Check out this answer from Consensus:
While ADHD symptoms can improve with age, the extent of improvement varies among individuals. Some may experience a significant reduction in symptoms, while others continue to exhibit impairing signs of the disorder. Genetic and environmental factors play a role in the stability and change of symptoms over time. Effective management, particularly in older adults, requires a personalized approach that considers the potential benefits and risks of treatment options.
Attention Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by symptoms of inattention, hyperactivity, and impulsivity. While traditionally considered a childhood disorder, ADHD can persist into adulthood. This article explores whether ADHD symptoms improve with age, drawing on findings from multiple research studies.
Persistence of ADHD into Adulthood
Research indicates that ADHD often persists into adulthood, though the rate of persistence varies depending on the criteria used for diagnosis. A meta-analysis found that when only those meeting full criteria for ADHD are considered, the persistence rate is about 15% at age 25. However, when including cases consistent with partial remission, the rate increases to approximately 65%1. This suggests that while some individuals may experience a reduction in symptoms, a significant proportion continue to exhibit impairing signs of the disorder.
Age-Related Symptom Changes
Studies have shown that ADHD symptoms can change with age. For instance, a longitudinal twin study found that while there is a high stability of ADHD symptoms from childhood to early adolescence, changes in symptoms are influenced by new genetic and environmental factors that emerge during adolescence5. This indicates that while some symptoms may persist, others may diminish or change in nature.
Cognitive and Motor Function in Older Adults
Research on older adults with ADHD is limited, but available studies suggest that cognitive performance can remain stable or even improve over time. A case series of older adults with ADHD found that cognition generally remained unchanged over a period of 5 to 21 years, with some individuals showing improvements in certain cognitive domains6. Additionally, a study examining motor function in children with ADHD found that while both boys and girls with ADHD showed age-related improvements in motor speed, boys exhibited less improvement in motor control compared to girls7.
Treatment and Management in Older Adults
The management of ADHD in older adults presents unique challenges. A review of ADHD in adults aged 50 years and older found that while many patients benefit from pharmacological treatment, the risk of side effects and somatic complications increases with age. Therefore, individualized therapy that balances the risk-benefit ratio is recommended3. Psychological therapies, either alone or in combination with medication, may also be beneficial.
Long-Term Outcomes
Long-term studies of children with ADHD indicate that early symptom trajectory is a strong predictor of later outcomes. The Multimodal Treatment Study of Children with ADHD (MTA) found that the type or intensity of treatment in childhood did not predict functioning 6 to 8 years later. Instead, early symptom trajectory was a significant predictor of long-term outcomes, suggesting that children with the best initial response to treatment have the best long-term prognosis8.
Does ADHD improve with age?
Sébastien Weibel has answered Unlikely
An expert from Strasbourg University Hospital in Psychiatry, Cognitive Science, ADHD
Longitudinal studies suggest that diagnosis of ADHD persists in adulthood in 50% of cases, but the symptoms are still noted in at least 80% of cases.
If the symptoms do not always improve, they change: hyperactivity is more internalized, impulsiveness takes other aspects and inattention very often persists. Problems may reappear when there is more demand or difficulty in life.
Does ADHD improve with age?
Jeanette C Mostert has answered Uncertain
An expert from Radboud University Medical Center in ADHD
ADHD is a developmental condition, which means that it starts in childhood. According to the DSM-5 (the handbook psychiatrists use to classify mental disorders), symptoms need to be present before the age of 12. About one third of children with ADHD ‘grow out’ of the condition, meaning that they do not suffer from the impairments anymore after the age of 25. The majority however (around 65%) keep experiencing symptoms and functional impairments even though not all people in this group still meet the full diagnostic criteria as described in the DSM-5 (this is called ‘sub-threshold ADHD’).
