KLINIKUM aktuell: Prof. Pogarell, what exactly does ADHD mean?

Prof. Oliver Pogarell: ADHD is the abbreviation for attention deficit hyperactivity disorder. This is a brain maturation disorder, which means that the disorder develops during brain development in childhood or adolescence. The disorder often runs in families and is therefore highly hereditary. The core symptoms of ADHD are hyperactivity, inattention and impulsivity. However, the individual symptoms can vary in severity.

KLINIKUM aktuell: It is not so rare for ADHD to be diagnosed in adulthood. Why is that?

Prof. Oliver Pogarell: Ideally, the disorder should be diagnosed and treated early, i.e. at the first signs, in order to avoid long-term negative consequences. However, the symptoms and the associated limitations are often not taken seriously enough or they change during adolescence and are therefore overlooked. Access to diagnosis and treatment in childhood and adolescence is also still very limited due to a lack of specialized therapists - even though it is estimated that up to six percent of all children and adolescents in Germany are affected. If ADHD is only diagnosed in adulthood, it is therefore not a newly developed disorder, but a persistent one. The onset in childhood is also an important diagnostic criterion.

KLINIKUM aktuell: How does ADHD manifest itself in adulthood?

Prof. Pogarell: The symptoms in adulthood correspond to those in childhood and adolescence, i.e. mainly attention deficit disorder, hyperactivity, disorganized behaviour, impulsivity and instability. However, the motor symptoms tend to fade into the background in adults. Many sufferers report difficulties with concentration at work, limitations in planning tasks and the inability to carry out activities systematically or purposefully. The fact that ADHD symptoms are detectable in various areas of life and lead to noticeable restrictions in everyday life and work is also an important diagnostic indicator. It is important that possible concomitant or secondary illnesses such as depression, anxiety, sleep disorders or substance abuse are also recognized and taken into account. It is also important to rule out other possible causes for the symptoms.

KLINIKUM aktuell: How is ADHD diagnosed in adults?

Prof. Pogarell : The diagnosis in adults is not fundamentally different from that in children and adolescents. There are no biomarkers, i.e. it is a clinical diagnosis based on the presence of certain symptom constellations and functional limitations in everyday life. A detailed medical history and a targeted examination are crucial. In the ADHD outpatient clinic, we also ask adults to provide reports from their school days and take a medical history from others in order to obtain indications of symptoms as early as childhood. There are screening instruments and self-assessment scales that can also be used.

KLINIKUM aktuell: Can ADHD still be treated in adulthood?

Prof. Pogarell: Regardless of the age at which the disorder was diagnosed, ADHD is a treatable condition. Negative consequences can often be limited by initiating therapy at an early stage. However, even if therapy was not started in childhood or adolescence, adults can be treated successfully.

KLINIKUM aktuell: What treatment approaches are there?

Prof. Pogarell : Medication is the main therapeutic approach for adults. In addition, detailed information and counseling are important, and the promotion of coping with the disease and stress avoidance as part of a multimodal therapy approach has also proved successful.

KLINIKUM aktuell: Who can those affected turn to?

Prof. Pogarell: Unfortunately, there is a gap in care and diagnostic and therapeutic services are only available to a limited extent in private practice. In fact, ADHD is still an underdiagnosed disorder with a very high number of unreported cases. If the disorder is suspected, a GP can be the first point of contact, from where referrals are then made to specialized practices or facilities. Psychiatrists have experience in making diagnoses. Some institutions offer specialized outpatient clinics - like we do at the LMU Hospital's outpatient psychiatric clinic.