What Do We Know About ADHD Symptoms Across the Life Span?

Thursday, August 25, 2022

ADHD Life Span: How Long Do Symptoms Last?

ADHD and menopause are making headlines, renewing conversations about how ADHD symptoms can change as people mature. Evidence shows that ADHD symptoms generally decline with age, but for some people symptoms carry over from childhood to adulthood (Vos & Hartman, 2022).

Because most ADHD research focuses on children, less is known about how symptom profiles change as people move into adolescence and adulthood. What do practitioners need to know about how ADHD looks and feels at different life stages?

Early Childhood

ADHD is often classified in one of three types:

hyperactive/impulsive, characterized by high energy, lots of movement, frequent risk-taking, and difficulty staying on task
inattentive, characterized by distractibility, trouble remembering, and difficulty following through on long-term or complex tasks
combined type, characterized by both inattentive and hyperactive/impulsive symptoms (National Institute of Mental Health, 2021)

It’s important to note that these characteristics are based on diagnostic criteria. They don’t reflect the strengths and abilities associated with ADHD, including charisma, hyperfocus, and creativity, among others.

ADHD symptoms can show up as early as the toddler years (Brown & Harvey, 2018). Young children with ADHD often have more externalizing symptoms, meaning those that are outwardly directed and easily observable. These symptoms include

being fidgety, restless, or overly active;
talking excessively;
interrupting or blurting out;
behaving impulsively;
losing things; and
having trouble with organization and follow-through on tasks (King et al., 2018).

Behaviors like these can disrupt classrooms, which explains why ADHD is often diagnosed once children start school.

It’s also important to note that sex and gender can affect how ADHD symptoms appear, even at this early stage. Inattention, for example, is more common among those assigned female at birth. Since inattention is less likely than hyperactivity to attract attention in a classroom, ADHD can be easier to spot in those assigned male at birth.

Teen Years

Evidence explaining the relationship of puberty, hormones, and ADHD symptoms is conflicting. Some studies have linked hormone fluctuations to worsening ADHD symptoms; others don’t show a clear connection between the two.

It is clear that ADHD symptom profiles shift in the teen years. Inattentive symptoms become more apparent, leading to academic difficulties as schoolwork becomes more demanding. Hyperactivity often declines. In adolescence, ADHD symptoms can lead to

risk-taking;
early, frequent sexual experiences;
substance use;
anxiety and depression;
more frequent auto accidents among those who drive; and
higher risk of pregnancy and sexually transmitted infections (Antoniou et al., 2012; Curry et al., 2017; Özgen et al., 2021; Norén Selinus et al., 2016).

Learn more: Why It's So Important to Assess Executive Function in Children with ADHD

Adulthood

ADHD symptoms persist into adulthood for 35%–65% of those diagnosed with the condition (Owens et al., 2016). Even so, in young adulthood, symptoms decrease for many people. When symptoms persist, ADHD can lead to

lower income,
greater risk of occupational disability,
more time lost from work, and
less educational attainment (Jangmo et al., 2021).

Researchers think emotional dysregulation, school and discipline problems, anxiety, depression, and social rejection play a big role in these outcomes (Owens et al., 2016). It’s important to note, however, that people with ADHD often compensate for symptoms in ways that help them to adapt and build new skills (Merkt et al., 2015).

In a 2018 review of the literature, Franke et al. described symptoms as “internal restlessness, ceaseless unfocused mental activity, and a difficulty focusing on conversation.” Researchers also noted problems with impulse control, attention switching, emotional responses, and problem-solving.

Few studies focus on the ways ADHD affects people who are pregnant or postpartum. During these periods of intense hormonal change, people may notice

greater distraction and more trouble focusing;
depression, especially as estrogen and dopamine levels drop; and
lower self-esteem.

When a birthing parent has ADHD, it’s 20%–30% more likely they’ll need a caesarean section. Many women who were incorrectly diagnosed with an anxiety or mood disorder earlier in life finally receive an ADHD diagnosis once their children do (Antoniou et al., 2021).

Learn More: Lived Experiences—ADHD in Girls & Women

Later Adulthood

Researchers agree that, for many people, ADHD life span symptoms decrease with age. It’s important to understand, however, that research also shows ADHD is “under-recognized and under-treated” in older adults. Some researchers have referred to older adults as the “blind spot” in ADHD research (Vos & Hartman, 2022).

It’s known that when estrogen levels drop during perimenopause and menopause, ADHD symptoms increase sharply for many women. Researchers think the surge in symptoms may be related to lower dopamine and lower estrogen levels. Trouble with focus or concentration, along with mood disorders, can result (Antoniou et al., 2021).

Other Factors to Consider

Changing comorbidity profiles. ADHD often co-occurs with other conditions. At varying times, the symptoms of those disorders may also change. Symptoms of other conditions may overshadow ADHD symptoms or cause more functional problems at different life stages.

Changing responses to treatment. Beginning in school-age children, medication is a first-line treatment, and it is associated with better lifelong outcomes. Even so, ADHD medications may need to be re-evaluated in pregnant or nursing people and in older adults taking medications for other health conditions.

Key Messages

ADHD symptoms may look more like hyperactivity and impulsivity early in childhood, especially among people assigned male at birth. In the teen years, inattentiveness and risk-taking behaviors may become more prominent. For many, inattentiveness and lack of focus persist into adulthood, when changing hormones can cause symptom surges. Early intervention, treatment, follow-up, and compensatory skills can lead to better outcomes at every age.