It is important to note that symptoms in adulthood may manifest themselves in a different way than in children. Hyperactivity for instance may in adults be experienced as a feeling of inner restlessness or ceaseless mental activity, which is difficult to notice from the outside. Many adults with ADHD have also developed tricks to deal with their symptoms, or have chosen professions in which their ADHD is less impairing (or even beneficial). On the other hand, ADHD in adulthood is associated with increased comorbidity with other mental disorders (i.e. depression, anxiety, substance use), lower income and job stability, and increased rates of divorce. This shows that for many people, ADHD is a lifetime condition.
Recommended further reading: Kooij, Bijlenga, Salerno et al. Updated European Consensus Statement on diagnosis and treatment of adult ADHD. European Psychiatry 56 (2019) 14–34.
Does ADHD improve with age?
Cynthia M Hartung has answered Uncertain
An expert from University of Wyoming in Psychology
Does ADHD Improve with Age?
Jessica Hinojosa, Anne Stevens & Cynthia Hartung
This question does not have a clear answer. Various factors determine if there are positive outcomes for those who struggle with attention-deficit/hyperactivity disorder (ADHD) and related impairments. In terms of neurological changes that occur, plasticity within the central nervous system allows for positive adaptational changes to take place as the brain fully matures into adulthood which in turn can eradicate some of the impairing components that come with ADHD (McAuley et al., 2017). More specifically, improvements in the posterior cingulate cortex and medial prefrontal cortex tend to be associated with the remission of ADHD (Guimarães-da-Silva et al., 2018). These changes in brain functioning suggest that the core components of ADHD (e.g., inattention, hyperactivity, impulsivity) lie on a continuum across the lifespan, and different symptoms may manifest differently depending on the setting (e.g., grade school, university, workplace, home) and developmental period. Additionally, the severity and number of ADHD symptoms predict the likelihood that ADHD symptoms will persist from childhood to adolescence to adulthood (McAuley et al., 2017). So, an individual with mild symptoms in childhood is predicted to be less impaired as an adult compared to an individual with severe symptoms in childhood. Furthermore, the comorbidity of ADHD with other disorders (e.g., conduct disorder, oppositional defiant disorder) may play a significant role in prognosis throughout the lifespan (Biederman et al., 2011). Outside of symptomology and biological aspects, parental influences within the family context provide implications for the outcomes of those with ADHD. In particular, the persistence of ADHD has been shown to be more likely in the presence of maternal psychopathology (Roy et al., 2016). Further, authoritative parenting styles have the potential to serve as a protective factor, which may decrease impairment related to the disorder. Behavioral parent training (Pelham & Fabiano, 2008), CBT and skills building interventions for children and adolescents (Sibley et al., 2016), and stimulant medication treatment (Barbaresi et al., 2006) may improve outcomes. In brief, we cannot say that ADHD symptoms and related impairment always improves with age; however, we can take a closer look at possible contributing factors that aggrandize ADHD impairments to determine what can be done to allow for a better outcome across the lifespan. It is thought that 40-50% of those diagnosed with ADHD in childhood will persist in showing clinically significant symptoms in adulthood (Sibley et al., 2016). The factors described above may help predict for which children symptoms will persist and for which symptoms will remit.
References
Barbaresi, W. J., Katusic, S. K., Colligan, R. C., Weaver, A. L., Leibson, C. L., & Jacobsen, S. J. (2006). Long-term stimulant medication treatment of attention-deficit/hyperactivity disorder: Results from a population-based study. Journal of Developmental and Behavioral Pediatrics : JDBP, 27(1), 1-10. doi:10.1097/00004703-200602000-00001
Biederman, J., Petty, C. R., Clarke, A., Lomedico, A., & Faraone, S. V. (2011). Predictors of persistent ADHD: An 11-year follow-up study. Journal of Psychiatric Research, 45(2), 150-155. doi:10.1016/j.jpsychires.2010.06.009
Guimarães-da-Silva, P. O., Rovaris, D. L., Silva, K. L., Karam, R. G., Rohde, L. A., Grevet, E. H., & Bau, C. H. D. (2018). Exploring neuropsychological predictors of ADHD remission or persistence during adulthood. Cognitive Neuropsychiatry, 23(5), 321-328. doi:10.1080/13546805.2018.1506324
McAuley, T., Crosbie, J., Charach, A., & Schachar, R. (2017). Clinical, sociobiological, and cognitive predictors of ADHD persistence in children followed prospectively over time. Journal of Abnormal Child Psychology, 45(4), 765-776. doi:10.1007/s10802-016-0189-x
Pelham, W. E., & Fabiano, G. A. (2008). Evidenced-based psychosocial treatments for attention-deficit/hyperactivity disorder: An update. Journal of Clinical Child and Adolescent Psychology, 37, 184-214.
