ADHD & the missing adults: can you really grow out of it?

People actually used to believe there was a magic switch that somehow meant people grew out of ADHD.

I can see why it’s appealing, right? All those (stereotypical) bouncy, loud little boys… where do they GO? (Imagine a puzzled looking professor scratching their head in wonder, while a VERY hyper focused graduate student struggles to complete their PhD just next door…)

What we USED to think was the ADHD was a behavioural problem - it’s why so many parents are still sent on parenting courses (and let me tell you, they are NOT friendly for ADHD or autistic adults trying to parent. I’ll tell you about that another time).

Now? Now we KNOW that ADHD is a neurodevelopmental difference, most often rooted in genetics but with other triggers that can cause similar differences in brain development and function.

The Myth: ADHD is a ‘Phase’

Is it any wonder, when we frame ADHD as ‘behaviour’, that so many adults and inattentive ADHDers of all ages were missed as children? We know now that the most challenging part of ADHD isn’t what other people see - it’s what is happening inside our brains and bodies. We know that the racing car speed thoughts, the impulsivity, the shame, the inability to tune in and follow one train of thought - those are as likely to affect boys as they are girls and adults too. THAT is the real ‘ADHD’ (and please hurry up with a better name).

While we are here, inattentive? I think what that means is ‘inattentive what they are told they ought to be paying attention to’ - most ‘Inattentive presentation’ ADHDers can focus and attend extremely well when their interest based nervous systems are ignited and engaged…

The Data Speaks

When we look at the data for ADHD, there's a weird thing happening. The number of diagnosed children is high, but what about adults? The numbers just don't add up. So, where do they go? According to research, approximately 50-60% of children diagnosed with ADHD continue to exhibit symptoms into adulthood. This gap or discrepancy in the numbers could be due to underdiagnosis in adults or a lack of follow-up into adulthood.

The dreadful state of ADHD services in the UK - in all nations - is just horrific. Adults who have waited 5-6 years just for a diagnosis are then left without support or medication, and not just because of a shortage that we are facing just now. It makes sense, in a way, that the health services will focus on the children and teens who they are a) more comfortable diagnosing and b) they feel are at a more critical stage in life. The problem? The people waiting on a diagnosis and self-medicating, burning out or not coping are their parents, their teachers, their friends… and the burden of mental health problems is one you can’t just count in lost days of work or potential earnings.

via GIPHY

Looking at approximate rates of diagnosis - around 15% in children (in western countries where there is less stigma and more access to diagnostic services) - and then comparing it to adults - around 4-5% in the same countries - we have to ask where did they all go?

• internalising behaviours

• lack of adult diagnosis or assessments

• developing coping strategies to reduce appearance of ADHD

• the negative impact of untreated ADHD: earlier death from multiple factors, including accidental death, addictions, obesity, diabetes and so on.

Some of them might be IN PRISON - as the rate of ADHD among the prison population is around 25% -yes, one in four. Makes sense that those people might be the ones whose impulsivity, dopamine seeking and ‘maladaptive coping mechanisms’ could have led them into the wrong end of the law.

The Reality: ADHD is a Lifelong Condition

Research shows that ADHD is a neurodevelopmental difference that continues into adulthood for the majority of individuals. Symptoms may change or become less external, but they don't disappear. For example, hyperactivity may lessen, but issues with attention and impulsivity may continue, manifesting in different ways such as difficulty in time management or maintaining adult relationships. The research on ADHD and marriage is sobering - divorce rates are higher than ever but with ADHD? Higher still. - again the problem isn’t ADHD but a lack of understanding, acceptance and skills for us to adapt and thrive whatever is going on in our brains.

The Grey Hair Mistake

Getting your first grey hair doesn't mean you've outgrown ADHD. It's not a rite of passage that magically cures you. ADHD is not a phase; it's a part of how your brain functions. The symptoms may change, and that outer hyperactivity may become an internal one, you may develop coping mechanisms, but the underlying neurodevelopmental aspects remain.

