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Live fast, die young? A review on the developmental trajectories of ADHD across the lifespan
Open accessAbstract
Attention-deficit/hyperactivity disorder (ADHD) is highly heritable and the most common neurodevelopmental disorder in childhood. In recent decades, it has been appreciated that in a substantial number of cases the disorder does not remit in puberty, but persists into adulthood. Both in childhood and adulthood, ADHD is characterised by substantial comorbidity including substance use, depression, anxiety, and accidents. However, course and symptoms of the disorder and the comorbidities may fluctuate and change over time, and even age of onset in childhood has recently been questioned. Available evidence to date is poor and largely inconsistent with regard to the predictors of persistence versus remittance. Likewise, the development of comorbid disorders cannot be foreseen early on, hampering preventive measures. These facts call for a lifespan perspective on ADHD from childhood to old age. In this selective review, we summarise current knowledge of the long-term course of ADHD, with an emphasis on clinical symptom and cognitive trajectories, treatment effects over the lifespan, and the development of comorbidities. Also, we summarise current knowledge and important unresolved issues on biological factors underlying different ADHD trajectories. We conclude that a severe lack of knowledge on lifespan aspects in ADHD still exists for nearly every aspect reviewed. We encourage large-scale research efforts to overcome those knowledge gaps through appropriately granular longitudinal studies.
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“it is unclear whether the prevalence of adult ADHD changes with age.”
From The decreasing prevalence of ADHD across the adult lifespan confirmed (2022) · cites this paper as [5]
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“compared to childhood ADHD, adult ADHD has received far less research attention”
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“adult ADHD definitions strongly varying between studies”
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“few large population-based data sets spanning the full adult lifespan available [4-7]”
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The gut-microbiome in adult Attention-deficit/hyperactivity disorder - A Meta-analysis
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van Doornik, R., der Oord, S. V., Luijckx, J., Groenman, A. P., Leijten, P. H. O., Luman, M., Hoekstra, P. J., van den Hoofdakker, B. J., & Dekkers, T. J. (2024) · BMC Psychiatry · doi:10.1186/s12888-024-05649-8 · Cited by 8
“When left untreated, problems may exacerbate and put children at risk of adverse outcomes later on in life, such as school dropout, delinquency, substance use and depression [3, 4].”
BackgroundAndersen, A. C., Sund, A. M., Thomsen, P. H., Lydersen, S., Young, S., & Nøvik, T. S. (2024) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2024.2301774 · Cited by 4
“Psychiatric comorbidity including behavioural problems, substance use disorder, anxiety, and depression disorders is common and there is a high risk of adverse outcomes and a negative life trajectory into adulthood [5,6].”
BackgroundSexual development in ADHD and internet pornography consumption
Privara, M., & Bob, P. (2023) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2023.1240222 · Cited by 7
Is WISC-IV Working Memory Index associated with ADHD symptoms in 7–8-year-olds?
Marinopoulou, M., Hallerbäck, M. U., Bornehag, C., & Billstedt, E. (2023) · Applied Neuropsychology Child · doi:10.1080/21622965.2023.2176232 · Cited by 4
“These variables were chosen because they have been shown to influence hyperactivity, inattention and EF (Franke et al., 2018; Jurado & Rosselli, 2007).”
Tarchi, L., Damiani, S., La‐Torraca‐Vittori, P., Frick, A., Castellini, G., Politi, P., Fusar‐Poli, P., & Ricca, V. (2023) · Developmental Psychobiology · doi:10.1002/dev.22366 · Cited by 5
H is for hypersexual: Sexuality in youths with ADHD
Hale, E. W., Murphy, M. O., & Thompson, K. (2022) · Frontiers in Child and Adolescent Psychiatry · doi:10.3389/frcha.2022.1048732 · Cited by 4
“Though diagnosis focuses on an extended period of disruptive hyperactive-impulsive and/or inattentive symptoms attention, ADHD has also been associated with an increased risk for obesity, sleep problems, sexually transmitted infections, immune disorders, metabolic disorders, and other health risks [2].”
