Gifted Issues Discussion homepage Forums Twice Exceptional Pearson presentation TODAY: outing ADHD fakers

I don't think you're supposed to outgrow ADHD, are you?

I've read that study for work, I think. It's fairly damning, and there's some other stuff along the same lines, IIRC. Basically, the meds seem to reduce the problem behaviors and make life easier but somehow, they don't do much for long-term success. There are also some interesting findings re medicating and risk for drug and alcohol addiction--no difference either way.

However, there have been some other studies finding small positive effects on school performance. I don't think we have really conclusive evidence just yet.

Cognitive-behavioral therapy is looking better for ADHD, I believe? Diet has also been prtety convincingly shown to be a factor for many. Sleep issues are also thought to be an undiscovered factor for a lot of kids. Sleep is huge.

My understanding, based on the understanding of our team of professionals, is that meds without behavior therapy or other teaching supports get you a win on the day the child was medicated, but not necessarily long-term gains. Most kids who have ADHD can't access CBT or other behavior therapy without meds; the therapies themselves require some focus and self-awareness. But if you use the meds to get them able to work on the issues, and then actually do the work of CBT or other therapy, you get growth that matters.

YMMV, of course.

I'll see what I can dig up for you today.

One of the drug classes which is a known epigenetic trigger for affective dysfunction is steroids. Regardless of the reason for them, I mean. That one in particular I'm familiar with because I have a child that has both the right genetics for susceptibility, and also has occasionally fairly urgent need for steroids.

Here's one that is relatively recent, though I don't KNOW that I love the methodology here since I think it fails to account for genetic differences in the compared populations and also for differential diagnostic methods.

http://www.sciencedirect.com/science/article/pii/S0165032702001805

There is quite a lot of research in this particular area-- but I'll warn parents that this is some VERY frightening reading.

http://online.liebertpub.com/doi/abs/10.1089/104454603322163925

This is a very good review article (I highly recommend this one as a balanced and thorough examination of risk):

http://www.sciencedirect.com/science/article/pii/S0028390804001820

http://www.ncbi.nlm.nih.gov/pmc/articles/PMC2898838/

If nothing else, I think that those amply demonstrate that these drugs that tweak the catecholamine neurotransmitter systems are complex things in terms of risk-benefit, and that it is FAR from clear what those risks and benefits are to any one individual.

Wikipedia tends to be my "go-to" place for trying to find unbiased info, and it says that the proportion of children meeting the criteria drops by half in the 3 years following diagnosis. So I would guess they either never had it in the first place, or they grew out of it (brain maturity or whatever).


"An 8 year follow up of children diagnosed with ADHD (combined type) found that they often have significant difficulties in adolescence, regardless of treatment or lack thereof.[120] In the US, less than 5 percent of individuals with ADHD get a college degree,[121] compared to 28 percent of the general population aged 25 years and older.[122] The proportion of children meeting criteria for ADHD drops by about half in the three years following the diagnosis and this occurs regardless of treatments used.[123][124] ADHD persists into adulthood in about 30 to 50 percent of cases."

HowlerKarma--thanks, I will take a look. As I said before, I'm not sure what I could do differently because she seems severely affected and non-functional in school when not on meds. But I still want to know what the risks are (as long as it is good solid research and doesn't just raise more questions than it answers). The "mania" when taken off is scary to me, although I think it only lasts a day or two. I thought Ritalin has been prescribed for years so why aren't there good studies of the long-term effects?

"Growing out of it" may be the wrong term. It's possible that they just grew up a bit. Kids develop at different rates.

Statistically, (based on heaps and heaps of stuff I've read over the past seven years) between 40-70% of childhood ADHD cases are outgrown.

(so... what does that mean, really? is it actually ADHD or misdiagnoses? ...and how scary is it that as many as 70% of ADHD cases could be misdiagnosed?)

...OR maybe kids really CAN outgrow it.

But if they are "outgrowing" it, doesn't that mean that it's, um...

how to say...

normal, developmentally, for those particular children? See, this is the same thing that I wonder with ASD. What if we're lumping all of these underlying etiologies together on the basis of SYMPTOM similarities? I mean, "shortness of breath" isn't always asthma, right? (In fact, it CAN be completely normal!!)

So what if "inattentiveness" and "poor follow-through" or "impulsivity" isn't dysfunction or at least not the same KIND of dysfunction in everyone, either?

Honestly, THAT is what bothers a lot of neuropharmacology people about pediatric psychopharmacology. There's a lot of tweaking of neurochemistry happening there, and we KNOW that it alters development in some specific ways... but what we DON'T know is what constitutes authentically "dysfunctional" in a mechanistic sense in that population to begin with.

Children are very difficult to study in placebo-controlled groups. The bar for ethics there is (rightly) extraordinarily high. So mostly, nobody knows what happens to the control group-- or to the experimental one-- because it's unclear right away whether or not physicians and parents are selecting different treatment options on the basis of something relevant to a different level of severity, a possible different underlying 'dysfunction' to begin with, etc. Some kids "outgrow" asthma, too, and others worsen-- dramatically-- even WITH treatment. Did they all have the same condition? Probably not.


As others have noted, the FLORID cases of out-there behavior, sure-- everyone can see that those are "non-NT" in some way, even if we don't always have any idea what it means in terms of brain activity or diagnostics.

Where there's no such bright line between yes/no, then maybe it isn't actually "disease" at work so much as some kind of spectrum. Maybe in the case of EF, it's (for the majority) a heritable developmental delay, and not a permanent impairment.

If one googles "Can you outgrow ADHD?" one gets "Probably not! and "Sometimes!" from a variety of reputable sources. Interesting.

It seems to me that a lot of these "outgrowing" incidents must be either misdiagnoses or children learning to compensate.

Yes, I tend to think along these lines as well. Or that it's a spectrum, like ASD. Actually, they're finding more and more ASD/ADHD overlap.