Can you grow out of ADHD?
That's what I'm talking about today.
I'm Dr. Tracey Marks, a psychiatrist,
and I make mental health education videos.
For a long time,
the model of attention deficit hyperactivity disorder
has been that it's a neurodevelopmental disorder
that starts in childhood.
Neurodevelopmental simply means that it's an abnormality
that affects how your brain develops.
As a reminder, the symptoms of ADHD are inattentiveness,
hyperactivity, and impulsivity.
You don't have to have all three for the diagnosis.
Executive dysfunction is also associated with ADHD,
even though it's not a part
of the formal diagnostic criteria.
The expected course of ADHD has been
that about 50% of people with childhood ADHD
continue to have symptoms into adulthood.
But a study from earlier this year found that
only 10% of children completely grow out of ADHD.
That leaves 90% of people
continuing to have it into adulthood.
Another finding that goes against the grain
of established beliefs about the disorder
is that it's not binary,
like you either have it or you don't.
It's a threshold issue.
You can have aspects of it
that don't create many problems for you,
or you can be fully loaded with the symptoms
that cause a lot of impairment.
We also thought that once it manifests
in a way that comes to the attention of others,
like your teachers or caregivers,
that those problems stay that way forever,
unless you're in the group of people who grow out of it.
But this recent study
looked at 558 children with ADHD combined type,
meaning they have both inattention
and hyperactivity symptoms.
They monitored their symptom progress over 16 years.
That's a long time for a study follow up.
They found that only 20% of the children
had persistent symptoms the entire 16 years.
They found that the natural course of the illness
for most people is that it has a zigzag course.
The symptoms fade in and out,
depending on your circumstances.
These study findings are also consistent
with what I've seen in my practice.
I only treat adults, and I've seen adults
who started taking medication in elementary school
and continue into adulthood.
That's the traditional standard course.
But I've also seen scores of people who come to me
as the first doctor that they've seen for ADHD,
at least for getting an evaluation to see if they have it.
They may have had mild symptoms as a child, but they got by.
But now something has changed
where the demands of their life
outstripped their ability to compensate
for whatever mild deficit they had.
These breakpoints that cause a worsening of mild symptoms
or a relapse of symptoms that disappeared at one point
usually correspond to changes in academic or work demands.
For example, you may have been a slow reader in school
and/or had some extra energy
such that you had trouble settling down in class,
but you never really became a discipline problem.
And you settled with being a C student.
Or you spent a lot of time studying
just to keep up with your work to make A's or B's,
but you made it through high school,
but now you struggle to keep up with the college-level work.
So you see a psychiatrist for the first time in college.
Or you squeak by in college
but graduate studies become your breaking point.
Another scenario is you do okay in your first job
because the work doesn't tax
your attentional resources too much.
But then you get a promotion or a higher intensity job
that depletes your mental resources in a way
that you find yourself unable to keep up.
These are some examples
of how you can seem okay for a while and then not be okay.
So what happens to the person
who starts having more problems with ADHD as an adult?
Are you stuck having problems
and needing to take medication forever?
Not necessarily.
These study findings and my own experience support the idea
that your symptoms can come and go.
How problematic they are
can depend on how much your school, work,
or life stresses your weaknesses.
Not everyone with ADHD has the same attentional weaknesses.
For example, you may have trouble working continuously
for more than an hour
without becoming irreversibly distracted
or losing all motivation to continue.
But you're okay with meetings
as long as there's interaction with others.
This works for you
because you can pay attention in conversation,
but you don't have as much control
when your thoughts are all internal
and you're left to yourself to think and focus.
In this case, you may do just fine in a job
where you work in teams
and there's lots of meetings and collaborations,
or you may do well with the kind of job
where you travel and meet with people.
But sitting at a computer for three hours
and working on a spreadsheet would be the end of you.
ADHD does not create a generic blanket-level of deficits
that everyone has.
There will be things that you're good at
and things that you're not good at.
Going back to the previous example,
you could have an outside sales job
where you meet and greet with people
and that fits your vibe very well,
because you never stay stagnant
for more than 40 minutes at a time.
If you don't know what you can and can't do well,
you could change jobs and get one that requires you
to spend hours reading emails and creating spreadsheets
and not understand why you're failing miserably at that job.
Then you could see me for medication
because you took it as a child,
but you stopped and did fine for years,
and now here you are having trouble again.
You get on medication
and then you're now able to keep up with your work,
but you don't like that you're now back taking medication.
With some exploring, we discover what kinds of tasks
let you fly under the radar of your ADHD
and the ones that stir up problems for you
and make your symptoms unmanageable.
You may not have complete control
over changing your job responsibilities at the moment,
but now you've got something that you can shoot for
for finding a job that you can do
that exploits your strengths and doesn't require much of you
in the areas where you're the weakest.
If you don't have a therapist,
you can still try and figure this out on your own
by looking back and seeing
what are some of the tasks that you've done,
what are some of the environments in which you've worked
where things seem to flow for you.
You still may have had some bumps
but your ADHD symptoms were manageable.
Then, look at what you've done
where it felt like you were trying to put a square peg
in a round hole.
Other circumstances that can affect
the severity of your symptoms
or how much impairment they cause you are diet.
The cleaner, the better.
Clean means a minimal amount of processed foods and sugar.
Also, your exercise level and how much sleep you get matter.
If you have another disorder,
like depression or substance abuse,
the course of those illnesses
affect the severity of your ADHD symptoms.
So if you get depressed, your ADHD can destabilize.
I will say that the executive dysfunction
tends to be something that hangs in the background,
even when you have good control over your attention,
focus, hyperactivity, or distractability.
Take a look at this video for more on executive dysfunction.
I plan to talk more about
how ADHD can affect your emotional control.
But in the meantime, watch my ADHD skills playlist
for managing some of your ADHD symptoms without medication.
Thanks for watching. See you next time.