells, dispenses, otherwise places on the market, acquires, or otherwise obtains” narcotics (No. 1)
• Possesses narcotics “without also being in possession of a written permit for their acquisition” (No. 3)
• “provides false or incomplete information in order to obtain a prescription for a narcotic drug for oneself or another person …” (No. 9)

The court may refrain from imposing a penalty if the offender acquires or possesses narcotics “solely for personal use in small quantities” (Section 29(5) BtMG). (Legal provision.)⁴ Under certain conditions, the public prosecutor’s office may refrain from prosecution (Section 31a BtMG). (Legal provision.)⁵ A person over the age of 21 who unlawfully supplies narcotics to a person under the age of 18 shall be punished by imprisonment for a term of not less than one year (Section 29a(1)(1) BtMG). (Legal provision.)⁶ No published decision by a federal court or higher regional court regarding the transfer of prescribed ADHD medications was found (as of October 8, 2026). For the related substance ethylphenidate, the Federal Court of Justice (BGH) determined that 15 g of methylphenidate is equivalent in effect to 10 g of amphetamine. (Court decision.)⁷ Citing this decision, the Bavarian Higher Regional Court (BayObLG) established a threshold for methylphenidate of 15 g of active ingredient, which constitutes a “non-negligible amount” (para. 20). (Court decision.)⁸

A young man with ADHD had hoarded 502 Ritalin capsules containing 10.66 g of methylphenidate instead of taking them. Because he had obtained the prescriptions by providing false information, they were not considered valid authorization, and his possession was a criminal offense under Section 29(1)(3) of the German Narcotics Act (BtMG) (para. 8 and 10). (Court decision.)⁸

The Bochum Regional Court found that a defendant had developed a psychological dependence on methylphenidate and had obtained additional prescriptions by providing false information (para. 4). (Court decision.)⁹

Physicians may prescribe Schedule III controlled substances, such as methylphenidate or lisdexamfetamine, only if their use is justified (Section 13(1) of the German Narcotics Act (BtMG)). (Legal provision.)² Prescribing without a medical indication is a criminal offense under § 29(1), sentence 1, no. 6, letter a of the BtMG, as the Federal Court of Justice (BGH) ruled in the case of a substitution physician (para. 14). (Court decision.)¹⁰ No published decision was found regarding physicians who prescribed stimulants without a medical indication. The BGH decision is not related to ADHD.

Prompted by a methylphenidate prescription that a doctor had written for his son, the Federal Administrative Court (BVerwG) ruled that regulatory authorities may access prescriptions for controlled substances but not medical patient records (Headnote, paras. 2, 10). (Court decision.)¹¹

In determining the “significant amount” of other stimulants, courts used the therapeutic doses used in ADHD treatment as a benchmark:

• In determining the threshold level for methamphetamine, the Federal Court of Justice (BGH) took into account the therapeutic use of amphetamine and methamphetamine for ADHD in the United States (para. 14, 17). (Court decision.)¹²
• In the case of the designer stimulant 4-fluoroamphetamine, the Kleve Regional Court based its decision on the therapeutic dosages of dexamfetamine (para. 123 et seq.). (Court decision.)¹³
• In the MDPV case, the Regional Court of Kleve relied on the therapeutic daily doses of methylphenidate (para. 99). (Court decision.)¹⁴

The Cologne Administrative Court held that the requirements for a permit under Section 3(2) of the Federal Narcotics Act (BtMG) for the personal cultivation of cannabis by an adult with severe ADHD were, in principle, met because methylphenidate had not been effective and because the decision was based on a subjective, individual assessment rather than on controlled studies (para. 49, 66). The lawsuit failed solely due to the lack of safety precautions for the cultivation room. The decision was issued prior to the Cannabis Act of 2017 and the Recreational Cannabis Act of 2024. (Court decision.)¹⁵

2. Road Traffic and Driver’s Licenses¶

 

2.1. Driving Fitness for People with ADHD¶

A person is deemed fit to operate motor vehicles if they “meet the necessary physical and mental requirements.” If a person is only conditionally fit, the driver’s license is issued with restrictions or conditions (Section 2(4) of the Road Traffic Act (StVG)). If facts come to light that give rise to concerns regarding a person’s fitness, the authority may order a medical or medical-psychological evaluation (Section 2(8) of the Road Traffic Act (StVG)). The police must report any facts that suggest more than temporary deficiencies in fitness to the driver’s license authority (Section 2(12) StVG). (Legal provision.)¹⁶ Anyone who is unfit to drive must have their driver’s license revoked (Section 3(1) StVG). (Legal provision.)¹⁷ In cases of conditional fitness, the authority restricts the driver’s license or imposes conditions (Section 46(2) FeV). (Legal provision.)¹⁸ Anyone who, due to physical or mental impairments, cannot navigate traffic safely may only participate “if precautions have been taken to ensure that they do not endanger others” (Section 2(1) FeV). (Legal provision.)¹⁹

Doubts regarding fitness arise “in particular” when facts indicate a medical condition listed in Appendix 4 or 5 of the FeV. The specialist conducting the medical evaluation should not also be the treating physician. If a person fails to submit a required medical evaluation by the deadline, the authority may conclude that the person is unfit (§ 11, paras. 2, 8 FeV). (Legal provision.)²⁰ Appendix 4 of the FeV lists only “more common medical conditions.” Its assessments apply “in typical cases.” Compensation “through special adjustments or through specific behavioral controls and changes is possible.” Under No. 7 (mental disorders), it lists organic psychoses, dementia, intellectual disabilities, as well as affective and schizophrenic psychoses, but not ADHD. (Legal provision.)²¹ The basis for the assessment is the assessment guidelines for fitness to operate a motor vehicle (Appendix 4a of the FeV). (Legal provision.)²² According to the Federal Highway and Transportation Agency, they have a “normative character.” (Official information.)²³ In the version effective as of August 19, 2026, they do not contain a chapter on ADHD. ADHD is mentioned there only twice as a common comorbid condition associated with alcohol and cannabis dependence (Chapters 3.13.1.1 and 3.13.2.1). (Government information.)²⁴

Mental functioning is assessed using criteria from the evaluation guidelines (Chapter 2.5) that are independent of any diagnosis. Doubts may arise “due to a reduction in visual orientation, the ability to concentrate, attention, reaction time, and resilience.” The assessment of functional capacity is “diagnosis-independent.” Performance tests require: (Information from the authorities.)²⁴

• For passenger cars and motorcycles (Group 1), a percentile rank of at least 16 in all tests (age-independent standards)
• For trucks, buses, and passenger transport (Group 2), at least the 33rd percentile in the majority of the tests and at least the 16th percentile in all relevant tests
• a driving test in cases of doubt

According to the assessment guidelines, chronic fitness-for-duty deficiencies can be compensated for “through medical treatment of illnesses” (Chapter 2.6). If they require “constant compensation,” fitness for duty may only be considered conditional. It must be determined whether “self-observation, self-control, and reliability (compliance)” are sufficient to ensure adherence to the treatment regimen before driving or to refrain from driving. (Official information.)²⁴ According to Chapter 3.14.2, a whole range of medical conditions are only improved through medication “to the extent that the prerequisites for operating motor vehicles can be regained through treatment alone.” Medication with significant adverse effects “such as slowed reaction times and impaired concentration” precludes eligibility. During the initial phase, “particularly careful medical supervision is necessary.” The chapter does not explicitly mention stimulants. (Official information.)²⁴

Courts have reached differing conclusions on whether an ADHD diagnosis in and of itself raises doubts about a person’s fitness to drive:

• No, generally only in cases of known traffic violations or symptoms that affect driving ability. Although ADHD can affect a person’s fitness to drive, “despite the statistically significantly increased risk,” a general doubt is not justified because “the composition and severity of symptoms vary greatly from person to person.” The authority must provide a clear and reasonable explanation for its decision. Nervousness during a police stop is not sufficient grounds (BayVGH, paras. 14–17) (Court decision.)²⁵
• No, usually not on its own, but certainly in conjunction with other factors relevant to driving ability (in this case, pain, high blood pressure, and medical cannabis). ADHD is “not covered by Annex 4 to the FeV” (Munich Administrative Court, para. 44) (court decision.)²⁶
• No, a “general doubt regarding fitness to drive” cannot be substantiated. However, obvious and frequent traffic violations should be investigated (Administrative Court of Würzburg) (Court decision, secondary citation via verkehrslexikon.de.)²⁷
• Yes, ADHD requiring treatment “in and of itself gives rise to doubts about fitness to drive” (Munich Administrative Court, para. 41, overturned by the Bavarian Higher Administrative Court) (court decision.)²⁸

A commentary on driver fitness assessments cites ADHD as an example of a possible cause of documented behavioral problems while driving. (Technical Information.)²⁹

In assessing driving fitness following a substance-induced psychosis, the Higher Administrative Court of Lower Saxony also considered ADHD—which had previously been treated with medication—as a possible comorbidity and noted that ADHD symptoms often persist into adulthood. (Court decision.)³⁶

2.2. Duty to Disclose, Examination, and Physician-Patient Confidentiality¶

Applications for a driver’s license in classes AM, A1, A2, A, B, BE, L, or T must be accompanied by a vision test certificate and proof of first aid training; applications for Classes C and D must include a medical certificate in accordance with Annex 5 (§ 21(3) FeV). § 21 FeV does not require a declaration regarding medical conditions. (Legal provision.)³⁷ It has not been verified whether state authorities nevertheless include health-related questions on their application forms. According to a patient advocacy group, the use of medically prescribed methylphenidate does not need to be disclosed when applying for a driver’s license because ADHD is not listed in Annex 4. (Specialized information.)³⁸

Applicants for truck and bus license classes must undergo a medical examination to determine “whether there are any signs of medical conditions that could preclude full or conditional eligibility.” Applicants for bus licenses and a driver’s license for passenger transport (taxi, rental car, medical transport) must additionally meet requirements regarding “stress tolerance, … orientation skills, … concentration, … attention span, … and reaction time.” The official medical certificate form asks about “mental illnesses/addictions (alcohol, drugs, medications).” (Legal provision.)³⁹ A driver’s license for passenger transport is issued for a maximum of five years; in cases of doubt regarding fitness, §§ 11 through 14 of the FeV (§ 48 FeV) apply. (Legal provision.)⁴⁰

Physicians are liable to criminal prosecution if they disclose, without authorization, a secret entrusted to them (Section 203 of the German Criminal Code (StGB)). (Legal provision.)⁴¹ In individual cases, a report to the driver’s license authority may be justified under § 34 StGB (justifiable emergency) if the protected interest significantly outweighs the interest that is impaired. (Legal provision.)⁴² According to an article in the Deutsches Ärzteblatt, there is no general obligation to report to third parties. The physician may decide to make a report after weighing the circumstances. “The mere diagnosis of an addiction” generally does not justify a report, and a “complete account of the medical history” is impermissible. The underlying case law (including BGH, judgment of Oct. 8, 1968, VI ZR 168/67) was not consulted in the original. (Specialized information, secondary citation.)⁴³ The 2023 German Traffic Court Conference rejected a mandatory reporting requirement for physicians regarding individuals unfit to drive. In cases of reasonable suspicion and after exhausting therapeutic and counseling options, a report is deemed permissible. (Expert recommendation.)⁴⁴

2.3. Stimulants and Driver’s License Laws¶

According to Annex 4 of the FeV, the following are excluded: (Legal provision.)²¹

• “the use of narcotics as defined by the Narcotics Act” (No. 9.1)
• the “abuse (regular excessive use) of psychoactive medications” (No. 9.4)
• in the case of long-term treatment with medications, an “impairment of the ability to operate motor vehicles below the required level” (No. 9.6.2)

In cases where there are indications of the use of narcotics or the misuse of psychoactive medications, the authority shall order a medical evaluation (Section 14 FeV). (Legal provision.)⁴⁵ Since August 19, 2026, Chapter 3.14.1 of the assessment guidelines has contained the following sentence: “This does not apply if the substance results from the intended use of a medication prescribed for a specific medical condition.” This sentence does not appear in Appendix 4, No. 9.1 of the FeV. (Official information.)²⁴ No case law regarding this revised version has yet been found (as of October 8, 2026).

According to Section 9.1, even a single instance of hard drug use renders a person unfit to drive. (Court ruling.)⁴⁶ This also applies to amphetamine, regardless of whether the driver was under its influence. (Court ruling.)⁴⁷ Taking methylphenidate without a prescription also disqualifies a person from driving. The following individuals were deemed unfit to drive:

• Ritalin without a corresponding doctor’s prescription (Court decision, secondary citation via verkehrslexikon.de.)⁴⁸
• Taking Ritalin for months without a prescription (Court decision, secondary citation via juraforum.de.)⁴⁹
• Ritalin “even just once as a self-experiment” (Court ruling, secondary citation via verkehrslexikon.de.)⁵⁰
• non-prescription methylphenidate, which, according to the court, met the criteria of No. 9.1 on its own (para. 32) (Court decision.)⁵¹

In the case of long-term treatment as prescribed, fitness to drive is determined not by Section 9.1, but by Section 9.6 of Appendix 4 to the FeV. It is waived “only” if performance is impaired to a degree below the required level, which must be clarified by an expert opinion. (Court decision.)⁵² * (Court decision.)*⁵³ It must then be determined whether the medication is medically indicated and prescribed, whether it is taken reliably as prescribed, whether there are no permanent impairments, whether the underlying condition does not have any implications relevant to traffic safety, and whether the person with ADHD refrains from driving when impaired. In the case of medications containing amphetamines, these requirements must be “interpreted even more strictly.” If a patient exhibits symptoms typical of drug use despite a prescription, they are deemed unfit to drive. (Court decision.)⁵⁴ Similarly, the principles regarding amphetamine-containing medications must be “applied particularly strictly.” (Court decision.)⁵⁵

The following were not sufficient proof that the medication was taken as directed:

• a medical certificate regarding Vyvanse that did not specify the medical condition, the date of prescription, or the prescription period (court decision.)⁵⁴
• Prescriptions for lisdexamfetamine that were issued only after the incident (Aachen Administrative Court, para. 30) (Court decision.)⁵⁵
• the reference to atomoxetine, which does not contain amphetamine (VG Aachen, para. 33) (court decision.)⁵⁵
• the allegation that Vyvanse was taken, when the forensic enantiomer analysis revealed the presence of R-amphetamine (street amphetamine) in addition to S-amphetamine, and the person with ADHD did not provide any proof of a prescription (BayVGH, paras. 8, 16) (Court decision.)⁵³
• the reference to Vyvanse, if the person with ADHD was unable to prove that her positive amphetamine test result was due to a medication prescribed by a doctor at the time of use. The court upheld the revocation of the driver’s license (Gelsenkirchen Administrative Court, paras. 28–31) (court decision.)⁵¹

Methylphenidate (Medikinet, Ritalin) may not result in a positive test for amphetamine in gas chromatography analysis. Anyone who has amphetamine in their blood in addition to methylphenidate has ingested it separately (Düsseldorf Higher Regional Court, para. 7 et seq.). (Court decision.)⁵⁶ * (Court decision.)*⁵² Without gas chromatographic analysis, however, it cannot be established with sufficient certainty whether the amphetamine in the blood originates from Vyvanse or from other sources of consumption (Düsseldorf Administrative Court, headnote). (Court decision.)⁵² According to an expert opinion obtained by the Cologne Administrative Court, however, rapid immunochemical tests for methylphenidate can yield false-positive results for amphetamines. A confirmatory analysis using gas chromatography and mass spectrometry, however, reliably distinguishes between the two active ingredients. A confirmed finding of amphetamines in the blood could therefore not be explained by the use of Ritalin (para. 38, 39). (Court decision.)⁵⁷

In 2018, a court ruled that taking prescribed Medikinet in combination with occasional cannabis use constituted mixed substance use that rendered the individual unfit for service. (Court decision.)⁵⁸ The rule on mixed substance use that was in effect at the time (No. 9.2.2, Appendix 4 of the FeV, previous version) is no longer included in the current Appendix 4. (Legal provision.)²¹

Before the Recreational Cannabis Act took effect, the Gelsenkirchen Administrative Court ruled that the daily use of medical cannabis for alleged ADHD constituted regular use that precludes fitness to drive, because cannabis therapy without prior attempts at other treatments contradicts the S3 guideline on ADHD (para. 74 et seq.). (Court decision.)⁵⁹

According to the case law of the Higher Regional Courts, the following applies to the medication clause in § 24a(4) of the Road Traffic Act (StVG) with regard to medically prescribed cannabis:

• The Oldenburg Higher Regional Court overturned a conviction for driving under the influence of THC because the person with ADHD had been prescribed cannabis by a doctor. Deficiencies in the prescription—such as follow-up prescriptions issued over the phone or a lack of dosage instructions—were not his fault; the doctor bore ultimate responsibility. (Court decision.)⁶⁰
• The Higher Regional Court of Brandenburg ruled that a cannabis prescription issued solely via telemedicine was sufficient for a driver with ADHD because in-person consultations are not yet required by law and the doctor is responsible for evaluating the patient’s condition. (Court decision.)⁶¹

2.4. Traffic Crimes and Administrative Offenses¶

Anyone who drives a vehicle even though they are “unable to drive the vehicle safely as a result of consuming alcoholic beverages or other intoxicating substances” is subject to punishment, even in cases of negligence (Section 316 of the German Criminal Code (StGB)). (Legal provision.)⁶² Anyone who endangers others as a result of this or “due to mental or physical impairments” is liable to prosecution under § 315c StGB. (Legal provision.)⁶³ The exception for the intended use of prescribed medications in § 24a(4) of the Road Traffic Act (StVG) applies only to administrative offenses. (Legal provision.)⁶⁴ It “does not preclude prosecution of the act as a criminal offense (Section 316 StGB)” and must be “interpreted restrictively” (Hamm Higher Regional Court, Headnotes, regarding medical cannabis). (Court decision.)⁶⁵ Methylphenidate is not listed in the schedule to § 24a StVG. Details can be found on the page “Bringing Stimulants from Abroad” (section on Germany).

