Why Do Some People Not Get Diagnosed with ADHD as Kids Despite Meeting Criteria?
It is a common misconception that children diagnosed with ADHD will outgrow the condition as they mature. However, ADHD is a neurodevelopmental disorder that persists into adulthood. Dr. Russell Barkley has noted that while outward behaviors seen in childhood may become internalized, the core symptoms of ADHD often continue throughout life.
ADHD: A Condition Born with but Not Always Diagnosed in Childhood
While ADHD is indeed a condition one is born with, it is not present in half of the individuals who have childhood diagnoses. Approximately 50% of children with ADHD will no longer have the condition as adults. This phenomenon can be attributed to two distinct groups.
Children Who Outgrow ADHD
Around 20% of children diagnosed with ADHD will completely outgrow the condition and exhibit no differences from non-ADHD adults. They do not have the same challenges and symptoms as they did during their childhood.
Improvement and Adaptation in Adulthood
Another 30% of children diagnosed with ADHD may show enough improvement in adulthood that their symptoms are reduced, but the condition still exists, though not to the same degree as a severe disorder.
Understanding why some individuals outgrow ADHD and others continue to have significant symptoms is complex. Several factors have been proposed to explain these variations.
Factors Influencing Outgrowing ADHD
Gender Discrepancies
Boys vs. Girls: Boys are more likely to outgrow ADHD than girls. The reason behind this can be attributed to the nature of the ADHD symptoms and how they present in boys versus girls.
Identifying Male Behavior: Boys often exhibit behavior that is considered normal for their age and development, which can lead to incorrect ADHD diagnoses. Girls, on the other hand, may be diagnosed more accurately because their symptoms are less aligned with typical boy behavior.
Hormonal Influences: Hormones play a significant role in the brain chemistry of both boys and girls. Young boys have high, uncontrolled levels of testosterone, which can exacerbate ADHD symptoms. For girls, hormonal fluctuations during puberty can worsen symptoms, and continuous hormonal changes throughout their lives can also impact ADHD.
Adult Symptom Underreporting: Men are less likely to seek medical help for physical or psychological issues, which can result in underreported symptoms of ADHD. This can lead to a lower diagnosis rate among men, making it appear as though more women continue to have severe symptoms.
Theories on Outgrowing or Continual ADHD
Several theories attempt to explain why some individuals outgrow ADHD while others continue to have the condition:
Theorizing the Nature of ADHD
Theory 1: Misdiagnosis: Some individuals who outgrow ADHD may never have had ADHD in the first place, and their symptoms were caused by other issues.
Theory 2: Slower Brain Maturity: Some children may have brains that mature more slowly, potentially outgrowing ADHD over time without any underlying disorder.
Theory 3: Compensation and Plasticity: Some individuals may develop compensatory brain functions, similar to how individuals can relearn skills after brain damage.
Theory 4: Different Types of ADHD: There could be different subtypes of ADHD with varying prognosis rates.
Challenges in Diagnosing ADHD
Despite these theories, there remains significant disagreement on where to draw the line between normal behavior and ADHD. Over the years, the diagnostic criteria have been adjusted lower, leading to a large number of false positives. Many individuals diagnosed with ADHD do not meet the true criteria or do not have severe enough symptoms to benefit from treatment, which has led to concerns about overdiagnosis.
The opposite situation also occurs, where many adults are being diagnosed with ADHD despite not having the condition. This underreporting can skew the data, making it appear that more people outgrow ADHD than actually do.