Just 10% of kids with ADHD outgrow it, study finds

Most children diagnosed with attention deficit hyperactive disorder (ADHD) don’t outgrow the disorder, as widely thought. It manifests itself in adulthood in different ways and waxes and wanes over a lifetime, according to a study published Aug.13 in the American Journal of Psychiatry.

“It's important for people diagnosed with ADHD to understand that it's normal to have times in your life where things maybe more unmanageable and other times when things feel more under control,” said lead researcher Margaret Sibley, associate professor of psychiatry and behavioral sciences at the University of Washington School of Medicine and a researcher at Seattle Children’s Research Institute.

Study authors from 16 institutions in the United States, Canada, and Brazil said decades of research characterize ADHD as a neurobiological disorder typically first detected in childhood that persists into adulthood in approximately 50% of cases. But this study found just 10% of children completely outgrow it.

“Although intermittent periods of remission can be expected in most cases, 90% of children with ADHD in the Multimodal Treatment Study of ADHD continued to experience residual symptoms into young adulthood,” they wrote.

ADHD is characterized by two main cluster of symptoms, according to researchers. The inattentive symptoms look like disorganization, forgetfulness, and having trouble staying on task. Then there are also the hyperactive, impulsive symptoms. In children, those symptoms look like having a lot of energy, such as running around and climbing on things. In adults, it manifests more as verbal impulsivity, difficulty with decision-making, and not thinking before acting. The disorder affects people differently and looks different depending on what phase of life someone's in.

Some people with ADHD also report a unique ability to hyper-focus. Olympic athletes Michael Phelps and Simone Biles have been open about their ADHD diagnosis.

While many people may experience symptoms similar to ADHD, it is estimated the disorder roughly affects 5% to 10% of the population, said Sibley.

16 years of research

This study followed a group of 558 children with ADHD for 16 years – from 8-years old to 25 years-old. The cohort had eight assessments, every two years, to determine whether they had symptoms of ADHD. The researchers also asked their family members and teachers about their symptoms.

Sibley said the belief that 50% of children outgrow ADHD was first put forward in the mid-1990s. Most studies, she said, only re-connected with the kids one time in adulthood. So, researchers didn’t get to see that the ADHD that they thought had gone away actually does come back.

Coping with ADHD

Researchers have yet to find what causes ADHD to flare. Sibley said it could be stress, the wrong environment, and not having a healthy lifestyle of proper sleep, healthy eating, and regular exercise. Also, if a person is not taking the time to manage symptoms and really understand what works best for them, then the symptoms are probably going to get more out of control, she said.

Medication and therapy are the two main treatment for ADHD. But, Sibley said, people can pursue their own healthy coping skills as well.

Researchers found that most people who technically no longer meet criteria for ADHD in adulthood still have some traces of ADHD, but they were managing well on their own.

“The key is finding a job or a life passion that ADHD does not interfere with,” Sibley said. “You are going to see a lot of creative people have ADHD because they're able to be successful in their creative endeavors despite having ADHD, whereas people who might be required to do very detail-oriented work at a computer all day – that could be a really hard combination for a person with ADHD.“

Sibley said the time to seek professional help is when the symptoms are causing a problem in your life. This includes not performing your best, problems with other people, having a hard time getting along, difficulty maintaining healthy, long-term relationships with loved ones and friends, and inability to complete basic daily tasks – whether that's parenting, staying on top of your finances, or just keeping an organized household.

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The institutions and their researchers on this study are: Seattle Children's Research Institute, Department of Psychiatry and Behavioral Sciences at University of Washington School of Medicine (Sibley); Department of Psychiatry and Behavioral Health at Ohio State University, and Nisonger Center, Columbus (Arnold); Child Development Center, School of Medicine, University of California, Irvine (Swanson); Division of Child Psychiatry, McGill University, and Montreal Children’s Hospital, Montreal (Hechtman); Department of Psychiatry, University of Pittsburgh School of Medicine, Pittsburgh (Kennedy, Molina); Department of Psychiatry and Behavioral Sciences, University of California, San Francisco (Owens, Hinshaw); The REACH Institute, New York (Jensen); Department of Psychology, University of California, Berkeley (Hinshaw); Royal’s Institute of Mental Health Research, University of Ottawa, Ottawa (Roy); Department of Psychology, University of Maryland, College Park (Chronis-Tuscano); Departments of Psychiatry and Pediatrics, Icahn School of Medicine at Mount Sinai, New York (Newcorn); ADHD and Developmental Psychiatry Programs, Hospital de Clinicas de Porto Alegre, Federal University of Rio Grande do Sul, Porto Alegre, Brazil (Rohde).