Roy, A., MBBS, Hechtman, L., MD, Arnold, L. E., MD, Sibley, M. H., PhD, Molina, B. S. G., PhD, Swanson, J. M., PhD, . . . MTA Cooperative Group. (2016). Childhood factors affecting persistence and desistence of attention-Deficit/Hyperactivity disorder symptoms in adulthood: Results From the MTA. Journal of the American Academy of Child & Adolescent Psychiatry, 55(11), 937-944.e4. doi:10.1016/j.jaac.2016.05.027
Sibley, M. H., Graziano, P. A., Kuriyan, A. B., Coxe, S., Pelham, W. E., Rodriguez, L., . . . Ward, A. (2016). Parent-teen behavior therapy + motivational interviewing for adolescents with ADHD. Journal of Consulting and Clinical Psychology, 84(8), 699-712. doi:10.1037/ccp0000106
Does ADHD improve with age?
Paul G Overton has answered Near Certain
An expert from University of Sheffield in Neuroscience
ADHD doesn’t necessarily improve with age, it depends on which symptoms of ADHD you have – hyperactivity, impulsivity or attentional problems. Evidence suggests that hyperactive symptoms tend to decline whilst attentional symptoms remain. So, those diagnosed with a primarily hyperactive presentation may well improve whilst those diagnosed with a primarily attentional presentation may not.
Does ADHD improve with age?
Mary V Solanto has answered Likely
An expert from Hofstra Northwell School of Medicine in ADHD
Research (summarized in the pivotal article cited below) shows that by age 25, only 15% of those diagnosed with ADHD in childhood still meet full criteria for the disorder. However, 65% continue to have persistence of some symptoms and experience impairment in work or social functioning, that can be addressed by treatment.
Faraone, S. V., et al. (2006). “The age-dependent decline of attention deficit hyperactivity disorder: a meta-analysis of follow-up studies.” Psychological Medicine (on line at CUP.org) 36(2): 159-165.
BACKGROUND: This study examined the persistence of attention deficit hyperactivity disorder (ADHD) into adulthood. METHOD: We analyzed data from published follow-up studies of ADHD. To be included in the analysis, these additional studies had to meet the following criteria: the study included a control group and it was clear from the methods if the diagnosis of ADHD included subjects who did not meet full criteria but showed residual and impairing signs of the disorder. We used a meta-analysis regression model to separately assess the syndromatic and symptomatic persistence of ADHD. RESULTS: When we define only those meeting full criteria for ADHD as having ‘persistent ADHD’, the rate of persistence is low, approximately 15% at age 25 years. But when we include cases consistent with DSM-IV’s definition of ADHD in partial remission, the rate of persistence is much higher, approximately 65%. CONCLUSIONS: Our results show that estimates of ADHD’s persistence rely heavily on how one defines persistence. Yet, regardless of definition, our analyses show that evidence for ADHD lessens with age. More work is needed to determine if this reflects true remission of ADHD symptoms or is due to the developmental insensitivity of diagnostic criteria for the disorder.
Does ADHD improve with age?
R Whelan has answered Uncertain
An expert from Trinity College Dublin in Psychology, Neuroimaging, Addiction
ADHD is considered to be a neurodevelopmental disorder that starts in childhood but can continue into adulthood, with symptoms persisting in 40-67% of the cases (Kessler et al. 2010; Kooij et al. 2010; American Psychiatric Association 2013; Sibley et al. 2016).