The product information describes the effect on driving ability (Section 4.7) as:

• “Moderate to large effect” for guanfacine (Intuniv) (Prescribing Information.)⁶⁶
• “moderate influence” in Medikinet Adult (Prescribing Information.)⁶⁷
• “moderate influence” for Medikinet tablets (Prescribing Information.)⁶⁸
• “moderate influence” for Ritalin Adult (Prescribing Information.)⁶⁹
• “Moderate risk” associated with Vyvanse, due to possible dizziness, drowsiness, and visual disturbances (Prescribing Information.)⁷⁰
• May affect Attentin; “exercise caution” when driving (Technical information.)⁷¹

Patients “should be warned about these possible effects” (Medikinet Adult, Ritalin Adult, Vyvanse). (Prescribing Information.)⁶⁷ According to the prescribing information, Vyvanse may cause positive results in drug tests and doping controls. (Prescribing Information.)⁷²

3. Labor Law and the Practice of a Profession¶

3.1. Application, Right to Ask Questions, and Disclosure¶

Any person who has been induced to make a declaration of intent through fraudulent misrepresentation may rescind it (Section 123(1) of the German Civil Code (BGB)). Rescission is possible within one year of discovery and is barred after ten years (Section 124 BGB). (Legal provision.)⁷³ * (Legal provision.)*⁷⁴ A person is entitled to rescind an employment contract only if they provided a false answer to a “legitimately asked question,” and only if the deception was the cause of the contract’s conclusion. The Federal Labor Court (BAG) expressly left open the question of whether an employer may still ask about a recognized severe disability during the hiring process following the enactment of the General Equal Treatment Act (AGG) (para. 16 et seq.). (Court decision.)⁷⁵ A permissible question requires “a legitimate, reasonable, and worthy interest.” If this interest is lacking, the incorrect answer is “not unlawful.” (Court decision.)⁷⁶ In an existing employment relationship, a question regarding a severe disability is permissible in any case after six months. Anyone who answers it incorrectly cannot later invoke special protection against termination (headnote, para. 52). (Court decision.)⁷⁷

Questions about medical conditions may be asked only to the extent that they are relevant to the intended job. This is supported by:

• Accident insurance providers: The scope of a pre-employment medical examination must be limited to health data that is “relevant to the job requirements for the position to be filled” (with reference to the Federal Labor Court [BAG], judgments of June 7, 1984—2 AZR 270/83 and of August 1, 1985—2 AZR 101/83; not read in the original) (Information from the authorities.)⁷⁸
• An employers’ association: “Employees are not generally required to disclose information about illnesses that have been cured or are currently active.” Illnesses that permanently prevent an employee from performing their job must be disclosed (Technical Information.)⁷⁹
• A social law portal: Disclosure during the job application process is necessary only “if and to the extent that ADHD could limit one’s ability to perform or suitability for the intended job.” There are “neither particularly suitable nor particularly unsuitable occupational fields.” (Specialized information.)⁸⁰

3.2. Disability, Protection Against Discrimination, and Laws Governing Persons with Severe Disabilities¶

The AGG is intended to prevent discrimination based on, among other things, a disability. (Legal provision.)⁸¹ It prohibits both direct and indirect discrimination. (Legal provision.)⁸² This also applies if the person engaging in discrimination “merely assumes” a disability (Section 7(1) AGG). (Legal provision.)⁸³ Different treatment is permissible if the reason constitutes “a substantial and decisive occupational requirement” (Section 8(1) AGG). (Legal provision.)⁸⁴ Claims must be asserted in writing within two months (Section 15(4) AGG). (Legal provision.)⁸⁵ If one party presents circumstantial evidence of discrimination, the other party bears the burden of proof (Section 22 AGG). (Legal provision.)⁸⁶

ADHD is not mentioned in the standards. It may be considered a disability under labor law according to:

• According to the European Court of Justice: A disability is a long-term limitation resulting from physical, mental, or psychological impairments that, in interaction with barriers, may hinder participation in working life. This may also include a curable or incurable illness. Illness as such is not a separate ground for discrimination (para. 38, 41 et seq.) (Court decision.)⁸⁷
• According to the Federal Office of Public Health (BAG): A disability exists when “a person’s physical function, mental capacity, or mental health is limited over the long term” and, as a result, participation “may be substantially impaired.” A specific degree of disability (GdB) is not required. Chronic illnesses and stigmatization by society are also covered. By contrast, a diabetic whose condition is “well-controlled” cannot be considered disabled (para. 57, 68, 72) (Court decision.)⁸⁸
• the Federal Labor Court (BAG): The term corresponds to § 2(1) of SGB IX; “a specific degree of disability is not a determining factor” (para. 32) (court decision.)⁸⁹

According to Section 2(1) of SGB IX, people with disabilities are individuals with “physical[n], psychological[n], intellectual[n] or sensory impairments,” which, in combination with barriers, “are highly likely to prevent them from participating in society for longer than six months.” A person is considered severely disabled if they have a GdB of at least 50. With a GdB of 30 or 40, equivalent treatment may be granted if, without it, the person cannot obtain or retain a suitable job. (Legal provision.)⁹⁰ Equivalence is granted upon application by the Federal Employment Agency and takes effect on the date the application is received (Section 151(2) of SGB IX). (Legal provision.)⁹¹ According to the Federal Social Court (BSG), the fact that the applicant already has a suitable job does not preclude this, because a change in occupational fields must also be possible without discrimination (headnote, para. 21). (Court decision.)⁹²

Persons with severe disabilities and those deemed equivalent are entitled to a workplace, work environment, work organization, and work schedule that are adapted to their disability, to the extent that this is reasonable, and to part-time work if it is necessary due to their disability (Section 164(4), (5) SGB IX). (Legal provision.)⁹³ Their termination requires the prior approval of the Integration Office (Section 168 of SGB IX). (Legal provision.)⁹⁴ This does not apply during the first six months of employment or if the severe disability has not been documented at the time of termination (Section 173 of SGB IX). (Legal provision.)⁹⁵ Public employers must invite applicants with severe disabilities to an interview (Section 165 of SGB IX). (Legal provision.)⁹⁶ All employees who are unable to work for more than six weeks within a one-year period are entitled to workplace integration management (Section 167(2) SGB IX). (Legal provision.)⁹⁷

Senates of the Federal Labor Court (BAG) have reached differing conclusions on whether an employer’s failure to provide reasonable accommodations for an employee with a disability constitutes discrimination under the General Equal Treatment Act (AGG):

• “There is much to support this” (8th Senate, para. 19) (court decision.)⁹⁸
• “There is, of course, no basis for this.” Employees cannot directly invoke the UN Convention on the Rights of Persons with Disabilities against private employers. Prior to a termination during the probationary period, there is no requirement to conduct a preventive procedure under Section 167(1) of SGB IX. However, the rights under Section 164(4) of SGB IX already apply during the probationary period and in small businesses (2nd Senate, Headnote, paras. 21, 25, 31) (Court decision.)⁹⁹
• Requirement to implement preventive measures within the first six months (Cologne Regional Labor Court, superseded by the Federal Labor Court in 2025) (Court decision.)¹⁰⁰

The Federal Labor Court (BAG) approved a second trial period—limited to six months—with the support of a job coach for an employee with attention deficit disorder who is considered equivalent to a standard employee. His skills could only be fully utilized with support tailored to his condition; therefore, the extended trial period was objectively justified (para. 2, 19, 20). (Court decision.)¹⁰¹

3.3. Pre-employment Medical Examination, Occupational Physician, and Data Protection¶

Health data are special categories of personal data whose processing is generally prohibited (Art. 9(1) GDPR), with exceptions for labor law and occupational medicine (Art. 9(2)(b), (h) GDPR). (Legal provision.)¹⁰² In an employment relationship, health data may be processed if this is necessary to fulfill obligations under labor law and no overriding legitimate interest precludes it. When assessing the voluntary nature of consent, the dependency inherent in the employment relationship must be taken into account (Section 26(2), (3) BDSG). (Legal provision.)¹⁰³ Occupational physicians “are bound only by their medical conscience and must observe the rules of medical confidentiality” (Section 8(1) ASiG). (Legal provision.)¹⁰⁴

Occupational health screening does not include “verification of medical fitness for occupational requirements” (Section 2(1)(5) ArbMedVV). (Legal provision.)¹⁰⁵ Examinations may not be conducted “against the will” of employees. The preventive care certificate states only that an appointment took place, when it took place, and for what reason (§ 6 ArbMedVV). (Legal provision.)¹⁰⁶ According to the workers’ compensation insurance carriers, the following applies to fitness-for-duty examinations: (Official information.)⁷⁸

• “Aptitude assessments require a legal basis.” Specific legal bases can be found, for example, in the Driver’s License Regulation and the Locomotive Engineer’s License Regulation.
• Applicants “cannot be forced to undergo a fitness-for-duty examination”
• “Medical conditions that could lead to health limitations only in the long term may not, as a general rule, be the subject of a pre-employment medical examination.”
• The doctor “shall inform the employer solely as to whether the applicant is suitable for the position to be filled.” Diagnoses or medical findings “under no circumstances” may be disclosed.

The former occupational health examination G 25 is now known as the DGUV recommendation “Driving, Control, and Monitoring Activities” (E FSÜ) and is classified as a fitness assessment. (Government information.)¹⁰⁷ A government information office noted regarding antidepressants that taking them “is not in itself a criterion for exclusion”; each case must be examined individually. It did not comment on stimulants. (Government information.)¹⁰⁸

According to the DGUV recommendations, occupational health screening and fitness-for-work assessments must be strictly separated. Accident prevention regulations that require suitable insured persons “do not, on their own, constitute a legal basis for fitness assessments, nor does the mere existence of DGUV recommendations” (Chapter 1.2.4). The recommendation on “Driving, Control, and Monitoring Activities” lists as relevant factors, among others, “significant effects of long-term medication” and mental disorders with a risk of relapse or “with severe, pronounced symptoms and an unfavorable prognosis.” Less severe disorders are initially expected to result in fitness subject to conditions, such as limited working hours (Sections 7.4 through 7.4.4). The recommendations do not mention ADHD or stimulants. Details can be found in the section on bus drivers. (Expert recommendation.)¹⁰⁹

3.4. Medications and Drugs in the Workplace¶

Insured persons “must not, through the consumption of alcohol, drugs, or other intoxicating substances, place themselves in a state in which they may endanger themselves or others.” This “also applies to the use of medications” (Section 15(2), (3) DGUV Regulation 1). (Legal provision.)¹¹⁰ An employer must not employ insured persons who are “obviously unable to perform work without endangering themselves or others” (§ 7 (2) DGUV Regulation 1). (Legal provision)¹¹¹ According to DGUV Rule 100-001, risks may arise “in particular” from sleeping pills and sedatives, antidepressants, antiepileptics, neuroleptics, and certain pain relievers. It does not mention stimulants. For medications that are therapeutically necessary, insured individuals should consult the prescribing physician or the company physician regarding their fitness for work. With consent, consultation between the two may be advisable. (Government information.)¹¹²

Labor court rulings on drugs and medications:

• An employee is generally not required to consent to routine blood tests for alcohol or drug abuse. Such testing is permissible only in cases of “serious[r] concern” based on specific circumstances (court decision.)¹¹³
• The use of amphetamine and methamphetamine may justify the immediate termination of a professional driver’s employment, even without proof of specific impairment while driving. The case concerned illegal use, not prescription medication (Headnote, para. 18) (Court decision.)¹¹⁴
• If a breach of duty is beyond the employee’s control due to illness or addiction, there is no basis for attributing fault, so only termination for personal reasons may be considered (para. 16, alcohol dependence) (court decision.)¹¹⁵

Engaging in prohibited conduct does not preclude a work-related accident (Section 7(2) of Book VII of the Social Code). (Legal provision.)¹¹⁶ If an inability to drive caused by psychotropic drugs (benzodiazepines) was the sole material cause of the accident, the Federal Social Court (BSG) held that there was no insurance coverage, even if the medication was medically prescribed. The court left open whether this also applies to medications without intoxicating effects. (Court decision.)¹¹⁷ Uninsured causes preclude attribution if they supersede the insured cause (para. 42, alcohol). (Court decision.)¹¹⁸ No decision was found regarding prescribed stimulants and accident insurance or drug screening.

3.5. Disciplinary Law and Vocational Rehabilitation¶

In the context of disciplinary law, the Federal Administrative Court left open the question of whether ADHD can constitute a qualifying factor under § 20 of the German Criminal Code (StGB). The decisive factors are the severity of the condition and the resulting limitations on professional and social functioning, which were not present in the person with ADHD (para. 32, 36). (Court decision.)¹¹⁹ In another disciplinary proceeding, the Higher Administrative Court (OVG) had granted a civil servant significantly diminished culpability due to a recurrent depressive disorder in conjunction with persistent ADHD (demotion instead of dismissal). The Federal Administrative Court (BVerwG) dismissed the appeal. (Court decision.)¹²⁰ In a proceeding aimed at promoting vocational participation, the Regional Social Court (LSG) had dismissed the argument regarding an “ADHD-specific ability to hyperfocus” as “purely speculative.” The Federal Social Court (BSG) found the objection regarding the disregarded motion to introduce evidence to be well-founded. (Court decision.)¹²¹

The Higher Administrative Court of Lower Saxony denied a retired civil servant his pension despite his diagnosis of ADHD. While the court acknowledged that the condition had contributed to his excessive debt, it found that it did not constitute a significantly diminished capacity to form criminal intent or a mitigating factor in this chain of causation. (Court decision.)¹²⁵

4. Occupations with specific health requirements¶

4.1. Police¶

Police Service Regulation 300 (PDV 300) governs the medical assessment of fitness for police service. It is not publicly available. ADHD and hyperkinetic disorders are listed as conditions that preclude fitness for police service in:

• the version cited by an administrative court in 2021, whose Section 11.1.2 lists, among other things, psychoses, depression, anxiety and personality disorders, suicidal tendencies, and “hyperkinetic syndromes” (Ansbach Administrative Court, para. 40) (Court decision.)¹²⁶
• a revised version published in response to a Freedom of Information request (drafts from 2016 to 2018), in which section 11.1.2 reads “Neuropsychological deficits, e.g., ADD/ADHD.” It also lists disorders “beginning in childhood and adolescence” (11.1.9), and it explicitly requires inquiries into “prior psychiatric and psychotherapeutic treatment, as well as the use of medications and drugs.” It is unclear whether this version is in effect: (Administrative regulation.)¹²⁷

As an administrative regulation, PDV 300 defines the concept of fitness for police service (VG Ansbach, para. 38). (Court decision.)¹²⁶ However, the mere listing of a medical condition in PDV 300 does not allow for a blanket conclusion of unfitness. A prognosis on a case-by-case basis is required. (Court decision.)¹²⁸ No stricter prognostic standard applies to police applicants than to other civil servants (see Section 5.1). (Court decision.)¹²⁹

The Federal Police requires information and medical findings regarding psychiatric disorders, “including those in previous years (e.g., depression, anxiety disorders, obsessive-compulsive disorder, ADD/ADHD),” specialist medical reports for completed treatment, and asks about “conditions requiring long-term medication.” (Official information.)¹³⁰ The Berlin Police information sheet lists mental disorders in general but does not mention ADHD. (Official information.)¹³¹

The Berlin Administrative Court ruled that the rejection of an applicant for the police force on the grounds of ADHD during childhood and adolescence was unlawful. According to a court-ordered expert opinion, the applicant no longer exhibited any ADHD symptoms in adulthood. Neuropsychological tests revealed “results within the normal range or even above average.” Medication had been discontinued at age 19. A recurrence was deemed unlikely. (Court decision, secondary citation from the press release regarding Attorney Bertling.)¹³² * (Court decision, secondary citation regarding Haufe.)*¹³³ According to another report, the expert estimated the probability of permanent incapacity for duty or significant absences at “less than ten percent.” (Court decision, secondary citation via Rechtslupe.)¹³⁴ According to the court’s annual report, two cases (VG 26 K 352.14 and VG 26 K 29.15) involved applicants who had been deemed ineligible due to ADHD during childhood and adolescence. (Government agency information.)¹³⁵

The Saxon Higher Administrative Court upheld the dismissal of a police cadet diagnosed with ADHD in adulthood. The police physician had determined that attention deficits constituted grounds for exclusion in light of the use of firearms, the use of direct coercion, shift work, and special-authorization vehicle operations. The court also considered it appropriate to note that the regular intake of Ritalin—a controlled substance—could not always be guaranteed while on duty (para. 8, 10). (Court decision.)¹³⁶

In its application form, the Hessian police explicitly cite ADHD as an example of a mental health condition that generally precludes eligibility for police service, and also lists current or past medication use as grounds for exclusion. Applicants must certify in writing that they do not have any of these health conditions. (Government information.)¹³⁷ Courts, on the other hand, require a case-by-case assessment of medical fitness (see Section 5.1).

The Munich Administrative Court upheld the rejection of a police applicant who had failed to disclose ADHD—for which he had received medication until 2020—in the police medical questionnaire, even though the questionnaire explicitly asks about ADHD (para. 25, 27). An applicant must disclose all medically diagnosed and treated conditions on his or her own initiative, and a correction provided only upon request does not dispel doubts regarding character suitability (para. 28 et seq.). The court left open the question of whether the applicant’s previous ADHD precluded his fitness for police service (para. 31). (Court decision.)¹³⁸

According to the federal government, Police Service Regulation 300 has been under revision since 2018 because case law regarding the medical fitness of candidates for civil service positions has changed the assessment criteria (response to Question 15). (Government information.)¹³⁹ The original document on the Bundestag server has not been verified.

