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Can You Grow Out of Attention Deficit Disorder?

There's a story that's been all over the place the last couple days about a couple of recent studies saying that just because kids have behavior problems when they're younger doesn't mean they're doomed to fall behind in school as they get older.

According to the piece in the New York Times, the findings could change the way educators deal with kids with disorders like ADHD (attention deficit hyperactivity disorder). Previous research has shown that kids with ADHD suffer from some kind of deficit or flaw, but one of these recent studies by the National Institute of Mental Health says these kids are just developing slower than others. There's also a good piece on this on npr.org:

Check out the stories and let us know your thoughts or share your stories with us. Are you the parent of a child with ADHD, and if so, have your kids been treated differently in school? Are you an adult who was diagnosed with ADHD or some other behavioral disorder when you were a kid? How has that diagnosis affected you?

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What was the question again?

Sent by andy carvin | 1:06 PM | 11-14-2007

i did read the article in the times and as an educator whose observed the effects of adhd i would say that one size never fits all and that there are different degrees of adhd and how it can effect the child's educational experience. i have observed extremely distracting behaviors in young children which make it so difficult for the teacher to teach and the child to access/interact with the lessons and the school environment...and subsequently, seen positive effects of the exactly correct medications administered by a knowledgeable professional...so perhaps the point is, regardless of whether or not the child eventually outgrows or matures into a teenager or adult who copes, changes or "catches up"...it is very important that young child has a right to have a positive early education experience and that his/her peers, teachers and parents discover how best to help the
child maximize his/her chances of receiving positive attention during those early formative years!

Sent by jan | 7:28 PM | 11-14-2007

Dear NPR,
I was disappointed with your story on 11/12/07 concerning the research published on line by the National Academy of Sciences on the implications of the longitudinal MRI's of children with ADHD. While it is nice to have physical evidence of the phenomenon that has been observed for decades that children with ADHD mature 2-3 years later than non-ADHD children, your story emphasized a conclusion that is not supported by the evidence. You stated that ADHD went away in half the cases even if parents did nothing. Had you taken the time to examine this further you would have found that the vast majority of the field discarded this idea at least a decade ago. The Multimodal Treatment Study of ADHD (1999) , demonstrated that 1/3 of physicians offered absolutely nothing to the children in the community treatment arm of the study out of the mistaken belief that "it will go away as he gets older." Encouragement and validation of this kind of passivity on the part of both parents and physicians can only have disastrous consequences for children with ADHD who would otherwise benefit from early intervention. In the rush to get these findings on the air you almost certainly have done harm.

Supporting Evidence:
It has never made much sense that a condition that is clearly both genetic and neurological would be expected to go away with age. No other genetic disorder and no other neurological disorder goes away with advancing age, why should ADHD?
The "disappearance" of ADHD is merely an artifact of research methodology. While the childhood diagnostic criteria for ADHD are the most sensitive and specific criteria in the DSM (Diagnostic and Statistical Manual) they have never been validated in adult samples. Simply put adults with ADHD look different than children with ADHD. This has been demonstrated by Biederman et al that the "disappearance" of ADHD is strictly a factor of that particular researcher defined remission.
Biederman and colleagues have demonstrated that these differences are due more to how the researchers defined the disorder and what constituted "remission" than it did with actual disappearance of the condition. Under strict DSM rules a person who has 6 out of 9 criteria has ADHD but a person who reports only 5 out of 9 criteria does not. If, for instance, the researcher defined remission as persistence of the full childhood syndrome (and especially continuation of the hyperactive component) documented in childhood with severe functional impairment as an adult, "remission" rates were very high (60-70%). The 6 out of 9 cutoff and the requirement for manifestation of symptoms prior to 7 years of age were originally just arbitrary guesses. Research has shown that the lower cut offs have the same sensitivity and specificity .
If, on the other hand, the investigator allowed adult recollection of childhood impairment and broader ranges and areas of impairment, the rate of persistence of ADHD into adulthood was much higher (93%) . It is important to note that this is not as sloppy as it may sound. Multiple studies have found that recollection in adulthood of lifelong impairments if anything still underestimates true prevalence. , Barkley has demonstrated that symptoms and impairments can also be effected by who is reporting. Children and adolescents tend to self-report far fewer symptoms and impairments than do their parents. It is the parental report of their child's symptoms that best correlates with significant impairments out in the real world. With adults on the other hand, there is very good correlation between symptoms/diagnostic criteria and impairments pretty much regardless of reporting source (self, significant other, clinician, or employer). Adults have such a high degree of correlation between symptoms and impairments that 100% of adults who reported only 4 criteria from either the inattentive or impulsive/hyperactive subsets of diagnostic criteria will have significant impairment in one or more areas of adult functioning. This gives strong support for the case of setting the diagnostic cut-offs for adults with ADHD at four (4) out of nine (9) criteria as opposed to the current six out of nine cut-off for children. As a consequence, strict adherence to the diagnostic cutoffs of 6 out of 9 of either inattention or impulsive-hyperactive criteria set will both grossly under-diagnosis ADHD in adults and adolescents and make it appear that the ADHD has gone away as the person got older. It is now generally accepted that people do not outgrow ADHD but rather they outgrow our child-based set of diagnostic criteria.
It is my hope that NPR would correct this misleading story with better and more mainstream data.

Sincerely,

William W. Dodson, M.D.
Board Certified in Psychiatry
Specializing in Adult ADHD

Sent by William W. Dodson, M.D. | 10:01 AM | 11-15-2007

How about this possible observation... Instead of showing how some kids outgrow ADHD and others don't... maybe they are observing two different types of disorders. Perhaps one is simply slower developement and the other is, in fact, ADHD.

Sent by Brian Zuber | 3:33 PM | 11-15-2007

I don't know what 'early intervention' is supposed to mean exactly. I was diagnosed with ADHD when I was 7 and failed first grade. I was extremely restless (read hyperactive) because I was extremely bored. I was tested extensively and put on Ritalin at the requirement of my teachers, which I recall made me sleep through class. It was the preference of my educators that I sleep rather than disturb the other students. The testing also produced information that forced my educators to acknowledge that I was "not being challenged." Essentially I was reading at what was deemed a 12th grade level in 1st grade after failing my grammar classes, my IQ was 167 which is considered high, and I was very good at math (this is somewhat conflicting with the Times story). After several years of being drugged in school I was admitted to a very difficult high school for the arts where I was challenged for the first time, at which point my ADHD miraculously vanished. Frankly I think that assuming a child who cannot sit still and focus on uninteresting material is slow, is very strange, and new information on ADHD inevitably makes me think of our society's tendency to admire the normal for no real reason other than it's ease of being understood.

Sent by pop_rouge | 3:58 PM | 11-15-2007

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