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The remission of ADHD – What parents report?

David Rabiner, Ph.D.Research ProfessorDuke UniversityAttention Research Update, David Rabiner, Ph.D.
The remission of ADHD – What parents report?

How often does ADHD remit in children? At what age are parents most likely to report ADHD remission in their child, and what factors are associated with a greater likelihood of parent-reported remission?

These interesting questions were examined in a study recently published online in the Journal of Attention Disorders [Barnard-Brak, L. (2024).

Parental report of remission in ADHD: Results from a community-based, nationally representative sample. Journal of Attention Disorders, DOI: 10.1177/1087054723129005Data for this study came from the National Survey of Children’s Health, a large, community-based and nationally representative sample of children from 0 to 17-years-old; the survey administered beginning in 2003 and has been administered in multiple years since then. The sample included 4,580 parents who reported having a child who been diagnosed ADHD. The average age of these children was 8.15 years and approximately two-thirds were male. These children were considered ‘remitted’ if their parents reported in a subsequent administration of the survey that their child no longer had ADHD. To identify the age at which parents were most likely to report remission, they took the average age of these ‘remitted’ children. To examine factors associated with an increased likelihood of remission, the researchers considered the following: presence of comorbid disorder severity of parent-reported ADHD symptoms, whether the child had ever received behavioral treatment (42% had)whether the child had ever received medication treatment (55% had)whether the child had a special education plan or an individualized education plan (40% did)

Results – Of the 4,580 children who had been reported to have had ADHD at a prior time, only 341 (7.45%) were reported to no longer had ADHD during a subsequent administration of the survey; these children were considered ‘remitted’.The average age at which remission was reported was 13.84 years, Given that the average age of diagnosis was 8.15 years, the duration of the disorder among children whose ADHD remitted was just over 5.5 years. Parent-reported remission of ADHD was more likely in children who had comorbid disorders, less severe ADHD symptoms, and who had received behavioral treatment at some point in time. Remission of ADHD was less likely for males. Having received medication treatment or having a special education plan was not related to the likelihood of remission.

Summary and implications – An important finding from this study is that parent-reported rates of ADHD remission through age 17 are relatively infrequent at under 8%. This indicates that the vast majority of children who are ever diagnosed with ADHD are likely to carry that diagnosis thru childhood and adolescence. Even among children whose parents report indicate that ADHD had remitted, the duration of the disorder still persists for over 5.5 years on average. These findings highlight the chronic or at least persistent nature of ADHD and thus the need for ongoing monitoring and treatment. It is noteworthy that behavioral treatment increased the likelihood of ADHD remission while medication treatment did not. However, drawing causal conclusions from these findings about the efficacy of these treatments is not possible because no information on the quality, intensity, or duration of either form of treatment was provided. There may have been important differences between families who chose one approach vs. the other, which are related to differences in the rates of remission that were reported. The fact that having additional disorders also increased the likelihood of remission is perplexing. The author suggests this may reflect that the other disorders were more prominent than the child’s ADHD.

While using longitudinal data from a nationally representative sample is a study strength, a limitation is that detailed diagnostic information on the children could not be collected. Thus, some children who were reported to have ADHD may have been misdiagnosed originally. Similarly, some parents may not have accurately identified when their child’s ADHD had remitted, or had different ideas of what constitutes ‘remission’, thus introducing uncertainty into the results obtained. While such complications can’t be ruled out, it seems unlikely that this would alter the basic finding that parents observing ADHD remission in their child – at least thru late adolescence – is relatively infrequent. As noted above, this highlights the importance of ongoing treatment and treatment monitoring in order to maximize the likelihood a child’s healthy development.
Copyright © 2024 by David Rabiner
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