Study: Only 1 in 10 Children with ADHD Will Outgrow Symptoms
Roughly 90% of children with ADHD will not outgrow the disorder by adulthood, according to a new study that also found that ADHD “waxes and wanes” for many individuals as they age.
August 30, 2021
Most children with ADHD won’t outgrow the disorder, according to a study published this month in The American Journal of Psychiatry1 that challenges the widely held notion that ADHD symptoms do not commonly persist into adulthood.
Findings from the study, which followed 558 children with ADHD from the Multimodal Treatment Study of ADHD (MTA) over 16 years, show that only 9.1% of subjects “recovered” from ADHD by the study endpoint, when most participants were about 25 years old.
The study also found that ADHD symptoms wax and wane over time for many individuals who continue to experience the disorder. “The results suggest that over 90% of individuals with childhood ADHD will continue to struggle with residual, although sometimes fluctuating, symptoms and impairments through at least young adulthood,” the researchers wrote.
The findings, according to the authors, depart from the historic conclusion that childhood ADHD persists into adulthood in about 50% of cases2 3 4. “This conclusion is typically based on single endpoints, failing to consider longitudinal patterns of ADHD expression,” the authors wrote.
For the study, researchers examined data on ADHD symptoms, level of impairment, existing comorbidities, and treatment use from the eight assessments the participants underwent as part of the MTA. (Follow-up evaluations took place 2 to 16 years after baseline.) The authors identified participants with fully remitted, partially remitted, and persistent ADHD at each time point. Full recovery was defined as sustained remission across multiple time points until the end of the study in the absence of ADHD treatment.
About 30% of participants experienced full remission at some point in the study, but the majority (60%) experienced a recurrence of ADHD after initial remission. Only about 10% of participants demonstrated stable ADHD persistence across study time points. Overall, about 63% of participants had fluctuating periods of remission and recurrence, which may have been impacted by treatment status at the time.
The authors say that the findings support a more informed perspective on ADHD, especially its tendency to fluctuate in appearance. Clinicians, the authors suggest, can communicate to families that most adolescents and young adults with ADHD experience at least intermittent relief from their ADHD symptoms that may be modulated by treatment and personal or life circumstances.The findings also underscore the importance of continued periodic screening for recurrent symptoms and impairments in patients even after successful treatment.
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1Sibley, M., Arnold, L, Swanson, J. et.al. (13 August 2021). Variable patterns of remission from ADHD in the multimodal treatment study of ADHD. The American Journal of Psychiatry. https://doi.org/10.1176/appi.ajp.2021.21010032
2Barkley, R. A., Fischer, M., Smallish, L., & Fletcher, K. (2002). The persistence of attention-deficit/hyperactivity disorder into young adulthood as a function of reporting source and definition of disorder. Journal of Abnormal Psychology, 111(2), 279–289. https://doi.org/10.1037/0021-843X.111.2.279
3 Sibley, M., Mitchell, J., Becker, S. (2016). Method of adult diagnosis influences estimated persistence of childhood ADHD: A systematic review of longitudinal studies. The Lancet Psychiatry, 3(12), 1157-1165. https://doi.org/10.1016/S2215-0366(16)30190-0
4Sibley, M. H., Swanson, J. M., Arnold, L. E., Hechtman, L. T., Owens, E. B., Stehli, A., Abikoff, H., Hinshaw, S. P., Molina, B., Mitchell, J. T., Jensen, P. S., Howard, A. L., Lakes, K. D., Pelham, W. E., & MTA Cooperative Group (2017). Defining ADHD symptom persistence in adulthood: optimizing sensitivity and specificity. Journal of child psychology and psychiatry, and allied disciplines, 58(6), 655–662. https://doi.org/10.1111/jcpp.12620