4.2. German Armed Forces¶

The “Military Medical Assessment” regulation, in its July 2021 version, classifies “ADHD (even when treated) with good psychosocial integration” under health category III 13 (3). (Administrative regulation.)¹⁴⁰ This results in the following:

• Fitness for military service (fitness level 1 or 2), because Grade III does not constitute unfitness for military service
• For officer candidates: “No assignment is ruled out”
• For enlisted personnel and noncommissioned officers, exclusion applies only to specific assignments (fire safety, signal operations, certain driver assignments, military driving instructors, aircraft mechanics, and aircraft equipment technicians)
• a prohibition on technical uses by the Military Counterintelligence Service
• in cases of mental disorders that currently result in a significant or permanently substantial impairment of the ability to adapt, function, or participate in society, temporary or permanent unfitness for military service (Grade V or VI)
• In cases of doubt, a psychiatric evaluation by a specialist is required before assigning Grade III

Since March 2024, health classification codes have been included in a separate, non-public document. It remains unclear whether the classification for ADHD has remained the same in that document. Classifications IV through VI preclude enlistment as a temporary or career soldier. (Administrative regulation.)¹⁴¹ According to information from the Bundeswehr (as of 2019), ADHD “does not in and of itself constitute grounds for exclusion from a career or service in the Bundeswehr.” There are no specific guidelines for mental illnesses treated with medication. (Official information.)¹⁴²

The questionnaire under the Conscription Act asks about height, weight, severe disability or equivalent status, education, and self-assessment of physical fitness; it does not ask about mental illnesses (Section 15a WPflG). (Legal provision.)¹⁴³ During the medical examination, conscripts undergo a “thorough medical examination of their mental and physical fitness” and must, upon request, provide information and submit documents (Section 17 WPflG). (Legal provision.)¹⁴⁴ The categories of fitness are fit for military service, temporarily unfit for military service, and unfit for military service (Section 8a of the Military Service Act). (Legal provision.)¹⁴⁵ According to the Federal Ministry of Defense, the new military service is scheduled to take effect on January 1, 2026. The questionnaire will consist of twelve questions and will be mandatory for men but voluntary for women. (Government information.)¹⁴⁶

According to the Bundeswehr Personnel Office, even ADHD that is being treated can result in a determination of “fit for duty and eligible for assignment with restrictions” if the individual is well integrated psychosocially and their ability to adapt, perform, and function in a group is only marginally impaired. Earlier statements based on ZDv 46/1 and a 2012 letter from the Federal Ministry of Defense (BMVg) are therefore outdated. (Official information, published by ADHD Deutschland e. V.)¹⁴⁷

4.3. Aviation¶

For pilots, neither the EU Regulation (Part-MED) nor EASA’s interpretive materials explicitly mention ADHD. (Legal provision.)¹⁴⁸ The following apply:

• Psychiatric evaluation prior to a fitness-for-duty determination in cases of a diagnosis or documented history of a “mental or behavioral disorder” (MED.B.055(d)), with referral to the appropriate authority
• During the initial examination for Class 1, a comprehensive psychological evaluation that also assesses “childhood behavioral problems” (AMC1 MED.B.055)
• Generally, individuals taking psychoactive medication that may impair flight safety are deemed unfit. If stability while on long-term medication is confirmed, conditional fitness (OML) may be considered (AMC1 MED.B.055(e)(3))
• Drug screening, including for amphetamines
• No exercise of rights for medications that may impair safe performance, and aeromedical advice when starting regular medication (MED.A.020)

A corresponding rule applies to air traffic controllers (ATCO.MED.B.055). (Legal provision.)¹⁴⁹ No medical certificate is required for the Part-66 maintenance personnel license. People with learning disabilities, explicitly including “attention deficit hyperactivity disorder,” are not disadvantaged under these provisions. (Regulatory information.)¹⁵⁰ A research report commissioned by EASA found that the U.S. Federal Aviation Administration (FAA) has its own decision-making guidelines for ADHD, whereas EASA does not. (Research report.)¹⁵¹

The Cologne Administrative Court rejected the argument that cannabis is used for self-treatment of ADHD as grounds for overturning the revocation of a reliability determination under aviation security law (para. 48). (Court decision.)¹⁵²

In 2011, the Australian Civil Aviation Safety Authority (CASA) deemed ADHD to be a concern in the context of aeromedical certification, in part because stimulants have a short-term effect and can impair the ability to recognize fatigue. According to guidelines drafted in collaboration with the New Zealand authority, a medical certificate was generally only considered if the condition was in remission without treatment, and medication had to have been discontinued for at least six months. Required documentation included, among other things, medical records dating back to the diagnosis, school and employment records, as well as information on traffic violations and criminal convictions. The authors were employees of the agency; the current status of CASA’s rules was not reviewed. (Narrative review with draft guidelines from an agency, E 4.)¹⁵³

4.4. Railroad¶

A train operator “must not suffer from any health disorders or take any medications or substances” that could, in particular, cause a “decrease in attention or concentration.” The examination includes a “screening for psychotropic substances, such as illicit drugs or psychotropic medications” and a psychological test assessing, among other things, “attention and concentration.” The employer must ensure that a train operator is not under the influence of substances that could impair concentration, attention, or behavior while on duty (Annex 4, § 12(5) TfV). ADHD is not specifically mentioned. (Legal provision.)¹⁵⁴

4.5. Seafaring¶

The Maritime Medicine Regulation explicitly lists “attention disorders (e.g., ADHD)” under “Other Disorders,” citing “impaired performance and reliability, and effects on social behavior” as the rationale. The Consequences are: (Legal provision.)¹⁵⁵

• generally, permanent unfitness for naval service (P), “provided that it is assessed that safety-related consequences may arise”
• limited suitability (R), “provided that suitability applies only to certain tasks”
• Suitability, “provided that no adverse effects at sea are expected. No incidents during past sea duty”

The physician evaluates medications that may affect the central nervous system on a case-by-case basis (Appendix 1, No. 5.2). Fitness for naval service with restrictions should be the exception (No. 6.1). (Legal provision.)¹⁵⁵ The medical history questionnaire asks about mental health conditions and regular medication use. (Official information.)¹⁵⁶

4.6. Guns and Hunting¶

A person is deemed unfit to possess a firearm if there are facts that justify the assumption that the person is “addicted to alcohol or other intoxicating substances, mentally ill, or mentally disabled,” or, due to personal circumstances, is unable to handle firearms with care and in an appropriate manner. If there are concerns, the authority will order a medical or psychological evaluation. Anyone under the age of 25 must always submit a certificate of mental fitness to obtain their first permit to acquire and possess a firearm (§ 6 WaffG). (Legal provision.)¹⁵⁷ Only individuals who have not had a therapeutic relationship with the person with ADHD within the last five years may serve as experts. For individuals under 25 years of age, an expert opinion based on recognized maturity assessment procedures is generally sufficient (§ 4 AWaffV). (Legal provision.)¹⁵⁸ A hunting license requires personal suitability under the Weapons Act (§ 17 BJagdG). (Legal provision.)¹⁵⁹ These provisions do not mention ADHD. No ruling regarding ADHD and suitability under weapons law was found.

The Bavarian Higher Administrative Court (BayVGH) interprets the term “mentally ill” in § 6 of the Weapons Act (WaffG) narrowly to mean a severe disorder of mental functioning and further refers to the serious mental illnesses listed in No. 7 of Appendix 4 to the FeV (para. 21). Neither the court nor Annex 4 of the FeV mentions ADHD. (Court decision.)¹⁶⁰ No decision was found that denied a firearms permit solely on the basis of ADHD or its treatment.

4.7. Healthcare professions, firefighting, security, and passenger transportation¶

Licensure requires that the applicant “is not medically unfit to practice the profession.” This applies according to:

• the Federal Medical Code (Section 3(1)(3)) (Legal provision.)¹⁶¹
• the Psychotherapists Act (legal provision)¹⁶²
• the Nursing Professions Act (legal provision)¹⁶³
• the Federal Pharmacists’ Code (legal provision)¹⁶⁴

A diagnosis of ADHD “does not necessarily and inevitably lead to a fire chief being medically unfit for duty.” ADHD is a condition “with a highly nonspecific clinical picture” featuring “fluid transitions to so-called normality.” In this case, the ADHD alleged by the municipality was not proven (Ansbach Administrative Court, para. 31, 33 et seq.). (Court decision.)¹⁶⁵ For fire department respiratory protection drills, the “influence of alcohol, drugs, or medication” is a disqualifying factor. (Official information.)¹⁶⁶ A license for the security industry (§ 34a GewO) requires reliability, sound financial standing, and professional competence, but not medical fitness. (Legal provision.)¹⁶⁷ For taxis, rental cars, and medical transport, the rules governing the driver’s license for passenger transportation apply (see Section 2.2). (Legal provision.)⁴⁰

The Bavarian Higher Administrative Court (BayVGH) upheld the suspension of an amphetamine-dependent physician’s medical license, even though the physician cited a newly diagnosed and medically treated ADHD as the cause of his addiction (paras. 41–45). Stabilization resulting from ADHD treatment would have had to be substantiated by qualified assessments of professional fitness by public health officials or medical specialists (para. 44). The ADHD diagnosis itself did not preclude the medical license; the decisive factor was the addiction. (Court decision.)¹⁷⁵

To obtain a medical license, a medical certificate no more than one month old is required, stating that there is no health-related disqualification (§ 39 (1), sentence 2, no. 6 ÄApprO). (Legal provision.)¹⁷⁶ Suspension of a medical license requires that the holder subsequently lose their fitness to practice or refuse to undergo a mandated examination, and the suspension must be lifted as soon as the grounds for it no longer apply (Section 6 BÄO). (Legal provision.)¹⁷⁷ ADHD is not mentioned in either of these regulations.

4.8. Bus driver¶

4.8.1. Driver’s License¶

Driver’s licenses for Classes D1, D1E, D, and DE are issued for a maximum of five years. If an applicant is only conditionally eligible, the authorities may issue the license with restrictions or conditions (Section 23(1), (2) FeV). (Legal provision.)¹⁷⁸ It is renewed if the holder demonstrates fitness in accordance with Annex 5 No. 1 of the FeV (medical examination) and visual acuity, and there are no facts indicating a lack of the necessary requirements. After reaching the age of 50, proof of meeting the performance requirements specified in Appendix 5, No. 2 of the FeV is also required (Section 24(1) of the FeV). (Legal provision.)¹⁷⁹ Annex 5 No. 2 of the FeV thus requires these performance tests—covering endurance, orientation, concentration, attention, and reaction time—for bus license classes only upon initial issuance and for renewals for individuals aged 50 and older. The supporting documents must not be more than one year old at the time of application (Annex 5, No. 3, FeV). (Legal provision.)³⁹ The official form for the medical certificate consists of two parts. Part I, containing the health questionnaire—including No. 12, “Mental Illnesses/Addiction (Alcohol, Drugs, Medications)”—“remains with the physician.” Part II is submitted to the authorities; it certifies whether “there are signs of illnesses that could preclude fitness or conditional fitness” and, if applicable, lists the findings. “As a rule, a preliminary examination (so-called ‘screening’) is sufficient” for the evaluation. (Legal provision.)³⁹ The template does not specify whether a physician must enter a diagnosed ADHD under No. 12 or whether they must classify it as a sign of a condition that precludes fitness. (ADxS assessment.)

In addition to a Class D driver’s license, bus and tour bus drivers do not need a separate license to transport passengers (Section 48(2)(4) of the German Driver’s License Regulations (FeV)). (Legal provision.)⁴⁰

Neither the Road Traffic Act nor the Driver’s License Regulation contains a requirement to notify the driver’s license authority of a new medical condition, diagnosis, or medication. The authority takes action if it becomes aware of facts that give rise to concerns regarding the driver’s fitness to drive (Section 46(3) FeV). (Legal provision.)¹⁸ Anyone who, due to mental impairments, cannot navigate traffic safely may only participate if precautions have been taken. This obligation rests with “the road user themselves or a person responsible for them” (Section 2(1) FeV). (Legal provision.)¹⁹ A traffic medicine expert determined that there is “no obligation to report.” However, treating physicians must inform the person with ADHD about the situation. (Technical information, presentation slides.)¹⁸⁰

With regard to long-term treatment with medications, Appendix 4 of the FeV makes no distinction between passenger cars and buses. In both categories, a person is deemed unfit only if there is an “impairment of the ability to operate motor vehicles below the required level” (No. 9.6.2). Annex 4 takes a stricter stance regarding other mental illnesses. After the resolution of an affective psychosis, fitness for Group 2 is granted only “if the individual is symptom-free” (No. 7.5.2). (Legal provision.)²¹ The Cologne Administrative Court applied this standard to cases of very severe depression (para. 25, by analogy). (Court decision.)¹⁸¹ The assessment guidelines justify stricter requirements for truck and bus drivers based on longer driving times, the potential severity of accidents, and the risk potential associated with vehicle use, which includes the transportation of passengers (Chapters 3.5 and 3.9.6). They do not mention methylphenidate, lisdexamfetamine, or atomoxetine, and do not contain a separate chapter on professional drivers. For Group 2, higher percentile ranks apply to the performance tests (see 2.1). Even in cases of performance deficits, conditional eligibility is possible, for example, with the requirement to drive only within specified driving times or within a limited radius (Chapter 2.5). (Official information.)²⁴

For the initial phase of medication treatment, the assessment guidelines do not recommend a general prohibition on driving. They require “particularly careful medical supervision during the initial phase,” followed by proof of medical supervision of the treatment at appropriate intervals. Higher doses of psychoactive medications can be expected to affect driving safety, “regardless of whether the underlying condition still affects the person with ADHD’s ability to adapt and perform” (Chapter 3.14.2). (Government information.)²⁴ According to the Bavarian Higher Administrative Court (BayVGH), it cannot necessarily be assumed that all patients are fit to drive after a period of medication adjustment. In cases of doubt, it considered psychological performance testing to be appropriate (para. 24, antidepressants and lithium, analogy). (Court decision.)¹⁸² For holders of a Group 2 license with a mental illness, authorities typically asked whether the requirements for Group 2—“with the necessary attention, resilience, reaction time, and ability to concentrate”—were met (para. 9, panic disorder, analogy). (Court decision.)¹⁸³

4.8.2. Bus Companies and Passenger Transportation Law¶

The BOKraft applies to public transit and tour bus companies. The operator may not order or permit operations “if he knows or ought to know that members of the driving or operating personnel are not qualified and suitable to ensure safe and proper transportation” (Section 3(1), sentence 3, BOKraft). (Legal provision.)¹⁸⁴ Drivers must “exercise the special care required by the fact that persons have been entrusted to their care for transportation” (Section 7 BOKraft). (Legal provision.)¹⁸⁵ The following applies to bus drivers pursuant to Section 9 BOKraft: (Legal provision.)¹⁸⁶

• “If a driver has a medical condition that impairs his or her ability to drive a vehicle safely in traffic, he or she may not drive” (Paragraph 2)
• Such illnesses “must be reported to the employer immediately” (para. 3)

In scheduled service, drivers are prohibited from “consuming alcoholic beverages or other substances that impair their ability to perform their duties while on duty or on call, or from commencing a trip while under the influence of such beverages or substances” (Section 8(3)(1) BOKraft). The same applies to occasional bus services (Section 8(4) BOKraft). (Legal provision.)¹⁸⁷ Violations of Sections 3, 8, and 9 constitute administrative offenses (Section 45 BOKraft) (Legal provision.)¹⁸⁸ , which may be punishable by a fine of up to 10,000 euros (Section 61(2) PBefG). (Legal provision)¹⁸⁹ Section 8 of the BOKraft does not provide for an exception for medically prescribed medications. However, both provisions are contingent on an actual impairment, not on a diagnosis or on the act of taking the medication per se. According to the wording, well-managed ADHD that does not impair driving safety is not subject to the reporting requirement. (ADxS assessment.) No case law regarding § 9 BOKraft and mental illnesses was found. The required curriculum for the professional driver’s qualification includes the “effects of alcohol, medications, or any substance that may cause a change in behavior” (Annex 1 No. 3.4 BKrFQV). The law governing professional driver qualifications does not impose any health requirements. (Legal provision.)¹⁹⁰

4.8.3. Investigation by the Employer¶

According to the Accident Prevention Regulation for Vehicles, an employer may only entrust the operation of vehicles to employees “who are physically and mentally fit” (Section 35(1)(2) DGUV Regulation 70). (Regulatory framework.)¹⁹¹ When assigning tasks, the employer must consider whether employees are capable of complying with safety regulations (Section 7 ArbSchG). (Legal provision.)¹⁹² Employees must also ensure the safety of persons affected by their actions (Section 15(1) ArbSchG). (Legal provision.)¹⁹³ The DGUV recommendation “Driving, Control, and Monitoring Activities” (E FSÜ, formerly G 25) is a guideline for occupational physicians. According to the DGUV recommendations, fitness assessments “generally require a specific reason and a legal basis.” Accident prevention regulations requiring suitable insured persons “do not in and of themselves constitute a legal basis for fitness assessments, nor does the mere existence of DGUV recommendations” (Chapter 1.2.4). Fitness-for-duty assessments may be conducted routinely only when there is a legal basis; however, they may also be conducted “when actual circumstances in an individual case provide a specific reason” (E FSÜ, Section 1). (Expert recommendation.)¹⁰⁹ In practice, according to the State Occupational Safety and Health Agency of North Rhine-Westphalia (NRW), the E FSÜ is often made mandatory through a company agreement. (Information from the authorities.)¹⁹⁴ The E FSÜ applies to the operation of vehicles in general (Section 6.1). Relevant legal regulations with their own requirements must be given priority (Section 7.4, footnote 2). For bus drivers on public roads, these are primarily the Driver’s License Regulation and the Assessment Guidelines. (Expert recommendation.)¹⁰⁹ In terms of content, the E FSÜ stipulates: (Expert recommendation.)¹⁰⁹

• The medical history includes questions about “current (long-term) medication” and “neurological and psychiatric disorders” (Section 7.1)
• Among other factors, she cites as relevant to the assessment “significant effects of long-term medication,” “chronic alcohol abuse, drug dependence, or other forms of addiction,” and “mental disorders or illnesses, even if they have subsided, provided that a relapse cannot be sufficiently ruled out. “Mental disorder with severe, pronounced symptoms and an unfavorable prognosis.” The individual severity must be taken into account, and it must be determined “whether performing the job is possible in the specific case” (Section 7.4)
• If the medical conditions are less severe, the physician should determine whether the individual is fit for work under certain conditions, such as “limiting the duration of work or assigning the individual to jobs that pose a lower risk to third parties.” If a change in the severity of the condition is expected, shorter time limits are recommended. Only in the case of particularly serious conditions, where such measures offer no prospect of success, is the individual “generally deemed unsuitable” (Sections 7.4.2 through 7.4.4).
• Examinations may not be conducted against the insured person’s will. If they refuse a required examination, a determination of fitness cannot be made, which may have “consequences under labor law” (Sections 7.1, 7.2)
• A reason for a reassessment during the course of the employment relationship may be “a well-founded, situation-specific doubt regarding suitability” (Section 7.3)
• The insured person receives a certificate stating the results of the examination, which they usually forward to their employer (Section 5)

The DGUV recommendations make no mention whatsoever of ADHD, stimulants, or atomoxetine (search conducted throughout the entire document). According to these criteria, ADHD is not automatically classified as a relevant condition simply because of the diagnosis; rather, it is only considered relevant in cases of severe symptoms with a poor prognosis or when the medication has significant effects. Even then, eligibility must first be assessed subject to certain conditions. (ADxS assessment.) The right to request a medical examination arises primarily from collective bargaining agreements:

• TVöD: “for justified reasons”—proof must be provided by a medical certificate from a company physician, personnel physician, or public health physician; costs are borne by the employer (Section 3(4) TVöD) (Regulations.)¹⁹⁵
• TV-N NW: “When warranted,” an examination by the company physician or designated physician to determine whether the employee “is capable of performing the duties required under the employment contract” (Section 4(3) TV-N NW) (Regulations.)¹⁹⁶
• TV-N Hessen: If there are reasonable grounds and a permanent inability to drive is certified, “additional expert opinions shall be consulted” (Section 3(2) TV-N Hessen) (Regulations.)¹⁹⁷

According to the Federal Labor Court (BAG), a public bus driver’s repeated refusal to undergo a medical examination by the company physician pursuant to § 3(4) of the TV-N Berlin collective bargaining agreement may justify termination (para. 17). The BOKraft itself does not stipulate an obligation to cooperate with medical examinations (para. 19). The employer may require cooperation “only in cases of justified doubts regarding the employee’s ability to work.” The employee is not required to accept the examination results; they are subject to full judicial review (para. 22). (Court decision.)¹⁹⁸ “Just cause” requires objective circumstances “which, based on a reasonable, realistic assessment, give rise to serious concern that the employee is not fit for work” (para. 29). The employee’s right to privacy is protected by medical confidentiality (para. 37). (Court decision.)¹⁹⁹ According to this standard, an ADHD diagnosis alone is unlikely to constitute grounds for concern; however, instances of poor performance on the job, accidents, or indications from the treating physician would. (ADxS assessment.) Employees have a secondary duty not to place themselves, either during or outside of working hours, in a state in which they could endanger themselves or others at work (para. 18). (Court decision.)¹¹⁴ What consequences this may have for informing the employer about taking medications that affect driving ability has not been decided in publicly available case law.

