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Experts warn of "ADHD generation"
Between 2006 and 2011, ADHD was diagnosed in almost 20 percent of all boys and 7.8 percent of girls born in 2000. This was the result of the "Doctor Report 2013" of the Barmer GEK health insurance company, which speaks of the "Generation ADHD".
ADHD diagnoses should not get out of hand. Pills against parenting problems are the wrong way, commented Dr. Rolf-Ulrich Schlenker, deputy chairman of the board of the Barmer GEK, the result of the investigation. According to the 2013 doctor's report, ADHD diagnoses are often made, especially in Würzburg. Professor Dr. Marcel Romanos, director of the clinic and polyclinic for child and adolescent psychiatry, psychosomatics and psychotherapy at the University of Würzburg, however, warns of hasty conclusions. The results cannot be generalized without restriction. The ADHD expert also sees a risk in blaming parents' incompetence as the cause of their children's problems. Studies have shown that ADHD is primarily genetic.
ADHD - the "Zappelphilipp syndrome" Attention deficit / hyperactivity disorder (ADHD) is one of the most common child psychiatric disorders and manifests itself through problems with attention, impulsiveness and hyperactivity. Affected children are unable to concentrate well, often fail to complete tasks, change jobs, suffer from nervousness and inner restlessness, and stand out in the classroom as "fidgeting". Children with ADHD can also experience developmental disorders in learning or social behavior. ADHD is classified as incurable by psychiatrists.
The exact causes of ADHD have not yet been fully clarified. Favorable factors of ADHD include exposure to alcohol and nicotine during pregnancy, pregnancy and birth complications, lower birth weight, infectious diseases, various pollutants and environmental toxins as well as diseases and injuries that affect the central nervous system. Experts speak of a multifactorial causation of ADHD, in which biological, psychological and social factors work together. Genetic causes also play an important role.
The cause of ADHD, above all genetically determined, scientists from the University of Cardiff in Wales already established a connection between the development of ADHD and the genome in 2010. For their study, the researchers compared the genome of 366 children diagnosed with ADHD with the DNA of 1,047 healthy people. It was found that twice as many of the ADHD children (15 percent) compared to healthy children (7 percent) had a clear and rare change in their DNA. Anita Thapar, a professor of neuropsychiatric genetics at Cardiff University and head of the study, reported that ADHD often does not occur in just one family member, so there is reason to suspect that an inherited cause is also responsible for ADHD. The study confirmed this presumption.
The difference in the genetic makeup of healthy children and ADHD patients essentially consists in deviations in the so-called gene copy number variants (CNV), the scientists explained. ADHD children were more likely to have defective DNA structures. Some parts are duplicate or missing completely. Experts have long suspected a connection between CNV and a predisposition to certain diseases such as schizophrenia.
Doctor report: Children of unemployed people have ADHD more often According to the Barmer GEK medical report, there is a dramatic increase in ADHD diagnoses. In the period from 2006 to 2011, the number of cases is said to have increased by 42 percent. Children from families with a low income are particularly affected. The risk is even higher if the parents are unemployed, the report says. In addition, the risk of ADHD decreases, the better the level of education. “We have to be careful that ADHD diagnostics don't get out of hand and that we manufacture an ADHD generation. Pills against educational problems are the wrong way, "warns Dr. Rolf-Ulrich Schlenker, deputy chairman of the board of the Barmer GEK.
Professor Dr. Marcel Romanos sharply criticizes statements like this. In an interview with the "Mainpost Würzburg" he reports that unfortunately it is often doubted that "ADHD is an illness". In the public discussion, educational errors would often be cited as the cause of ADHD.
“The reckless reproach that ADHD is due to the incompetence of the parents does not do the situation justice in any way. Families have to put up with a lot to help their affected children and often reach their limits. Many families even break up with this problem, ”said the expert.
Overwhelmed teachers, too little exercise and excessive media consumption are also often cited as causes. However, Romanos sees above all a genetic predisposition as a trigger of ADHD. Studies on identical and dizygotic twins would have proven beyond any doubt the connection between the genetic material and the disease. In 80 percent of identical twins with identical genetic makeup, both children are affected, in dizygotic twins only 30 percent. In about a third of ADHD children, one parent is also affected.
ADHD research at the Würzburg University Clinic for Child and Adolescent Psychiatry
The university clinic in Würzburg focused on ADHD research, reports the clinic director. The first is to research the causes of the disorder, which include not only the genetic but also environmental factors. On the other hand, one focuses on the therapy of those affected and their family members. So-called biomarkers, biological factors, would also be researched in order to be able to make a better diagnosis and prognosis. Then there are the psychological factors that would also be examined in Würzburg. A large psychological study was recently completed. As a preliminary result, according to Romanos, the knowledge that affected families can be helped particularly effectively if their environment is also treated can be cited. Accordingly, it is not enough to limit treatment to the child concerned. It must also be checked whether there are other mental illnesses within the family. It is not uncommon that the mother is also affected by ADHD, the expert said. Therefore, it would currently be examined whether the children also benefit from the treatment of the symptoms of the mothers. This is the first study of this kind worldwide.
