Is it possible to outgrow ADHD? Experts say it's complicated
The challenges of the diagnosis make it unclear whether the conditions is outgrown or simply becomes better managed, experts say.
When my 15-year-old son was given a diagnosis of attention deficit hyperactivity disorder (ADHD) at age 7, I was told that it was a lifelong chronic condition.
So I felt a little bit hopeful when a study published last winter in the Journal Of Developmental And Behavioral Pediatrics said that “an estimated 30 per cent to 60 per cent of children diagnosed with ADHD no longer meet diagnostic criteria for this disorder by late adolescence.”
DOES THAT MEAN THEY OUTGREW IT?
There is no simple answer, said Thomas Power, director of the center for management of ADHD at Children’s Hospital of Philadelphia, and the senior author of the study.
People are outgrowing the DSM criteria but not outgrowing their disorder for the most part.
He was one of eight experts I consulted, and while they fell into different camps on whether someone can outgrow ADHD, they all agreed that the answer is complicated.
Some said there could be a genetic component to outgrowing ADHD, while others told me that certain coping skills and job choices play a prominent role in lessening symptoms, which could make it seem that the person no longer has it.
Russell Barkley, a clinical professor of psychiatry at the Virginia Commonwealth University Medical Center, clarified that ceasing to meet the definition of ADHD in the Diagnostic and Statistical Manual of Mental Disorders, the main resource that clinicians use to make a diagnosis, does not mean that the person no longer has the issues of ADHD.
“People are outgrowing the DSM criteria but not outgrowing their disorder for the most part,” Barkley said.
“Diagnosing ADHD is not like leukemia, where you do a blood test and you know definitively you have leukemia,” said Dr William Barbaresi, a developmental behavioural paediatrician at Children’s Hospital in Boston, and professor of paediatrics at Harvard Medical School.
When a young child is given an ADHD diagnosis, doctors and clinicians rely on patient, parent and teacher feedback. But when a late adolescent or adult is assessed, it is normally based on self-reports only.
“There are a lot of reasons to wonder how accurate that report is since it is difficult to evaluate yourself,” said Barbaresi.
And Power noted, “Individuals with ADHD tend to underreport their symptoms.”
Ari Tuckman, a psychologist in West Chester, Pennsylvania, and author of Understand Your Brain, Get More Done: The ADHD Executive Functions Workbook, explained that the challenges of diagnosis contribute to the question of whether the condition is outgrown or if it simply becomes less of a problem.
“It’s not black-and-white that someone either has ADHD or doesn’t, so much as that it occurs on a spectrum of severity and some people make the cut while others fall short but still have more struggles than the average person does,” he said.
“Some adults have essentially become asymptomatic because they have been able to use coping strategies,” said Robyn Mehlenbeck, director of the George Mason University Center for Psychological Services and president of the Society for Developmental and Behavioural Pediatrics.
Having an ADHD diagnosis is not just having symptoms, it is actually being impaired.
Mehlenbeck, a clinical psychologist, further explained that if that person is not displaying symptoms but had ADHD as a child then she would diagnose them as having ADHD by history and she would not view them as outgrowing the diagnosis.
But Dr Tanya Froehlich, a developmental behavioural paediatrician at Cincinnati Children’s Hospital and professor at UC Department of Pediatrics, said that if coping skills improve a patient’s functioning, an ADHD diagnosis might not apply.
“Having an ADHD diagnosis is not just having symptoms, it is actually being impaired,” she said.
Doctors typically advise a combination of behavioural interventions, counseling and medication to address a child’s symptoms.
A child who can manage the symptoms of ADHD, allowing for a more successful experience in school, may reach a point when ADHD is far less of a problem. So facilitating success in school and ultimately in life may be the path to “outgrowing” the diagnosis.
Dr Damon Korb, a developmental behavioural paediatrician in Los Gatos, California, and author of Raising An Organised Child, explained that the best evidence for improving ADHD impairments supports behavioural training for the child and parent.
“When parents get information about ADHD and how to work with their kid when they are younger, then those kids tend to have the best outcome,” he said.
Dr Mark Bertin, a developmental behavioural paediatrician in Pleasantville, New York, and author of Mindful Parenting For ADHD, recommends a “detailed and appropriate school plan”.
He added, “It is important to recognise that someone might be academically gifted but lagging in all the skills that go into managing education like studying, handing in your school work and forgetfulness”.
Some adults have essentially become asymptomatic because they have been able to use coping strategies.
For some students with ADHD, remote learning may have certain advantages, since they will not forget their Chromebooks or their assignment on the bus.
And they also do not have to sit in a classroom to pay attention for several hours. But for others it may be more challenging because of the lack of support and structure that an in-person school day provides.
Power stressed the importance of students and parents forming strong relationships with their teachers to help the student achieve academic success.
Adolescents who have ADHD may have difficulty learning organisational and time management skills, which are necessary to be successful in traditional high school.
“Teaching organisational skills effectively to people with ADHD is hard because it’s a bit of circular logic – what do you need to implement an organisational plan? You need to be organised,” said Barbaresi.
He recommended using external systems such as electronic organisation systems with adult supervision and reinforcement. He also suggested that an assigned teacher do a brief check-in with the student at the start of the day.
Some of the challenges of ADHD may stem from the mismatch between a child’s strengths and the kinds of behaviour a typical school day requires. Depending on their career choices, adults may experience little or no impairment from ADHD.
“If you pick a career and you do your best at it, then your functioning is going to improve. What we tell people is that you want to pick a career that you are good at it, you enjoy it and someone will pay you to do it,” said Froehlich.
By Cheryl Maguire © The New York Times
This article originally appeared in The New York Times.