Reconciling Accounts of Declining and Increasing ADHD Severity with Age: A Scoping Review of the Literature
Year: 2026
Type: preprint
Abstract: Objective: Prospective longitudinal studies of childhood attention-deficit/hyperactivity disorder (ADHD) consistently indicate that, on average, individuals exhibit marked declines in symptom severity with age. Conversely, a growing body of adult ADHD qualitative studies highlight a paradoxical lifespan trajectory wherein individuals retrospectively report an escalation in ADHD severity over time. This scoping review will synthesize the available longitudinal literature and retrospective qualitative accounts of ADHD trajectories over the childhood-to-adult continuum to reconcile these divergent accounts of ADHD’s lifespan trajectory. Method: This review will adhere to PRISMA-ScR guidelines and include a systematic search of PubMed, PsycINFO, and EMBASE. Both longitudinal studies that track cohorts of individuals with ADHD over time and qualitative or cross-sectional studies that offer retrospective accounts of change in ADHD severity over development will be included. Studies will be evaluated based on their methodology for measuring longitudinal continuity, definitions of ADHD severity over time (i.e., DSM symptom counts/severity, functional impairment. cognitive tasks), sample compositions, ages of assessment, and overall conclusions. Contextual factors that may influence trajectory will also be extracted from articles. Results: Results will be organized in such a way that we will be set up to consider current paradoxical accounts of ADHD trajectory with attention to differences in change over time in various ADHD-related constructs (inattention vs. hyperactivity/impulsivity vs. impairment vs. other), based on measurement strategy, changing developmental contexts, and age-related neuroendocrine and cognitive changes. Discussion: We will discuss the extent to which the dual clinical narrative that ADHD severity both improves with age and worsens with age is an artifact of methodological differences between studies or represents a true U-shaped experience of improving ADHD followed by worsening ADHD (consistent with fluctuating ADHD models). Individual differences in trajectory will be discussed and explored. Clinical recommendations for individuals who treat ADHD across the lifespan will be discussed.
Author: Margaret Sibley
Language: English
Subfield: Psychiatry and Mental health
Field: Medicine
Domain: Health Sciences
Open Access status: green
OpenAlex ID: W7203934496