Attention Magazine December 2021

The Multimodal Treatment StudY OF ADHD (MTA) was a large study conducted in the 1990s that compared different treatments for children with ADHD to see which was most effective. As part of this research, the elementary school children who joined the study were visited by researchers every two years until they were in their mid-twenties.

There were about 600 children with ADHD in the MTA study and about 300 children without ADHD. At each visit, the youth, their parents, and teachers shared information with the researchers about how the participant was doing at home, at school, and with other people. As the children grew into adults, the researchers started asking questions about their jobs, romantic relationships, and even their own children.

A recent paper from the MTA revealed that in most of the participants, their ADHD fluctuated up and down across the years of the study. About ten percent of the participants experienced moderate to severe ADHD throughout the entire sixteen-year study. However, most participants had good years and bad years. In the good years, their ADHD was under control—sometimes hard to spot at all. In the more difficult years, their ADHD was severe and caused significant problems at school, at work, or in relationships.

There is a positive message in the ups and downs of ADHD—this disorder can be managed effectively with the right strategies. There is also a message of caution—even when things seem like they are going smoothly, ADHD can suddenly return in full force.

I was the lead author on this new MTA paper and after it was published, I had conversations with several adults with ADHD. Some said that identifying as an adult with ADHD was very important to helping them understand themselves. Did the MTA’s new research mean that this identity goes away if someone gets their symptoms under control? I don’t think so. Just like a person who is prone to depression or anxiety is not always depressed or anxious, a person who is prone to ADHD doesn’t always need to be experiencing these symptoms in full force.

There are good months and bad months, easy years and hard years. If you saw a doctor during the good years, they might say you no longer qualify for an ADHD diagnosis because you aren’t showing many symptoms at that time. Just like a person who has overcome cancer, you might be considered in remission. The new MTA study’s message to your doctor is that your remission is probably not permanent. Most people will struggle with the ups and downs of ADHD across the years of their life.

Doctors often tell patients that about half of people grow out of their ADHD. The new MTA research suggests that this may not be true. It seems like only about ten percent of the MTA participants really outgrew their ADHD over time. If someone was having a good year when they met with researchers, it might have looked like they had grown out of their ADHD. In reality, most ADHD would come back at some point.

If ADHD can go up and down, then our job together as providers and patients is to be detectives. We need to figure out what factors help you feel and do your best. We want you to crack the code and help you become the best version of yourself. We might ask you to consider:

• What kind of job would hold your interest and make you excited to go to work every day?
• What are you good at and how can your strengths help you be successful?
• What kind of people should you surround yourself with to support you when you need help?
• What strategies can you come up with to stop your ADHD from getting in the way of success?
• How do you need to structure your day to get things done?
• What kind of lifestyle helps you feel healthy and focused?

Some adults with ADHD that I talked to wanted to blame themselves if they hadn’t found ways to get on top of their symptoms yet. I told them to hang in there and stay positive. If you stick with the detective work, it will pay off. But progress can be gradual and no one should take on ADHD alone.

There are two treatments that are proven to be effective for ADHD in adults: medications and cognitive-behavioral therapy. Find a doctor that you trust and talk to them about these treatment options. Support can be especially important when a new challenge comes along, like a promotion at work, a change in your living situation, or the addition of a new member to your family.

Margaret Sibley, PhD, is an associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital. She has authored over ninety scholarly publications on ADHD in adolescence and adulthood, including a comprehensive therapist’s guide to treating ADHD in teens. Dr. Sibley’s research is funded by the National Institute of Mental Health and the Institute of Education Sciences. A member of the CHADD’s professional advisory board and the Motivational Interviewing Network of Trainers, she also serves on the editorial advisory board of CHADD’s Attention magazine.