In people without ADHD, the ability to self-regulate changes over time, with infants having very little, if any, “self-control” and adults having much more. Adults, that is, are less controlled by the moment and better able to act deliberately to achieve longer-term goals.
A person with ADHD will also become better at self-regulating over time, but will typically remain delayed compared to other people of the same age. For example, a 16-year-old with ADHD will have more self-control than he did when he was 5, but probably won’t have as much self-control as the next 16-year-old. As a result, both kids and adolescents with ADHD often appear “immature” compared to their peers.
Because of their delays in self-regulation, kids and adolescents with ADHD typically have difficulty meeting the daily expectations that increase with age. These expectations include:
Academic: Managing more complex and longer-term tasks; keeping track of assignments; working and staying focused on classwork/homework for an extended period of time.
Social: Maintaining appropriate “personal space;” taking turns; compromising; paying attention to others’ feelings and reading social cues.
Adaptive behavior: Completing chores and household tasks; managing time; driving safely; making appropriate and safe choices when out in the community; maintaining adequate personal hygiene; participating successfully in extracurricular activities.
ADHD is typically a chronic disorder, meaning that most children (50 to 80 percent) with ADHD continue to meet criteria for the diagnosis as they move into adolescence, and many (35 to 65 percent) continue to meet criteria as adults. Further, only a small number (10 to 20 percent) of children with ADHD will have no symptoms or impairment as adults. In other words, relatively few people appear to fully “outgrow” ADHD in adulthood.
Unfortunately, it is difficult to predict whether a particular individual with ADHD will experience a significant improvement in symptoms and impairment over time; however, individuals with more severe ADHD symptoms, greater impairments in functioning, family histories of ADHD, and additional psychiatric diagnoses (e.g., mood, anxiety, and substance use disorders) appear most at risk for continued difficulties.
Despite the generally chronic nature of ADHD, symptoms of the disorder, as well as impairment the disorder causes, often change over time. Hyperactive symptoms (e.g., running or climbing excessively; talking excessively; appearing “on the go” or “driven by a motor”) tend to decline the most, usually in later childhood and early adolescence, at which time obvious hyperactivity is often replaced by restlessness. Impulsive behaviors may also improve as children age, though consequences for the impulsivity that remains may become more serious (e.g., increased risk for automobile accidents and substance use). Inattentive symptoms of ADHD, on the other hand, appear the most stable over time. While an individual’s attention span may improve gradually with age, this may not be adequate to meet daily demands.
Although we know that symptoms of ADHD are likely to persist into adulthood, the good news is that effective treatment strategies (i.e., medication and use of environmental supports) are available to help adolescents and adults improve their ability to meet daily expectations.
If you have concerns about your child or adolescent with ADHD, Nationwide Children’s Hospital’s Big Lots Behavioral Health Services provides evaluation and treatment for the disorder; an initial appointment can be arranged by calling the Intake Department at (614) 355-8080.
Ben Fields, PhD, MEd, is a clinical psychologist at Nationwide Children’s Hospital. His primary clinical interests include assessment and treatment of Attention-Deficit/Hyperactivity Disorder (ADHD) and learning disorders, as well as parent behavior management training for disruptive behavior disorders.
Lynda Wolfe, PhD
Psychiatry and Behavioral Health
Lynda Wolfe, PhD is a clinical psychologist at Nationwide Children’s Hospital whose primary clinical interests include assessment and treatment of ADHD.
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