Does ADHD improve with age?
José Salavert has answered Near Certain
An expert from Universitat Autònoma de Barcelona in Psychiatry, Neuroimaging, Child Development
Attention-Deficit Hyperactivity Disorder (ADHD) is a neurodevelopmental disorder characterized by childhood onset of age-inappropiate levels of inattention, hyperactivity and impulsivity. Although some adverse environmental factors have been linked with ADHD, its high heritability and the early age of onset of the disorder, suggest strong genetic underpinnings (Faraone and Biederman 1998) (Faraone and Doyle 2001). It is estimated to affect about 5 % of child and adolescent population (Polanczyk, de Lima et al. 2007), with around 50 % of those carrying the disorder into adulthood (Biederman, Monuteaux et al. 2006). A meta-analysis of 32 follow-up studies showed a pooled persistence rate of 15 % applying the full childhood criteria, although another 65 % fulfilled adult ADHD partial remission criteria, with only about 20 % of childhood cases undergoing spontaneous remission (Faraone, Biederman et al. 2006).
ADHD’s core symptoms involve clusters of inattention, hyperactivity and impulsivity (APA 2000). Whereas symptoms of hyperactivity, impulsivity and deficit of attention are well characterized in children, these symptoms can be expressed in adult life in the form of inner restlessness, inability to relax, impatience, difficulty to make decisions, affective instability and stress intolerance, with the attentional deficit cluster of symptoms being usually the most functionally impairing in adults and closely related to executive impairment (Barkley 2003) (Kooij, Bejerot et al. 2010).
ADHD subjects show volume differences in grey matter structures of the brain according to neuroimaging studies, such as i.e. dorso-lateral prefrontal cortex, anterior cingulate and striatum. These structures are typically reduced in volume in ADHD children but would show a progressive volume normalization as children mature towards adulthood, with ADHD adults showing similar volumes than healthy adults as a possible compensatory overgrowth to prevent cognitive and motor inhibitory output impairment. This finding may be clinically relevant, supporting the frequent reduction in hyperactivity symptoms seen later in development in an important number of patients, which might be explained as a function of this volumetric normalization in motoric regulation regions; and gives support to the hypothesis of a posterior-anterior brain volume normalization with increasing age in ADHD subjects, normalization which seems to be favoured by effective psychological and psychopharmacological treatments.
In summary, neuroimaging studies have supported the conceptualization of ADHD as a developmental disorder with related measurable changes in brain structure and function across the lifespan, susceptible of improvement with age and appropiate therapeutical interventions such as cognitive-behavioural therapy anf pharmacological treatment.
Does ADHD improve with age?
Katie Grogan has answered Uncertain
An expert from University College Dublin in Neuropsychology
ADHD is a neuro developmental disorder and so this implies that there are brain changes that occurred very early on in someone’s life that has lead to significant deficits in certain domains of functioning. Generally these deficits are said to be long lasting. However, upon early and successful diagnosis of ADHD, a person can develop various strategies to compensate for the difficulties they experience, and often these strategies lead to increased skills that might even mask the symptoms of ADHD entirely.
Does ADHD improve with age?
Arunima Roy has answered Likely
An expert from University of Ottawa in Mental Health
For some, yes, ADHD does improve with age. However, others may experience a continuation of ADHD into their adult lives. It has been estimated that up to 70% of children with ADHD can continue to have symptoms in adulthood.
See:
https://www.mayoclinic.org/diseases-conditions/adult-adhd/symptoms-causes/syc-20350878
https://www.tandfonline.com/doi/abs/10.1080/14737175.2016.1204914?journalCode=iern20
https://onlinelibrary.wiley.com/doi/abs/10.1111/jcpp.12620
Does ADHD improve with age?
