Key Takeaway:
- ADHD symptoms can change, fluctuate or improve with age.
- Hyperactivity often declines, while inattentiveness may become more prominent.
- Only about 10% of children in a 2021 study experienced sustained remission into young adulthood.
Researchers are finding that attention deficit hyperactivity disorder symptoms can change with age, with hyperactivity often declining while inattentiveness becomes more persistent.
ADHD symptoms shift with age
ADHD is not a static condition, researchers say. Symptoms can emerge, disappear or fluctuate over time, making the disorder difficult to track across a person’s life.
A 2021 longitudinal study that followed children with ADHD for 16 years found that only about 10% experienced sustained remission into young adulthood. Another 10% had ADHD throughout the study, while symptoms waxed and waned for most participants.
At any given point, about half of the study participants met the criteria for ADHD. However, which participants met the criteria changed over time, underscoring how differently the condition can develop from one person to another.
ADHD symptoms fall into two main categories: inattentive and hyperactive-impulsive. Children must have at least six symptoms from one category to qualify for a diagnosis, while people 17 and older need at least five.
Hyperactivity often changes in adolescence
In younger children, hyperactive-impulsive symptoms are generally more noticeable. Michelle Martel, a psychology professor at the University of Kentucky, said preschool children with these symptoms may be constantly active, getting into things and running around a room.
As children grow older and face greater demands at school and home, inattentive symptoms can become more prominent. These include forgetfulness, poor attention to detail, difficulty completing tasks and disorganization.
A 2023 review found that children younger than 12 were roughly evenly divided among primarily inattentive, primarily hyperactive-impulsive and combined presentations. Among adolescents ages 12 to 18, inattentive symptoms became more common, while fewer than one-quarter qualified as primarily hyperactive-impulsive.
Adults rarely have symptoms that are exclusively hyperactive-impulsive. Instead, hyperactivity can become less physically obvious and may appear as persistent internal restlessness.
Adults may experience different challenges
Dr. Deepti Anbarasan, a clinical associate professor of psychiatry at the N.Y.U. Grossman School of Medicine, said hyperactivity in adults can feel more like an ongoing need to stay busy than the physical activity often seen in children.
Adults may feel uncomfortable without regular activity, she said, giving exercise as one example of a way some people manage that restlessness.
The condition also varies widely in severity and can overlap with anxiety, autism and oppositional defiant disorder, making diagnosis and long-term tracking more complicated.
Elizabeth, a 37-year-old Southern California environmental health and safety manager, was diagnosed with ADHD, as were her husband and two sons. She uses medication, whiteboards and to-do lists to manage daily responsibilities.
“I went from bouncing around between random jobs,” Elizabeth said, to being able to “focus well enough to have some direction.”
Her experience also illustrates why changes in ADHD symptoms matter beyond diagnosis. As children grow, their challenges can shift alongside new academic, social and workplace demands.
Researchers continue to study why symptoms change and why some people experience remission while others continue to meet diagnostic criteria. What is increasingly clear, however, is that ADHD can follow different paths throughout a person’s life.