4.8.4. Hiring Process, Inability to Work, and Ineligibility for the Transportation Service¶

A person is considered unable to work if, due to illness, they can no longer perform their most recent job. The determining factor is “the specific conditions that characterized the previous job” (Section 2(1) of the Unability-to-Work Guidelines). Medical treatment does not constitute incapacity for work, “unless the medical treatment itself” results in incapacity for work (Section 3(2)). (Administrative regulation.)²⁰⁰ A bus driver who is temporarily prohibited from driving a bus due to side effects during the onboarding phase may therefore be unable to work, even if he or she could perform office work. The guideline does not expressly address this case. (Assessment by ADxS.) In the event of incapacity for work through no fault of the employee, the employer continues to pay wages for up to six weeks (Section 3(1) EFZG). (Legal provision.)²⁰¹ A Hessian Regional Labor Court held that it was possible for a bus driver to be prohibited from driving a bus due to medication affecting the central nervous system, even though he drove a car in his private life (para. 18, 19, reproduction of the Regional Labor Court’s assessment). (Court decision.)²⁰² On the other hand, according to the Cologne Regional Labor Court (LAG), anyone who is permanently unfit to drive a bus and offers their services is “admittedly willing to work, but, viewed objectively, not capable of working” and has no claim to wages based on default of acceptance (para. 17, diabetes, analogy). (Court decision.)²⁰³

In a survey conducted by the Administrative Occupational Safety and Health Association among 1,419 active and former public transit drivers, 26.6% reported at least one instance of temporary unfitness to drive. The main causes of permanent unfitness for driving were mental health conditions, musculoskeletal disorders, and cardiovascular diseases. ADHD was not recorded separately. (Survey, n = 1,419, Q4.)²⁰⁴

4.8.5. Termination and Continued Employment¶

Labor courts have required the following prior to termination due to illness or unfitness to drive:

• a definitive negative prognosis. In the case of a bus driver with a mental illness, an expert opinion affirmed his fitness to drive a passenger car but ruled him unfit to drive buses and trucks. The testing psychologist did not consider the divided attention tests to be conclusive and recommended a driving test with a bus driving instructor. The termination was invalid due to the lack of a negative prognosis (para. 10, 11, 51, by analogy) (court decision.)²⁰⁵
• the offer of alternative employment, including through a staffing pool for employees who are unable to perform driving duties. In the case of a light rail operator, the clinic had advised against further work in passenger transportation due to the “necessity of taking medication” (headnote, para. 25, analogy) (court decision.)²⁰⁶
• the consideration of an alternative position instead of a notice of termination with the option of a new position, for example, in tram service in the case of hearing loss (Headnote 1, by analogy) (Court decision.)²⁰⁷
• the employer’s specific demonstration of a lack of opportunities for continued employment (headnote, analogy) (court decision.)²⁰⁸
• the option to implement treatment measures identified as effective within the workplace integration management process (para. 13) (court decision)²⁰⁹ , as applied to a bus driver experiencing psychological distress (court decision)²¹⁰

For a newly diagnosed case of ADHD, such a measure could involve starting medication followed by a suitability assessment. (ADxS Assessment) Employees with severe disabilities and those deemed equivalent are entitled to employment in which they can make the fullest possible use of their abilities. This entitlement does not apply if it conflicts with occupational safety regulations issued by the government or occupational accident insurance associations (Section 164(4), sentence 1, no. 1, and sentence 3 of SGB IX). (Legal provision.)⁹³ In the context of workplace integration management, the company physician is consulted as needed (Section 167(2), sentence 3, SGB IX). (Legal provision.)⁹⁷

Collective bargaining agreements in local public transportation provide varying levels of protection in the event of an inability to perform driving duties:

• TV-N NW: After more than 15 years of service, termination is only possible for cause or to demote the employee to a lower pay grade if the employee is permanently unable to perform their duties (Section 20(6) TV-N NW) (Regulations.)¹⁹⁶ . Some companies have established employee pools for employees who are permanently unable to work through works agreements (para. 29, not legally binding) (Court decision.)²¹¹
• TV-N Hessen: An employee who becomes unable to perform driving duties through no fault of their own will retain their previous scheduled pay upon reassignment only if they have reached the age of 55 and have been with the company for more than 15 years (Section 22(13) TV-N Hessen) (Regulations.)¹⁹⁷
• TV-N Bayern: Income protection in the event of inability to perform transportation duties is granted only following a work-related accident or occupational disease through no fault of the employee (Section 5(4) TV-N Bayern, accessed only via a search tool) (Regulations.)²¹²
• TV-N Berlin: Compensation for long-term employees who become unable to work through no fault of their own, calculated dynamically (para. 6, 17) (Court decision.)²¹³ , only for employees who had an employment relationship with the BVG as of August 31, 2005 (headnote) (Court decision.)²¹⁴

Inability to work as a driver alone does not constitute grounds for a pension. A Berlin bus driver was forced to accept a position as a doorman. (Court decision.)²¹⁵

4.8.6. Criminal Law, Liability, and Accident Insurance¶

Anyone who operates a vehicle even though they are “unable to operate the vehicle safely due to mental or physical impairments,” and thereby endangers other people, shall be punished by imprisonment for up to five years; in cases of negligence, the penalty is imprisonment for up to two years (Section 315c(1)(1)(b), (3) of the German Criminal Code (StGB)). (Legal provision.)⁶³ A driver must ascertain whether, based on his or her abilities, he or she is capable of meeting the requirements of road traffic. However, there is no rule of thumb stating that a driver can always recognize his or her own inability to drive (Headnote 1). (Court decision.)²¹⁶ The mere use of psychoactive medications does not prove an inability to drive. There must be evidence that the driver’s overall performance was impaired to such an extent that the vehicle could no longer be safely controlled (para. 7, 10; methadone and benzodiazepines). (Court decision.)²¹⁷ The Detmold Social Court did not treat medically prescribed psychotropic drugs the same as alcohol in the context of accident insurance, because they often enable insured persons to return to work. The accident insurance provider must provide full proof of medication-induced unfitness to drive (para. 22, 23, 34). In 1985, the Federal Social Court (BSG) had ruled differently regarding benzodiazepines (see 3.4). (Court decision.)²¹⁸ No decisions were found regarding employee liability or the right of recourse of the motor vehicle liability insurer in the event of accidents occurring while under the influence of prescribed medications.

5. Appointment to the Civil Service¶

5.1. Medical Fitness and Prognosis Criteria¶

Every German citizen has “equal access to any public office in accordance with his or her aptitude, qualifications, and professional performance” (Art. 33, para. 2, GG). (Legal provision.)²¹⁹ Appointments must be made without regard to a disability (§ 9 BeamtStG). (Legal provision.)²²⁰ A lifetime appointment requires successful completion of the probationary period (§ 10 BeamtStG). (Legal provision.)²²¹ Probationary civil servants may be dismissed if they have not proven themselves. If the sole reason is a lack of medical fitness, the possibility of reassignment must be considered beforehand (Section 23(3) of the Civil Service Act (BeamtStG)). (Legal provision.)²²² The General Equal Treatment Act (AGG) applies mutatis mutandis to civil servants (Section 24 AGG). (Legal provision.)²²³

According to the Federal Administrative Court, a candidate is deemed suitable “if he or she is physically, mentally, and character-wise up to the task of the office sought” (para. 10). An applicant is not medically fit “if there are factual indications justifying the assumption that it is highly probable that incapacity for duty will occur before reaching the statutory retirement age” (Headnote 2). The previous standard, under which premature incapacity for duty had to be ruled out with a probability bordering on certainty, has been abandoned (para. 16). The employer has no discretion in this matter. The medical report must “set forth the relevant facts and findings, explain the examination methods, and disclose its hypotheses and their basis” (para. 23). (Court decision.)²²⁴ Additional principles:

• A candidate is also deemed medically unfit if it is highly probable that he or she will be regularly absent due to illness over a period of years. If, after all available evidence has been exhausted, this cannot be either established or ruled out, the burden of proof falls on the employer (Headnote, para. 28) (Court decision.)²²⁵
• Statistical findings are only usable if they are “based on a sound foundation.” Specific aspects of individual cases must be taken into account (para. 32) (Court decision.)²²⁵
• If a medical condition was already known prior to the appointment on a probationary basis, the employer may take it into account in the permanent appointment only “if the basis for its assessment has changed in the meantime” (para. 15) (Court decision.)²²⁵
• The applicant must provide evidence of current medical fitness. Only the long-term prognosis is the responsibility of the employer (para. 13 et seq., recurrent mental Disorder) (court decision.)²²⁶
• “Overwhelming probability” means “more than 50 percent.” No stricter standard applies to police service. A higher probability compared to the general population does not in itself justify a rejection (Guiding Principles, paras. 25, 30, 32) (Court decision.)¹²⁹

The Federal Ministry of the Interior implemented the standard of “predominantly (i.e., more than 50 percent) likely” with immediate effect. (Government information.)²²⁷ The National Ethics Council had already proposed the threshold of more than 50% in 2005. According to that report, mental illnesses and behavioral disorders were the most common cause of early disability, accounting for 32% of cases. (Expert recommendation.)²²⁸

The Higher Administrative Court of North Rhine-Westphalia (OVG NRW) ordered the employer to reinstate a retired civil servant who had been dismissed, in part, on the grounds of ADHD with reduced stress tolerance, because this diagnosis had not been made in a verifiable manner and did not preclude him from performing his duties (para. 67 et seq.). (Court decision.)²²⁹

5.2. Mental Illness, Psychotherapy, and ADHD¶

According to the Baden-Württemberg Ministry of Education and Cultural Affairs, medical fitness “also includes physical and mental fitness.” “Psychotherapeutic treatment does not, therefore, generally preclude appointment as a civil servant.” If psychotherapy is reported, the physician will assess whether the applicant has sufficient mental stability. Pre-existing conditions and treatments must be disclosed. (Official information.)²³⁰ In Berlin, as of March 2024, four out of approximately 1,600 tenured teachers were not granted civil service status due to a lack of medical fitness. The evaluators based their assessments on the AWMF guidelines. (Official information.)²³¹

No published decision regarding civil service employment for individuals with ADHD outside the police force (Section 4.1) was found. Nor was any regulation or decision found regarding fitness for duty while on stimulant medication. According to the standards of the Federal Administrative Court (BVerwG), treatment with stimulants that does not currently impair performance is not a matter of current fitness for duty, but rather of prognosis, for which the employer requires concrete evidence. (ADxS assessment.)

5.3. Medical Examination by a Public Health Officer and Duty to Tell the Truth¶

The appointment must be rescinded retroactively if it was “brought about by coercion, fraudulent misrepresentation, or bribery” (Section 12(1) of the Civil Service Act [BeamtStG]; similarly, Section 14(1) of the Federal Civil Service Act [BBG], with a six-month deadline from the date of discovery). (Legal provision.)²³² * (Legal provision.)*²³³ Official survey forms ask for: (Government information.)²³⁴

• “Mental Illnesses”
• psychotherapeutic or psychiatric counseling or treatment
• “Taking medication regularly”
• “Have you taken psychiatric medications in the past?”
• Severe disability or equivalent status
• a confirmation that the form has been “completed truthfully and in full”

The PDV 300 medical history questionnaire also asks about illnesses “that are not specifically listed” and about treatment or counseling from a neurologist or psychotherapist. (Government information.)²³⁵

Concealment constitutes deception if the applicant was asked about the matter or knows that the fact is relevant to the decision. The burden of proof for fraudulent intent rests with the authority. Conditional intent is sufficient (SächsOVG, para. 14). (Court decision.)²³⁶ * (Court decision.)*²³⁷ The revocation of the appointment was upheld in:

• a previously undisclosed epileptic seizure, even if the medical history form did not explicitly ask about it, because medical conditions relevant to fitness for service that are not explicitly mentioned must also be disclosed (BayVGH, para. 17) (court decision.)²³⁸
• concealment of medical conditions on the medical history form, whereby the misrepresentation “may also be made to the public health officer” (Bayreuth Administrative Court, para. 49) (Court decision.)²³⁹
• a compulsive disorder that has existed since adolescence and was kept secret. The significance of prior mental health conditions for fitness “is virtually self-evident” (Court decision, secondary citation via Attorney Bertling.)²⁴⁰

The medical certificate required for a provisional or permanent appointment in Baden-Württemberg states that it “cannot be determined” that there is a “high probability” of significant absences or premature incapacity for duty. (Government information.)²⁴¹

The Higher Administrative Court of North Rhine-Westphalia (OVG NRW) upheld the dismissal of a correctional officer trainee who had taken Ritalin without a prescription to enhance his academic performance and had passed it on to fellow trainees, citing doubts about his character and suitability (para. 19 et seq.). (Court decision.)²⁴² The lower court had pointed out that while methylphenidate is prescribed for ADHD, it is misused as a “brain-doping” agent (para. 22, 24). A negative drug test did not exonerate the candidate because the test did not screen for methylphenidate (para. 35). (Court decision.)²⁴³ In parallel disciplinary proceedings, the Düsseldorf Administrative Court suspended the provisional suspension from duty because the employer had not specified the nature and severity of the misconduct (para. 53). (Court decision.)²⁴⁴

5.4. Applicants with severe disabilities and those deemed equivalent¶

Exceptions apply only to people with severe disabilities and those deemed equivalent. For them, “only the minimum level of physical fitness is required.” For applicants with a GdB below 50 who are not deemed equivalent, such exceptions “are also not required” (para. 35 et seq., 40). (Court decision.)²²⁴ The filling of civil service positions must be structured in such a way as to promote the hiring of people with severe disabilities (Section 211 of SGB IX). (Legal provision.)²⁴⁵ The following applies to people with severe disabilities:

• § 5 BLV (Federal): “Only the minimum level of physical fitness may be required” of people with severe disabilities. Appropriate accommodations must be provided in selection and examination procedures (Legal provision.)²⁴⁶
• § 13 LVO NRW: only the “minimum level of physical fitness required for the career,” including for persons of equivalent status (Legal provision.)²⁴⁷
• The SGB IX NRW Directive: Hiring is also permitted “if, as a result of their disability, early incapacity for work is possible,” with reference to the five-year waiting period under pension law (Administrative regulation.)²⁴⁸
• The Saxony Administrative Regulation: Eligibility if “it is not expected that permanent incapacity for duty will occur within five years,” including for those deemed equivalent (Administrative Regulation.)²⁴⁹
• the Bavarian Inclusion Guidelines: it is highly probable that the individual will remain fit for duty for at least another five years (cited by the Munich Administrative Court, which ruled in favor of an applicant with a GdB of 40 and equivalent status) (Court decision.)²⁵⁰
• The medical certificate in Baden-Württemberg: “Minimum level of medical fitness” and a five-year prognosis (Information from the authorities.)²⁴¹

5.5. Government Assistance and Private Health Insurance¶

Expenses for outpatient neuropsychological therapy are not eligible for reimbursement if “the treatment is limited exclusively to congenital impairments or disabilities of brain function without secondary organic brain damage, in particular attention deficit disorder with or without hyperactivity (ADHD or ADD)” (Section 30a(2)(1) BBhV). (Legal provision.)²⁵¹ Medications prescribed by a physician and available only at pharmacies are generally eligible for reimbursement, unless they are listed in Annex II of the Medications Directive (§ 22 BBhV). Stimulants are not expressly excluded in the BBhV. (Legal provision.)²⁵²

No private health insurance company may “reject an applicant solely on the basis of a disability.” As part of the enrollment campaign for civil servants, all civil servants—“even those with preexisting conditions”—will be “enrolled within six months of becoming civil servants.” Risk surcharges are capped at 30 percent, and there are no exclusions from coverage. Since 2019, this initiative has also applied to civil servants on a provisional basis. Not all companies participate. (Government information.)²⁵³

Under Lower Saxony’s subsidy regulations, melatonin is generally not eligible for subsidies as a “lifestyle medication” pursuant to Section 17(4)(1) of the NBhVO. An explicit exception is made for the treatment of sleep disorders in children and adolescents with ADHD. (Administrative Regulation.)²⁵⁷ The date and file number of the regulation were not determined.

