medication

Our understanding of ADHD has come a long way in just a few short years. Though it wasn't even formally recognized as a medical condition until the 1960s, by the time the 90s rolled around, diagnoses and stimulant prescriptions were extremely prevalent. (Raise your hand if you grew up in the era of "Anyone who struggles in school gets Ritalin!") Today, diagnoses and treatment are a lot more thoughtful and individualized, and there are more options for treatment and therapy including but not limited to stimulants like the well-known Ritalin. Even with all these advancements, though, we still have more to learn.

A new long-term study published in the Journal of Clinical Psychiatry has proven to be an excellent next step in getting a better understanding of the disorder, showing that a lot of what's commonly believed or assumed about ADHD is incomplete or just flat-out wrong.

Researchers studied 483 participants who were diagnosed with ADHD in childhood and continued to assess them for a period of 16 years. The study's authors wanted to get a sense of how ADHD symptoms might change over time.

What the researchers found surprised them. In most participants, symptoms of ADHD fluctuated greatly over the years rather than staying consistent. What surprised them even more were the environmental factors that seemed to play a role in those fluctuations.

ADHD brains work in mysterious ways, but we're starting to get a clearer picture. Photo by BUDDHI Kumar SHRESTHA on Unsplash

Researchers expected that greater life demands—like more responsibility at work, a heavier workload at school, major life changes, etc.—would exacerbate ADHD symptoms. What they found was the opposite.

It makes sense that a person that struggles with inattention or hyperactivity might have more trouble focusing when they have more "going on" and more distractions to pull them in different directions. It was a huge surprise to the researchers that, actually, people's ADHD symptoms seemed to ease up when life got hectic.

“We expected the relationship between environmental demands and ADHD symptoms to be the opposite of what we found,” study author, professor, and clinical psychologist Margaret H. Sibley explained. “We hypothesized that when life demands and responsibilities increased, this might exacerbate people’s ADHD, making it more severe. In fact, it was the opposite. The higher the demands and responsibilities one was experiencing, the milder their ADHD.”

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I have a 4-year-old with ADHD and the findings totally track for me based on what I've witnessed in our own life.

We find it's actually easier to be in perpetual motion sometimes—out running errands, doing activities, visiting friends and family—versus staying put too long. When we're just relaxing at home, that's when she tends to start bouncing off the walls! Her ADHD tendencies come out strong in these quiet periods, including what we sometimes playfully refer to as her "hoarding" dozens of coloring sheets or surrounding herself in giant piles of toys, blankets, and stuffed animals; thereby making a huge mess in the house.

Doing nothing or doing very little is not often a restful state for people with ADHD. Typically, people with ADHD experience more background noise than neurotypical brains—so a quiet, seemingly restful environment can sometimes amplify racing thoughts, negative self-talk, and impulsive behavior versus dampening it. You know how kids sometimes act out in school not because they're not smart, but because the material is actually too easy for them and they're bored? Something similar is at play in both of these scenarios.

Of course, as always in science, you have to be careful assuming causation from the findings.

The results show that staying busy may actually help relieve some ADHD symptoms. Annie Spratt/Unsplash

It's important to note that the results of the study don't definitively prove that being busy causes a decrease in ADHD symptoms.

“This might mean that people with ADHD perform their best in more demanding environments (perhaps environments that have stronger immediate consequences, like needing to put food on the table for a family or pay rent monthly). It also might mean that people with ADHD take more on their plate when their symptoms are relatively at bay," Sibley says. Either way, the correlation is certainly strong and worthy of more study.

In the meantime, the study's authors think the results could be viewed in a hopeful light for people just learning to manage their ADHD. “If you’re a doctor talking with a patient who is first getting diagnosed with ADHD, it’s a huge help for that person to hear the message that, ‘You’re going to have good years and not-so-good years, but things can go really well for you if you can get the right factors in place,'” Sibley said. As a parent, I can imagine how reassuring that would have been to hear early on in our own process.

We still have so much to learn. Photo by Europeana on Unsplash

With ADHD diagnoses on the rise, more and more research is being conducted. For example, a recent long-term study out of Sweden was just published linking use of ADHD medication with a reduction in traffic crashes, general injuries, and criminal behavior. That's a strong argument for continuing to hone in on accurate diagnoses and treatment for people who need it, as it clearly benefits society as a whole when done properly!

We're learning more and more about what the factors that affect positive ADHD outcomes are—what might exacerbate symptoms and what types of things can help—and we're starting to get a clearer picture of how people can manage this challenging disorder.

This article originally appeared last year. It has been updated.