Fluctuating ADHD Across the Lifespan with Margaret Sibley, PhD

Dr. Margaret Sibley, Professor of Psychiatry and Behavioral Sciences at the University of Washington School of Medicine and a clinical psychologist at Seattle Children’s Hospital, joins The JCP Podcast to discuss the evolving understanding of the trajectory of ADHD across the lifespan. The recipient of the 2024 Paul Wender Best Paper Award, Dr. Sibley shares her journey from political science to clinical psychology and offers a behind-the-scenes look at the landmark Multimodal Treatment of ADHD (MTA) study.

Challenging the traditional binary view of ADHD persistence versus remission, Dr. Sibley details the findings of her award-winning paper, revealing that for the majority of patients, ADHD follows a fluctuating course into adulthood rather than a static one. The conversation explores the critical role of "environmental fit," the complex interplay between anxiety and symptom management, and the distinct clinical profiles of those with persistent versus fluctuating ADHD. Today’s thoroughly enlightening episode offers vital nuances on how patient environments and comorbidities shape long-term outcomes beyond childhood diagnosis.

Episode Highlights:

00:00 – Introducing Dr. Margaret Sibley and the Paul Wender Best Paper Award

02:41 – From Political Science to Psychology: A path to public health

04:55 – The importance of engaging with patient advocacy groups like CHADD

08:06 – A historical look at the Multimodal Treatment of ADHD (MTA) study

11:59 – Why childhood treatment doesn't always predict adult outcomes

20:17 – Challenging the myth of permanent remission vs. persistence

24:53 – Defining the "Fluctuator": The most common ADHD profile

28:15 – The "Gas and Brakes" analogy: The role of comorbid anxiety

29:48 – Understanding comorbidities in severe, persistent ADHD

31:45 – Clinical Pearls: Environmental fit and rising to the occasion

34:09 – What’s next for the MTA study

Key Takeaways:

"The fluctuators are really kind of like your bread and butter people with ADHD."

"We should be thinking about environmental fit as a potential way to help people manage their ADHD better.”

"Make sure that you read the Reddit threads about what people are saying that have a condition that you're working with."

"Most people were looking at persistence as a finality, a single outcome... But it seems very dynamic."

"The persistent ADHD group have many more comorbidities... and are much more impaired in their daily lives. And so this is sort of our severe ADHD profile.”

"People do better in behavior therapy for ADHD if they have comorbid anxiety."

"Parental psychopathology was a strong predictor of being in that 10% stable ADHD group."

"When environmental demands were higher, people were more likely to be experiencing remission."

“Make sure that you go out there and try to be non-judgmental about the lenses people see aspects of mental health through, even if it's different than what you were trained in or even what the science says.”

Links:

• Journal of Clinical Psychiatry: psychiatrist.com/jcp/
• Dr. Margaret Sibley: https://www.margaretsibley.com/
• Dr. Sibley’s Award-Winning Paper: https://www.psychiatrist.com/jcp/fluctuating-adhd-multimodal-treatment-of-adhd-mta-study/