6. School, Vocational Training, College, and Exams¶

 

6.1. Compensation for Disadvantages and Protection for Students in Need: Fundamentals¶

No one may be disadvantaged because of a disability (Art. 3, para. 3, sentence 2, GG). (Legal norm.)²⁵⁸ A disability in the constitutional sense is a long-term, significant impairment. “Persons with chronic or mental illnesses are also protected if they are impaired in a correspondingly long-term and significant manner” (para. 36). Article 3, paragraph 3, sentence 2 of the Basic Law also protects against discrimination in favor of one type of disability over another (Headnote 2). Comments in report cards regarding accommodations are justified if they are provided in sufficient detail to ensure that the report cards are transparent overall (Headnote 5). The UN Convention on the Rights of Persons with Disabilities requires equal examination conditions, but does not require that performance go ungraded (para. 119). (Court decision.)²⁵⁹ According to the Federal Administrative Court (BVerwG), the right to compensation for disadvantages derives directly from Article 3(1) in conjunction with Article 12(1) of the German Basic Law (GG) for examinees “whose ability to demonstrate their existing capabilities is significantly impaired.” The accommodation must not result in overcompensation and must not be noted on the transcript. There is no right to grade protection (para. 16 et seq., 20). (Court decision.)²⁶⁰

According to the Conference of Ministers of Education, accommodations “must always be tailored to the individual case,” are mandatory for all teachers, and must be provided during exams “if the disability alone makes it difficult to demonstrate the student’s level of achievement.” Comments regarding accommodations do not belong in a final report card. (Official information.)²⁶¹ The recommendations regarding the area of special education focus on emotional and social development describe students who are “unable” to “demonstrate an average level of attention appropriate for their age” and provide for accommodations or extra time “as necessary.” (Official information.)²⁶² The 2024 revision cites a separate exam room as an example of accommodations. (Official information.)²⁶³ These resolutions do not mention ADHD. The guideline for exam-related accommodations at German schools abroad explicitly mentions ADHD in the context of “breaks and interruptions” and “attention disorders” when it comes to technical aids such as headphones. Accommodations for students with learning disabilities are “generally excluded” there. (Official information.)²⁶⁴

6.2. State Law¶

The states regulate measures to compensate for disadvantages and protect students in school laws, school regulations, and administrative rules. ADHD is

• specifically mentioned in:
  • the guidelines from Saxony-Anhalt, which list among those eligible individuals with “diagnosed mental or psychological disorders (e.g., … ADHD …) ” and include a separate chapter on ADHD/ADD. ADHD is “diagnosed exclusively by a medical professional.” Recommendations include minimizing distractions, providing a study booth or individual workspace, and visualizing time limits and breaks (Government information.)²⁶⁵
  • Thuringia’s guidance document on Section 59(5) of the Thuringian School Ordinance (ThürSchulO), which includes a separate chapter on ADHD/ADD and the same measures. A diagnosis alone does “not automatically lead to the granting of accommodations”; the basis is the educational assessment (information from the authorities.)²⁶⁶
  • According to the state government, Thuringia also provides, under § 59 of the Thuringian School Ordinance (ThürSchulO), measures to compensate for disadvantages and a temporary waiver of grades for students with ADHD (Information from the authorities.)²⁶⁷
  • Hamburg’s guidance document: Compensation for disadvantages “may also be considered” in cases of mental health conditions, including ADHD. However, these conditions do not “automatically” trigger such compensation. (Official information.)²⁶⁸
  • Berlin: In September 2025, the Senate Department of Education clarified that a long-term, significant impairment resulting from a mental health condition—including, explicitly, ADHD—may justify accommodations under Section 58(8) of the Berlin School Act (SchulG Berlin). In contrast, special protection is provided only for autism or severe speech disorders. Necessary outpatient psychotherapy during school hours is considered a valid reason for a leave of absence. (Official information published by the Berlin Chamber of Psychotherapists.)²⁶⁹
  • Berlin: The guidelines issued by the Berlin School Supervisory Authority cite ADHD as an example of a comparable, long-term, significant impairment. According to § 39(1) of the SopädVO, measures to compensate for this disadvantage may include, in particular, extended time limits, additional breaks, and a low-distraction environment. Work and social behavior remain excluded from this provision under Section 38(5) of the SopädVO (pp. 19, 183). (Administrative regulation.)²⁷⁰
• regarding characteristics typical of ADHD, as described in:
  • Mecklenburg-Western Pomerania: Distractibility, hyperactivity, and impulsivity are considered criteria for the special education focus area of emotional and social development. As accommodations for difficulties with attention and concentration, the Ministry of Education lists, among other things, extended time for written assessments and a reduction in the number of tasks while maintaining the same weighting (No. 3.3.3) (Official information.)²⁷¹
  • Lower Saxony: The decree “Special Education Support” dated February 1, 2005 (No. I.17) allows for accommodations to compensate for significant physical, psychological, and social challenges, such as by providing additional time to complete tasks and breaks. Motor restlessness and impulsivity are described as characteristics of the special education focus area “emotional and social development.” (Official information, secondary citation from a state legislative document.)²⁷²
• Excluded from compensation for disadvantages in Bavaria:
  • Bavaria: Students “with a long-term, significant impairment of their ability” to “demonstrate their existing capabilities” are eligible for accommodations. Accommodations are only available for physical or motor impairments, speech impairments, sensory impairments, autism, or dyslexia, and are noted on the report card (Art. 52(5) BayEUG) (Legal provision.)²⁷³ . Compensatory measures may include, among other things, an extension of working hours “by up to one-quarter, or in exceptional cases up to one-half,” separate rooms, and additional breaks (§ 33 BaySchO) (Legal provision.)²⁷⁴ . A written application and a medical certificate from a specialist are required. The accommodations are not listed on the report card (Section 36 BaySchO) (Legal provision.)²⁷⁵
  • In the 2020–21 school year, the Ministry of Education and Cultural Affairs, citing the ISB Handbook, took the position that the ability to concentrate was central to the academic performance requirements and that ADHD was therefore not eligible for compensation under §§ 33, 34 of the Bavarian School Ordinance (BaySchO). It cited a decision by the Augsburg Administrative Court dated September 7, 2005 (Au 3 E 05.00854), which was not made public. The only permissible measures were individual support measures under § 32 BaySchO outside the context of academic assessments. (Official information, published by SMV Bayern.)²⁷⁶
  • According to § 34(1) of the Bavarian School Ordinance (BaySchO), special protection is provided only for the specific impairments listed there; ADHD is not included. In the case of a chronic illness, § 32 of the BaySchO provides only for individualized support, such as a personalized break schedule, provided that it does not affect the assessment of academic performance. (Legal provision.)²⁷⁷²⁷⁸
• not mentioned in:
  • North Rhine-Westphalia: School administrators may extend exam times to the extent required by the student’s disability. According to the Münster District Government, accommodations to compensate for a disadvantage are tied to a “specialist medical diagnosis,” not to a need for special education support, and must not be noted on the report card (Government information.)²⁷⁹
  • Baden-Württemberg: The compensation for disadvantages “therefore does not affect the job requirements” and is provided, in particular, through adjustments to working hours or special assistance (Administrative Regulation.)²⁸⁰
  • Hesse: The type and scope are documented in the student’s file but are not noted on the report card (Information from the authorities.)²⁸¹
  • Saxony: “The diagnosed disability or impairment alone does not constitute sufficient grounds for granting compensation for a disadvantage.” (Government information.)²⁸²
  • Schleswig-Holstein: According to Section 2(1) of the NuNVO, a student is entitled to accommodations if their ability to demonstrate their actual academic potential is significantly impaired. Proof is provided by a medical certificate from a specialist. Accommodations are limited to dyslexia, physical-motor, speech, sensory, and autism-related impairments. The regulation, which was originally set to expire in July 2026, had its expiration date removed in June 2026. (Legal provision.)²⁸³
  • Rhineland-Palatinate: According to Section 5(2), the school regulations for inclusive education also apply to learning disabilities and chronic illnesses, and, according to Section 18(1), they focus on the effects in each individual case rather than on the diagnosis. (Legal provision.)²⁸⁴
  • Saarland: The Saarland Inclusion Ordinance expressly permits compensation for disadvantages under Section 16(1) even in cases of impairments in emotional and social development and mental health conditions. Section 15 lists measures such as extended time for completing exams, additional breaks, and a separate exam room. (Legal provision, secondary citation via lexaris.de.)²⁸⁵
  • Bremen: According to Section 16(2) of the BremInBilV, accommodations are possible, among other things, for impairments in emotional and social development and for chronic illnesses. For final exams, Section 16(6) requires a recommendation from the Mobile Service or the ReBUZ that is no more than 18 months old; medical certificates serve only as supplementary documentation. (Legal provision.)²⁸⁶
  • Brandenburg: Section 11(3) of the SopV permits the use of individualized assessment criteria—while maintaining the same level of academic standards—for students with special educational needs, such as those requiring support in emotional and social development, without a note on the report card. Circular 11/19, which explicitly provided for compensation for disadvantages in cases of mental illness, expired on July 31, 2024. No successor regulation was established. (Administrative regulation.)²⁸⁷

The restriction of special protection in Bavaria to certain disabilities could be debated in light of the prohibition against discriminating against one type of disability in favor of another (BVerfG 2023, Headnote 2). No decision on this matter specifically related to ADHD was found. (Assessment by ADxS.)

6.3. Case Law on Compensating for Disadvantages in ADHD Cases¶

For examination purposes, ADHD is considered a chronic condition. A condition that “impairs the examinee’s condition for an indefinite period—permanently—affects the examinee’s individual performance and does not entitle the examinee to withdraw from the examination,” unless treatment leads to the elimination of symptoms within a foreseeable period (Headnote 2). The examinee must immediately request accommodations due to a chronic condition (Guiding Principle 3). The appellate court had determined that the medication resulted in “only a suppression of symptoms limited to a few hours” (para. 25). The Federal Administrative Court left open “whether, in the case of ADHD, the granting of compensation for a disadvantage in vocational examinations is precluded because the impairments relate to an ability that is to be demonstrated in the examination” (para. 28). (Court decision.)²⁸⁸

The lower court in the case before the Federal Administrative Court (BVerwG) was the Higher Administrative Court of North Rhine-Westphalia (OVG NRW), which classified ADHD in adulthood as a chronic condition for the purposes of examination law (Headnote, paras. 59–63). Because treatment with methylphenidate merely alleviates the symptoms rather than restoring a guaranteed normal state, the condition did not entitle the individual to retroactively withdraw from exams already taken, even if the ADHD had not yet been diagnosed at the time of the exams. (Court decision.)²⁸⁹ Previously, in the same proceedings, the Federal Administrative Court (BVerwG) had overturned a Higher Administrative Court (OVG) ruling because, without an expert, it could not be determined whether a test-taker, as a layperson, should have recognized his ADHD-related impairment of performance earlier (para. 23, 26). (Court decision.)²⁹⁰

Courts have rejected requests for accommodations, extensions, or retroactive withdrawal based on ADHD or ADD

• because ADHD, as a chronic condition, itself shapes the level of performance to be assessed in the exam, in cases where:
  • a college exam (Bachelor’s in Public Administration). ADS impairs the ability to grasp the facts, the problem, and the solution “within a specified time frame” (guiding principle) (court decision.)²⁹¹
  • the same assessment in the main proceedings (GdB 30, medically recommended extension of 25 to 50%). Whether a medical condition impairs a person’s ability to perform or merely makes it more difficult to demonstrate that ability must be determined on a case-by-case basis based on the assessment requirements and the individual’s future occupation. The parallel drawn with dyslexia does not hold up (court decision.)²⁹²
  • Exams during legal clerkship (ADHD and migraine, severe disability), although, according to the student, ADHD no longer caused any relevant symptoms. Which abilities are being tested is “a legal, not a medical, question” (para. 16, 22) (court decision.)²⁹³
  • the 2026 Bavarian Abitur (ADHD and depressive episode, recommended extension of at least 30%). An impairment of the ability to concentrate, “which also includes ADHD,” does not justify compensation for a disadvantage. The Abitur also tests the ability to concentrate throughout the duration of the exam (para. 20 et seq.) (Court decision.)²⁹⁴
  • a master’s degree program (ADHD F90.0 with autistic traits, 25% extension), in which a footnote criticized the case law regarding chronic conditions as incompatible with Art. 3, para. 3, sentence 2 of the German Basic Law ( ) (court decision, secondary citation via reha-recht.de.)²⁹⁵
  • Exams taken by a student with ADHD in adulthood who had requested that they be converted to written assignments or oral exams. As a chronic disorder, the disorder affects the student’s mental capacity, which is precisely what the exam is intended to assess (para. 37) (Court decision.)²⁹⁶
  • a journeyman’s examination, because symptoms typical of ADHD, within the known range of variation, did not constitute an unforeseeable inability to take the exam (para. 61) (Court decision.)²⁹⁷
• because compensation for damages or rescission was not requested in a timely manner, in the case of:
  • a test-taker who was aware of his or her ADHD diagnosis but nevertheless took the exam and later claimed to be unfit to take the exam (para. 66) (court decision.)²⁹⁸
  • a case of ADS asserted only after the final exam, for which the school had no medical certificate and in which the student’s inability to take the exam was not apparent (para. 47) (Court decision.)²⁹⁹
  • a student who was merely informed of the ADHD diagnosis but did not request any specific measures and did not object to the failure to act (court decision.)³⁰⁰
  • a mere suspicion of ADHD in a medical opinion, which did not oblige the school to consider compensatory measures on its own initiative (para. 9) (Court decision.)³⁰¹
  • a student with ADHD whom the university was not required to inform, on its own initiative, about the accommodations provided for in the academic regulations (court decision.)³⁰²
• because the medical certificate did not distinguish between the ability to perform and the ability to demonstrate performance, in the case of:
  • the external examination for the intermediate school leaving certificate (Asperger’s syndrome and attention deficit disorder F90.0). Diagnoses alone would provide “no reliable information” on this matter (para. 20) (court decision.)³⁰³

Similarly, illness-related impairments “in thinking” (depression with concentration difficulties) do not justify a request for additional writing time. (Court decision.)³⁰⁴ This also applies if an illness (Long COVID) already affects cognitive performance. (Court decision.)³⁰⁵ No published decision granting and upholding compensatory measures for ADHD was found.

A medically confirmed diagnosis of ADHD alone did not obligate a transfer conference to grant an exceptional transfer (para. 21). (Court decision.)³⁰⁶ The lower court took into account that the elementary school had already, in practice, provided accommodations such as extended time and noise-canceling headphones (para. 23). (Court decision.)³⁰⁷

6.4. Disciplinary Measures in Schools¶

Serious breaches of duty in connection with a diagnosed ADHD “do not, as a general rule, preclude transfer to another school, even if special educational needs are identified in this context.” The class conference must take the ADHD into account in its discretionary decision (Higher Administrative Court of Lower Saxony, headnote). (Court decision.)³²⁰ A temporary partial exclusion from class due to a hyperkinetic disorder of social behavior was not unlawful on the grounds that the behavior might not be blameworthy due to the condition, since the measure serves to protect third parties. (Court decision.)³²¹ “Even a medically diagnosed ADHD is not a free pass for any misconduct at school.” (Court decision, secondary citation via lexika.de.)³²²

The Higher Administrative Court of North Rhine-Westphalia (OVG NRW) held that children with ADHD are generally able to control their behavior when basic disciplinary rules are applied and can therefore be influenced by disciplinary measures (para. 22). (Court decision.)³²³ ADHD therefore did not, as a matter of principle, preclude either disciplinary action or expulsion from school (OVG NRW 2020, para. 9 (court decision.)³²⁴ , VG Düsseldorf 2026, para. 36 (court decision.)³²⁵ ).

According to the Düsseldorf Administrative Court, a ban on entering school under Section 54(4) of the North Rhine-Westphalia School Act (SchulG NRW) required that a student with ADHD be genuinely unable to control his or her aggressive behavior, which had to be medically substantiated (Headnote 1, para. 18). Mere disruptions to class were not sufficient for this (para. 17). (Court decision.)³²⁶

When applying for admission to a secondary school, ADHD was not recognized as a hardship case in North Rhine-Westphalia because it is not a rare learning disability (para. 20). (Court decision.)³²⁷ Grounds for hardship had to be substantiated by medical certificates (para. 6). (Court decision.)³²⁸

6.5. Vocational Training and Higher Education¶

³²⁹³³⁰ *Training and examination regulations should take into account the special circumstances of people with disabilities, in particular “the duration of examination periods, the use of assistive devices, and the provision of assistance by third parties” (Section 65 BBiG, identical to Section 42q HwO). * **³³¹

• “Individual exams instead of group exams to avoid distractions”
• “Additional time as determined by the examination committee, particularly for the inattentive subtype”
• “additional breaks due to reduced concentration and motor restlessness”
• self-made study aids, such as cue cards or a personal formula guide
• As a case study for learning disabilities with ADHD: individual testing, extended time, a separate room, and the presence of a trusted person
• proof of eligibility, such as a doctor’s note, submitted no later than the time of exam registration

“Examination regulations must take into account the specific needs of students with disabilities to ensure equal opportunity” (Section 16, sentence 4, HRG). (Legal provision.)³³² The German Student Services Organization (Deutsches Studierendenwerk) lists measures to compensate for disadvantages, including extended writing time, breaks, and separate rooms, without specifically mentioning ADHD. (Specialized information.)³³³ When applying for college admission, students can submit a special application to claim circumstances beyond their control that prevented them from achieving better academic performance, supported by a school evaluation and supporting documentation such as medical reports from specialists. (Government information.)³³⁴

A determined GdB of 50, due in part to attention deficit disorder, was not sufficient for the Gelsenkirchen Administrative Court to grant an extension of BAföG beyond the maximum funding period, because the specific causal link to the delay in studies had not been demonstrated (para. 60). The court referred to leaves of absence and compensation for disadvantages (paras. 59, 61). (Court decision.)³³⁵

In applications for a college spot based on exceptional circumstances, a diagnosis of ADHD confirmed by a specialist was not sufficient. Evidence was required that, due to the condition, the applicant would in all likelihood be unable to cope with university studies in the future (para. 10 et seq.). (Court decision.)^{336 337 338} The paragraph numbers refer to Decision 6z L 968/11.

