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Nichtpharmakologische Therapiemöglichkeiten der Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung im Erwachsenenalter: ein Update

Nonpharmacological treatment options for attention deficit hyperactivity disorder in adulthood: an update

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Zusammenfassung

Die Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung (ADHS) im Erwachsenenalter ist mit einer Prävalenz von 2,5 % eine häufige Erkrankung, welche in Abhängigkeit der Responsekriterien zu 50–70 % erfolgreich medikamentös behandelt werden kann. Neben der Medikation stellen daher auch nichtpharmakologische Interventionen einen wichtigen Bestandteil der Behandlung dar. Wesentliche nichtpharmakologische Interventionen werden hier vorgestellt und in Bezug auf ihre Evidenz beschrieben. Nach den S3-Leitlinien stellt die Grundlage der Behandlung eine ausführliche Psychoedukation (PE) dar. Besteht nach PE und der Abklärung assoziierter Störungen weiterhin Behandlungsbedarf, kommt eine Pharmakotherapie zum Einsatz. Weitere psychosoziale Maßnahmen können dann begleitend oder ergänzend, z. B. bei nicht ausreichender Wirksamkeit der Medikation, zum Einsatz kommen. Hier sind vor allem kognitiv-behaviorale Konzepte und deren Variationen (dialektisch-behaviorale Therapie, metakognitives Training, Reasoning and Rehabilitation Therapy) und Coaching mit zunehmender Behandlungsevidenz zu nennen. Neurofeedback kann eingesetzt werden, wenn dadurch keine anderen psychosozialen Maßnahmen verzögert werden oder entfallen. Achtsamkeitstraining erscheint ebenso wie Sportinterventionen als ergänzend sinnvoll; hier sind aber, ebenso wie für das individualisierte kognitive Training, noch weitere Studien notwendig, um klare Aussagen hinsichtlich der Behandlungsevidenz im Erwachsenenalter zuzulassen. Weitere kontrollierte Untersuchungen zur Wirksamkeit nichtpharmakologischer Interventionen auf die ADHS und assoziierte Symptome und Erkrankungen sind daher wünschenswert.

Abstract

Attention deficit hyperactivity disorder (ADHD) in adulthood is a frequent disorder with a prevalence of 2.5%, which can successfully be treated by pharmacotherapy in 50–70% of cases, depending on the response criteria. Therefore, besides medication nonpharmacological interventions are an important component of the treatment. The essential nonpharmacological interventions are presented and described with respect to the evidence for treatment. According to the S3 guidelines an extensive psychoeducation (PE) functions as the basis of the treatment. If there is still a need for treatment after PE and the clarification of associated disorders, pharmacotherapy is applied. Further psychosocial interventions can then be used as accompaniment or supplement, e.g. when the effectiveness of medication treatment is insufficient. In particular, cognitive behavioral concepts and their variations (dialectic behavioral therapy, metacognitive training, reasoning and rehabilitation therapy) and coaching should be mentioned here, which show increasing evidence for treatment. Neurofeedback can be used if no other psychosocial treatment options are delayed or omitted due to the treatment. Mindfulness training and sport interventions seem to be meaningful as supplementation but similarly to the individualized cognitive training, further research studies are necessary to enable clear statements regarding treatment evidence in adulthood. Further controlled investigations regarding the effectiveness of nonpharmacological interventions on ADHD and associated symptoms and disorders are therefore desirable.

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  1. Klinik für Psychiatrie und Psychotherapie, Universitätsklinikum Bonn AöR, Venusberg-Campus 1, Gebäude 80/82, 53127, Bonn, Deutschland

    Silke Lux, Helena Rosen, Behrem Aslan & Alexandra Philipsen

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  1. Silke Lux
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Correspondence to Silke Lux.

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Interessenkonflikt

A. Philipsen war in den vergangenen fünf Jahren als Beraterin und Vortragende zum Thema ADHS für die Firmen Medice Arzneimittel Pütter GmbH sowie Shire/Takeda tätig. Sie hat finanzielle Kongressunterstützung von Janssen-Cilag, Servier und Forschungsmittel von der Firma Medice erhalten. Weiterhin ist sie Autorin von Artikeln und Büchern zu ADHS, die bei Hogrefe, Elsevier, Kohlhammer, Schattauer, Springer, Thieme, Oxford Press erschienen sind und ist Supervisorin für Verhaltenstherapie. S. Lux, H. Rosen und B. Aslan geben an, dass kein Interessenkonflikt besteht.

Für diesen Beitrag wurden von den Autoren keine Studien an Menschen oder Tieren durchgeführt. Für die aufgeführten Studien gelten die jeweils dort angegebenen ethischen Richtlinien.

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Lux, S., Rosen, H., Aslan, B. et al. Nichtpharmakologische Therapiemöglichkeiten der Aufmerksamkeitsdefizit‑/Hyperaktivitätsstörung im Erwachsenenalter: ein Update. Nervenarzt 91, 591–598 (2020). https://doi.org/10.1007/s00115-020-00916-x

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