A recent study has revealed that some people with attention deficit hyperactivity disorder (ADHD) cope best during periods of high stress.
Maggie Sibley, a clinical psychologist and psychiatry professor at the University of Washington and the study’s lead author, initially set out to learn whether it is possible for adults to recover from ADHD. In an earlier study, published in 2022, she investigated a National Institute of Mental Health data set that tracked 600 patients with ADHD over 16 years, starting from childhood.
“What we found was this pattern of fluctuating ADHD, and most of the people that were getting better, they would then get back to ADHD again,” she said.
For the more recent study, published last week in the Journal of Clinical Psychiatry, she went back to that same data set to try and figure out what circumstances might lead to relief from ADHD symptoms.
Sibley thought that ADHD patients would experience the most relief during periods of low stress. What she found was more counterintuitive.
Her study identified three different groups of ADHD patients: those who experienced periods of apparent full recovery, those who experienced partial remission, and those whose ADHD symptoms remained steady over time.
People who experienced temporary full recovery were most likely to experience it during times of “high environmental demand”, or, put more simply, stress. Those who had periods of partial recovery were also more likely to have comorbid anxiety.
Arij Alarachi, a psychology phD student at McMaster University who has researched ADHD and anxiety with St Joseph’s hospital in Hamilton, Canada, says it makes sense that ADHD would respond differently to different circumstances.
ADHD brains might not change that much, said Alarachi, but people can adapt their circumstances to better cope with their ADHD. As Sibley’s study shows, though, even among people with ADHD, those strategies might look different, since “ADHD comes in a lot of different shapes and sizes,” Alarachi added.
“ADHD patients may do best when they have to rise to the occasion. And we see that on the micro level … deadlines [could feel] helpful, or when things are more urgent, you’re able to be your most productive and hyperfocus,” said Sibley.
Although it’s impossible to completely untangle how much this is a result of ADHD patients choosing to take on more stress when their symptoms are in check.
Sara Vranes, who was diagnosed with ADHD at 36, relates to this idea. She said she sees her ability to hyperfocus under pressure as a “superpower”. Vranes now works with homeless communities, but had 15 years of experience as a midwife and doula before that, and she says she was most calm in crisis.
“I don’t want anyone to be hurt, but I was able to handle it because my brain just can hyperfocus. I could see everything clearly and see a process in my mind, and act on it in real time.” During downtime, however, she’s often anxious and can’t focus.
More than half of adults with ADHD also experience anxiety. But, Sibley’s study shows this might not always be a bad thing.
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“We call it a protective factor in ADHD,” she said, explaining that multiple studies have found that children with ADHD and anxiety respond better to behavioral treatment, like cognitive behavioral therapy, than children who just have ADHD.
Alarachi said that in her research, too, she’s come across people with ADHD who say anxiety helps them keep impulsivity in check. They will say: “My anxiety [has] kind of helped me stop myself from maybe acting on some of those impulses, or it’s kind of made me think about some of the consequences.”
“Think about it like the gas and the brakes in a car, right? The ADHD might be the gas, and then the anxiety is putting the brakes on, like getting people to inhibit a little bit,” said Sibley.
Anxiety and impulsivity might be more extreme in people with ADHD, “but somehow they’re canceling each other out in a way that kind of makes neither of those processes as problematic as they might be on their own, which is kind of an interesting concept”, Sibley added.
Alarachi and Sibley agree that people with ADHD should look within to figure out how best to relax and keep their anxiety to a reasonable level where it’s useful. Vranes has a hard time just relaxing in front of the TV, but says playing phone games and watching TV at the same time can help stop her mind from wandering.
Sibley has encountered ADHD patients who are most relaxed while exercising and socializing.
“I always tell people with ADHD, you have to learn to write your own owner’s manual,” Sibley said. “So you have to figure out, what is your brand of relaxation? What is your brand of decompressing?”