Do Children Outgrow ADHD? Research Suggests It’s Unlikely

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Attention Deficit Hyperactivity Disorder (ADHD), previously known as Attention Deficit Disorder, was once labeled “hyperkinetic disease of infancy.” Initially thought to affect only children who would eventually outgrow it, the focus was primarily on excessive movement and impulsivity, often associated with white boys who struggled to stay still.

Until the early 1990s, the prevailing belief was that children would outgrow ADHD by their late teens or early twenties. While perspectives have shifted, many scientists still estimated that a significant number of children might outgrow the disorder. The Child Mind Institute suggests that about one-third of children diagnosed with ADHD will no longer meet the criteria for the condition by young adulthood. However, a study published in the Journal of Developmental and Behavioral Pediatrics reported that “between 30 percent to 60 percent of children diagnosed with ADHD no longer meet diagnostic criteria by late adolescence.”

Yet, this is somewhat misleading. Psychologist Margaret Sibley, an associate professor at the University of Washington School of Medicine, conducted long-term research revealing that previous estimates were quite inaccurate. “Ninety percent of those diagnosed with ADHD continue to experience at least mild symptoms into adulthood,” she explained. In essence, the likelihood that your child will completely outgrow their ADHD is quite low.

Understanding the Different Presentations of ADHD

Recall the term “hyperkinetic disease of infancy”? It originally emphasized disruptive behaviors in children. Over time, ADHD was categorized into “subtypes” — hyperactive, inattentive, and a combination of both. This classification implies a static condition, suggesting that when a hyperactive child learns self-regulation, they have outgrown the disorder.

However, if we consider ADHD as a “presentation,” as defined by the DSM-V, it allows for the understanding that symptoms can change. For example, a child like Joey may have previously displayed hyperactive behaviors but may now struggle with organization and social cues. His ADHD hasn’t vanished; it has merely shifted from hyperactive to inattentive symptoms.

Sibley’s research, spanning from 1998 to when participants reached approximately 25 years old, illustrated that ADHD is an “on-again, off-again” condition, with symptoms fluctuating based on life circumstances. While Joey may have appeared symptom-free during high school, he could struggle during college when faced with new responsibilities.

ADHD and Brain Differences Persist

While symptoms may vary over time, the neurological aspects of ADHD remain constant. Research shows that even individuals who seem to have outgrown ADHD still exhibit changes in brain structure. For instance, studies of brain scans indicate that the caudate nucleus, an area crucial for learning and memory, shows reduced gray matter in those diagnosed with ADHD. This reduction persists irrespective of whether the individual still meets ADHD diagnostic criteria, indicating that the disorder does not simply disappear.

So, while some children may seem to outgrow ADHD, their symptoms can wax and wane as they navigate different life stages, often leading to the misconception that they no longer have the disorder.

What This Means for Your Child

Will your child require medication long-term? It’s possible. Dr. Larry Silver suggests evaluating whether to discontinue medication annually. Some children may develop sufficient coping mechanisms to manage without stimulants, while others might need ongoing support.

As Sibley emphasizes, even if your child appears to improve, regular follow-ups with a psychiatrist remain crucial. Fluctuations in symptoms can arise during significant life transitions. Understanding that it’s normal to have periods of stability, followed by challenges, can help parents support their children effectively.

Importantly, the knowledge that ADHD does not equate to poor parenting or laziness provides reassurance. The neurological differences that contribute to their ADHD remain, albeit manifesting in various ways. Instead of attributing struggles to character flaws, acknowledging them as part of the condition can lead to seeking appropriate help.

The good news is that with increased understanding of ADHD in both children and adults, better support and care options are becoming available. This shift helps reduce shame for those whose symptoms evolve from hyperactive to inattentive, paving the way for more comprehensive treatment options.

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Summary

Research indicates that children are unlikely to outgrow ADHD entirely, although symptoms may change over time. The misconception that ADHD disappears has been challenged by studies showing persistent brain differences, emphasizing the importance of ongoing support and understanding for those with the disorder.