To compensate for disadvantages and improve the average Abitur grade when applying to medical school, starting in the 2026–27 winter semester, school administrators must also indicate whether compensation for disadvantages or grade protection was granted during the student’s time at school, or explain why not, for example, because state regulations preclude this. In addition, it must be demonstrated that and how the disability affected the average grade. Up to one percent of spots are allocated through the hardship quota. A severe disability alone generally does not justify immediate admission under these rules; ADHD is not listed as a reason for hardship admission. (Official information.)³³⁹

In Bavaria, university examination regulations may only be approved if they take into account the specific needs of students with disabilities or chronic illnesses to ensure equal opportunities (Art. 84, para. 2, sentence 2, no. 5 BayHIG). (Legal provision.)³⁴⁰ The Bavarian Regulations on Legal Education grant accommodations only to the extent that the impairment does not affect the subject matter being tested. Extensions of time and breaks are permitted for up to one-quarter of the examination time, or up to one-half in cases of particularly severe impairment. Proof must be provided by a certificate issued by a public health or court-appointed physician (Section 13(1) BayJAPO). (Legal provision.)³⁴¹

6.6. Integration Assistance under Section 35a of SGB VIII¶

Children and adolescents are entitled to integration assistance if their mental health “is highly likely to deviate from the state typical for their age for more than six months” and their participation in society is therefore impaired. This deviation is determined by a child and adolescent psychiatrist, a child and adolescent psychotherapist, or a physician or psychotherapist with equivalent experience, based on the ICD (§ 35a, para. 1, 1a SGB VIII). (Legal provision.)³⁴² Support for schooling includes measures that enable or facilitate school attendance. Guidance and support may be provided jointly for several students (§ 112 SGB IX). (Legal provision)³⁴³ The obligations of schools remain unaffected (Section 10(1) SGB VIII). (Legal provision)³⁴⁴

Courts have reached differing conclusions as to whether simple ADHD (F90.0) constitutes a mental disorder within the meaning of Section 35a of SGB VIII:

• only if “a more serious mental Disorder arises as a secondary consequence of ADHD” (OVG NRW, para. 13) (Court decision.)³⁴⁵
• the same applies to a school assistant. A participation impairment may be assumed, for example, in cases of school phobia, total refusal to attend school, or social withdrawal, “but not merely in cases of school-related problems” (OVG NRW, paras. 16, 22) (court decision.)³⁴⁶
• similarly, in tax law, for a simple ADHD (BFH, para. 31) (court decision.)³⁴⁷
• Yes, “ADHD is a mental disorder,” also classified as F90.0. The position taken by the Higher Administrative Court of North Rhine-Westphalia (OVG NRW) is unfounded. The Youth Welfare Office was ordered to issue a new decision regarding a school assistant (Administrative Court of Hanover, headnote, appeal allowed) (court decision.)³⁴⁸

The principle that youth welfare services are secondary to the school applies only if the school provides services in a timely manner and actually meets the student’s needs. The “core area of educational work” is the sole responsibility of the school (para. 37, 39; integration assistant for attention deficit disorder and other Disorders). (Court decision.)³⁴⁹ The costs of a school transfer arranged by the parents due to ADHD were not reimbursed. (Court decision.)³⁵⁰ Integration assistance does not include outpatient medical treatment. A youth welfare office that had paid for psychotherapy for a teenager with ADHD provided by unlicensed therapists was not reimbursed by the health insurance company. (Court decision.)³⁵¹

Regarding the question of whether ADHD constitutes a (potential) mental disability under Section 35a of SGB VIII, the courts have ruled as follows:

• Given its prevalence, a mere diagnosis of a simple activity and attention disorder does not allow one to conclude that there is an impairment of participation (para. 60, 62). The court based its statement on prevalence on a Wikipedia article (para. 61). (Court decision.)³⁵²
• A secondary mental disorder associated with ADHD was considered sufficient only if, in terms of scope, severity, and duration, it impaired the child’s ability to participate—for example, in cases of school phobia or social withdrawal—but not in cases of mere school-related problems (para. 9). (Court decision.)³⁵³
• The Youth Welfare Office was not permitted to question a diagnosis of a hyperkinetic Disorder confirmed by a specialist without possessing the expertise required under § 35a(1a) of SGB VIII (para. 8). (Court decision.)³⁵⁴
• If the ADHD was adequately treated with methylphenidate, there was no need for it for that reason. For subsequent school anxiety, a connection to the ADHD had to be demonstrated (para. 8). (Court decision.)³⁵⁵
• A medical opinion stating that, despite the diagnosis of F90.0, there is no mental disorder fails to recognize the distinction between mental health issues and limitations on participation. The Youth Welfare Office was provisionally ordered to provide a school assistant. (Court decision.)³⁵⁶
• The Cottbus Administrative Court readily classified F90.0 as a mental disorder and provisionally granted a student an individual support assistant. (Court decision.)³⁵⁷
• If ADHD, as a mental disability, was the primary reason for the need for assistance, youth welfare services—rather than social assistance—had jurisdiction, even in cases involving an additional mild intellectual disability (para. 26). (Court decision.)³⁵⁸

Courts have ruled on school support for ADHD:

• In summary proceedings, the Bavarian Higher Administrative Court (BayVGH) ordered a youth welfare office to approve a school assistant for a fifth-grader with ADHD (F90.0). A one-hour observation during a dictation exercise—which is designed to accommodate children with ADHD—is merely a snapshot and cannot refute the consistent opinions of teachers and child and adolescent psychiatrists (para. 24 et seq.). (Court decision.)³⁵⁹
• The Munich Administrative Court ordered a youth welfare office to provisionally grant a full-day school support service to an elementary school student with ADHD and developmental disorders. Outbursts of anger and aggressive behavior during recess indicated a lack of social integration, even though the child appeared to be integrated into the classroom during a brief observation period (para. 37). (Court decision.)³⁶⁰
• The Higher Administrative Court of Lower Saxony overturned a preliminary injunction regarding school support services because, in principle, the cooperative assistance plan process must be completed first, and the specialist had not deemed such support necessary. (Court decision.)³⁶¹
• The Higher Administrative Court of Lower Saxony rejected a request for in-school support for a student with a hyperkinetic social behavior disorder because no permanent impairment of participation had been established, and it remained unclear whether the support would cause the student to be marginalized. Read via an online search tool; case numbers not available. (Court decision.)³⁶²

Courts have ruled on a case-by-case basis whether integration assistance covers the costs of a private school:

• The Cologne Administrative Court generally considered regular schools capable of implementing ADHD-specific measures, such as clear communication and reinforcement (para. 26). (Court decision.)³⁶³
• The Düsseldorf Administrative Court regularly ruled that secondary schools were unsuitable due to large class sizes without additional support (para. 47). (Court decision.)³⁶⁴
• The Cottbus Administrative Court ordered a youth welfare office to cover the private school tuition for a student with ADHD, a tic disorder, and a perceptual disorder. (Court decision.)³⁶⁵

The Aachen Administrative Court held that an increase in the foster care allowance for foster parents under Section 39(4) of SGB VIII in cases of particularly severe ADHD was possible in principle, but rejected it in this specific case because the foster care insurance fund was already paying a foster care allowance under Section 37 of SGB XI due to the ADHD (para. 29 et seq.). (Court decision.)³⁶⁶

6.7. Administering Medication in Schools and Daycare Centers¶

Students are covered by statutory accident insurance while attending school, as are children in daycare facilities and college students (§ 2 (1) No. 8 SGB VII). (Legal provision.)³⁶⁷ According to accident insurance regulations, “there is generally no obligation to administer necessary medication … as a matter of principle.” If the responsibility for administering medication is transferred from the parents to the school, insurance coverage applies. Civil liability on the part of the teacher is “generally excluded, even if the medication was administered incorrectly,” except in cases of intent or gross negligence. A written agreement regarding the medication, timing, dosage, side effects, and emergency measures is recommended. (Official information.)³⁶⁸ In Brandenburg, administering medication is not part of teachers’ official duties. Voluntary administration requires a written agreement with the parents and the approval of the school administration. Medications must be stored safely, labeled with the student’s name, and protected from access by unauthorized persons. (Administrative regulation.)³⁶⁹ No specific rules regarding controlled substances such as methylphenidate in schools were found.

6.8. Special Education Schools and Homeschooling¶

Before placing a child in a special education school, it must be determined whether ADHD is the cause of the academic difficulties and whether the child can be adequately supported in a general education school through therapy and special education services (para. 8, 13). (Court decision.)³⁷⁰ The Gelsenkirchen Administrative Court ruled that the referral of a Realschule student with ADHD to a special education school for emotional and social development was manifestly unlawful because the school did not provide instruction in accordance with the Realschule curriculum and the authorities had not determined the causes (para. 18 et seq.). (Court decision.)³⁷¹

A hyperkinetic syndrome with social disorder did not constitute grounds for home schooling because the diagnosis did not, in principle, prevent the child from attending school. (Court decision.)³⁷²

6.9. Privacy at School¶

Doctors may disclose an ADHD diagnosis to a school only if they have been released from their duty of confidentiality or if the disclosure is necessary to protect a higher legal interest (Section 9(2) MBO-Ä). (Regulations.)³⁷³ The professional codes of conduct of the state medical associations are authoritative and may differ.

According to the Bavarian State Commissioner for Data Protection, public schools may not require students to disclose the nature of an illness, not even in medical certificates (Question 11). Whether parents choose to inform the school of an ADHD diagnosis is therefore up to them. (Government information.)³⁷⁴

State law governs the handling of health data in schools:

• In North Rhine-Westphalia, data that goes beyond what is necessary for school-related purposes—such as an ADHD diagnosis—may be collected only with consent and may be transmitted to the school psychology service only with consent (Section 120(2), (7) of the North Rhine-Westphalia School Act (SchulG NRW)). Only parents and students have the right to access school records (Section 120(9)). (Legal provision.)³⁷⁵
• In North Rhine-Westphalia, medical and psychological records must be kept separately from the student’s master file and stored under lock and key; medical reports and certificates may not be processed automatically. When a student changes schools, information regarding health impairments may only be disclosed to the extent that special educational support is being considered. The assignment to specific sections has not been verified. (Legal norm.)³⁷⁶
• In Baden-Württemberg, schools may process health data only on the basis of a legal provision or with explicit consent; as a general rule, students aged 16 and older have the right to access their own records (Nos. 1.4, 2.1.2). Student records and special education evaluations must be destroyed two years after the student leaves school (No. 2.5.3). It has not been verified whether this regulation will still apply in 2026. (Administrative regulation.)³⁷⁷

In 2012, the Berlin Senate Administration clarified that the school administration does not make ADHD diagnoses; rather, these are typically made by child and adolescent psychiatrists or child and adolescent psychotherapists. (Government information, secondary citation via kleineanfragen.de.)³⁷⁸

7. Severe Disabilities, Social Benefits, and Taxes¶

7.1. Degree of disability¶

The GdB is determined upon application in increments of 10, but only for a GdB of 20 or higher (Section 152(1) of SGB IX). In cases of multiple impairments, it is determined “based on the effects of the impairments as a whole” (Section 152(3) of Book IX of the Social Code). (Legal provision.)³⁷⁹ The Medical Care Regulation assesses “hyperkinetic disorders and attention disorders without hyperactivity” (Part B, No. 3.5.2). “In the absence of social adjustment difficulties, there is no impairment of participation.” In cases of social adjustment difficulties, the degree of impairment (GdS) is: (Legal Standard)³⁸⁰

• Impairments that prevent integration into various areas of life, even with comprehensive support, 80 to 100
• Impairments that make integration into various areas of life impossible without extensive support or supervision, 50 to 70
• Impact on the ability to integrate into various areas of life (such as mainstream preschool, mainstream school, the general labor market, public life, and home life) or a need for supervision beyond what is typical for the child’s age: 30 to 40
• No effect on the integration capacity of 10 to 20

“As a general rule, the GdS does not exceed 50 after the age of 25.” The ICD criteria must be met; comorbid mental disorders must be considered separately; and a blanket determination based on a specific age is not possible (Preliminary Note to No. 3.5). The GdB and GdS are assessed according to the same principles. The values are guidelines. Calculation methods such as addition are not permitted. Functional capacity cannot be inferred from the GdB (Part A, Nos. 1.1, 1.2, 1.5, 3.2). (Legal provision.)³⁸⁰

Courts have ruled on ADHD as follows:

• An individual GdB of 40 for a child, because both criteria for the 30–40 increment were met (impacts in multiple areas of life and an increased need for supervision). Combined with a heart condition (individual GdB of 20), which further complicated school integration, this resulted in a total GdB of 50. The “H” designation was denied (court decision.)³⁸¹
• An individual GdB of 20 for depression and ADHD in an adult who has completed their education and has a stable employment situation (Court decision, secondary citation via versorgungsmedizinische-grundsaetze.de.)³⁸²

The BSG adopted Section 3.5.2 as the standard for determining whether ADHD constitutes a “serious illness” under health insurance law. An individual GdS score of 50 is generally only reached if integration “is not possible without comprehensive support” (para. 13, 19). (Court decision.)³⁸³

A separate GdB rating for ADHD (Part B, No. 3.5.2 of the VersMedV) was introduced in 2011 upon the recommendation of the Medical Expert Advisory Board. According to the explanatory memorandum to the regulation, the severity of the condition generally decreases as the brain matures, and in cases where symptoms persist, a disability level higher than GdS 50 is not generally to be expected from the age of 25 onward (p. 4 ff.). The primary criteria are the ability to integrate, difficulties with social adjustment, and the level of care and therapy required. (Legal provision, explanatory memorandum to the regulation.)³⁸⁴

The Sixth Amendment to the VersMedV dated September 29, 2025, revised only the Common Principles in Part A and left section 3.5.2 on ADHD in Part B unchanged. According to Part A, No. 1.3.4, typical treatment consequences are already included in the table values; however, exceptional consequences or side effects of treatment justify a higher GdB. (Legal provision.)³⁸⁵

7.2. Designation H¶

For children and adolescents, guidance, support, and supervision are also considered forms of assistance. Only the portion that exceeds the needs of a healthy child of the same age is taken into account. “In cases of profound developmental disorders with a GdS of at least 50, and in cases of other behavioral and emotional disorders of equal severity that begin in childhood and involve long-term, significant difficulties in adapting, a state of helplessness is generally assumed to persist until the age of 18” (Part A No. 5). ADHD is not specifically mentioned there. (Legal provision.)³⁸⁰ The “H” designation is entered if the severely disabled person is considered helpless within the meaning of § 33b of the Income Tax Act (EStG) (§ 3 of the Severely Disabled Persons Assistance Regulation (SchwbAwV)). (Legal provision)³⁸⁶ The “H” designation is equivalent to a classification in care level 4 or 5 (§ 65(2) EStDV). (Legal provision.)³⁸⁷ Generally, a need for assistance is only deemed to exist starting with care level 4 (LSG Berlin-Brandenburg, Headnote 2). (Court decision.)³⁸¹

7.3. Taxes and Child Benefits¶

People with a GdB of at least 20 receive a lump-sum payment. The amount is: (Legal provision.)³⁸⁸

• 7,400 euros for those classified as requiring assistance (classification code H)
• 2,840 euros for a GdB of 100
• 2,460 euros for a GdB of 90
• 2,120 euros for a GdB of 80
• 1,780 euros for a GdB of 70
• 1,440 euros for a GdB of 60
• 1,140 euros for a GdB of 50
• 860 euros for a GdB of 40
• 620 euros for a GdB of 30
• 384 euros for a GdB of 20

The flat-rate allowance for a child may be transferred to the parents (Section 33b(5) of the Income Tax Act (EStG)). (Legal provision.)³⁸⁸ A child who has reached the age of majority is taken into account without any age limit if he or she is “unable to support himself or herself due to a physical, mental, or psychological disability” and the disability arose before the age of 25 (Section 32(4), sentence 1, no. 3 of the German Income Tax Act (EStG)). (Legal provision.)³⁸⁹ The disability must be a significant contributing factor for this to apply. Gainful employment alone does not preclude entitlement. (Court decision.)³⁹⁰ No decision by the Federal Fiscal Court (BFH) regarding child allowance in cases of ADHD was found.

Regarding extraordinary expenses related to ADHD, the Federal Fiscal Court (BFH) ruled:

• Whether a disability exists is determined in accordance with Section 2(1) of SGB IX. In cases of simple ADHD (F90.0), a deviation from mental health can only be affirmed if it leads to a more extensive mental Disorder (Guiding Principle 1, para. 31) (court decision.)³⁴⁷
• A teenager who had been placed in out-of-home care due to ADHD and school refusal was found to have a disability. The deduction was denied because the required prior medical certificate from a public health officer was missing. This documentation “cannot be replaced by other documents” (Headnote 2, para. 14) (Court decision.)³⁹¹
• Expenses for a school for gifted children may be tax-deductible if attendance at the school was medically indicated (child with attention deficit disorder and giftedness) (Court ruling.)³⁹²

Tax courts did not recognize private school costs for children with ADHD as an extraordinary financial burden because the schools did not provide therapeutic treatment by medical professionals and the costs were considered living expenses (Düsseldorf Tax Court, para. 37 (court decision.)³⁹³ , Cologne Tax Court, paras. 55–57 (court decision.)³⁹⁴ ).

The Lower Saxony Fiscal Court classified ADHD accompanied by school refusal as another disability within the meaning of § 64 EStDV. Therefore, for costs associated with out-of-home placement, medical necessity must generally be demonstrated before the measure begins (para. 17). (Court decision.)³⁹⁵

The Federal Fiscal Court (BFH) left open the question of whether a foster child with ADHD is subject to a shorter period than two years without sufficient contact with their biological parents, because the appeal had not sufficiently addressed the issue. The two-year rule for school-age children remained in effect (para. 11, 12). (Court decision.)³⁹⁶

7.4. Rehabilitation Assistance, Long-Term Care, Social Security Benefits, and Health Insurance¶

7.4.1. Integration Assistance for Adults¶

Adults receive integration assistance if they are “significantly limited in their equal participation in society (significant disability).” In the case of other impairments, benefits “may” be provided (Section 99 of SGB IX). (Legal provision.)³⁹⁷

7.4.2. Disability Pension and Rehabilitation¶

A person is considered to have reduced earning capacity if, under the usual conditions of the general labor market, they are able to work fewer than six (part-time) or three (full-time) hours per day (Section 43 of Book VI of the Social Code). (Legal provision.)³⁹⁸

The German Pension Insurance’s guideline on the sociomedical assessment of mental disorders includes a separate section on ADHD in adults: (Expert recommendation.)³⁹⁹

• Under no circumstances can it be assumed that ADHD per se is associated with a reduction in work performance. However, in severe cases involving significant disorganization, distractibility, and a lack of reliability, the ability to work may be impaired in individual cases, although comorbid conditions often carry more weight than ADHD itself (Chapter 8.8.4.1, p. 175)
• In severe cases, activities that place high demands on adaptability, concentration, and reaction time—particularly those involving responsibility for people and machinery, interaction with the public, field work, significant time pressure, or increased risk—may be impaired (p. 175)
• A need for rehabilitation exists when, despite adequate medical treatment and, if necessary, psychotherapy, significant limitations on participation remain. Services to facilitate participation in working life are primarily intended for people with ADHD (p. 175 ff.)
• In 2010, hyperkinetic disorders (F90) were the initial diagnosis in 234 completed inpatient medical rehabilitation cases and in 63 new cases of disability pensions due to reduced earning capacity (Tables 1 and 4; page numbers not confirmed)

The Pension Insurance Assessment Portal, launched in September 2025 to replace the guidelines, did not yet include a chapter on ADHD as of October 2026. (Government information.)⁴⁰⁰ The AWMF guideline on the assessment of mental and psychosomatic disorders (as of 2019) also does not contain a section on ADHD. (Expert recommendation.)⁴⁰¹

The pension insurance system also provides medical rehabilitation for children and adolescents with ADHD. A need for rehabilitation exists if treatment at the place of residence does not achieve sufficient stabilization to support a positive prognosis for future employment (Chapter 10.1.6). In 2017, 1,418 of the 8,158 pediatric rehabilitation cases covered by the Pension Insurance due to mental disorders were attributed to the diagnosis F90, of which 1,111 were boys (Table 13). (Expert recommendation.)⁴⁰² The DRV guideline on substance use disorders lists methylphenidate among the stimulants with potential for dependence. (Expert recommendation.)⁴⁰³

The Bavarian Social Court (LSG Bayern) denied a disability pension to a plaintiff with ADHD in adulthood and recurrent depression. Several expert opinions had confirmed, despite certain limitations, that she was capable of working at least six hours a day—provided, for example, that extremely monotonous tasks were excluded. The decisive factor for the court was that the plaintiff was able to structure her daily routine, manage a six-person household with four children, and engage in volunteer work. A quantitative reduction in work capacity was not established until late 2013, by which time the requirements under insurance law were no longer met. (Court decision.)⁴⁰⁴ Full text provided by the user via beck-online; only the grounds for the decision were evaluated, not the editorial headnotes.