BackgroundFurukawa, E., Uchida, R., Tatsuki, M. O., Fitts, M., & Tripp, G. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.885496 · Cited by 4
“Four of the top 5 nouns for boys and girls occupied the same position [friend (1), brother (3), world (4), people (5)].”
BackgroundChange Blindness in Adolescents With Attention-Deficit/Hyperactivity Disorder: Use of Eye-Tracking
Hochhauser, M., Aran, A. A., & Grynszpan, O. (2022) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2022.770921 · Cited by 6
“Studies have shown that deficits in visual processing, vigilance, and inhibition continue into adolescence, at the same time, showing inconsistencies in response times impairments specifically in adolescence (7).”
BackgroundDoes Anxiety Symptomatology Affect Bullying Behavior in Children and Adolescents with ADHD?
Pityaratstian, N., & Prasartpornsirichoke, J. (2022) · Child & Youth Care Forum · doi:10.1007/s10566-022-09681-1 · Cited by 10
“3:1 in this study is consistent with the male preponderance rates in ADHD samples from other studies (Franke et al., 2018; Owens et al., 2015).”
ResultPolygenic profiles define aspects of clinical heterogeneity in ADHDPreprint
Schork, A., LaBianca, S., Brickell, I., Helenius, D., Loughnan, R., Mefford, J., Palmer, C., Walker, R. L., Gådin, J., Krebs, M., et al. (2021) · medRxiv · doi:10.1101/2021.07.13.21260299 · Cited by 4
Correll, C. U., Starling, B. R., & Huß, M. (2021) · CNS Spectrums · doi:10.1017/s1092852921000341 · Cited by 3
“Ameta-analysis of 18 trials found that, compared with placebo, treatment with methylphenidate resulted in a moderate improvement in ADHD symptoms in adults.21 Additionally, a large analysis of 133 studies (51 of which focused on adults) found that amphetamines, methylphenidate, bupropion, and atomoxetine improved ADHD…”
BackgroundResultInfluentialRostami, M., Khosrowabadi, R., Albrecht, B., Rothenberger, A., & Pouretemad, H. (2020) · Nordic Journal of Psychiatry · doi:10.1080/08039488.2020.1787512 · Cited by 4
The Positive Aspects of Attention-Deficit/Hyperactivity Disorder among Famous People
Lee, J. W., Seo, K., & Bahn, G. H. (2020) · Psychiatry Investigation · doi:10.30773/pi.2020.0036 · Cited by 5
Multi-Informant Ratings of Irritability and Disruptiveness in School-Aged Children with ADHD
Vuori, M. A., Autti‐Rämö, I., Junttila, N., & Tuulio‐Henriksson, A. (2020) · International Journal of Disability Development and Education · doi:10.1080/1034912x.2020.1755426 · Cited by 4
“Approximately 5% of children suffer from clinically significant symptoms (Franke et al., 2018; Sayal et al., 2018).”
BackgroundNeurobiological Convergence in SPDs and ADHD: Insights from a Narrative Review
Corbo, D., & Grandi, L. C. (2026) · Biology · doi:10.3390/biology15020198 · Cited by 3
“These results are of critical importance since they demonstrate that even ADHD has a different clinical profile across the lifespan; also, in terms of the comorbidity profile [74,75], these changes do not reflect brain-related modifications [25].”
