Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung bei Kindern und Jugendlichen

ZUSAMMENFASSUNG

Die Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) ist eine der häufigsten psychiatrischen Störungen des Kindes- und Jugendalters und zeichnet sich durch die Symptomtrias Unaufmerksamkeit, Impulsivität und Hyperaktivität aus. Die Störung beginnt in der Kindheit und persistiert oft bis ins Erwachsenenalter. ADHS ist zumeist begleitet von komorbiden Störungen, insbesondere Sozialverhaltensstörungen, affektiven Störungen und Angststörungen. Sie führt zu deutlichen Beeinträchtigungen des Funktionsniveaus und der Lebensqualität der Patienten und ist assoziiert mit einer Vielzahl von Risiken und weiteren Beeinträchtigungen. Die Therapie ist multimodal und richtet sich nach dem Alter der Patienten und dem Schweregrad der Symptomatik.

Die Arbeit gibt eine Übersicht über die Symptomatik der ADHS, die Ätiologie, die Diagnostik sowie die leitliniengerechte, evidenzbasierte Therapie. Dabei werden insbesondere psychosoziale und pharmakologische Behandlungsoptionen vorgestellt.

ABSTRACT

Attention deficit hyperactivity disorder (ADHD) is one of the most common psychiatric disorders in children and adolescents defined by the core symptoms of inattention, impulsivity and hyperactivity. The disorder begins in childhood and often persists into adulthood. ADHS is frequently associated with comorbidities including oppositional defiant disorder, affective disorders and anxiety disorders. It leads to functional impairment, reduced quality of life and is associated with a range of risks and further impairments. The treatment requires a multimodal approach taking into account the age of the patients and the severity of symptoms.

This work gives an overview of the symptomatology of ADHD, the etiology, the assessment and evidence-based treatment according to current clinical guidelines presenting psychosocial and pharmacological treatment options.

