This paper is a selective review of published research on ADHD from childhood to old age. It covers studies of children, adolescents and adults, and does not say how many studies or people it drew on.
ADHD often does not go away at puberty, the review reports. A cited pooled analysis of studies that followed children with ADHD suggests at least 15% still fully met the criteria by age 25. A further 50% still had impairing symptoms. Estimates varied a lot. Newer European studies found persistence of up to 80% in young people with the combined type, which the authors suggest may reflect more severe cases or ratings by others instead of self-ratings.
Symptoms shift with age. Hyperactive and impulsive behavior shows more in very young children. Inattention shows more in middle childhood and tends to last, while outward signs of physical hyperactivity fade. Emotional ups and downs become a growing burden. Oppositional and conduct problems are most common in children, while substance use problems grow in adolescence and adulthood. Cited work linked childhood ADHD to a higher risk of teen nicotine use and young adult alcohol problems.
The authors say knowledge is badly lacking on nearly every lifespan question, especially for older adults. They suggest treatment at every age should combine education about ADHD, medication and ADHD-focused psychotherapy, and they flag the move from child to adult services as a point where many people are lost to follow-up.
Talk with a clinician about your own situation.
The numbers Stats and what the terms mean
The statistics behind the plain-language claims above.
- Faraone, 2006: share of children with ADHD still meeting full diagnostic criteria by age 25, at least 15%, with a further 50% meeting criteria for ADHD in partial remission.
- One included meta-analysis of cohort studies (cited in Franke, 2018): risk of nicotine use in middle adolescence after childhood ADHD, OR: 2.36, 1.71 to 3.27.
- One included meta-analysis of cohort studies (cited in Franke, 2018): risk of alcohol use disorder in young adulthood after childhood ADHD, OR: 1.35, CI: 1.11 to 1.64. What the terms mean:
- OR (odds ratio) A number that compares the odds of an outcome in one group with the odds in another, where a value above 1 means higher odds; here it compares people with and without childhood ADHD.
- CI (confidence interval) A range of values around a result that fit the data reasonably well, where a narrow range means a more precise result; here it is the range given after each odds ratio.
- Meta-analysis A study that pools the numbers from several earlier studies on the same question into one overall answer.
- Cohort study A study that follows a group of people over time and compares what happens to those with a certain trait and those without it, without assigning anything; here the trait was childhood ADHD.
Source: Barbara Franke, Giorgia Michelini, Philip Asherson, et al.. Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan. European Neuropsychopharmacology (2018). doi:10.1016/j.euroneuro.2018.08.001