ADHD: severity may fluctuate over the years with periods of remission

Margaret H. Sibley of the Department of Psychiatry at the University of Washington School of Medicine and colleagues analyzed data on 483 people with combined ADHD who attended six centers in the United States. and in Canada. Combined type ADHD is characterized by a significant presence of both inattention symptoms and hyperactivity/impulsivity symptoms. (Three types of ADHD: symptoms and diagnostic criteria)

These people had participated in a study for at least 16 years, from 8 to 25 years on average, in which they were assessed for ADHD every two years.

Four groups were identified:

• TDAH stable persistent (11%): These participants met criteria for ADHD in each year of the study.

• Stable partial remission (16%): These participants went from persistent ADHD to partial remission, which was maintained until the end of the study. In partial remission, patients are doing better to the point of no longer meeting criteria for ADHD, but still have milder problems that affect their functioning.

• Recovery (9%): These participants experienced a complete remission of ADHD that persisted for at least two consecutive assessments without being followed by an episode of recurrence. In remission, patients have virtually no symptoms or impairments and have completed their treatments.

• Fluctuations (64%): these participants oscillated between these three statuses of complete remission, partial remission and full-fledged ADHD. Over the 16-year follow-up period, they may have experienced three or four periods of remission during which assessments did not indicate ADHD. These remissions first appeared in early adolescence, around the age of 12, with symptoms reappearing after a few years.

The fluctuations, the study shows, appear to be influenced by environmental factors. Participants tended to have fewer symptoms when they were in school, working, or had obligations to others.

At first glance, this finding contradicts conventional thinking about how daily demands affect ADHD symptoms, says the researcher.

« We did find a strong relationship, but it was the opposite of our hypothesis. We found that during the years when people were getting better, they actually seemed to live much more demanding lives ».

We can deduce either that they do better when they are busy and have external responsibilities, or it is only during periods of life when symptoms are under control that they are able to meet the demands of their lives, she comments.

Researchers emphasize the importance, for better management of ADHD, of identifying personal factors that contribute to periods of remission.

« Although science still doesn’t know what factors help people, it is possible for a patient to work with a therapist or simply reflect on their own life to understand: “When I had these periods of remission, when I was really well, what made me feel well? Can I replicate this in my life? »

« If you are a doctor and you are talking to a patient who is diagnosed with ADHD for the first time, it is very helpful for that person to hear the following message: “You are going to have some good years and some not so good ones. but things can go very well for you if you can put the right factors in place.” »

For more information, see the links below.

(1) DSM-5, 5th edition of the “ Diagnostic and Statistical Manual of Mental Disorders »,American Psychiatric Association2013. French translation: Diagnostic and Statistical Manual of Mental DisordersMasson, 2015. The first edition of the DSM was published in 1952.

Psychomedia avec sources : Journal of Clinical Psychiatry, University of Washington.
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