New findings challenge the belief that half of children with ADHD outgrow the condition by adulthood. Although patients may show intermittent periods of symptom remission, 90% of children with ADHD followed into young adulthood continued to experience residual symptoms, according to the results of a prospective longitudinal study published in the American Journal of Psychiatry.

“It’s important for people diagnosed with ADHD to understand that it’s normal to have times in your life where things may be more unmanageable and other times when things feel more under control,” said lead researcher Margaret H Sibley, PhD, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a researcher at Seattle Children’s Research Institute.

Previous longitudinal studies on ADHD focused on a single time point and, thus, were not designed to identify patients who experience symptom remission and later develop symptom recurrence, the study authors explained.


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To better understand the disease course, researchers examined longitudinal patterns of remission from ADHD among 558 children enrolled in the Multimodal Treatment Study of ADHD (MTA). The children underwent 8 assessments over a 14-year follow-up period starting 2 years after baseline (mean age, 10.44 years) up to 16 years after baseline (mean age, 25.12 years). Participants with fully remitted, partially remitted, and persistent ADHD at each time point were identified using parent, teacher, and self-reports of ADHD symptoms and impairment, treatment utilization, and comorbidity.

Fluctuating Persistence and Remission of ADHD Symptoms Found

Approximately one-third of children with ADHD (31.4%) experienced full remission at 1 time point during the follow-up period, with a range of 1.4% at the 2-year assessment to 18.5% at the 10-year assessment; however, full or partial recurrence of ADHD symptoms was found in 60% of these patients after an initial period of full remission. A majority of patients (63.8%) experienced a fluctuating persistence and remission of ADHD in the absence of recovery. Recovery from ADHD, defined as sustained remission to study endpoint, was found in 9.1% of patients.

The results suggest that “full remission at a single time point should not be conflated with recovery from ADHD,” the authors noted. They called for continued periodic screening for recurrent symptoms and impairments after successful treatment of ADHD.

The findings are limited by the observational study design and discontinuation of follow-up at approximately 25 years of age. The sample included patients with combined type ADHD; thus, the findings may not be generalizable to other ADHD subtypes or presentations. Missing data may also limit the findings.

Some study author(s) declared affiliations with biotech, pharmaceutical, and/or device companies. Please see the original reference for a full list of authors’ disclosures.

Reference

Sibley MH, Arnold LE, Swanson JM, et al; MTA Cooperative Group. Variable Patterns of remission from ADHD in the multimodal treatment study of ADHD. Am J Psychiatry. Published online: August 13, 2021:appiajp202121010032. doi:10.1176/appi.ajp.2021.21010032