Hormonal effects on externalizing problems in females across the lifespan
Martel, M. M., Eng, A. G., Nirjar, U., Petersen, M. K., Ramirez, M. P., Litteral, C. A., & Robinson, L. E. (2025) · Frontiers in Neuroendocrinology · doi:10.1016/j.yfrne.2025.101206 · Cited by 3
Tomlinson, E., Owen-Smith, A., Benavente, M., Cooper, C., Jones, H. E., Ward, M., Walker, J. G., Wang, H., Manzano, C. L., Hank, D., et al. (2025) · BMJ Open · doi:10.1136/bmjopen-2024-095479 · Cited by 3
van der Plas, N. E., Noordermeer, S. D. S., Oosterlaan, J., & Luman, M. (2025) · Journal of the American Academy of Child & Adolescent Psychiatry · doi:10.1016/j.jaac.2025.04.012 · Cited by 16
Guigou, Y., Hennequin, A., Marchand, T., Chebli, M., Pisella, L., Staccini, P., & Vannucci, V. D. (2025) · Frontiers in Psychiatry · doi:10.3389/fpsyt.2025.1466107 · Cited by 3
Federico, A., & Bradshaw, J. L. (2025) · Infant Behavior and Development · doi:10.1016/j.infbeh.2025.102039 · Cited by 3
The hippocampus–IPL connectivity links to ADHD traits through sensory processing sensitivity
Zhou, L., Xu, T., & Feng, T. (2025) · Cerebral Cortex · doi:10.1093/cercor/bhaf063 · Cited by 4
Genomics of Attention Deficit Hyperactivity Disorder
Haavik, J. (2025) · Psychiatric Clinics of North America · doi:10.1016/j.psc.2025.01.011 · Cited by 4
Self-citationGurgel, W. D. S., Garcia‐Argibay, M., D'Onofrio, B. M., Larsson, H., & Polanczyk, G. V. (2024) · Journal of Child Psychology and Psychiatry · doi:10.1111/jcpp.14093 · Cited by 5
Self-citationAbsent or Hidden? Hyperactivity in Females With ADHD
Wettstein, R., Navarro-Ovando, V., Pirgon, E., Kroesen, J., Wettstein, K., Kroesen, H., Mathôt, R. A. A., & Dumont, G. (2024) · Journal of Attention Disorders · doi:10.1177/10870547241273152 · Cited by 4
Ginting, R., Sagala, A. K., Nst, M. A., Simamora, M., Pulungan, R. A., Silalahi, R. U., Ginting, S. N. B., Pane, S., & Fatimah, Y. N. (2023) · DIKSI Jurnal Kajian Pendidikan dan Sosial · doi:10.53299/diksi.v4i2.361 · Cited by 3
Derin, S., Ersin, M., & Selman, S. (2023) · Psikiyatride Guncel Yaklasimlar · doi:10.18863/pgy.1241913 · Cited by 3
He, Q., Keding, T. J., Zhang, Q., Miao, J., Russell, J. D., Herringa, R. J., Lu, Q., Travers, B. G., & Li, J. J. (2023) · Journal of Neurodevelopmental Disorders · doi:10.1186/s11689-023-09498-6 · Cited by 4
“…also supports the possibility that the genetic liability for ADHD may be developmentally specific, such that the AnnoPred ADHD PGS was only associated with IA but not HI symptoms in adolescence, which is consistent with the relative stability of IA symp-tomology over time in individuals [27].”
ResultRoessner, V., Ehrlich, S., Backhausen, L. L., Rempel, S., & Uhlmann, A. (2022) · European Child and Adolescent Psychiatry · doi:10.1007/s00787-022-02043-1 · Cited by 3
“This is all the more regrettable since better knowledge about the heterogeneous courses of ADHD symptoms is critically needed to better inform patients, relatives, and clinicians regarding the individuals at risk for unfavourable outcomes in later life [2].”
BackgroundA Systematic Screening of ADHD-Susceptible Variants From 25 Chinese Parents–Offspring Trios
Li, Q., Meng, Y., Wang, J., Xie, Y., Li, T., & Sun, W. (2022) · Frontiers in Genetics · doi:10.3389/fgene.2022.878036 · Cited by 4
“It has been estimated that at least 15% of children diagnosed with ADHD (childhood ADHD) will continue to retain a full diagnosis by the age of 25, approximately 40% will show just partial remission and continue to experience impairing symptoms, and only 40% will get a complete remission (Franke et al., 2018).”
BackgroundAl-Ani, R. K., Al-Sumiadai, M. M., Abdulla, A. I., & Sarhat, A. R. (2021) · Al-Anbar Medical Journal · doi:10.33091/amj.2021.171061 · Cited by 3
“However, inattentive symptoms don’t seem to have a comparable developmental advantage and in general, it will stay constant into adulthood [19].”
