Can ADHD be cured?

CONTRIBUTION CURRENTLY IN PROGRESS

The question of whether ADHD can be cured is easily misleading. It is often misunderstood and misused.

The general - and correct - answer is: ADHD is very treatable, but not curable.
This is so universally valid that any advertising claim that this or that drug / medication / psychotherapeutic concept can cure ADHD can be safely disposed of without examination.

However, if you take a closer look, the answer must be more nuanced. Even then, the general answer will be: ADHD in itself cannot be cured.
However, there are cases where this may be different.

• 1. ADHD is very treatable
• 2. Curing ADHD
  • 2.1. What is ADHD
  • 2.2. ADHD - symptom treatment vs. cure
  • 2.3. ADHD remission in adulthood
• 3. Right to choose the form of treatment

1. ADHD is very treatable¶

ADHD is highly treatable¹² and may be the most treatable psychiatric problem of all.³⁴ Effect sizes of stimulants on ADHD symptoms are the highest ever found for psychiatric medications⁵
While amphetamines show an Effect size of 0.8-1.5 (NNT = 1.6) for ADHD in adults, internal medications for hypertension or antidepressants show an NNT of 10.⁶
The response rate for stimulants in ADHD is also remarkable. While only one in two patients with anxiety disorders responds to treatment with the first choice of medication⁷, 70% (to MPH) to 80% (to amphetamine medication) of patients with ADHD do so.

Today’s drug and psychological treatment methods for ADHD enable the symptoms to be largely or completely eliminated. However, a cure would also require the symptoms to disappear permanently without ongoing further treatment, and not just by means of coping strategies.
Long-term behavioral therapy can achieve a comparable effect to medication - but only after years. However, incorrectly applied psychotherapy can cause just as much damage as unsuitable medication.

2. Curing ADHD¶

There are (too many) books that use the supposed curability of ADHD as a hook and mislead readers.
ADHD as a whole is definitely not curable. Advertising promises in this direction are banal charlatanry.

However, if you take a closer look, you can identify individual groups within ADHD whose ADHD symptoms may be curable.

2.1. What is ADHD¶

ADHD is the abbreviation for attention deficit hyperactivity disorder. First of all, this is a name, not a classification.
In our opinion, ADHD would be better described as a syndrome than a Disorder.
A syndrome is a group of symptoms that occur together but do not necessarily have a common cause.
A Disorder is a single symptom or condition that affects the function of an organ or system.
In our opinion, ADHD has far too many different causes to be summarized under a common disorder term.

The specialist literature considers ADHD in the narrower sense as a neuronal developmental disorder. DSM 5 classifies ADHD together with schizophrenia and autism as a neuronal developmental disorder.
However, classification in a two-dimensional structure, as specified by the DSM, is not a definition.
We believe that the majority of ADHD cases are probably due to a neuronal developmental disorder.
However, not all cases of ADHD are based on a neuronal developmental disorder.

One could now deliberately define the term ADHD in such a way that all cases in which the ADHD symptom criteria according to DSM or ICD are met and these are also attributable to a neuronal developmental disorder are (allowed to be) called ADHD and all others are not.
According to this model of thinking, ADHD could be divided into primary ADHD (as a neuronal developmental disorder) and secondary ADHD (all other causes).
However, we are not aware of any guideline that makes this distinction so transparently.

Secondary causes of ADHD can be, among many others, craniocerebral trauma, sleep-related breathing disorders, vitamin or mineral deficiencies or Consequences of encephalitis (also in adulthood). Now one could say that this is not ADHD, but merely ADHD-like symptoms that result from other disorders and must be named as such, e.g. ADHD-like symptoms as a result of craniocerebral trauma, as a result of sleep-related breathing disorders, as a result of vitamin or mineral deficiency or as a result of adult encephalitis.
This is certainly scientifically correct, but in practice it leads to more problems than it solves.

