Attention Deficit Hyperactivity Disorder, previously known only as Attention Deficit Disorder, was once was called “hyperkinetic disease of infancy.” Doctors thought it only occurred in kids (who outgrew it), and focused on symptoms of excessive movement and, to some small degree, impulsivity. Hyperkinetic disease of infancy may have morphed into ADHD, but it was generally considered a disorder for white boys who couldn’t sit still.
Up until the early 1990s, clinical consensus was: your kid will grow out of it by their late teens or early twenties. While that changed, most scientists still estimated that many or most kids would outgrow ADHD. Child Mind Institute still claims one-third of kids diagnosed with ADHD will “will no longer meet the criteria by the time they reach young adulthood.”
Sort of accurate. A study published in the Journal of Developmental and Behavioral Pediatrics found that “an estimated 30 percent to 60 percent of children diagnosed with ADHD no longer meet diagnostic criteria for this disorder by late adolescence.”
Kind of accurate. Senior author of the study, Thomas Power, director of the center for management of ADHD at Children’s Hospital of Philadelphia, told The New York Times that the possibility of outgrowing ADHD has no simple answer.
Mostly wrong. Psychologist Margaret Sibley, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine, conducted recent long-term research showing all previous estimates are wildly inaccurate. “Ninety percent [of those diagnosed with ADHD] still struggle with at least mild symptoms as adults — even if they have periods when they are symptom free,” she told The Washington Post.
In other words: your kid probably only has a small chance of completely outgrowing their ADHD.
There Are Several Presentations of ADHD
Remember “hyperkinetic disease of infancy”? It focused on disruptive behavior and kids. Eventually, docs refined ADHD into “subtypes” of hyperactive, inattentive, and a combination of the two. “Subtype” assumes something static: the disorder’s presentation doesn’t change. So when the boy turning over chairs and running away from the teacher learns better self-regulation — he doesn’t upend desks and yell at his college professors — he’s assumed to grow out of the disorder.
But shift “disorder” into “presentation,” like the DSM-V. “Presentation” implies a person’s symptoms can shift. While Joey used to throw chairs and run away, he’s learned better self-regulation. But he has trouble organizing his assignments, reading social cues, and tuning out in class. Joey’s ADHD hasn’t disappeared. It’s shifted from hyperactive to inattentive. He did not outgrow ADHD; his ADHD’s presentation simply shifted.
Using that criteria, Sibley followed subjects from 7-9 years old at eight different sites starting in 1998 and ending when the kids were about twenty-five. She discovered that ADHD is “on-again, off-again condition, with symptoms fluctuating depending on life circumstances.” Your kid might be hyperactive, shift into inattentive symptoms in high school, seem to get it together freshman year of college, but bomb out junior year when they try to juggle a job and academics.
Before, Joey would have been seen as cured by high school, but still had a crap time staying organized and keeping friends. Miracle: Joey does great in college. Then when his life falls apart junior year, he’s simply lazy and unable to cope. Not true — his ADHD symptoms have shifted. So while this has big clinical implications (we know more about ADHD), it also helps remove shame and blame for adults struggling with ADHD symptoms.
You Don’t Outgrow ADHD: Brain Differences Persist
While symptoms may ebb and flow, your brain doesn’t outgrow ADHD. Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD) explains that when scientists conducted brain scans of people who allegedly outgrew ADHD, their “caudate nucleus, a section of the brain that plays a role in how we learn, process and store memories, and communicate,” still had reduced gray matter compared with those who had never been diagnosed with ADHD.
Courtney Lopresti, MS, who’s studied these brain differences, says that the caudate nucleus “contributes to a wide variety of cognitive functions including memory,” and the reduction of gray matter in that area “was present regardless of whether or not the participant still met the diagnostic criteria of ADHD.” So children diagnosed with ADHD still had changes in their brain matter regardless of whether they were displaying typical ADHD symptoms. “ADHD doesn’t disappear just because symptoms become less obvious—its effect on the brain lingers,” she reports.
So children may seem to outgrow ADHD. But their symptoms wax, wane, and change as they age and their life circumstances shift — sometimes making it seem as if they’ve outgrown the disorder.
They haven’t. In 90% of the cases, their symptoms will pick up again — maybe in a different form.
What’s This Mean For Your Kid?
Will your kid be on medication for life? Maybe. Perhaps. Larry Silver, M.D., recommends taking children off medication once a year. If symptoms crop up again, put them back on it. Some children may have learned enough self-regulation and coping mechanisms to come off stimulant medication. However, some may not have — and some adults, during part or all of their lives, may also need stimulant medication. For the most part, you don’t outgrow ADHD. Your child may have periods during which they seem symptom-free, but be ready for changes.
And as Sibley told The Washington Post, even if your kid seems better, don’t ditch those psychiatrist visits. “The obvious implication for doctors is that they should be monitoring patients who seem like they’ve gotten better, and keep having them come back,” she said.
Moreover, she explained that it’s important for people with a past diagnosis of ADHD to realize that symptoms can crop up again, particularly during big life changes. Life circumstances can make a big difference in whether or people seem to “outgrow ADHD”: “It’s important to understand that it’s normal to have some times in your life when things feel more manageable,” Sibley said, “but there may be others when they feel more out of control, and that’s the time to seek professional help.”
Don’t lose hope. Adult ADHD is manageable. This shouldn’t be a doom-and-gloom prediction for your child. In fact, it’s helpful to realize that if their symptoms recur, it’s not a sign of bad parenting, laziness, or some kind of moral failing. The brain differences that led to their ADHD diagnosis are still present, and they’re only manifesting in different ways. This might lead, instead of punishment and blame, to a psychiatrist visit.
If anything, it’s good news. We know more about how ADHD works in children and adults, and that will lead to better care — especially for teens and adults who are often shamed and blamed when their symptoms shift from hyperactive to inattentive. Your formerly-hyper teenager isn’t lazy about remembering his books. He’s exhibiting different ADHD symptoms. This research will mean more people get help for their ADHD symptoms. They’ll know they didn’t outgrow ADHD and stop blaming themselves when their symptoms shift or recur.
For adults with ADHD, that absence of blame means everything.