Schlüsselwörter

ADHS - Entwicklungsstörungen - Leitlinie - multimodale Therapie

Keywords

ADHD - developmental disorders - guidelines - multimodal treatment

Publication History

Article published online:
26 April 2021

• Literatur

• 1 Polanczyk G, Lima MS de, Horta BL. et al The worldwide prevalence of ADHD: a systematic review and metaregression analysis. Am J Psychiatry 2007; 164 (06) 942-948
• 2 Polanczyk GV, Willcutt EG, Salum GA. et al ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol 2014 [cited 2020 Nov 24]; 43 (2). 434-442 Available from: URL https://www.ncbi.nlm.nih.gov/pmc/articles/PMC4817588/pdf/dyt261.pdf
• 3 Faraone SV, Asherson P, Banaschewski T. et al Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1: 15020
• 4 World Health Organization. Multiaxial classification of child and adolescent psychiatric disorders: The ICD-10 classification of mental and behavioural disorders in children and adolescents. Cambridge. New York: Cambridge University Press; 1996
• 5 APA American Psychiatric Association. Diagnostic and statistical manual of mental disorders: DSM-5. Arlington: American Psychiatric Association; 2013
• 6 Faraone SV, Biederman J, Mick E. The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies. Psychol Med 2006; 36 (02) 159-165
• 7 Taurines R, Schmitt J, Renner T. et al Developmental comorbidity in attention-deficit/hyperactivity disorder. Atten Defic Hyperact Disord 2010; 2 (04) 267-289
• 8 Wittchen HU, Jacobi F, Rehm J. et al The size and burden of mental disorders and other disorders of the brain in Europe 2010. Eur Neuropsychopharmacol 2011; 21 (09) 655-679
• 9 Biederman J, Faraone SV, Mick E. et al High risk for attention deficit hyperactivity disorder among children of parents with childhood onset of the disorder: a pilot study. Am J Psychiatry 1995; 152 (03) 431-435
• 10 Faraone SV, Larsson H. Genetics of attention deficit hyperactivity disorder. Mol Psychiatry 2019; 24 (04) 562-575
• 11 Gizer IR, Ficks C, Waldman ID. Candidate gene studies of ADHD: a meta-analytic review. Hum Genet 2009; 126 (01) 51-90
• 12 Poelmans G, Pauls DL, Buitelaar JK. et al Integrated genome-wide association study findings: identification of a neurodevelopmental network for attention deficit hyperactivity disorder. Am J Psychiatry 2011; 168 (04) 365-377
• 13 Mooney MA, McWeeney SK, Faraone SV. et al Pathway analysis in attention deficit hyperactivity disorder: An ensemble approach. Am J Med Genet B Neuropsychiatr Genet 2016; 171 (06) 815-826
• 14 Demontis D, Walters RK, Martin J. et al Discovery of the first genome-wide significant risk loci for attention deficit/hyperactivity disorder. Nat Genet 2019; 51 (01) 63-75
• 15 Elia J, Glessner JT, Wang K. et al Genome-wide copy number variation study associates metabotropic glutamate receptor gene networks with attention deficit hyperactivity disorder. Nat Genet 2011; 44 (01) 78-84
• 16 Breeman LD, Jaekel J, Baumann N. et al Attention problems in very preterm children from childhood to adulthood: the Bavarian Longitudinal Study. J Child Psychol Psychiatry 2016; 57 (02) 132-140
• 17 Pettersson E, Sjölander A, Almqvist C. et al Birth weight as an independent predictor of ADHD symptoms: a within-twin pair analysis. J Child Psychol Psychiatry 2015; 56 (04) 453-459
• 18 Han J-Y, Kwon H-J, Ha M. et al The effects of prenatal exposure to alcohol and environmental tobacco smoke on risk for ADHD: a large population-based study. Psychiatry Res 2015; 225 1–2 164-168
• 19 Obel C, Zhu JL, Olsen J. et al The risk of attention deficit hyperactivity disorder in children exposed to maternal smoking during pregnancy – a re-examination using a sibling design. J Child Psychol Psychiatry 2016; 57 (04) 532-537
• 20 Kennedy M, Kreppner J, Knights N. et al Early severe institutional deprivation is associated with a persistent variant of adult attention-deficit/hyperactivity disorder: clinical presentation, developmental continuities and life circumstances in the English and Romanian Adoptees study. J Child Psychol Psychiatry 2016; 57 (10) 1113-1125
• 21 Sergeant JA. Modeling attention-deficit/hyperactivity disorder: a critical appraisal of the cognitive-energetic model. Biol Psychiatry 2005; 57 (11) 1248-1255
• 22 Willcutt EG, Doyle AE, Nigg JT. et al Validity of the executive function theory of attention-deficit/hyperactivity disorder: a meta-analytic review. Biol Psychiatry 2005; 57 (11) 1336-1346
• 23 Luman M, Tripp G, Scheres A. Identifying the neurobiology of altered reinforcement sensitivity in ADHD: a review and research agenda. Neurosci Biobehav Rev 2010; 34 (05) 744-754
• 24 Kuntsi J, Wood AC, Rijsdijk F. et al Separation of cognitive impairments in attention-deficit/hyperactivity disorder into 2 familial factors. Arch Gen Psychiatry 2010; 67 (11) 1159-1167
• 25 Nigg JT, Karalunas SL, Gustafsson HC. et al Evaluating chronic emotional dysregulation and irritability in relation to ADHD and depression genetic risk in children with ADHD. J Child Psychol Psychiatry 2020; 61 (02) 205-214
