Attention deficit hyperactivity disorder (ADHD) has mostly been thought of as a childhood disorder, one that some children outgrow as they enter adulthood. But many adults continue to have ADHD symptoms or even get diagnosed for the first time with ADHD in young adulthood.
Nearly 7% of adults globally have symptomatic ADHD. It was once believed that about 50% of people with childhood ADHD go into remission as adults. However, the short follow-up periods of many studies miss what doctors see in practice. Many adults continue to have ADHD limitations and symptoms that come and go.
Growing evidence points to ADHD following a relapsing/remitting cycle, with periods of mild to no symptoms, followed by periods of noticeable symptoms.
What Is a Remitting/Recurring ADHD Cycle?
Symptoms of adult ADHD include impulsiveness, difficulty focusing, trouble staying organized or managing time, and mood swings or short temper. Treatment focuses on minimizing symptoms and their effect on your life.
As an adult with ADHD, you may find that you have periods of feeling well, with systems in place that work, and little disruption to daily functioning. This can be with or without medication or therapy. You may experience three or fewer symptoms and no longer meet the clinical definition of ADHD.
Then, maybe a major life change happens or you enter a period of high stress and symptoms return, as does your diagnosis. This appears to be a common cycle for many people over age 18 with ADHD.
So far, research into this cycle is limited, but it’s a growing area of focus.
How Often Does Adult ADHD Remission Happen?
First, a definition of remission. A standardized definition of remission doesn’t yet exist, but it’s generally thought to mean having three or fewer symptoms and not meeting the clinical definition of ADHD, which means six or more symptoms. Partial remission means about four or five symptoms that still have some effect on your daily functioning.
About a third of people with ADHD experience remission at some point in their lives. In one of the longest studies looking at people with ADHD, over 16 years, nearly 30% of the people followed into adulthood experienced full remission at some point. And more than 60% of people in the study had periods of remission and recurrence across the follow-up period.
Another study with a 6-year follow-up of adult-onset ADHD, found that about one-third of participants experienced remission during the study period. Remission rates were similar among people who took medication for their ADHD and those who did not. And another study with a 7-year follow up of adults found that about a third of participants experienced full or partial remission.
Because studies in adults are limited, few have longer follow-ups to determine how long remission lasts.
What Drives ADHD Remission in Adulthood?
As a newer area of study, it’s not well known what contributes to remission. Childhood factors, such as the initial severity of ADHD as a child and parental mental health, may influence persistence of ADHD symptoms into adulthood.
In adulthood, people with persistent ADHD are more likely to have anxiety, conduct disorder, or dependence on marijuana. That makes it harder to know the effects of ADHD compared with the effects of substance abuse or other mental health issues.
Then there are factors related to growing and maturing. Within this view, there are three thoughts on what may contribute to remission:
- Your brain normalizes. During adulthood, your brain matures and begins to look more like a neurotypical brain (like that of someone without ADHD). People with ADHD tend to have slower development of attentive and executive functioning, which could lead to the resolution of some symptoms with age.
- Your brain compensates. Some parts of your brain may change, possibly because of treatment reducing some symptoms. Other parts of your brain still have anomalies related to ADHD.
- You compensate. Adults are more able to control their surroundings and daily routines, making it easier for them to create systems that work. Your brain stays the same, but you develop environmental and behavioral strategies to reduce the effects of your symptoms on daily life. For example, you may have habits you follow to stay organized or to focus during meetings.
It’s also possible that all three of these factors come into play as you age.
Overall, researchers and doctors are still learning more about ADHD remission and how ADHD affects adults over time. So, when you meet with your doctor or counselor, you may not talk specifically about remission or recurrence, but rather focus on your quality of life and how to keep symptoms from affecting your daily life.
