My child has ADHD - now what?

The question «Is my child ill or just different?» is not easy to answer. Even the definition of illness is difficult: it is considered a disorder of physical, mental and social well-being. The definition becomes more precise when we bring the suffering or pain of those affected into play.

Is the child suffering, is it in mental or physical pain? If the answer to this question is «yes», an illness can be assumed - regardless of which behavioural abnormalities are observed.

If we suspect that our child might be ill, we need to look at the child and collect signs of illness. For example, we ask: «Are you distressed? », or: «Are you in pain? », and observe whether they are eating little, crying or sleeping badly.

Looking at living conditions

If illness is suspected, the next question we need to ask ourselves is: «Is it the living conditions that are causing the suffering and behavioural problems?» The person must be considered as a whole: Body, psyche and social relationships influence the child's well-being.

The correct response to signs of ADHD begins with analysing and adapting living conditions. If these are unhealthy, it will make everyone ill sooner or later. Mental disorders such as ADHD are particularly sensitive to context and environment. For example, simple communication, clear rules and sufficient praise are important, as are a regular daily routine and strict regulation of media consumption.

The child's suffering and pain must be greater without therapy than with therapy.

Learning to play a musical instrument also reduces the symptoms. Regular physical activity such as jogging, swimming, yoga, aerobics and tai chi has a positive effect on symptoms and anxiety.

Some children respond strongly to changes in their diet. Fish oil and diets without industrially processed foods as well as reducing sugar are also promising. Iron, magnesium, vitamin B complex and zinc reduce ADHD symptoms if the children have a deficiency.

Specialist diagnosis for ADHD

ADHD does not have a clearly measurable physical clinical picture. As a result, there are still no obvious criteria for the disease, only symptoms. If the symptoms are present, it is not yet clear that it is ADHD.

The child may have ADHD symptoms but still be healthy. Depression and other disorders must be excluded by differential diagnosis. This can only be done by a specialist in behavioural disorders.

Benefits and risks of the therapy

Once the child has been diagnosed with ADHD by a specialist, the next question is: «Which therapy will help my child and which will hurt?» Any therapy may only be used if its benefits are proven to consistently outweigh the expected undesirable side effects or other risks of the therapy.

The child's suffering and pain must be greater without therapy than with therapy. The particular challenge of ADHD therapy is that every child reacts differently to the therapy. What benefits one child may harm another. The child must therefore be constantly observed and questioned by parents and therapists.

An ADHD medication is only considered effective if its efficacy has been demonstrated in empirical double-blind studies in comparison with a placebo. If the superiority of the active substance over the placebo is refuted in new trials, this therapy must be discarded. In this way, new findings are always included in the evaluation of a therapy. The fact that medical practice is constantly being reviewed and corrected does not mean that we are failing in our ability to heal, but that we are constantly trying to improve the benefits of the therapy.

Therapeutic options

As ADHD is a collective term for various mental disorders, therapy is also necessary that works on several levels simultaneously. This therapy includes, firstly, the aforementioned adjustments to the child's living conditions and, secondly, non-drug forms of treatment such as parent training and psychotherapy, Recommendations on methylphenidate Examination before prescribing: cardiovascular system, blood values, liver values, differential diagnosis to rule out depression/anxiety disorder.

Multimodal therapy: MPH should only be prescribed by a specialist as part of an overall strategy with psychological, educational and social measures. Effectiveness: If the ADHD symptoms do not improve within one month, the medication is discontinued.

Short-term therapy harbours a high risk of non-life-threatening side effects; life-threatening effects do not occur with a short duration of therapy of up to six months. Constant monitoring of weight and appetite loss, sleep disturbance, blood pressure, heart rate, liver toxicity, growth retardation and psychiatric disorders (risk of suicide and development of dependence); Ritalin holidays every three months: The drug should be discontinued after one year. Longer effectiveness has not been proven.

The child may have ADHD symptoms but still be healthy.

Withdrawal symptoms that correspond to ADHD symptoms may occur on discontinuation as they have excellent effects without side effects. In particularly severe cases, and only when the above strategies prove inadequate, drug treatment should be considered. According to the drug information, this treatment must be part of an overall therapeutic strategy and be carried out under the supervision of a specialist in behavioural disorders.

The reason for this caution is that the most commonly prescribed drug methylphenidate (MPH) can also have severe side effects. A new and independent overview study by the Cochrane Research Network (2015), for example, found that the positive effect of MPH is less well researched than previously assumed.

The researchers criticise the fact that no systematic studies on benefits and risks and no studies on long-term use have been carried out. This unclear research situation makes it even clearer that all adults involved must ensure that every single child benefits from their MPH therapy in terms of health, which is no easy task (see box below).

Great attention is required

ADHD is a challenge. However, critically analysing the effectiveness of ADHD therapies helps us to recognise positive and negative effects on the child more quickly. Children and parents are not left to their own devices; teachers and other healthcare professionals are there to support the family. The solution is to pay close attention to the children, their idiosyncrasies and their needs.