Can ADHD Get Worse With Age? Facts And Myths Uncovered
Like many mental health conditions, attention-deficit/hyperactivity disorder (ADHD) tends to come with its share of misconceptions. For example, some people maintain that ADHD isn't a "legitimate" medical disorder, and its symptoms aren't symptoms at all but simply character traits. This can be a monumentally harmful myth for the 129 million children and adolescents and 366 million adults diagnosed with the disorder around the globe.
ADHD is recognized as a diagnosable and treatable neurodevelopmental disorder by leading healthcare authorities, such as the American Psychiatric Association, Centers for Disease Control and Prevention, and the U.S. Department of Education.
Another common misconception about ADHD can be that it either worsens or "goes away" with age. In most cases, both are untrue. While ADHD is typically diagnosed in childhood, ADHD symptoms often persist into adulthood. However, the severity of symptoms does not normally intensify as one grows older. In other words, ADHD may persist into adulthood, but it doesn't typically get worse with age when properly treated. Often, therapy constitutes an important and effective part of treatment, and it can be accessed in person or online.
ADHD symptoms and how they change with age
The Diagnostic and Statistical Manual of Mental Disorders (DSM-V) generally recognizes three distinct types of ADHD classified according to their predominant symptoms.
Predominantly inattentive type
- Is easily distracted by external stimuli
- Has difficulty concentrating on tasks
- Is often forgetful during daily activities
- Tends to lose things needed to complete daily tasks or activities
- Frequently makes careless mistakes when completing tasks or activities
- Has difficulty completing tasks or following instructions
- Has trouble organizing tasks or activities
- Avoids tasks or activities requiring sustained mental effort
- Appears as if they aren't listening during conversations or when engaged by others
Predominantly hyperactive/impulsive type
- Is regularly impatient
- Interrupts others in conversations
- Has difficulty taking turns or waiting in line
- Is unable to stay seated in appropriate situations
- Compulsively "bounces" from one activity to another
- Has difficulty engaging in quiet activities
- Talks excessively
- Fidgets or taps hands and feet
- Compulsively fidgets with objects
Combined presentation
ADHD may also emerge as a combination of inattentive and hyperactive-impulsive types. Individuals with combined presentation ADHD might have difficulty focusing on a task and sitting still long enough to finish it.
Changes in ADHD with age
ADHD presentation and symptoms typically vary between people and over time, but research indicates they usually first appear between three and six years old.
For example, individuals in late elementary to early middle school often become more independent at school and in social settings. For children and adolescents with ADHD, this can create unique academic and social challenges including, but not limited to, the following:
- Academic decline due to inattentive symptoms and difficulty comprehending more complex instructions
- Frequently missed deadlines and assignments due to struggles with time management and disorganization
- Challenges with interacting socially due to problems with recognizing social cues
- Difficulty maintaining age-appropriate peer relationships because of problems adhering to social norms and contexts
- Problems with interpersonal relationships because of impulsive behaviors
As one grows into high school and young adulthood, individuals may experience many of the same struggles, but new challenges can also emerge. For example:
- Problems managing multiple deadlines and responsibilities at work and school due to organization and time management challenges
- Lack of impulse control, potentially contributing to risky behaviors like substance misuse and unprotected or reckless sexual encounters without considering the consequences
- Challenges with establishing and maintaining relationships due to emotional dysregulation, difficulty reading social cues, and impulsive speech
During this time, individuals often experience significant life transitions, like moving on from academic life into the workforce, changing jobs, going through family life transitions, and more. ADHD can present unique challenges with adapting to change, transitioning between life events, making long-term plans, and setting goals.
Despite evolving challenges, studies suggest that with proper treatment and management, ADHD prevalence in adults often declines between ages 18 to 24.
It can be important to note, however, that some research indicates even if symptoms disappear entirely, brain anomalies associated with ADHD usually remain as one ages.
Other factors that can influence how ADHD changes with age
Experts have varying explanations for why ADHD symptoms can change with age:
Early misdiagnosis
There can be many reasons why ADHD might be misdiagnosed early on. Errors in the assessment of developmental age and relative maturity and lack of symptom recognition may play a role. Research indicates that factors like gender may also impact diagnosis.
Age of intervention
Early intervention can be essential to effective ADHD treatment. Although updated evidence may be needed, researchers posit that not only may the developing brain be more receptive to lasting modifications, but early intervention may also "bypass" or lessen the impact of factors that might complicate treatment effectiveness, like struggles with peer socialization and poor academic performance. It may also curb the development of potentially harmful coping mechanisms as one ages.
Treatment adherence and effectiveness
ADHD treatment is often a two-way collaboration between a mental health professional and their client. A thorough, consistent, regularly monitored treatment plan typically requires effort from both parties for the most favorable long-term outcome.
Environmental support
A robust and supportive network of friends, family, doctors, therapists, and peers can be crucial for successful ADHD outcomes.
Stress
Studies repeatedly show that people with ADHD tend to be exposed to more everyday stress on average than neurotypical people and that stress exposure may be strongly linked to the persistence of ADHD symptoms from childhood to adulthood.
Comorbid disorders
Comorbidities like substance use disorder, anxiety, and mood disorders can be common in adult ADHD cases and may have a significant impact on symptom severity and frequency.
ADHD diagnosis
Diagnosis for ADHD typically involves several steps. It may begin with a comprehensive evaluation in which a mental health professional gathers information about the individual's experiences, behavior, and symptoms. They may also want to interview a person’s parents, spouse, or family for a broader perspective on the individual's behaviors.
Behavioral assessments, such as rating scales and questionnaires, may be used to gather information about the individual's behavior across different settings, such as home and school. In many cases, a medical history and physical examination are conducted to rule out other potential causes for the symptoms and ensure that no underlying medical conditions contribute to the behavior.
ADHD treatment
Treatment for ADHD is often multifaceted and may require a combination of interventions tailored to the individual's unique symptoms and challenges. For example, intervention for children may include parental training and education, as well as individual education plans (IEPs) to support students with ADHD in school.
Medication can be prescribed by a doctor or psychiatrist to improve attention, focus, and impulse control.
Behavioral therapy, such as cognitive behavioral therapy (CBT), can be effective in managing ADHD symptoms. These types of therapies usually focus on teaching skills to help individuals manage their behavior, improve organizational skills, and cope with challenges associated with ADHD.
Support groups can offer individuals and families affected by ADHD the opportunity to connect with others facing similar challenges and share strategies for coping and managing symptoms.
Treatment outcomes can vary, and finding the most practical combination of strategies may take some time. Regular follow-up appointments can be essential to monitor the effectiveness of treatment and make any necessary adjustments.
Because of ADHD's unique challenges, some people find that the accessibility and flexibility of online therapy can offer an excellent alternative to conventional treatment. Online therapy platforms like BetterHelp can offer access to a broader pool of mental health professionals experienced in treating people of all ages with ADHD.
Virtual therapy is often more affordable than traditional treatment without insurance, and studies repeatedly show that it can be just as effective in treating a wide range of mental health conditions, like ADHD and comorbid disorders.
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