When my 15-year-old son was given a diagnosis of attention deficit hyperactivity disorder 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 percent to 60 percent of children diagnosed with A.D.H.D. 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 A.D.H.D. at Children’s Hospital of Philadelphia, and the senior author of the study.
He was one of eight experts I consulted, and while they fell into different camps on whether someone can outgrow A.D.H.D., they all agreed that the answer is complicated. Some said there could be a genetic component to outgrowing A.D.H.D., 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 A.D.H.D. 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 A.D.H.D.
“People are outgrowing the D.S.M. criteria but not outgrowing their disorder for the most part,” Dr. Barkley said.
“Diagnosing A.D.H.D. is not like leukemia, where you do a blood test and you know definitively you have leukemia,” said Dr. William Barbaresi, a developmental behavioral pediatrician at Children’s Hospital in Boston, and professor of pediatrics at Harvard Medical School.
When a young child is given an A.D.H.D. 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 Dr. Barbaresi.
And Dr. Power noted, “Individuals with A.D.H.D. tend to underreport their symptoms.”
Ari Tuckman, a psychologist in West Chester, Pa., and author of “Understand Your Brain, Get More Done: The A.D.H.D. 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 A.D.H.D. 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 Behavioral Pediatrics.
Dr. Mehlenbeck, a clinical psychologist, further explained that if that person is not displaying symptoms but had A.D.H.D. as a child then she would diagnose them as having A.D.H.D. by history and she would not view them as outgrowing the diagnosis.
But Dr. Tanya Froehlich, a developmental behavioral pediatrician at Cincinnati Children’s Hospital and associate professor at U.C. Department of Pediatrics, said that if coping skills improve a patient’s functioning, an A.D.H.D. diagnosis might not apply.
“Having an A.D.H.D. diagnosis is not just having symptoms, it is actually being impaired,” she said.
Doctors typically advise a combination of behavioral interventions, counseling and medication to address a child’s symptoms. A child who can manage the symptoms of A.D.H.D., allowing for a more successful experience in school, may reach a point when A.D.H.D. 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 behavioral pediatrician in Los Gatos, Calif., and author of “Raising an Organized Child,” explained that the best evidence for improving A.D.H.D. impairments supports behavioral training for the child and parent.
“When parents get information about A.D.H.D. 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 behavioral pediatrician in Pleasantville, N.Y., and author of “Mindful Parenting for A.D.H.D.,” recommends a “detailed and appropriate school plan.” He added, “It is important to recognize 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.”
For some students with A.D.H.D., 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.
Dr. Power stressed the importance of students and parents forming strong relationships with their teachers to help the student achieve academic success. A student who has A.D.H.D. is eligible to receive a 504 plan, which provides accommodations like extra time or a distraction-free setting for taking tests — all of which may be altered if the student is not in the classroom.
Adolescents who have A.D.H.D. may have difficulty learning organizational and time management skills, which are necessary to be successful in traditional high school.
“Teaching organizational skills effectively to people with A.D.H.D. is hard because it’s a bit of circular logic — what do you need to implement an organizational plan? You need to be organized,” said Dr. Barbaresi.
He recommended using external systems such as electronic organization 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.
Dr. Froehlich suggested that teenagers with A.D.H.D. attend organization training classes, such as one offered in Cincinnati called Academic Success for Young Adolescents with A.D.H.D. She also recommended The Challenging Horizons Program, a school-based treatment for middle and high school students with A.D.H.D.
Some of the challenges of A.D.H.D. may stem from the mismatch between a child’s strengths and the kinds of behavior a typical school day requires. Depending on their career choices, adults may experience little or no impairment from A.D.H.D.
“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 Dr. Froehlich.