Most children with attention deficits don’t just grow out of them, new research suggests, but early supports in high school may help them avoid long-term academic problems.
While prior studies have suggested at least half of students with attention deficit hyperactivity disorder no longer have symptoms as adults, a new study in the American Journal of Psychiatry finds the real picture is more complicated. Researchers as part of an ongoing federal study tracked children diagnosed with ADHD from around age 7 into their early 20s.
Nearly a third of children went through periods with no attention problems, but researchers found fewer than 1 in 10 children truly “grew out” of their symptoms permanently.
“After a period of full remission, recurrent ADHD symptoms were the rule, rather than the exception,” concluded Margaret Sibley, an associate professor in behavioral medicine and psychiatry at Seattle Children’s Hospital and the lead author, in the study. “Overall, the results suggest that over 90 percent of individuals with childhood ADHD will continue to struggle with residual, although sometimes fluctuating, symptoms and impairments through at least young adulthood.”
All adolescents, including those with attention deficits, improve their self-regulation compared to elementary-age children, so children with ADHD do often become less impulsive and able to pay attention for longer periods of time. But, “kids with ADHD may be developmentally improving in those areas, but they’re still at a relative disadvantage [compared] to their peers,” said George DuPaul, an associate dean for research in the school psychology program at Lehigh University’s college of education, who was not part of the longitudinal study.
“There’s been a sense that ADHD was primarily a problem of childhood that went away in adolescence, although that myth has been debunked many times over,” DuPaul said.
Separate new federal data finds nearly twice as many students are identified with attention deficit hyperactivity disorder or similar learning disorders as teenagers than as elementary age students, and the disparities in identification for poor students and students of color are wider in secondary school than in lower grades.
While in general, children whose parents attained only a high school diploma or less are more likely to be diagnosed with ADHD or a learning disability than children whose parents were better educated, roughly 15 percent versus 13 percent, the disparity was particularly striking for white students. More than 1 in 5 white students whose parents earned a high school diploma or less are labeled as having attention or learning disabilities, compared to only 13 percent of white students from more educated families.
These students in particular not only need support in learning to manage their time and focus, but in advocating for themselves without the more intensive structural supports more often available in primary school.
“Classrooms are kind of the worst places that we can put students with ADHD, and that’s particularly true with the high school level, where you have multiple teachers, each of whom have different expectations for performance and different perceptions of student performance,” DuPont said. “So now the student has to discriminate, negotiate all of that, while sustaining attention to longer term assignments and studying for tests.”
In a separate study in the Journal of School Psychology, DuPaul and his colleagues evaluated an expansion of the Challenging Horizons Program, originally developed for middle school students. Students in the program receive 30 mentoring sessions, twice each week, to practice and receive feedback on organization, study skills, and social behavior. In high school, the students also practice becoming their own education advocates, setting and monitoring indicators of their academic progress and behavior and developing strategies to address specific problems.
The researchers found small to moderate improvements in students’ organization skills and homework performance, but those early benefits “translated into protection against a greater decline over the course of the year,” DuPaul said. Students who had received the mentoring support had better report card grades six months into the school year than did peers with ADHD who did not participate in the program.
He suggested that while high school students need to learn more skills in managing their behaviors as they get older, their parents and secondary teachers could help by remaining more engaged with older students, particularly during transition periods.
“For students with disabilities across the board, supports drop from middle school to high school, even as you have more responsibilities,” he said. “The teachers tend to be more subject-matter oriented rather than student-oriented, because we only see them for a portion of the day. ... But from a public health perspective, [mentoring] is this kind of academic inoculation, to protect against the decline that students with ADHD would typically experience over the course of the school year.”
