Can ADHD be a symptom of malnutrition

Attention Deficit / Hyperactivity Disorder (ADD, ADHD)

therapy

Treatment depends on the severity of the symptoms and the age of the child. It is usually helpful to have an individually tailored mix of advice, action strategies, behavioral therapy methods and, often, medication. Experts speak of a "multimodal therapy concept". What is used depends on how pronounced the restrictions are and how old the child is.

Most of the time, the treatment can take place on an outpatient basis. If the behavioral abnormalities are very pronounced, so that there are massive conflicts with the environment, inpatient or partial inpatient therapy is sometimes necessary. This can also be appropriate if the situation at home is particularly difficult or there are additional illnesses.

The aim of the treatment is to enable the child to make the most of his or her possibilities. Together with parents and other caregivers, they learn to better control their own behavior, defuse conflicts and also develop strategies for dealing with distractibility.

Clarification and counseling (psychoeducation)

In the first step, parents learn how ADHD expresses itself and how they can best help their child. You learn to define clear rules and to remain consistent. At the same time, they are encouraged to specifically strengthen their child's self-esteem and to recognize and praise positive behaviors - even in rudimentary form.

Ideally, the teachers and educators of the affected child should also be given detailed information about ADHD and, together with experts and parents, consider how they can best respond to specific problems. Educators should know that the children concerned are not simply "stupid", "lazy" or "naughty".

Older children and adolescents also usually find out about their "handicap" themselves. If they are more aware of how they act in certain situations, they can also take countermeasures more effectively. It is also very important that those affected are involved in the treatment. In adolescence at the latest, they otherwise no longer feel like doing therapies or taking drugs that are supposed to "make them normal" or "calm them down". If you know where your strengths and weaknesses lie and how you can deal with them and which treatment will help you in what way, you are much more willing to continue with it.

Parents sometimes blame themselves when they learn that their child has ADHD. They believe they have failed in their upbringing. Contact with other people affected can take this pressure off them. In self-help groups, those affected find out that they are not alone with their fate - and what options there are to most of life with ADHD.

psychotherapy

In the treatment of ADHD, behavioral therapeutic measures are primarily used. Therapy can be addressed to the child or to his or her parents. The experts may also develop specific programs for the situation in school or kindergarten. Ideally, the therapy starts exactly where the conflicts arise.

With the help of behavior therapy, those affected should recognize how they react in a certain situation and why. In this way they can learn to deal with problems better in the long term.

For example, experts try different exercises to improve the child's attention. Parents are offered methods that help them to convey rules and structures to the child. Examples are:

  • The Coin Amplifier System: This reward system is widely used in the treatment of ADHD. This involves talking to the child about positive behavior that should be encouraged as much as possible. This behavior is practiced with plans and transferred to everyday life. To make things easier for the children, they receive a coin for every positive behavior. Several coins can later be exchanged for something that the children really want. That could be a visit to the cinema, a reading lesson or a new CD. Gradually, the use of coins will be reduced. Over time, this creates a permanent learning effect.
  • Response cost: Rewards are also used here, but the system works a little differently. A reward for good behavior is agreed with the child. However, as soon as the child behaves undesirably, this reward is withdrawn. However, this system should only be used with caution and in good consultation with an expert. Children with ADHD usually have low self-esteem and little tolerance for frustration. They are therefore often very sensitive to punishment.

Medication

Medication is designed to enable people to concentrate better, be more attentive, and have more control over impulsive reactions. Most commonly, drugs are used that have a stimulating effect (methylphenidate and amphetamines). But there are also other active ingredients.

Treatment guidelines recommend the use of medication in children aged six and over if the ADHD symptoms are so pronounced that the child and their environment are significantly impaired. In these cases, medication can often help the child quite quickly.

It is important to examine the child carefully before administering any medication. The treating expert must recognize any risk factors that could speak against the medication or require special caution, for example heart disease. He should also talk to the parents in detail about the effects and possible side effects. All drugs can cause side effects. Some studies found that the drugs had negative effects on the height and weight of children. Other studies did not find such effects. As far as is known so far, the final size of the children is unlikely to be affected.

The length of treatment depends on how the ADHD symptoms develop. In an acute crisis, the dose can rarely last for a few weeks or months. The therapy is usually designed for a longer period of time. The treating expert should check at least once a year whether further drug treatment is really necessary. In 85 to 90 percent of those affected, the drugs bring the desired success. If treatment with medication is no longer necessary or no longer desired, this should be discussed with the attending physician. In particular, the transition to adulthood, with more demands on organization, personal responsibility and independence, harbors many challenges.

Methylphenidate: This stimulant drug increases the neuronal availability of dopamine and norepinephrine and is sold under many names. Today's products differ mainly in the duration of their effectiveness. Therapy can be started with a fast-acting form or a sustained-release form with delayed release of the active ingredient. The respective dose is determined individually and may have to be adjusted after a while. The prescription of methylphenidate is subject to the Narcotics Act, which means that the doctor must use special prescriptions that are valid for a maximum of one week.

Methylphenidate does not increase the risk of drug, nicotine or alcohol addiction, and some studies indicate a reduced risk. Possible side effects such as tics, increased restlessness or headaches usually disappear again after setting the correct dose. Because the drug can sometimes increase blood pressure or heart rate, regular check-ups are recommended, especially during the adjustment phase.

Amphetamines: They also increase the neuronal availability of norepinephrine and dopamine and also release both messenger substances. They are particularly suitable for those affected by methylphenidate who do not work sufficiently or who react to it with side effects such as depressive moods or tics. The use of amphetamines also seems beneficial for additional social disorders and aggressive behavior disorders. For a time, amphetamines were not offered as finished drugs in Germany, but instead produced individually as juice in the pharmacy if required. This is still possible today, but D-amphetamine is now available as a tablet. Lisdexamfetamine is a newer drug that has a longer duration of action than most other stimulants and is believed to have low risk of abuse. Amphetamines are also subject to the Narcotics Act and require follow-up controls similar to methylphenidate.

Non-stimulating drugs: 

Atomoxetine, which is actually an antidepressant, increases the neural availability of norepinephrine and can also reduce the symptoms of ADHD. The side effects are similar to those of methylphenidate, except that sexual problems can occur more frequently. A slow and careful dosage helps to avoid side effects. In many cases, the effect is only delayed, so that the effect can often only be reliably assessed after several weeks of the optimal dose. Atomoxetine has the advantage over stimulants that it cannot be misused.