7.4.3. Long-Term Care Insurance¶

A person is considered to be in need of long-term care if, due to health-related impairments affecting their independence, they are expected to require assistance for at least six months. The criteria include “motor-related behavioral disturbances, nighttime restlessness,” and “socially inappropriate behavior” (Section 14 of SGB XI). For children, a comparison is made with children who have developed appropriately for their age (Section 15(6) of SGB XI). (Legal provision.)⁴⁰⁷ * (Legal provision.)*⁴⁰⁸ Under the previous law (care levels), a girl with ADHD and a GdB of 50 did not receive a care allowance because her basic care needs were less than 45 minutes per day and supervision was not recognized. This does not apply under the current law governing care levels. (Court decision.)⁴⁰⁹

In care assessments for children, Module 3 (Behaviors and Psychological Problems) is age-independent. The decisive factor is whether the child can regulate their behavior—such as impulse control—without assistance from others. Child psychiatric treatment and medication may indicate relevant problems; however, developmentally typical behavior and parenting challenges are not taken into account (KF 4.3). ADHD is explicitly cited as an example of a focus area for medical rehabilitation of children that the Medical Service may recommend (KF 7.3.4). (Administrative regulation.)⁴¹⁰

7.4.4. Health Insurance¶

Medical care includes medical and psychotherapeutic treatment as well as medications and therapeutic agents. Special consideration must be given to the needs of people with mental illness (Section 27 of Book V of the Social Code). (Legal provision.)⁴¹¹ Prior to the approval of a methylphenidate preparation for adults, the Federal Social Court (BSG) had denied a claim for the provision of off-label treatment to adults (BSG, judgment of June 30, 2009 – B 1 KR 5/09 R). (Court decision, secondary citation via the Berlin-Brandenburg Social Court.)⁴¹² Medikinet Adult was launched on the German market in mid-2011. (Court decision.)⁴¹³ Medical cannabis for ADHD requires a serious medical condition and a well-founded assessment by the physician as to why standard therapies are not an option. (Court ruling.)³⁸³ * (Court ruling.)*⁴¹⁴ Details can be found on the pages “Restrictions on Treatment and Medication Choices in Germany” and “Medical Cannabis for ADHD.”

State Social Courts have ruled on the right to receive cannabis for ADHD covered by health insurance under Section 31(6) of SGB V:

• A GdB of 30 determined for ADHD indicates that the condition is not severe (para. 68), and it has not been demonstrated that no recognized standard treatment is available (para. 71). (Court decision.)⁴¹⁵
• In cases of ADHD with comorbid autism spectrum disorder and long-term cannabis use, multimodal treatment at a specialized outpatient clinic following inpatient detoxification was the standard of care (paras. 27–29). (Court decision.)⁴¹⁶
• Standard treatments were available, including stimulants, atomoxetine, and psychosocial interventions, and the medical justification did not explain why these were ruled out (paras. 29–31). The Recreational Cannabis Act of 2024 did not alter these requirements (para. 32). (Court decision.)⁴¹⁷
• Neither the diagnosis nor the course of the condition was documented, and only two methylphenidate prescriptions had been issued over the course of three years. (Court decision.)⁴¹⁸

Prior to the approval of methylphenidate for adults, the Braunschweig Social Court ordered a health insurance provider, in summary proceedings, to continue providing uninterrupted coverage to an 18-year-old in vocational training because the term “adolescents” used in the approval did not specify a rigid age limit (paras. 25, 29, 31). (Court decision.)⁴¹⁹

Occupational therapy for ADHD can be prescribed at the expense of statutory health insurance under diagnostic group PS1 as psychological-functional treatment, cognitive training, or sensorimotor-perceptual treatment. Since the reform of psychotherapist training, licensed psychotherapists are also permitted to provide these services. (Information from the authorities.)⁴²⁰

In the case of a student with ADHD and Asperger’s syndrome, the Federal Social Court (BSG) ruled that illness-related delays can extend mandatory student health insurance coverage only until the student reaches the age of 37 at the latest (para. 2, 24). (Court decision.)⁴²¹

7.4.5. Basic Income Support and Social Compensation Law¶

Under the basic income support program, additional expenses related to ADHD—such as fees for open all-day schools and transportation costs to therapy—did not result in an increase in financial need (para. 95). (Court decision.)⁴²² According to an expert opinion, a child’s questionable ADHD diagnosis did not justify a larger-than-reasonable apartment because the urge to move around did not have to be satisfied within the home (para. 48). (Court decision.)⁴²³ In contrast, the Braunschweig Social Court (SG) granted tutoring for a student with ADHD and dyslexia as learning support under Section 28(5) of SGB II; compensation for educational disadvantages did not preclude the entitlement. (Court decision.)⁴²⁴

In the context of social compensation law, the Higher Social Court of North Rhine-Westphalia (LSG NRW) did not consider ADHD to be a consequence of acts of violence suffered during childhood because it could not be causally attributed to those acts (para. 72). (Court decision.)⁴²⁵
Under social compensation law, a link between early childhood neglect and a later diagnosis of attention deficit disorder was deemed unlikely. (Court decision.)⁴²⁶

8. Criminal Law¶

8.1. Criminal Responsibility¶

A person acts without culpability if, at the time of committing the act, they are, due to a pathological mental disorder, a profound disturbance of consciousness, a mental disability, “or another severe mental disorder, incapable of recognizing the wrongfulness of the act or of acting in accordance with that recognition” (Section 20 of the German Criminal Code [StGB]). (Legal provision.)⁴²⁷ If this capacity is significantly diminished, the penalty may be mitigated (Section 21 of the German Criminal Code [StGB]). (Legal provision.)⁴²⁸ Adolescents are criminally responsible if they are sufficiently mature in terms of their moral and mental development (§ 3 JGG). Juvenile criminal law applies to adolescents if, at the time of the offense, they were still equivalent to a juvenile in terms of their development (Section 105 of the German Juvenile Criminal Code (JGG)). (Legal provision.)⁴²⁹ * (Legal provision.)*⁴³⁰ ADHD is not mentioned in these provisions.

The Federal Court of Justice left open the question of whether ADHD should be classified as a pathological mental disorder or as another severe mental disorder. “A psychiatric diagnosis alone is not equivalent to a threshold criterion under Section 20 of the German Criminal Code (StGB).” Characteristics such as “mood swings, low frustration tolerance, a tendency toward arguments, and impulsivity” are not, in and of themselves, sufficient to establish significantly diminished criminal responsibility. The decisive factor is “whether, in everyday life outside the context of the alleged offenses, there have been limitations on the defendant’s professional and social functioning” (paras. 19–21). (Court decision.)⁴³¹ Further principles:

• Educational attainment, employment, and long-term romantic relationships indicate that ADHD and Asperger’s syndrome do not result in a severe impairment of social adjustment. The initial criteria and the ability to exercise control are legal issues that the court itself must examine (para. 11, 16) (Court decision.)⁴³²
• If a severe mental disorder other than a personality disorder or ADHD is diagnosed, this strongly suggests a significant impairment of the ability to exercise self-control. In such cases, acting in a planned manner has little probative value (para. 8, 10) (Court decision.)⁴³³
• The claim that a defendant failed to understand the purpose of a courier delivery due to ADHD-related “racing thoughts” must be substantiated by facts (para. 13, 21) (Court decision.)⁴³⁴
• Antisocial development stemming from a hyperkinetic Disorder (F90.1) does not preclude conditional intent to kill without further elaboration (para. 8) (Court decision.)⁴³⁵

Trials courts found that the defendant had significantly diminished criminal responsibility in the following cases:

• a hyperkinetic disorder of social behavior that has developed into an antisocial personality disorder (para. 3) (Court decision.)⁴³⁶
• an autism spectrum disorder combined with a hyperkinetic disorder of social behavior in an adolescent (para. 10) (Court decision.)⁴³⁷
• recurrent depressive disorder in conjunction with persistent ADHD (disciplinary law) (court decision.)¹²⁰

The Higher Regional Court of Hamm overturned a judgment because the Regional Court had failed to address the issue of criminal responsibility in the case of a defendant with untreated ADHD (headnote). The diagnosis alone does not necessitate such a discussion. However, ADHD could constitute a serious mental disorder within the meaning of Sections 20 and 21 of the German Criminal Code (StGB), and, when combined with circumstances such as a quick temper or loss of control, a discussion of this issue is warranted (paras. 17–19). The fact that the defendant had stopped taking his ADHD medication on his own initiative prior to the offense was not sufficient, without further findings, to attribute the loss of control to him as his own fault (para. 15, 21). (Court decision.)⁴³⁸

In the practice of state courts, ADHD alone rarely led to diminished criminal responsibility:

• In cases involving premeditated acts and an unremarkable personal history, the Essen Regional Court ruled that the fourth element of § 20 of the German Criminal Code (StGB) was not met (para. 971 et seq.) (Court decision.)⁴³⁹
• The Regional Court of Münster cited an expert opinion stating that persistent ADHD could be forensically significant, particularly in cases involving highly impulsive offenses, which was not the case with the planned crimes (para. 142) (court decision.)⁴⁴⁰
• An expert was unable to either confirm or rule out ADHD in childhood in retrospect, but ruled out current ADHD, so the initial criterion no longer applied (para. 84) (court decision.)⁴⁴¹
• The Regional Court of Düsseldorf could not rule out a significant impairment of the ability to exercise self-control in cases involving hyperkinetic Disorder combined with alcohol, cannabis, emotional distress, and borderline intelligence (para. 197) (Court decision.)⁴⁴²

The Bochum Regional Court classified regular, abusive use of Ritalin as psychological dependence, but ruled out a personality change within the meaning of § 20 of the German Criminal Code (StGB) and committed the defendant to a psychiatric facility pursuant to § 64 StGB due to a lack of a causal link between the symptoms and the offense (para. 284, 326). (Court decision.)⁹ The Federal Court of Justice (BGH) overturned a commitment order in a case where a defendant had taken large quantities of Ritalin prior to the offense because the threshold requirement under § 20 StGB remained unclear (para. 3, 10). (Court decision.)⁴⁴³

The Federal Court of Justice (BGH) overturned a ruling because the Regional Court had determined that a witness diagnosed with ADHD was competent to testify based solely on medical reports that were read aloud, rather than by hearing testimony from the treating physicians (para. 5, 6). (Court decision.)⁴⁴⁴

8.2. Disciplinary Measures, Sentencing, and Corrections¶

8.2.1. Committal pursuant to Sections 63 and 64 of the German Criminal Code (StGB)¶

Committal to a psychiatric hospital requires that the individual have committed an act while in the state described in Sections 20 or 21 of the German Criminal Code (StGB) and that there be a likelihood of further serious offenses (Section 63 StGB). (Legal provision.)⁴⁴⁵ Committal to a rehabilitation facility requires a substance use disorder involving “a persistent[r] and serious[r] impairment of one’s lifestyle, health, ability to work, or performance” and the prospect of successful treatment (Section 64 of the German Criminal Code (StGB)). (Legal provision.)⁴⁴⁶ Courts have ruled:

• A person who only enters a state of significantly impaired control in certain stressful situations (ADHD, alcohol, excessive stress) is not in a permanent state within the meaning of § 63 StGB (para. 15) (court decision.)⁴³¹
• If experts determine that the ADHD or hyperkinetic Disorder that served as the basis for the placement no longer exists, the courts must independently address this issue when considering whether to continue the placement (court decision.)⁴⁴⁷ * (court decision.)*⁴⁴⁸
• If amphetamine and cannabis use has served as “self-medication” alongside prescribed medication for over 15 years, it is questionable whether this constitutes a serious impairment within the meaning of Section 64 of the German Criminal Code (StGB). According to the expert, “treatment of his ADHD was the primary need” (para. 12, 14) (court decision.)⁴⁴⁹
• In the case of a young man with ADHD who had stopped taking Ritalin at age 16 or 17 and had “self-medicated” with narcotics, a finding of a pattern of abuse could not be ruled out solely because he had ceased use shortly before his incarceration (para. 5) (Court decision.)⁴⁵⁰
• A defendant used methamphetamine “because he has ADHD, and using it calmed him down and made his mind clearer and more focused.” The Federal Court of Justice (BGH) addressed the obligation to hear an expert witness regarding Section 64 of the German Criminal Code (StGB) (para. 4) (court decision.)⁴⁵¹
• A hyperkinetic disorder of social behavior must be assessed in terms of the likelihood of successful treatment under § 64 of the German Criminal Code (StGB) (para. 13) (court decision.)⁴⁵²

A juvenile had been placed in a facility due to a severe hyperkinetic disorder of social behavior, with diminished capacity to stand trial under § 63 of the German Criminal Code (StGB). The Federal Constitutional Court (BVerfG) found that the decisions regarding the continuation of the commitment violated his fundamental right to liberty, in part because the expert was employed by the clinic’s operating entity and was therefore not an external expert (para. 3, 49, operative part). (Court decision.)⁴⁵³

8.2.2. Sentencing¶

If a defendant used cannabis as an “alternative medication” to prescribed Ritalin, this establishes “a concrete link between the defendant’s medical condition and the offense,” which must not be disregarded when determining whether the case constitutes a less serious offense (para. 8). (Court decision.)⁴⁵⁴

8.2.3. Preventive Detention and Enforcement of Sentences¶

In proceedings concerning preventive detention, ADHD in adulthood was taken into account as a factor in assessing the risk of reoffending, and its treatment with medication was recommended as a risk-reducing measure following release (para. 108). (Court decision.)⁴⁵⁵ One expert deemed methylphenidate unsuitable due to the convicted person’s addictive behavior and recommended atomoxetine or guanfacine (para. 33). The Senate assessed ADHD as an additional risk factor (para. 79, 90). (Court decision.)⁴⁵⁶

In enforcement proceedings, higher regional courts assumed that convicted individuals consumed alcohol or cannabis to alleviate ADHD symptoms (para. 5 (court decision.)⁴⁵⁷ , para. 34 (court decision.)⁴⁵⁸ ).

A court order requiring the regular administration of prescribed medication constitutes an order for medical treatment involving a physical intervention and is therefore permissible only with the consent of the convicted person (para. 26). (Court decision.)⁴⁵⁹ The Higher Regional Court of Brandenburg overturned an abstinence and monitoring order that had been issued to a convicted person despite known ADHD medication that could potentially affect drug tests. The Sentence Enforcement Chamber must determine the type, location, and frequency of the tests itself and assess their reasonableness in accordance with Section 68b(3) of the German Criminal Code (StGB). (Court decision.)⁴⁶⁰

8.2.4. Correctional System¶

Prisoners are entitled to necessary medical treatment, including the “provision of medication, bandages, medical supplies, and assistive devices” (Section 58 of the State Penitentiary Act). (Legal provision.)⁴⁶¹ Under state penal code laws, prisoners are entitled to necessary medical treatment, including medications, in accordance with the standards of statutory health insurance. The laws do not contain specific provisions regarding ADHD or stimulants. Examples:

• Bavaria, Art. 60 and 63(1) of the Bavarian State Penitentiary Act (BayStVollzG) (Legal provision)⁴⁶²
• North Rhine-Westphalia, § 45(1) StVollzG NRW, provided that no special provisions regarding the execution of sentences preclude this (only the original version has been reviewed) (Legal provision.)⁴⁶³

Prisoners may seek judicial review of the treatment provided by the prison physician. Because they lack the freedom to choose their own physician, prisoners are particularly dependent on this review, and courts may not decline to exercise it on the grounds of a lack of medical expertise (para. 18). The decision concerned diabetes. (Court decision.)⁴⁶⁴ Any medical measure taken by the prison physician is subject to review, including a reduction in dosage, although the court only examines whether the limits of medical discretion were observed. The case concerned a painkiller. (Court decision.)⁴⁶⁵ The Federal Constitutional Court (BVerfG) expressed concerns when a criminal enforcement chamber retroactively justified the transfer of a prisoner to a security unit on the grounds of his ADHD, even though the prison had not relied on that basis (para. 5). (Court decision.)⁴⁶⁶ No case law regarding methylphenidate in prison was found.

8.3. Juvenile Criminal Law¶

The juvenile court may issue an order to undergo therapeutic treatment only with the consent of the legal guardians; for youths aged 16 and older, the youth must also give consent (Section 10(2) JGG). (Legal provision.)⁴⁷⁶ The Juvenile Court Assistance Service must be consulted prior to any order (§ 38(6) JGG). (Legal provision.)⁴⁷⁷ To assess the juvenile’s developmental status, an examination by an expert with experience in adolescent psychiatry may be ordered (Section 43(2) of the German Juvenile Court Act (JGG)). (Legal provision.)⁴⁷⁸

Criminal courts cited a diagnosis of ADHD as the reason for delayed maturity and therefore applied juvenile criminal law to adolescents pursuant to § 105 of the JGG:

• Aachen Regional Court (para. 290) (Court decision.)⁴⁷⁹
• Aachen Regional Court, identical wording (para. 116) (court decision.)⁴⁸⁰
• Arnsberg Regional Court, upon the recommendation of the Juvenile Court Assistance Service, in the case of a nearly 21-year-old (para. 59). In that case, ADHD did not automatically diminish the probative value of a confession made during questioning (para. 44) (Court decision.)⁴⁸¹

9. Insurance Law¶

The policyholder must disclose known risk factors “about which the insurer has inquired in writing.” Withdrawal from the contract is excluded unless there has been a violation resulting from either willful misconduct or gross negligence. If the insurer would have entered into the contract under different terms even had it been aware of the circumstances, rescission on the grounds of gross negligence is excluded; in such cases, the contract is amended. These rights apply only if the policyholder has been specifically informed in writing (§ 19 VVG). (Legal provision.)⁴⁸² They expire after five years; in cases of intent or fraudulent misrepresentation, after ten years (§ 21 VVG). (Legal provision.)⁴⁸³ The right to rescind the contract on the grounds of fraudulent misrepresentation remains unaffected (§ 22 VVG). (Legal provision.)⁴⁸⁴ Voidability requires that the deception was the cause of the mistake and the conclusion of the contract (para. 23, health questions incorrectly checked by the agent). (Court decision.)⁴⁸⁵ The insurer generally may not require a general waiver of confidentiality. If it collected data without a sufficient legal basis, it may be prevented from relying on that data to support a claim of rescission based on fraudulent misrepresentation (Headnotes). (Court decision.)⁴⁸⁶ Policyholders of private health, accident, and life insurance policies are subject to the duty of confidentiality under § 203 StGB. (Legal provision.)⁴¹

The Higher Regional Court of Brandenburg dismissed a claim under an occupational disability insurance policy based on ADHD. The insured had not specifically described the last job he had held, and the court ruled that what matters is the impact of the condition on the specific occupation, not general functional capacity. (Court decision.)⁴⁸⁷

The Thuringian Higher Regional Court classified ADHD as a mental disorder that fell under the exclusion clause of a supplemental children’s disability insurance policy covering personality and behavioral disorders. Although ADHD can also be caused by a condition involving organic brain damage, the clinical report in the case at hand indicated that the causes were psychosocial stressors, and the mere assertion of a genetic predisposition was not sufficient to reinstate coverage. (Court decision.)⁴⁸⁸ Full text provided by the user via beck-online; only the grounds for the decision were analyzed. The court based its remarks on the causes of ADHD on a Wikipedia article.