• Don’t discount your challenges: Use an online rating scale or self-assessment tool to see where you are.

• Find a local charity - ADDA in the USA, or ADHD UK in Great Britain, or ADHD Ireland in Eire to discover their adult services

• Peer Support: this is incredibly powerful. To be with others who understand that you are NOT making it up, that it’s all too real? Dismantling the years of hiding can be liberating - and help reduce the difficult traits just with relief.

• Assessment is useful to access medication and also means you can communicate with places like your bank or health services differently. If you can pursue it, there’s a good chance you’ll find the positives that come from it worth the persistence.

• Focus on self-acceptance and compassion - rather than trying to squeeze yourself into the Neurotypical Shoes that pinch our toes and give us blisters… I know but most of us remember the hard leather school shoes and how difficult they were to get used to. I think when we lean into being ourselves, all the positives that can travel with ADHD have more room to grow.

ADHD isn't something you grow out of; it's something you grow with. Understanding this is crucial for both self-acceptance and societal awareness. As we age, the way ADHD impacts our lives may change, but it doesn't mean it’s disappeared. It's essential for healthcare providers, educators, and the community at large to recognize this to provide appropriate support and interventions.

I feel particularly passionate that ADHDers over 60 are just ignored - almost completely - online and by most services. Again, ADDA are leading the field in this and peer support will be even more important for us going into our ‘golden’ - rather than greying - years.

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Katherine

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Further reading:

Asherson, P., Leaver, L., Adamou, M., et al. (2022) Mainstreaming adult ADHD into primary care in the UK: guidance, practice, and best practice recommendations. BMC Psychiatry 22(640).

Johnson J., Morris S. and George S. (2020) Attention deficit hyperactivity disorder in adults: what the non-specialist needs to know. British Journal of Hospital Medicine 81(3), 1-11.

Storebø O.J., Elmose Andersen M., Skoog M., et al. (2019) Social skills training for attention deficit hyperactivity disorder (ADHD) in children aged 5 to 18 years. Issue 6. Art. No.: CD008223. John Wiley & Sons, Ltd.

Visser SN, Danielson ML, Bitsko RH, Holbrook JR, Kogan MD, Ghandour RM, Perou R, Blumberg SJ. Trends in the parent-report of health care provider-diagnosed and medicated attention-deficit/hyperactivity disorder: United States, 2003-2011. J Am Acad Child Adolesc Psychiatry. 2014 Jan;53(1):34-46.e2. PMID: 24342384 

Barbaresi WJ, Colligan RC, Weaver AL, Voigt RG, Killian JM, Katusic SK. Mortality, ADHD, and psychosocial adversity in adults with childhood ADHD: a prospective study. Pediatrics. 2013 Apr;131(4):637-44. PMID: 23460687 

Merikangas KR, He JP, Burstein M, Swanson SA, Avenevoli S, Cui L, Benjet C, Georgiades K, Swendsen J. Lifetime prevalence of mental disorders in U.S. adolescents: results from the National Comorbidity Survey Replication--Adolescent Supplement (NCS-A). J Am Acad Child Adolesc Psychiatry. 2010 Oct;49(10):980-9. PMID: 20855043 

NCS-A Lifetime and 12M prevalence estimates. 2005; https://www.hcp.med.harvard.edu/ncs/ 

Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, Faraone SV, Greenhill LL, Howes MJ, Secnik K, Spencer T, Ustun TB, Walters EE, Zaslavsky AM. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006 Apr;163(4):716-23. PMID: 16585449 

Kessler RC, Berglund P, Demler O, Jin R, Merikangas KR, Walters EE. Lifetime prevalence and age-of-onset distributions of DSM-IV disorders in the National Comorbidity Survey Replication. Arch Gen Psychiatry. 2005 Jun;62(6):593-602. PMID: 15939837