Attention-deficit/hyperactivity disorder (ADHD) is a neurodevelopmental disorder affecting approximately 5% of children worldwide. The causal mechanisms of ADHD remain unclear as the aetiology of this disorder seems to be multifactorial. One research field addresses the impact on lipid metabolism and particularly serum lipid fractions on the development of ADHD symptoms. This post hoc analysis aimed to investigate long-term changes in serum levels of lipoproteins in children and adolescents with ADHD and controls. Data of German children and adolescents from the nationwide and representative “Kinder- und Jugendgesundheitssurvey (KiGGS)” study were analysed at baseline and at a ten-year follow-up. At the two time points, participants in the control group were compared with those in the ADHD group, both before and after propensity score matching. Differences in total cholesterol, low-density lipoproteins (LDL), high-density lipoproteins (HDL) and triglycerides were assessed between matched children with and without ADHD. In addition, subgroups with versus without methylphenidate use were compared at both time points. At baseline before matching, there were no significant differences for lipid parameters between participants in the ADHD group (n = 1,219) and the control group (n = 9,741): total cholesterol (Exp(ß) = 0.999, 95%-CI 0.911–1.094, p = .979), LDL (Exp(ß) = 0.967, 95%-CI 0.872–1.071, p = .525), HDL (Exp(ß) = 1.095, 95%-CI 0.899–1.331, p = .366) and triglycerides (Exp(ß) = 1.038, 95%-CI 0.948–1.133, p = .412). Propensity score matching confirmed the non-significant differences between the ADHD and non-ADHD group at baseline. At the 10-year follow-up, n = 571 participants fulfilled complete inclusion criteria, among them 268 subjects were classified as ADHD. The two groups did not significantly differ in lipid fractions, neither cross-sectionally nor with regard to long-term changes. There was also no significant difference between methylphenidate subgroups. In this sample of children and adolescents we could not reveal any significant associations between serum lipid fractions and the diagnosis of ADHD, neither cross-sectionally nor longitudinally; even when methylphenidate use was considered. Thus, further studies using larger sample sizes are required to investigate putative long-term changes in serum lipid fractions related to ADHD.

Background: Attention-deficit hyperactivity disorder (ADHD) is one of the most common behavioral disorders in childhood and adolescence associated with relevant psychosocial impairments. The basic pathophysiology of ADHD may be related, at least partly, to a deficit in autonomic arousal processes, which not only influence core symptoms of the disorder, but may also lead to blood pressure (BP) deviations due to altered arousal regulation. Objectives: This study examined long-term changes in BP in children and adolescents with ADHD up to young adulthood. Methods: In children and adolescents aged between 7 and 17 years at baseline, we compared BP recordings in subjects with (n = 1219, 11.1%) and without (n = 9741, 88.9%) ADHD over a 10-year follow-up using data from the nationwide German Health Survey for Children and Adolescents (KiGGS). Propensity score matching was used to improve the comparability between children in the ADHD and control groups with now n = 1.190 in each group. Results: The results of these matched samples revealed that study participants with ADHD showed significantly lower systolic BP (107.6 ± 10.7 mmHg vs. 109.5 ± 10.9 mmHg, p < 0.001, Cohen’s d = 0.17) and diastolic BP (64.6 ± 7.5 mmHg vs. 65.8 ± 7.4 mmHg, p < 0.001, Cohen’s d = 0.16) at baseline. In a sensitivity analysis with a smaller (n = 272) and more stringently diagnosed ADHD group, the significant differences remained stable with somewhat higher Cohen’s d; i.e., 0.25 and 0.27, respectively. However, these differences did not persist after 10-year follow-up in a smaller matched longitudinal sub-group (ADHD n = 273; control n = 323), as subjects with and without ADHD had similar levels of systolic (123.4 ± 10.65 vs. 123.78 ± 11.1 mmHg, p = 0.675, Cohen’s d = 0.15) and diastolic BP (71.86 ± 6.84 vs. 71.85 ± 7.06 mmHg, p = 0.992, Cohen’s d = 0.16). Conclusions: At baseline, children and adolescents with ADHD had significantly lower BP (of small effect sizes) compared to the non-ADHD group, whereas this difference was no longer detectable at follow-up ten years later. These developmental alterations in BP from adolescence to early adulthood may reflect changes in the state of autonomic arousal, probably modulating the pathophysiology of ADHD.

Der medizinische, rechtliche und gesellschaftliche Kontext, der die medizinische Indikation als Voraussetzung ärztlichen Handelns begründet, unterliegt Erosionstendenzen. Deshalb lässt sich hinsichtlich der rechtlichen Verwendung der medizinischen Indikation eine beachtliche Unsicherheit feststellen. Die Arbeit löst diese Unsicherheit anhand eines innovativen ärztlichen Behandlungskonzepts auf. Die verfassungsrechtliche Analyse der medizinischen Indikation zeigt, dass der Informed Consent grundsätzlich als Indikationsäquivalent dienen kann. Voraussetzung hierfür ist, dass die rechtliche Ausgestaltung des Informed Consent in der jetzigen Form weiterentwickelt und so das verfassungsrechtliche Ergebnis abgestützt wird. Als Reformoption kommt hierfür das in der Arbeit entwickelte KAIBRE-Modell für die ärztliche Behandlung in Betracht. Durch die Unterscheidung zwischen indizierten, nichtindizierten und kontraindizierten Behandlungszielen und Maßnahmen wirkt das Entscheidungsmodell der zunehmenden Dysfunktionalität der Einwilligungsvoraussetzung entgegen. The medical, legal and social context that justifies the medical indication as a condition for medical action is subject to erosion tendencies. Therefore, there is considerable uncertainty regarding the legal use of the medical indication. The dissertation resolves this uncertainty by means of an innovative medical treatment concept. The constitutional analysis of the medical indication shows that informed consent can basically serve as an indication equivalent. The condition for this is that the legal form of informed consent is further developed in its current form, so that the constitutional result is thus supported. The KAIBRE model for medical treatment developed in this dissertation can be considered a reform option. By distinguishing between indicated, non-indicated and contra-indicated treatment goals and procedures, the decision model reduces the increasing dysfunctionality of informed consent.