A recent study has found that some people with attention deficit hyperactivity disorder (ADHD) cope best during periods of high stress.
Maggie Sibley, a clinical psychologist and professor of psychiatry at the University of Washington and lead author of the study, initially set out to see whether it was possible for adults to recover from ADHD. In an earlier study published in 2022, she examined a National Institute of Mental Health dataset that followed 600 patients with ADHD for 16 years, starting in childhood.
“What we found was this pattern of fluctuating ADHD, and most of the people who got better went on to have ADHD again,” she said.
For the more recent study, published last week in the Journal of Clinical Psychiatry, she went back to the same dataset to try to figure out which conditions might lead to relief of ADHD symptoms.
Sibley thought ADHD patients would experience the most relief during periods of low stress. What she found was more counterintuitive.
Her research identified three distinct groups of ADHD patients: those who experienced periods of apparent full recovery, those who experienced partial remission, and those whose ADHD symptoms remained stable over time.
People who experienced temporary full recovery were most likely to do so during periods of “high environmental stress,” or, more simply, stress. Those who experienced periods of partial recovery were also more likely to have comorbid anxiety.
Arij Alarachi, a doctoral student in psychology at McMaster University who has studied ADHD and anxiety at St. Joseph’s Hospital in Hamilton, Canada, said it makes sense that ADHD would respond differently to different conditions.
ADHD brains may not change all that much, Alarachi said, but people can adapt their circumstances to better manage their ADHD. As Sibley’s research shows, these strategies can look different even in people with ADHD, because “ADHD comes in many different shapes and sizes,” Alarachi added.
“ADHD patients do best when they have to seize the opportunity. And we see that on a micro level … deadlines (can) help, or when things are more urgent, you can be most productive and hyper-focused,” Sibley said.
Although it’s impossible to fully disentangle the extent to which this is a result of ADHD patients choosing to experience more stress when their symptoms are under control.
Sara Vranes, who was diagnosed with ADHD at age 36, agrees with this idea. She says she sees her ability to hyperfocus under pressure as a “superpower.” Vranes now works with homeless communities, but previously spent 15 years as a midwife and doula, and she says she was most calm during a crisis.
“I don’t want anyone to get hurt, but I was able to deal with it because my brain can just hyperfocus. I could see everything clearly and see a process in my head and act on it in real time.” In her free time, however, she often experiences anxiety and struggles to concentrate.
More than half of adults with ADHD also experience anxiety. But Sibley’s research shows that this doesn’t always have to be a bad thing.
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“We call it a protective factor in ADHD,” she said, explaining that multiple studies have shown that this is the case in children with ADHD and anxiety respond better to behavioral therapies, such as cognitive behavioral therapy, than children who have ADHD alone.
Alarachi said that in her research, she also encounters people with ADHD who say that anxiety helps them control impulsivity. They’ll say, “My anxiety has helped me somewhat to stop myself from acting on some of those impulses, or it’s made me think about some of the consequences.”
“Think of it like the gas and the brakes in a car, right? ADHD can be the gas, and then anxiety puts the brakes on, like you’re making people slow down a little bit,” Sibley said.
Anxiety and impulsivity can be more extreme in people with ADHD, “but somehow they cancel each other out in a way that doesn’t make either of those processes as problematic as they could be on their own, which is a pretty interesting concept,” Sibley added.
Alarachi and Sibley agree that people with ADHD need to look inward to figure out how to best relax and keep their anxiety at a reasonable level where it helps. Vranes finds it hard to just relax in front of the TV, but says playing phone games and watching TV at the same time can keep her mind from wandering.
Sibley has found ADHD patients who were most relaxed while exercising and socializing.
“I always tell people with ADHD, you have to learn to write your own manual,” Sibley said. “So you have to figure out, what’s your type of relaxation? What’s your brand of decompression?