Is the ADHD gene dominant?

ADHD in adults: still little researched


With psychotherapy that accompanies the medication, compensation strategies and a more favorable interaction style can be learned.

Hardly any other mental illness has been investigated as well as attention deficit / hyperactivity disorder (ADHD) in childhood and adolescence. However, the fact that adults also suffer from this disorder was almost overlooked. Since doctors and psychologists have only been dealing with ADHD in adulthood for a short time, very few reliable findings and long-term studies are available.
According to the current state of knowledge, ADHD is a neurobiological disease. An estimated one to four percent of adults in Germany are affected by ADHD. It is assumed that the symptoms appear in childhood and adolescence and persist in 30 to 50 percent of those affected in adulthood. The core symptoms include attention deficits, hyperactivity and impulsiveness, with motor hyperactivity in adults being significantly less pronounced than in children and adolescents. What remains, however, is an inner restlessness, a strong urge to exercise, as well as impulsiveness and attention problems. The severity of symptoms changes in the course of development. The persistence is
individually pronounced, so that
ADHD can express itself very differently in adults. The impairment caused by ADHD often only increases with age. The condition can occur without hyperactivity and is known as attention deficit disorder (ADD). Diagnostically, a distinction is made between the attention-deficit, the hyperactive-impulsive and the mixed subtype.
ADHD has a genetic basis. "Studies on heredity show a high proportion of hereditary factors," reported Dr. med. Wolfgang Retz, Neurocenter of Saarland University, Homburg / Saar, during the congress of the German Society for Psychiatry, Psychotherapy and Neurology e.V.
(DGPPN) in November 2003 in Berlin. Family tree analyzes lay one
(ko) dominant inheritance close. However, no significant gene region has yet been identified on the basis of linkage analyzes. In contrast, associations with candidate genes - above all of the dopaminergic system - were found in numerous studies, but also with genes of the serotonergic and noradrenergic system. Associations of ADHD with the dopamine transporter gene (DAT1) and the dopamine4 receptor gene (DRD4) are best established. Although the results of the association studies are inconsistent, ADHD is most likely to be one
assume polygenetic and multifactorial disease.
Neuroscientific research indicates that certain brain functions are impaired in ADHD patients. The affected regions include the frontal cortex, the motor cortex and the limbic system. The core disorder appears to be out of control. Those affected have problems, for example, with making movements, paying attention for a long time and suppressing impulses to act. They can barely control emotions, find it difficult to cope with frustrations, are easily excitable, distractible, and impatient. The “executive functions” are responsible for controlling mental performance, feelings and behavior, such as planning skills, working memory performance, selective and permanent attention and flexibility. These functions only develop as the brain ages and matures. These functions are insufficiently developed in ADHD patients. This is why current publications also speak of a “dysexecutive disorder”.
Adult ADHD patients often suffer from other mental illnesses. In practice, ADHD occurs combined with depression, borderline personality disorder, bipolar affective disorder, antisocial personality disorder, substance abuse, and learning disabilities. The high comorbidity makes diagnosis difficult. "As individual symptoms - such as hyperactivity - sometimes improve in adults, but other disorders appear, the diagnosis is often overlooked," said Dr. med. Ludger Tebartz van Elst, Freiburg University Medical Center.
Arrests twice as common in ADHD
Adult ADHD patients are impaired and disadvantaged by their disease in many ways. This is shown by the new long-term study "Capturing America’s Attention", which was carried out by scientists from Massachusetts General Hospital and presented at the annual congress of the American Psychiatric Association (APA) in early May. According to this study, which included 1,001 adult ADHD patients and those who were not affected, those affected were three times more likely to suffer from stress, depression, or other emotional problems than those who were not affected. This repeatedly leads to failures in work and private life. The disease also affects self-esteem. Only 40 percent of those affected are “optimistic about the future” (those not affected: 67 percent). Only 50 percent of those affected can accept and accept themselves as they are (non-affected: 76 percent). In addition, ADHD patients live dangerously. They harm themselves more often from the consumption of nicotine, alcohol and medication and are arrested twice as often as those who are not affected. ADHD patients also have more problems with relationships. Those affected are less happy in their partnerships, their partnerships are more unstable and break up twice as often. In school and at work, most ADHD patients stay below their means. The disease prevents them from reaching their full potential. Therefore, they rarely achieve higher school leaving qualifications and academic degrees. Because of their symptoms, those affected change their jobs more frequently, are laid off more often, are employed for relatively short periods of time and are more often unemployed.
By no means all those affected seek help. Some manage to live with their symptoms and behave in such a way that the disease goes unnoticed. Some even seem to succeed in positively contributing to a varied activity. The patients who have problems and need help, on the other hand, feel a clear level of suffering. "Therapy is urgently needed in the case of deep depression, extreme lack of drive and permanent motor restlessness," says Dr. med. Doris Ryffel-Rawak, specialist in psychiatry and psychotherapy in Bremgarten / Switzerland. But also the impending loss of the job, constant tense anger or the inability to organize everyday life should lead those affected to therapy.
There is no cure for ADHD, but many symptoms can be reduced. Standard treatment includes drug therapy, psychoeducation, and psychotherapy. According to the current state of knowledge, medication cannot be dispensed with. “The drugs of choice include stimulants; Second choice drugs are noradrenergic tricyclic antidepressants, ”emphasized Dr. med. Andreas Kordon from Lübeck University Hospital. Although their effectiveness in children and adolescents has been proven, there are too few comparative and long-term studies on the effectiveness in adults. Therefore, no drugs for the treatment of ADHD in adulthood have yet been approved in Germany. In the United States, however, atomoxetine was recently approved specifically for the treatment of ADHD in children and adults. Atomoxetine is not a stimulant, it has no potential for abuse or dependence, and it has an antidepressant effect.
With accompanying psychotherapy, patients learn how to deal constructively with the disorder, compensation strategies and a more favorable style of interaction. These skills are intended to improve everyday and relationship skills as well as maintain professionalism and compliance. For example, cognitive techniques that stop and avoid thoughts that destabilize emotionally and trigger feelings of helplessness, hopelessness and affect intolerance are helpful.
Multimodal therapy
In addition to cognitive techniques, group therapy, coaching and psychoanalytical-interactional therapy apparently also help to reduce symptoms. At the Freiburg ADHD outpatient clinic, positive treatment results could be achieved with elements of dialectical-behavioral therapy according to Marsha Linehan. According to experts, therapy for ADHD patients should be multimodal. Relatives should be informed and involved. The co-treatment of comorbid disorders is also essential. Dr. phil. Marion Sonnenmoser

1. Kordon A, Kahl K: attention deficit / hyperactivity disorder (ADHD) in adulthood. Psychother Psych Med 2004; 54: 124-136.
2. Heßlinger B, Philipsen A, Richter H, Ebert D: On the psychotherapy of attention deficit / hyperactivity disorder (ADHD) in adults. Behavior therapy 2003; 13: 276-282.
3. Barkley RA, Fischer M, Smallish L, Fletcher K: Young adult follow-up of hyperactive children: antisocial activities and drug use. Journal of Child Psychology and Psychiatry and Allied Disciplines 2004; 45: 2: 195-211.
4. Long-term study "Capturing America’s Attention" on the Internet:
ADHD in adults: still little researched

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