Research and Fluctuating Focus with Dr. Maggie Sibley

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May 12, 2025

This week features Dr. Maggie Sibley, a clinical psychologist and professor at the University of Washington, specializing in ADHD research. She discusses her findings on the fluctuating nature of ADHD symptoms, revealing that they often change more than previously thought. Dr. Sibley explores how life demands can impact symptom severity, the evolving understanding of adult ADHD, and the importance of personalized strategies for management. Listeners will gain insights into motivation, the role of community support, and practical tips for navigating ADHD challenges.

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INSIGHT

ADHD Symptoms Fluctuate Over Time

Most people with ADHD experience significant symptom fluctuations over years, not a steady decline or disappearance.
About 68% showed ups and downs in symptoms between childhood and late 20s, challenging old beliefs about "growing out" of ADHD.

INSIGHT

More Life Demands Reduce Symptoms

Having more responsibilities in life tends to correlate with reduced ADHD symptoms, contrary to expectations.
External life demands may create natural motivation that helps manage ADHD better.

ANECDOTE

ADHD Symptoms Vary Over Time Scales

ADHD symptom fluctuations happen both over years and within days or weeks.
People notice "waves" of symptom severity over time and day-to-day variation creates ups and downs within those waves.

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This week I’m talking with Dr. Maggie Sibley, a clinical psychologist and professor at the University of Washington School of Medicine. Dr. Sibley has spent over two decades studying ADHD, and is author or co-author of over 120 research papers on the topic. And she is the author of Parent-Teen Therapy for Executive Function Deficits and ADHD: Building Skills and Motivation.

So recently, when I was working on the newsletter for the show, I came across an article about ADHD titled "Study describes fluctuations, remissions seen with ADHD,” and that felt like it was worth investigating more. While reading through the paper that was linked into the article I got to thinking, “hey, I’d love to ask some more questions about the findings in this paper,” and it occurred to me, hey, I can just reach out to the author of the paper for a conversation on the podcast.

And so that’s what today’s show is all about, we dig into that paper, titled “Characteristics and Predictors of Fluctuating Attention-Deficit/Hyperactivity Disorder in the Multimodal Treatment of ADHD (MTA) Study” that looks into symptom fluctuation based on the a review of the Multimodal Treatment of ADHD (MTA) Study. We talk about how ADHD symptoms don’t just disappear but actually tend to fluctuate — a lot more than many researchers expected. We also dive into why having more going on in life might actually make your ADHD symptoms less severe (or how that’s just one interpretation of the results), how motivation works for us, and what it means to find your own “sweet spot” of structure. Plus, we get into the upcoming diagnostic guidelines for adult ADHD from the American Professional Society for ADHD and Related Disorders.

This is definitely an episode you don’t want to miss if you really enjoy the sciency side of things.

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This Episode's Top Tips

1. ADHD symptoms don’t always follow a straight decline or improvement. Symptoms can often fluctuate, sometimes improving for years and then intensifying again. Expect waves, not a straight line, and don’t blame yourself when experiencing higher-than-normal symptoms.
2. When you’re in a phase where ADHD feels more manageable, that’s a great time to try and take on more meaningful responsibilities — like work, school, or parenting — that can help create external structure and reinforce good patterns.
3. While having more life demands (like a busy schedule, work responsibilities, or kids) can improve ADHD functioning by creating natural urgency and external motivators, it’s also important to make sure it doesn’t tip into overload.
4. Not all clinicians are trained to recognize ADHD in adults, especially when childhood histories are murky. If your concerns are dismissed, it’s okay — and important — to seek out a more knowledgeable provider. And on that note, look out for updated diagnostic and treatment guidelines for adult ADHD from APSARD (American Professional Society for ADHD and Related Disorders). While these guidelines won’t change any of the diagnostic criteria in the DSM, they will help give clinicians clearer, evidence-based advice on how to apply them when evaluating ADHD in adults.