1. The diagnosis of ADHD is symptom-based, not cause-based.
2. It would confuse the diagnosis if the causes were to be differentiated.
   1. The number of different causes is far too large to be fully clarified in one diagnostic test. This may be possible for individual, easily identifiable groups.
   2. It takes years to clarify all possible causes.
   3. Evidence: No existing study on the field prevalence of ADHD distinguishes between primary and secondary ADHD, although the subjects in such studies are usually examined by ADHD specialists
3. The treatment of ADHD with medication or psychotherapy is symptom-based and is highly effective at the symptom level.
   1. It would be inhumane and irresponsible to deprive people with ADHD of symptomatic treatment through medication or psychotherapy for all these years
   2. It would be medical malpractice and bodily harm, as untreated ADHD symptoms (of any origin) produce secondary comorbidities, causing psychological and physical harm, and are associated with a shortened life expectancy
4. We are far from knowing all the possible causes of “secondary” ADHD. Should we, the more we know, split off all the newly recognized earlier ADHD parts from ADHD and relabel them? Then the theory of some conspiracy-minded science deniers would be proven in advance: ADHD doesn’t exist in the end. Because ADHD would only exist as long as we don’t know the causes. And once we know them all, ADHD will no longer exist. At the very least, this way of thinking leads to a logical short circuit.
5. Primary ADHD (as a neuronal developmental disorder) is also not a monocausal disorder, but a syndrome. It can be caused by hundreds of different genes, chromosomal aberrations and a surprisingly high number of monogenetic defects (see under Development).
6. The concept of the disease would differ for people with ADHD depending on the time. At the time of diagnosis, when a possible cause has not yet been found, they have ADHD. If you later find the cause that triggered the symptoms in this person with ADHD and can eliminate it, they don’t have ADHD? This view seems very treatment-oriented to me. However, as the practitioners should be familiar with the symptoms and causes, there is no need for easy-to-understand terms. The comprehensibility of terms should be based on the person with ADHD - they can only orient themselves based on the symptoms.
7. The boundaries between secondary causes of ADHD and neuronal developmental disorders are not clear-cut. The brain develops until around the mid-20’s. All secondary (or let’s say: non-genetic) influences can also affect brain development during this period.

In our opinion, ADHD is a syndrome. It is impossible, if not pointless, to try to categorize a syndrome in a cause-related context.

We therefore consider it more advisable to use ADHD as a term for the entirety of primary and secondary ADHD. This avoids uncertainty among diagnosticians, practitioners and people with ADHD.
At the same time, as part of the treatment, careful attention should be paid to possible causes of secondary ADHD and all of them should be gradually ruled out.
From the point of view of the practitioner, careful examination of the various causal pathways can sometimes reveal “secondary” ADHD, which becomes asymptomatic if the cause is adequately treated - or, if you want to call it that, can be cured.

2.2. ADHD - symptom treatment vs. cure¶

Some evidence suggests that in some cases a partial cure for ADHD (including primary ADHD) may be possible. Successful psychotherapy can significantly reduce symptoms to the point where the diagnostic criteria are no longer met. Neurofeedback appears to be able to permanently reduce symptoms in some cases or, in the best case (albeit rarely), even eliminate them. Training persistent primitive reflexes can resolve them.
There are also cautious indications that very early medication with methylphenidate as well as long-term medication could have measurable healing effects ¹¹¹²

Secondary ADHD can be successfully treatable if the cause that triggers the secondary ADHD symptoms can be treated.
The following are particularly prominent examples

• Sleep-related disorders
• Asthma
• Allergies
• Food intolerances
• Vitamin deficiency
• Mineral deficiency
• etc.

2.3. ADHD remission in adulthood¶

If ADHD is completely incurable, the question arises as to why ADHD in 20 to 50 % of the children with ADHD decreases to such an extent by adulthood that ADHD is no longer diagnosed. Although the people with ADHD (so-called subclinical ADHD) usually have more problems than people who have never had ADHD, their symptoms are no longer severe enough to meet the diagnostic criteria (which, by the way, does not mean that they no longer need support, but only that it can no longer be billed as a health insurance benefit).
There are several possible explanations for this, either alone or together:

• Lack of knowledge about the changing symptoms in adulthood, so that adult ADHD, which manifests differently, is no longer recognized
• Coping strategies are developed more effectively so that the symptoms are better masked
• Change in life circumstances; in particular, discontinuation of school organized mainly by extrinsic motivation and replacement by training or studies in a field chosen by the individual (more intrinsic motivation).
• Actual remitting (subsiding) of symptoms, e.g. due to post-maturation of affected brain regions
• Real recovery

This question, which has not yet been conclusively answered, allows us to retain a little bit of hope.
It is certain that long-term psychotherapy and neurofeedback can have a curative effect and significantly reduce the severity of symptoms, and that drug treatment can generally largely eliminate the symptoms and enable a stress-free life without any burdensome side effects.

3. Right to choose the form of treatment¶

Some people reject treatment of ADHD with medication on principle. This appears to be more a question of attitude than a question of fact. One study reports that the following factors in particular influence parents’ decisions as to whether children with ADHD receive medication:¹³

• The extent to which ADHD is perceived as a stigma
• The basic attitude towards medication for ADHD
• Knowledge about ADHD.