Treatment for ADHD consists of a combination of psychotherapeutic measures In order to provide the best possible advice to the affected children and their families, after the diagnosis has been made, intensive information is first provided on the symptoms of ADHD. This is followed by various behavioral therapy measures, reports Romanos. Drug treatment, for example with psychostimulants such as methylphenidate (Ritalin), is only possible in severe cases of ADHD. Children who did not need Ritalin would not have one either. However, the drug works most strongly against the core symptoms in ADHD children.
The best results were achieved when children who received a medication were also undergoing behavioral therapy. A strong effect of the behavioral therapy measures can be observed especially in those affected who suffered from other mental illnesses such as depression in addition to ADHD. Psychiatric comorbidities are not uncommon in ADHD. However, the children who only had ADHD would not have shown any additional noticeable effect from behavioral therapy, said the clinic director. Although there is little scientific evidence to support the effectiveness of behavioral therapy in a pure ADHD disorder, the guidelines recommend it. In contrast, the effectiveness of Ritalin has been clearly demonstrated.
Ritalin in ADHD is controversial According to the medical report 2013 by the health insurance company Barmer GEK, the prescription frequency of methylphenidates (Ritalin) increased in a similar way to the increasing number of ADHD diagnoses, with the amount of daily doses declining for the first time after 2010. In 2011 alone, Ritalin was prescribed 336,000 times. Children were most often given the drug when they were eleven years old. Accordingly, at least 10 percent of boys and 3.5 percent of girls take anti-ADHD medication at least once in their lives. The cash register is extremely critical of this development. "Ritalin must not be the first choice per se," warns the deputy chairman of the Barmer GEK.
Romanos also expressly speaks out “against a non-indexed Ritalin prescription”. A diagnosis must be made clearly and unambiguously. With mild form of ADHD, psychotherapeutic treatment without medication is often sufficient. In severe cases, however, Ritalin is necessary. The discussion and especially the rejection of the drug would primarily affect people who have never treated an ADHD child and are not affected themselves. However, this one-sided view goes beyond the interests and needs of those affected. Even self-help groups would advocate Ritalin, reports the doctor.
Romanos firmly rejects the accusation of the Barmer GEK that Ritalin might be used too quickly in the “ADHD stronghold of Würzburg”. He sees a high degree of medical competence in Lower Franconia. The doctor excludes negligent action on the part of the doctors. Despite good care for ADHD patients, there are long waiting times. So there is no need to "unnecessarily make an ADHD diagnosis". Ritalin is not prescribed as a percentage more often in Lower Franconia than in other regions of Germany. This is also shown by the doctor's report. The prescription frequency of Ritalin did not increase between 2011 and 2012. However, the number of diagnoses for ADHD and the medication prescription for adults has increased.
„ADHS stronghold Würzburg ”is in the middle of the field internationally The clinic director is annoyed with the report of the Barmer GEK. The diagnosis rate of ADHD of 4.14 percent in children and adolescents ranks Romanos in the middle in an international comparison. It is not recognizable that doctors would make a corresponding diagnosis too carelessly. In Würzburg, the number of diagnoses would increase because the university clinic as well as the established child and adolescent psychiatrists form a specialist center for ADHD, which could possibly make a diagnosis that would otherwise not be recognized. Many families from other federal states would even come to the clinic. Although these would not appear in the doctor's report, on the other hand, the privately insured and the data from the other statutory health insurance companies were also missing. The report is only a secondary data analysis and is neither a scientific study nor an epidemiological investigation. Romanos may see the report as a political instrument that is generally used to question mental illnesses.
Occupational therapy does not make sense for ADHD When looking at the costs of treating ADHD, the doctor's report shows that Ritalin only incurs about ten percent of the treatment costs. Psychotherapy and occupational therapy are significantly more expensive, explains Romanos. It is already known that occupational therapy has no effect on ADHD. Other countries have therefore deleted them from their treatment catalog. Alternatives to drug therapy such as neurofeedback would have to be researched further. The data situation there is still very bad.
According to Romanos, the discussion about Ritalin has primarily to do with the assessment of mental illness in our society. Patients with biliary colic who would have gotten them from high-fat food and too much alcohol would not be stigmatized. In the case of mental illnesses such as depression, which those affected would have received through no fault of their own, the question of guilt would be asked. It is not accepted that "mental illnesses can affect everyone and are therefore part of our society," criticizes the doctor. It is important to counter this development. Often, parents would be charged with ADHD for not caring for their children, watching too much TV, or missing exercise. Prejudices like this would, however, contribute to the trivialization of ADHD and defame the families affected. (ag)
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Picture: Nicole Celik / pixelio.de