The study was supported by cooperative agreements and grants from the National Institute of Mental Health and National Institute of Drug Abuse to University of California, Berkeley (U01 MH50461,N01MH12009, HHSN271200800005-C, DA-8-5550), Duke University (U01 MH50477, N01MH12012, HHSN271200800009-C, DA-8-5554), University of California, Irvine (U01MH50440, N01MH12011, HHSN271200800006-C, DA-8-5551), Research Foundation for Mental Hygiene, New York State Psychiatric Institute/Columbia University (U01 MH50467, N01 MH12007, HHSN271200800007-C, DA-8-5552), Long Island Jewish Medical Center (U01 MH50453), New York University (N01MH 12004, HHSN271200800004-C, DA-8-5549), University of Pittsburgh (U01 MH50467, N01 MH 12010, HHSN271200800008-C, DA-8-5553, DA039881), and McGill University (N01MH12008, HHSN271200800003-C, DA-8-5548).

COI Statement:

Dr. Sibley has served as a consultant for Takeda Pharmaceuticals,
receives book royalties from Guilford Press, and receives research support
from NIH and the Institute of Education Sciences. Dr. Arnold has
received research funding from Autism Speaks, Curemark, Eli Lilly, Forest,
Neuropharm, NIH, Novartis, Noven, Shire, and YoungLiving; he has
served as a consultant or on advisory boards for Gowlings, Neuropharm,
Novartis, Noven, Organon, Otsuka, Pfizer, Roche, Seaside Therapeutics,
Shire, Sigma Tau, and Tris Pharma; and he has received travel support
from Noven. Dr. Swanson has received research support from and/or
served as a consultant, advisory board member, or speaker for Alza, Celgene,
Celltech, Cephalon, CIBA, Eli Lilly, Gliatech, Janssen, McNeil,
Novartis, Richwood, Shire, UCB, and Watson. Dr. Hechtman has served
on the advisory board of, been a speaker for, and/or received research
funding from Eli Lilly, IronShore, Ortho Janssen, Purdue, and Shire; she
has received research support from CIHR and the McGill Interdisciplinary
Initiative in Infection and Immunity; and she has received royalties from
the American Psychiatric Association, Guilford Press, Johns Hopkins University
Press, and Oxford University Press. Dr. Jensen receives royalties
from American Psychiatric Association Press, Guilford Press, Oxford University
Press, and Random House. Dr. Hinshaw has received research
grants from NIMH and royalties from Oxford University Press and St. Martin’s
Press. Dr. Roy has held stocks in Pfizer and Viatris. Dr. Chronis-
Tuscano has received research funding from NIH and royalties from
Oxford University Press. Dr. Newcorn has received research support
from Otsuka, Shire, and Supernus and honoraria from Shire for disease
state lectures, and he has served as a consultant or on advisory
boards for Adlon, Arbor, Cingulate Therapeutics, Corium, Esai, Ironshore,
Lundbeck, Medice, Mind Medicine, Myriad, NLS, OnDosis, Rhodes, Shire/
Takeda, Supernus, and the U.S. National Football League. Dr. Rohde has
received grant or research support from and/or served as a consultant,
advisory board member, or speaker for Bial, Janssen-Cilag, Medice,
Novartis/Sandoz, Pfizer, and Shire/Takeda; he has received royalties
from Oxford University Press and ArtMed and travel grants from Shire;
and the ADHD and Juvenile Bipolar Disorder Outpatient Programs
chaired by Dr. Rohde have received unrestricted educational and
VARIABLE PATTERNS OF REMISSION FROM ADHD IN THE MTA
8 ajp.psychiatryonline.org Am J Psychiatry 00:00,  2021
research support from Novartis/Sandoz and Shire/Takeda. The other
authors report no financial relationships with commercial interests.