Adult ADHD
Visual Abstract
Age-Dependent Decline of Symptoms of Attention Deficit Hyperactivity Disorder: Impact of Remission Definition and Symptom Type
Which symptoms resolve first in ADHD?
J Biederman, E Mick, S V Faraone
Summarized by:
April 22, 2023
study source
Am J Psychiatry
May 2000
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Measuring ADHD rates can be tricky. Different definitions of ADHD and ADHD remission can lead to different results.
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Even though most kids with ADHD show some improvement by the time they’re adults, many still have some ADHD symptoms that can affect their everyday function.
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Among the different types of ADHD symptoms, difficulties with paying attention take the longest to get better.
ADHD Remission and Symptoms
Objectives
Generally, most kids who develop ADHD show improvement by the time they are adults. However, it can be difficult to define and measure how many actually "get better."
Study Quote
Symptom decline in attention deficit hyperactivity disorder (ADHD) was examined with different definitions of remission.
Method
Researchers followed 128 boys with ADHD to see how symptoms changed over time. They split the symptoms into different symptom types to see whether certain types of symptoms got better first.
Study Quote
Symptoms in 128 boys were measured five times over 4 years. The prevalences of syndromatic (less than full syndrome), symptomatic (less than subthreshold diagnosis), and functional (full recovery) remission were estimated as a function of age with multivariate logistic regression.
Results
Overall, 62% of participants in the study no longer had ADHD by the time they reached age 18.
The percentage of individuals with ADHD who get better can vary dramatically between studies. Much of this is due to differences in how we measure and define ADHD, which is a key shortcoming in the field that this study is aiming to help address.
Generally, researchers found that difficulties with attention took the longest to get better. Most of the boys in the study still had enough difficulties with attention to qualifying for ADHD.
A study of 128 boys found that hyperactivity and impulsivity symptoms of ADHD were more likely to get better compared to difficulties with attention.
These results are based on syndromatic remission, meaning that the person no longer has enough symptoms to qualify for ADHD.
However, as you can see in the chart below, many individuals still had issues with attention and hyperactivity, even if they did see improvement.
The red line represents individuals who no longer had enough symptoms to qualify under the definition of ADHD. The green line represents the number of individuals who no longer had significant symptoms or impact on their lives fromhyperactivity.
Most individuals experienced improvements in hyperactivity over time, though most still had at least some impact on their lives
The chart below shows the data for attention-based ADHD symptoms. Compared to the data above, fewer individuals got better as they reached adulthood. Nearly all participants in the study had some symptom or impact on their lives from difficulty paying attention.
Most who had ADHD as children still showed some inattention symptoms as adults.
Study Quote
Age was significantly associated with decline in total ADHD symptoms and symptoms of hyperactivity, impulsivity, and inattention. Symptoms of inattention remitted for fewer subjects than did symptoms of hyperactivity or impulsivity. The proportion of subjects experiencing remission varie...
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Conclusions
This study highlights one of the key challenges in measuring and evaluating ADHD. If we use ADHD testing to estimate rates of ADHD, we may miss many cases where someone still has symptoms of ADHD that affect their daily function, even though they no longer meet the full criteria for ADHD.
This can make it challenging to measure ADHD and to compare data between different research studies in the field.
Study Quote
These results indicate that differences in reported remission rates reflect the definition used rather than the disorder’s course. They provide systematic support for the clinical observation that hyperactivity and impulsivity symptoms tend to decline at a higher rate than inattention sy...
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