Joanna Moncrieff has answered Near Certain
An expert from University College London in Mental Health, Psychiatry
ADHD is a contested concept, but the most obvious manifestations (symptoms), hyperactivity and distractibility, improve with age.
Does ADHD improve with age?
Kristi R Griffiths has answered Likely
An expert from Westmead Institute for Medical Research in ADHD, Neuroimaging
A follow up study by Faraone et al (2015) showed that while only 15% of people with childhood ADHD still meet criteria for the disorder by their mid 20’s, around two thirds of them still experience some form of functional impairment. While hyperactivity tends to improve with age, symptoms of inattention are more likely to persist.
Does ADHD improve with age?
Timothy Wigal has answered Near Certain
An expert from University of California, Irvine School of Medicine in Child Development, Clinical Research, Psychology
I think that ADHD does improve with age in the sense that functional impairment decreases for most people. This is because: 1) the symptoms associated with overactivity decrease with age, 2) many people learn “strategies” to help them cope with the impairment and, 3) the attentional aspects of ADHD (which do remain constant) are greatly influenced by context but context can become less debilitating as people age out of school and school-based activities. In other words, the core deficits of ADHD (easily distracted and unable to sustain attention) manifest in settings like classrooms and homework activities that lead to functional impairment. As people age they can choose for themselves jobs and activities that are less likely to show impairment because they are inherently more interesting or in situations with fewer distractions or allow for frequent “breaks”.
Does ADHD improve with age?
Mayuresh S Korgaonkar has answered Uncertain
An expert from University of Sydney in Mental Health, Neuroimaging
Some theories suggest that neurodevelopmental delay might be an underlying cause for ADHD and there is a possible ‘catch up’ later in life. However, there is not a huge evidence base that I am aware of that can say this for sure. The type of studies that are required to confirm this need to be longitudinal that evaluate and followup individuals with ADHD from childhood to adulthood.
Does ADHD improve with age?
Ernesto Reyes-Zamorano has answered Unlikely
An expert from Universidad Anahuac Mexico in Neuropsychology
Although some symptoms appear to diminish with age, especially those of hyperactivity, it’s been shown several times in different lines of research that most of the children diagnosed with ADHD grow to be adults with impairments in several life areas, like work, finances, relationships, etc. Nowadays it’s the scientific consensus that ADHD it’s a lifelong disease, that some of its main symptoms may change over time, like hyperactivity in the child becomes a feeling of restlessness in adults, but that in most cases it does not improve without treatment just by growing up.
Does ADHD improve with age?
Paulo A Graziano has answered Unlikely
An expert from Florida International University in ADHD
Between 60-78% of children diagnosed with ADHD in childhood continue to meet diagnostic criteria into adolescence and adulthood as documented by various longitudinal studies (e.g., Barkley et al., 1990; Biederman et al., 2010) as well as a meta-analysis (Faraone, Biederman, & Mick, 2005). It is important to note that children’s ADHD profile does change somewhat as they age as the hyperactivity domain gradually lessens and becomes less noticeable while attention problems tend to persist more.
Does ADHD improve with age?
Anne Lise Brantsæter has answered Unlikely
An expert from Norwegian Institute of Public Health in Epidemiology, Environmental Science
ADHD is a lifelong impairment and does not improve with age, but early diagnosis and treatment, can help the patients handle their symptoms better.
Does ADHD improve with age?
Gregory A Fabiano has answered Uncertain
An expert from University at Buffalo in Psychology
The answer to this question depends on what is being assessed. It does appear to be the case that some symptoms decrease over time (the symptoms of ADHD are largely validated in elementary-aged students, and even with some modifications in DSM-5 may not be representative of adolescent and adult manifestations). Follow-up studies appear to support fewer symptoms as being present in adolescents and young adults.
However, if one considers functional impairments such as in social functioning within families, with peers, and with partners, educational achievement and attainment, and employment outcomes such as income, job status, and job retention, there does not appear to be an improvement with age, when individuals are compared to adolescents and adults without ADHD.