• 26 Shaw P, Lerch J, Greenstein D. et al Longitudinal mapping of cortical thickness and clinical outcome in children and adolescents with attention-deficit/hyperactivity disorder. Arch Gen Psychiatry 2006; 63 (05) 540-549
• 27 Hoogman M, Bralten J, Hibar DP. et al Subcortical brain volume differences in participants with attention deficit hyperactivity disorder in children and adults: a cross-sectional mega-analysis. The Lancet Psychiatry 2017; 4 (04) 310-319
• 28 Cortese S, Kelly C, Chabernaud C. et al Toward systems neuroscience of ADHD: a meta-analysis of 55 fMRI studies. Am J Psychiatry 2012; 169 (10) 1038-1055
• 29 Deutsche Gesellschaft für Kinder- und Jugendpsychiatrie, Psychosomatik und Psychotherapie, et al Interdisziplinäre evidenz- und konsensbasierte (S3) Leitlinie „Aufmerksamkeitsdefizit-/Hyperaktivitätsstörung (ADHS) im Kindes-, Jugend- und Erwachsenenalter“ (AWMF-Registernummer 028–045). 2018 www.awmf.org/leitlinien/detail/ll/028-045.html
• 30 Döpfner M, Götz-Dorten A. DISYPS-III Diagnostik-System für Psychische Störungen nach ICD-10 und DSM-5 für Kinder und Jugendliche – III. Göttingen: Hogrefe; 2017
• 31 Döpfner M, Schürmann S, Frölich J. Therapieprogramm für Kinder mit hyperkinetischem und oppositionellem Problemverhalten: THOP. 4th ed. Weinheim: Beltz; 2007
• 32 Sanders MR, Turner K. Trainermanual für das Teen Triple P Gruppenprogramm. Münster: Verlag für Psychotherapie; 2006
• 33 Jans T, Jacob C, Warnke A. et al Does intensive multimodal treatment for maternal ADHD improve the efficacy of parent training for children with ADHD? A randomized controlled multicenter trial. J Child Psychol Psychiatry 2015; 56 (12) 1298-1313
• 34 Plück J, Wieczorrek E, Wolff Metternich T. et al Präventionsprogramm für Expansives Problemverhalten (PEP). Ein Manual für Eltern- und Erziehergruppen. Göttingen: Hogrefe; 2006
• 35 Lauth GW, Schlottke PF. Training mit aufmerksamkeitsgestörten Kindern. 6., vollst. überarb. Aufl. Weinheim: Beltz, Psychologie Verlags Union; 2009
• 36 Walter D, Döpfner M. Leistungsprobleme im Jugendalter. Therapieprogramm für Jugendliche mit Selbstwert-, Leistungs- und Beziehungsstörungen, SELBST, Band 2. Göttingen: Hogrefe; 2009
• 37 Cortese S, Adamo N, Del Giovane C. et al Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. The Lancet Psychiatry 2018; 5 (09) 727-738
• 38 Coghill D. The impact of medications on quality of life in attention-deficit hyperactivity disorder: a systematic review. CNS Drugs 2010; 24 (10) 843-866
• 39 Chen Q, Sjölander A, Runeson B. et al Drug treatment for attention-deficit/hyperactivity disorder and suicidal behaviour: register based study. BMJ 2014; 348: g3769
• 40 Chang Z, Lichtenstein P, Halldner L. et al Stimulant ADHD medication and risk for substance abuse. J Child Psychol Psychiatry 2014; 55 (08) 878-885
• 41 Lichtenstein P, Halldner L, Zetterqvist J. et al Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med 2012; 367 (21) 2006-2014
• 42 Man KKC, Coghill D, Chan EW. et al Association of Risk of Suicide Attempts With Methylphenidate Treatment. JAMA Psychiatry 2017; 74 (10) 1048-1055
• 43 Faraone SV. The pharmacology of amphetamine and methylphenidate: Relevance to the neurobiology of attention-deficit/hyperactivity disorder and other psychiatric comorbidities. Neurosci Biobehav Rev 2018; 87: 255-270
• 44 Wilens TE, Spencer TJ. The Stimulants Revisited. Child and Adolescent Psychiatric Clinics of North America 2000; 9 (03) 573-603
• 45 Arnold LE. Methyiphenidate vs. amphetamine: Comparative review. J Atten Disord 2000; 3 (04) 200-211
• 46 Graham J, Coghill D. Adverse effects of pharmacotherapies for attention-deficit hyperactivity disorder: epidemiology, prevention and management. CNS Drugs 2008; 22 (03) 213-237
• 47 Faraone SV, Biederman J, Morley CP. et al Effect of stimulants on height and weight: a review of the literature. J Am Acad Child Adolesc Psychiatry 2008; 47 (09) 994-1009
• 48 Vetter VL, Elia J, Erickson C. et al Cardiovascular monitoring of children and adolescents with heart disease receiving medications for attention deficit/hyperactivity disorder corrected: a scientific statement from the American Heart Association Council on Cardiovascular Disease in the Young Congenital Cardiac Defects Committee and the Council on Cardiovascular Nursing. Circulation 2008; 117 (18) 2407-2423
• 49 Chen VC-H, Chan H-L, Wu S-I. et al Methylphenidate and mortality in children with attention-deficit hyperactivity disorder: population-based cohort study. Br J Psychiatry 2020; 1: 1-9
• 50 Childress AC. A critical appraisal of atomoxetine in the management of ADHD. Ther Clin Risk Manag 2016; 12: 27-39
• 51 Dickson RA, Maki E, Gibbins C. et al Time courses of improvement and symptom remission in children treated with atomoxetine for attention-deficit/hyperactivity disorder: analysis of Canadian open-label studies. Child Adolesc Psychiatry Ment Health 2011; 5: 14
• 52 Sallee FR, Kollins SH, Wigal TL. Efficacy of guanfacine extended release in the treatment of combined and inattentive only subtypes of attention-deficit/hyperactivity disorder. J Child Adolesc Psychopharmacol 2012; 22 (03) 206-214