One cannot assume THE therapy. Since all people are different, it is also important to create an individual form of therapy. You can find out here what this can look like and what it is based on.
Not every ADD/ADHD needs to be treated. Often the knowledge about the problem and dealing with it is enough.
Children need structure and organisational aids, for example, to help them cope better with everyday school life. We provide you with checklists for this purpose on the Homepage of the OptiMind Institute to the Download available.
In our training seminars you will learn that children with ADD/ADHD have a very special "instruction manual" that is important to know.
The same principles apply to adults. The main focus is on how they can better organize their daily lives. Important aids include annual calendars, to-do lists and reminders. In this way, those affected should get more structure in their everyday life and always keep track of less interesting activities.
However, if children or adults develop "considerable" impairments and comorbidities, such as massive self-esteem disorders, school failure or even refusal, threatened loss of employment or perhaps also pronounced partnership conflicts, then it is time to think about further therapeutic interventions.
Basically, these can be classified into 2 areas:
- the non-medicinal area
- the medicinal area
Non-medicinal area
A psychological accompaniment (behavioral therapy)
Here the child/adult should learn to structure and organise themselves better. In addition, a way should be found to better deal with feelings and impulsivity. For years, we have been working very closely with the child and youth therapist Dr. Dipl.-Psych. Petra Marina Hammer, who provides absolutely competent psychological care for our young patients. Behavioural therapy is covered by statutory and private health insurance.
Adult treatment is often complicated by other comorbidities or problems that have "accumulated" over the life course. Typical comorbidities in children and adults with ADD/ADHD are:
- Self-esteem disorder
- Anxiety Disorder
- Depression
- Additional partial performance disorders such as LRS, Dyscalculia
- Tics
- Rarely obsessive thoughts or even compulsive acts
- Eating Disorders
You need a very experienced psychologist to distinguish between the different symptoms. Our task is therefore to distinguish disorders from each other and to set priorities in the therapy.
Just as an aside, regular exercise and various forms of mindfulness training, as well as organizational and stress management training, have also proven effective.
Medicinal area
People with ADD/ADHD have a harder time in some respects. Because in school and at work, it is often precisely the skills with which they are "at war" - such as attention, diligence or concentration - that are required. However, people with ADD/ADHD are by no means lazy or stupid. Many even possess special qualities, such as being extremely creative, enthusiastic or inventive.
Some people with ADD/ADHD with marked symptoms can only experience what it is like to be not only
- To have chaos in the head
- living in emotional extremes
- to drown in absentmindedness
- to be inconvenienced by their high impulsiveness
but to be able to act more self-determined and with foresight.
How do these drugs work?
In principle, the drugs work in the same way - they reversibly, i.e. only for a fixed time, block the reverse transport ("re-uptake") of the neurotransmitters norardrenaline and dopamine in the "pre-synaptic part" of the synapse between nerve cells. This increases the concentration of these neurotransmitters in the synaptic cleft and improves the transmission of information between nerve cells. The mode of action of the new drug with the active ingredient "guafacine" has not yet been clarified.
How is that to be understood? A little biology
Nerve cells, or so-called neuronal networks, constantly exchange information with each other. This happens through neurotransmitters. In the centres that are primarily responsible for attention and impulse control ("executive functions"), these are the neurotransmitters noradrenaline and dopamine. You can think of it this way: the new information travels along nerve cell 1 as an electrical impulse and at its end causes a release of the neurotransmitters dopamine/norepinephrine. Since nerve cells do not "stick" to each other but are separated by a fine gap, the "synaptic cleft", this neurotransmitter first gets there. On the other side of the synaptic cleft is nerve cell 2, which captures this neurotransmitter through receptors. According to the "all or nothing principle", after a certain number of these postsynaptic receptors of nerve cell 2 are occupied, an electrical discharge occurs that corresponds to the information passed on from nerve cell 1. Superfluous and unconsumed neurotransmitters in the synaptic cleft are now quickly pumped back out of the synaptic cleft by so-called "dopamine transporters" into nerve cell 1 in order to be available for the next information transfer (re-uptake).
In the case of ADD/ADHD, it has now been proven by genetic research that this re-uptake is "over-functioning", i.e. it is too strong, so that there is always too low a concentration of neurotransmitters remaining in the synaptic cleft, thus impairing the transmission of information.
The drugs ensure that this "re-uptake" proceeds more slowly by inhibiting the dopamine transporters in their function for a while. This increases the concentration of dopamine and norepinephrine in the synaptic cleft and improves the transmission of information and thus attention and impulse control.
It is important for you to understand, then, that with the drugs there is not a "structural" change to the nerve cells, but a "functional" change for a period of time.
The group of medications that can favorably influence ADD/ADHD through this mechanism is broadly divided into stimulants and non-stimulants.
Stimulants
The World Health Organization WHO defines stimulants as substances that stimulate the activity of the Nerves increase, accelerate or improve. The stimulant "methylphenidate (MPH)" is approved for medical use and in the treatment of ADD/ADHD in children and adults. For about two years, the stimulants "lisdexamfetamine" and "dexamfetamine" have also been approved exclusively for children and adolescents. Stimulants generally fall under the narcotics law (BTM-obligatory) to avoid abuse. In experienced medical hands, however, they are a very effective component to enable therapeutic successes, for example, in behavioral therapy. Meanwhile, there is a therapy experience with these drugs over more than 50 years, which makes possible risks and side effects calculable.
Non-stimulants
The substance "atomoxetine" should be mentioned here in particular, which received approval in Germany years ago for use in children and adolescents or for the continuation of treatment in adults. Even though this substance is not subject to "BTM", special measures of medical control are necessary in order to keep possible risks and side effects small. This includes, for example, regular blood counts and especially liver value checks.
Recently approved in children is the substance "Guafacin".
The sustained-release formulation of guanfacine was launched in Germany in January 2016. This preparation is approved as part of a comprehensive overall therapeutic strategy for children and adolescents aged 6 years and older with ADHD when treatment with stimulants (methylphenidate, amphetamine) is not an option, was intolerable or proved ineffective - i.e. it is a so-called "second-line drug". Approximately 3 weeks should be expected until the onset of effect after the start of therapy.
Guanfacine has been approved in the USA since 2009, also for adults, where it can also be used in combination with a stimulant. Guanfacine is not subject to BtM.
The exact effect profile in ADS/ADHS has not yet been fully elucidated. It is known that guanfacine acts as:
- selective alpha2A-adrenergic receptor agonist
- modifies postsynaptic norepinephrine transmission
- modulates signal transmission and strengthens the functional connectivity of the neuronal network in the prefrontal cortex
According to the SmPC, very common adverse reactions (≥1/10) are: drowsiness (somnolence), headache, sedation, abdominal pain, fatigue. In the studies, there was an average reduction in systolic and diastolic blood pressure of 2-3 mmHg and a reduction in heart rate of 3 beats/min.
We have deliberately refrained from a more detailed presentation of the properties of these drugs, as this would go beyond the scope of these information pages and in our opinion this should be done in the individual case and in doctor-patient contact. Unfortunately, in recent years we see more and more patients pre-informed by "Dr.Google", who have gathered an enormous amount of knowledge from the "net", but cannot "sort" the knowledge in the right place and are then often even more perplexed or even principally biased.
Annotation. The author