The Krefeld Regional Court ordered a private daily nursing care insurance provider to pay benefits for a child with ADHD and care level 3, because the policy terms were tied to the determination made by the long-term care insurance fund, and the insurer could therefore no longer argue that ADHD did not constitute a need for long-term care. (Court decision, secondary citation via versicherungsrechtsiegen.de.)⁴⁸⁹

10. Sports and Doping¶

Stimulants (Class S6) are “prohibited during competition.” Amphetamine and lisdexamfetamine are classified as nonspecific substances (S6.A), while methylphenidate is classified as a specific substance (S6.B). All optical isomers are included. The list explicitly mentions ADHD as an indication for such substances. Atomoxetine and guanfacine are not on the list. (Regulations.)⁴⁹⁰ To obtain a therapeutic use exemption for methylphenidate or amphetamines for “ADS and ADHD,” the NADA requires: (Official information.)⁴⁹¹

• For children, a diagnosis must be provided by a child and adolescent psychiatry department, a neuropediatrics department, a pediatric practice specializing in ADHD, or a social pediatrics center, including a medical report, a neurological examination, an assessment of cognitive functioning, behavioral questionnaires, and a report—no more than three months old—on the course of treatment and attempts at tapering off medication
• For adults: diagnosis by child and adult psychiatry
• an approval period of “usually one year to start with”

Athletes in a NADA testing pool and players in certain leagues (e.g., the men’s 1st through 3rd Bundesliga soccer leagues, the women’s 1st Bundesliga) must apply for a therapeutic use exemption before using the substance. All others must apply for it retroactively only after a doping test. NADA authorizations are initially valid only for national competitions. A medical justification is required explaining why no permitted alternatives can be used. (Official information.)⁴⁹²

It is prohibited to use a doping substance “without medical justification” with the intent of gaining an advantage in an organized sports competition. The prohibition does not apply to substances that are prohibited only in competition when used outside of competition (Section 3(1) Anti-Doping Act). (Legal provision.)⁴⁹³ Self-doping is a criminal offense only for elite athletes in the testing pool and for athletes who derive significant income from sports (Section 4(7) Anti-Doping Act). (Legal provision.)⁴⁹⁴ The distribution and prescription of doping substances “for the purpose of doping in human sports” is prohibited for everyone (Section 2(1) AntiDopG). (Legal provision.)⁴⁹⁵

A professional ice hockey player who took lisdexamfetamine for ADHD and was suspended due to a delayed medical exemption failed in his lawsuit seeking damages against his club. The Düsseldorf Labor Court held that applying for the medical exemption was the player’s responsibility and did not consider the team doctors to be agents of the club in this regard (Headnote, para. 65). (Court decision.)⁴⁹⁶

11. Family Law, Legal Guardianship, and Liability¶

11.1. Custody and Medication¶

If parents with joint custody cannot agree on an ADHD diagnosis or medication, the family court may, upon request, delegate the decision to one parent, subject to restrictions or conditions (Section 1628 of the German Civil Code (BGB)). (Legal provision.)⁴⁹⁷ If the parents live apart, mutual agreement is required for matters of significant importance. Everyday decisions are those that occur frequently and do not have effects on the child’s development that are difficult to reverse (Section 1687(1) BGB). (Legal provision.)⁴⁹⁸ The guiding principle is the solution that best serves the child’s best interests (Section 1697a(1) of the German Civil Code (BGB)). (Legal provision.)⁴⁹⁹ Parents shall discuss matters of parental care with the child to the extent appropriate given the child’s level of development and shall strive to reach mutual agreement (Section 1626(2) of the German Civil Code (BGB)). (Legal provision.)⁵⁰⁰

Whether and how to administer methylphenidate as part of child and adolescent psychiatric treatment is not a matter of everyday life, but rather a matter of considerable importance in the field of health care, comparable to the decision regarding vaccination (Headnote, para. 42). The Higher Regional Court of Karlsruhe upheld the delegation of decision-making authority to the mother because the father had delayed the treatment for months and had contributed to its discontinuation (para. 43). The family court may not make the decision itself but must delegate it to the parent whose approach better serves the child’s best interests (para. 39, 40). That parent decides on the medication and dosage in consultation with the specialist physician (para. 45). (Court decision.)⁵⁰¹ Full text provided by the user. The link to landesrecht-bw.de could not be verified using the tool due to an access restriction.

Family courts ruled on a dispute between separated parents regarding ADHD treatment:

• In an ongoing dispute over a child’s medically recommended and already initiated medication, the Higher Regional Court of Brandenburg granted sole custody of the child to the mother pursuant to Section 1671(1) of the German Civil Code (BGB), after other treatments had proven insufficient. The father retained his right to information under Section 1686 of the German Civil Code (BGB). (Court decision.)^502503504
• In 2016, the same court upheld joint custody, even though the mother objected on the grounds that the father refused to allow medical treatment. Even irreconcilable differences of opinion on specific important matters must be resolved in accordance with § 1628 of the German Civil Code (BGB) (Headnote 2). (Court decision.)⁵⁰⁵
• The Higher Regional Court of Braunschweig ruled that a father’s comprehensive power of attorney regarding custody was sufficient, even though the child had been diagnosed with ADHD and treatment decisions were pending, as long as doctors had not specifically rejected the power of attorney. (Court decision.)⁵⁰⁶
• The Wolfenbüttel Local Court rejected the request for joint custody, in part because the parents could not even reach an objective agreement regarding an ADHD diagnosis. (Court decision.)⁵⁰⁷
• The Düsseldorf Local Court denied visitation rights to a father who repeatedly told his daughter that her ADHD medication was an illegal, addictive drug and who did not give her the medication on visitation days (para. 8 et seq.). The decision regarding the medication rested with the mother, who had sole custody. (Court decision.)⁵⁰⁸

If refusing or forcing treatment jeopardizes the child’s welfare, the family court may override the decisions of the custodial parent or revoke custody of health matters in whole or in part (Section 1666(3)(5) and (6) of the German Civil Code (BGB)). (Legal provision.)⁵⁰⁹ There are no consequences for an obligation to administer ADHD medication. Courts have taken the following into account:

• A mother’s vehement refusal to discontinue an ADHD medication—which was now ineffective due to its low dosage—as suggested by the pediatrician, following the transfer of custody to the father (para. 13) (Court decision.)⁵¹⁰ The Higher Regional Court of Hamm upheld the revocation of health care authority (para. 51, 66). (Court decision.)⁵¹¹
• that a mother had failed to ensure her son took his ADHD medication, in a case involving the partial revocation of parental rights (court decision.)⁵¹²
• that a mother did not actively seek a diagnosis and treatment for her children with ADHD, as grounds for denying the transfer of custody (para. 23) (court decision.)⁵¹³
• that ADHD medication alone did not meet the educational needs of a child with an additional attachment disorder and social behavior disorder, because it only improves concentration (para. 33) (court decision.)⁵¹⁴
• that a teenager with ADHD refused to take medication, noting that the child’s wishes carry greater weight as he or she gets older (para. 28, 43; citations verified only for general meaning) (court decision.)⁵¹⁵

11.2. Maintenance¶

Child support covers all living expenses, including the costs of raising the child (Section 1610(2) of the German Civil Code (BGB)). (Legal provision.)⁵¹⁶ Irregular, exceptionally high costs may also be claimed as special needs for past periods; after one year, this is only permitted in cases of default or pending litigation (Section 1613(2)(1) of the German Civil Code (BGB)). (Legal provision.)⁵¹⁷ Courts have ruled:

• A child with ADHD could not be left unsupervised for long periods of time; the estimated childcare costs were deducted from the fictitious income of the parent providing care (para. 35) (Court decision.)⁵¹⁸
• Child care support for a mother who had to supervise her 13-year-old son, who has a hyperkinetic social disorder. Starting at age 15, full-time employment is considered reasonable because medication can be optimized by that time (para. 52, 55) (Court decision.)⁵¹⁹
• ADHD treated with weekly occupational therapy was still within the usual scope of care and did not limit the obligation to work full-time. Any increased care needs had to be specifically demonstrated (para. 92) (Court decision.)⁵²⁰
• An educational computer for a child with ADHD, a condition that had been known for years, was not considered a special need because the purchase could be planned in advance (para. 27) (Court decision.)⁵²¹

11.3. Placement and Measures Involving Deprivation of Liberty for Children¶

The Federal Court of Justice (BGH) held that, under the law in effect at the time, the nighttime restraint of a child with early-onset autism and ADHD in an open special education facility did not require authorization under § 1631b of the German Civil Code (BGB) (Headnote 1, paras. 11, 14). (Court decision.)⁵²² Under § 1631b(2) of the German Civil Code (BGB), which is currently in force, the regular or prolonged deprivation of liberty in facilities through the use of mechanical devices or medication requires the approval of the family court. (Legal provision.)⁵²³ In 2012, the Federal Court of Justice (BGH) addressed the issue of the secure placement of a child who had been diagnosed, among other things, with a hyperkinetic disorder of social behavior (para. 6). (Court decision.)⁵²⁴

11.4. Legal Guardianship¶

Legal guardianship is established when an adult is legally unable, either in whole or in part, to manage his or her own affairs due to an illness or disability. It may not be ordered against the person’s free will, and it takes precedence over powers of attorney and other forms of assistance (Section 1814 of the German Civil Code (BGB)). (Legal provision.)⁵²⁵ The Federal Court of Justice (BGH) twice criticized regional courts for assessing the significance of ADHD in determining the need for guardianship without possessing the necessary expertise:

• A regional court had revoked the guardianship of a 20-year-old with ADHD on the grounds that ADHD is easily treatable, and had disregarded two expert opinions without demonstrating the necessary expertise (para. 7, 12). The expert had classified ADHD combined with developmental delay as a mental disability for the purposes of guardianship law (para. 14). The person with ADHD could not be referred against his will to assistance for young adults under § 41 SGB VIII (para. 16). (Court decision.)⁵²⁶
• A regional court had concluded that ADHD diagnosed by hospital physicians had no significant impact (para. 5, 15). An expert opinion must be up to date; if there are indications that the situation has changed, at least one supplementary opinion must be obtained (para. 12). (Court decision.)⁵²⁷

Both decisions were rendered under the old guardianship law. Compulsory medical treatment for individuals under guardianship is permitted only under strict conditions, only on an inpatient basis in a hospital, and only with the approval of the guardianship court (Section 1832 of the German Civil Code (BGB)). The law does not provide for outpatient compulsory medication, such as with stimulants. (Legal provision.)⁵²⁸

11.5. Liability and Duty of Supervision¶

Children under the age of seven are not liable for damages; in road and rail traffic, this applies until their tenth birthday, except in cases of intentional misconduct. Older minors are not liable if they lacked the understanding necessary to recognize their responsibility (Section 828 of the German Civil Code (BGB)). (Legal provision.)⁵²⁹ Parents are liable for damages that their minor child unlawfully causes to third parties if they have breached their duty of supervision. Fault is presumed; parents may exonerate themselves (Section 832(1) BGB). (Legal provision.)⁵³⁰ The extent of supervision is determined by the child’s age, disposition, and character, as well as by what reasonable parents must do in the specific situation to prevent harm (para. 11). (Court decision.)⁵³¹ For a child with pronounced impulsivity, therefore, closer supervision may be required than for peers of the same age. No ADHD-specific supreme court decision on this matter was found. (ADxS assessment.)

12. Medical and Pharmaceutical Law¶

12.1. Informed Consent and Medical Liability¶

If a child is not capable of giving consent, the legal guardians must consent to ADHD medication (Section 630d(1), sentence 2, BGB). (Legal provision.)⁵³² Before prescribing stimulants, the physician must provide information about the type of medication, risks, prospects of success, and equivalent alternatives with different risks. The essential details must be explained to the child in a manner appropriate to the child’s level of development (Section 630e(1), (5) BGB). (Legal provision.)⁵³³ The explanation must be provided orally; a reference to signed information sheets is not sufficient (para. 13). (Court decision.)⁵³⁴

In a medical malpractice case, adoptive parents accused a pediatrician of jumping to a diagnosis of ADHD and failing to recognize fetal alcohol syndrome. The Federal Court of Justice (BGH) overturned the Frankfurt Higher Regional Court’s decision dismissing the lawsuit because the latter had determined the medical standard without consulting an expert (para. 3, 14). The BGH did not rule on whether there had been medical malpractice. (Court decision.)⁵³⁵ The Higher Regional Court of Cologne was unable to establish a connection between a delayed cesarean section and a later diagnosis of hyperkinetic syndrome, even under the relaxed standard of proof set forth in § 287 of the German Code of Civil Procedure (ZPO) (para. 64). (Court decision.)⁵³⁶

12.2. Telemedicine, Prescriptions, and E-Prescriptions¶

Treatment provided exclusively remotely is permitted only on a case-by-case basis if it is medically justifiable and the required standard of care is maintained in the assessment, consultation, treatment, and documentation (§ 7 (4) MBO-Ä). (Regulations.)³⁷³ The German Medical Association emphasized that every prescription issued as part of exclusively remote treatment requires a case-by-case assessment of medical justifiability. (Technical Information.)⁵³⁹ In the opinion of the Federal Opium Control Board, a prescription for a controlled substance is justified only if the physician is convinced of its necessity based on his or her own examination. Prescriptions for controlled substances should be sent by mail only in exceptionally justified cases (Question 27). (Official information.)⁵⁴⁰ The former prohibition on dispensing medications under pharmaceutical law in cases of an obvious lack of direct contact between physician and patient is no longer included in Section 48(1) of the German Medicines Act (AMG). (Legal provision.)⁵⁴¹ The regulations do not expressly address whether an ADHD diagnosis followed by a prescription for stimulants, conducted exclusively via video, meets these requirements.

In the U.S., the Drug Enforcement Administration temporarily suspended the requirement for an in-person examination prior to prescribing controlled substances during the COVID-19 pandemic, which benefited providers offering ADHD treatment exclusively via telemedicine. (Legal overview; full text not accessible to us, E 4.)⁵⁴² The Federal Court of Justice (BGH) ruled that an internet platform that advertises conditions treatable with medical cannabis—such as ADHD—and refers treatment requests to cooperating physicians violates the ban on public advertising for prescription drugs under Section 10(1) of the German Advertising Act (HWG). (Court decision.)⁵⁴³

Section 360(2), sentence 2, of SGB V has required contracted physicians, effective July 1, 2025, to issue electronic prescriptions, including for controlled substances. (Legal provision.)⁵⁴⁴ However, § 8(1) of the BtMVV continues to require the use of the official form. (Legal provision.)⁵⁴⁵ As of June 2025, the BfArM had not yet announced a date for the digitization of narcotic prescriptions. (Official information.)⁵⁴⁰ The status as of October 2026 is unclear.

12.3. Diagnosis by doctors, psychotherapists, and alternative practitioners¶

Who is authorized to diagnose and treat ADHD:

• Licensed psychotherapists are authorized to identify disorders that constitute a medical condition and can therefore also diagnose ADHD; however, as part of treatment, they must arrange for a somatic evaluation (Section 1(2) of the Psychotherapy Act (PsychThG)). They are not permitted to prescribe medication (Legal provision.)⁵⁴⁶
• Alternative practitioners are permitted to practice medicine (Section 1 of the Alternative Practitioners Act [HeilprG]), but they may not prescribe ADHD medications because prescription drugs and controlled substances require a doctor’s prescription (Legal provision.)⁵⁴⁷²
• Standardized psychometric tests may be delegated to qualified staff. Taking a medical history, determining the indication, evaluating test results, making a diagnosis, and deciding on treatment remain strictly personal medical duties (Expert recommendation.)⁵⁴⁸

12.4. Law Governing Contract Physicians¶

A pediatrician practicing as a primary care physician may bill for specialist services related to the diagnosis and treatment of ADD/ADHD only if he or she possesses the required formal qualifications, even if he or she claims that care in his or her region would otherwise not be ensured (para. 42, 45). (Court decision.)⁵⁴⁹ The Licensing Committee may grant pediatricians and adolescent medicine specialists temporary authorization to perform specialist medical activities if care commensurate with demand is not guaranteed (Section 73(1a), sentence 3, SGB V). (Legal provision.)⁵⁵⁰ The Berlin-Brandenburg Social Court upheld a claim for reimbursement of fees against a pediatrician because ADHD is not a systemic metabolic disorder within the meaning of the former EBM code 04001. (Court decision.)⁵⁵¹

12.5. Patent and Competition Law¶

The Federal Patent Court declared the German supplementary protection certificate for lisdexamfetamine invalid because the active ingredient did not constitute a new product compared to the already approved dexamfetamine (para. 14). (Court decision.)⁵⁵² The finality of the decision was not reviewed. The Regional Court of Düsseldorf subsequently denied a request for a preliminary injunction filed by the certificate holder against a generic drug supplier (paras. 3–6). (Court decision.)⁵⁵³ In summary proceedings, the Higher Regional Court of Düsseldorf refused to prohibit the sale of a dietary supplement containing omega-3 and omega-6 fatty acids for children with ADHD without making a final ruling on its efficacy (para. 18 et seq., 30). (Court decision.)⁵⁵⁴

13. Right of Residence¶

A prohibition on deportation due to illness applies only in cases of life-threatening or serious illnesses that would be significantly worsened by deportation. Medical care in the destination country does not have to be equivalent to that in Germany (Section 60(7) of the Residence Act). (Legal provision.)⁵⁵⁵ A medical condition must be substantiated by a qualified medical certificate that includes, among other things, the diagnosis according to ICD-10, the severity of the condition, and the medications listed by active ingredient and international name. If it is not submitted immediately, the authority may, as a general rule, disregard the claim (Section 60a(2c), (2d) of the Residence Act). (Legal provision.)⁵⁵⁶

In cases involving deportations, the courts ruled:

• Anyone who relies on methylphenidate must also provide substantiated evidence that it is unavailable in their country of origin (para. 6). Feeling unwell or having difficulty concentrating upon discontinuation did not constitute a significant, concrete risk (para. 7). (Court decision.)⁵⁵⁷
• In the case of two children with hyperkinetic disorder (F90.0 and F90.1) who were taking Medikinet, the condition did not meet the threshold set forth in § 60(7), sentence 1, of the Residence Act (AufenthG) (para. 127). (Court decision.)⁵⁵⁸
• A 10-year-old child with ADHD was deemed fit to travel despite a medical certificate stating that the child was unfit to travel. The concern that the child would receive inferior care in the country of origin pertained to country-specific prohibitions on deportation, not to the child’s fitness to travel (paras. 52–54). (Court decision.)⁵⁵⁹
• A 10-year-old child’s ADHD and a specialist’s concern about potential decompensation did not prevent the father’s deportation because the prognosis was unfounded and did not take into account previous periods of separation. (Court decision.)⁵⁶⁰
• Without medical evidence, the claim that a child suffered from ADHD was deemed irrelevant (para. 18). (Court decision.)⁵⁶¹