Bilgiç, A., Uzun, N., Işık, Ü., Açıkel, S., Çoşkun, F., & Akça, Ö. (2021) · Children's health care · doi:10.1080/02739615.2021.1894938 · Cited by 3
“ADHD in adults is related to a variety of unfavorable factors such as the presence of comorbid psychiatric disorders, poor parenting styles, low education level and low family income (Efron et al., 2018; Franke et al., 2018), which may be responsible for poor offspring behavioral outcomes.”
BackgroundSchjøtt, J. D., Heitmann, K., Bakkebø, T., & Jahnsen, J. A. (2020) · Frontiers in Pharmacology · doi:10.3389/fphar.2020.607915 · Cited by 3
Kuang, Y., & Flouri, E. (2020) · British Journal of Educational Psychology · doi:10.1111/bjep.12395 · Cited by 6
Mosheva, M., Dar, N., Madi, L. R., Weizman, A., & Gothelf, D. (2020) · International Clinical Psychopharmacology · doi:10.1097/yic.0000000000000323 · Cited by 3
“Psychiatric comorbidities of ADHD in general, and comorbidity of disruptive disorder in particular, have a negative effect on outcomes including higher rates of functional impairments, higher persistence of ADHD into adulthood, increased risk for development of substance use disorders and depression (Franke et al., 20…”
BackgroundADHS im Kindes- und Jugendalter. Update 2020
Popow, C., & Ohmann, S. (2020) · Pädiatrie & Pädologie · doi:10.1007/s00608-020-00789-y · Cited by 7
“Klinik und Komorbiditäten Die klinische Vielfalt des ADHS wird neben den Kardinalsymptomen auch beeinflusst durch das Lebensalter ([14, 118, 156, 314, 342]; .”
BackgroundHess, J., Radonjić, N., Patak, J., Glatt, S., & Faraone, S. (2019) · bioRxiv · doi:10.1101/652792 · Cited by 3
Self-citationADHD genetic liability and physical health outcomes - A two-sample Mendelian randomization studyPreprint
Leppert, B., Riglin, L., Dardani, C., Thapar, A., Staley, J. R., Tilling, K., Smith, G., Thapar, A., & Stergiakouli, E. (2019) · bioRxiv · doi:10.1101/630467 · Cited by 3
ADHD-INTERNALIZING DISORDER CO-OCCURRENCE IN CHILDHOOD AND ADOLESCENCE
Goh, P. K. (2021) · UKnowledge (University of Kentucky) · doi:10.13023/etd.2021.260 · Cited by 2
Panvino, F., Zaccaria, V., Pica, M., Amitrano, N., Pisani, F., & Di Brina, C. (2025) · Children · doi:10.3390/children12060798 · Cited by 2
van der Plas, N. E., Noordermeer, S. D. S., Franke, B., Hartman, C. A., Hoekstra, P. J., Rommelse, N. N. J., Sprooten, E., Luman, M., & Oosterlaan, J. (2026) · Psychiatry Research · doi:10.1016/j.psychres.2026.117308 · Cited by 3
Self-citationCarbone, M. G., Tripodi, B., Matarese, I., Bellini, A., Rizzato, R., Tagliarini, C., Rocca, F. D., Dominicis, F. D., Maremmani, I., Perugi, G., et al. (2026) · Journal of Clinical Medicine · doi:10.3390/jcm15072688 · Cited by 2
“This is especially the case when ADHD symptoms persist into adulthood and are accompanied by impairments in executive control and reward processing [12,74,75].”
Metadata
- Authors
- Franke, B., Michelini, G., Asherson, P., Banaschewski, T., Bilbow, A., Buitelaar, J. K., Cormand, B., Faraone, S. V., Ginsberg, Y., Haavik, J., Kuntsi, J., Larsson, H., Lesch, K.-P., Ramos-Quiroga, J. A., Réthelyi, J. M., Ribases, M., & Reif, A.
- Affiliations
- Radboud University Nijmegen (NL)
- King's College London (GB)
- Heidelberg University (DE)
- Radboud University Medical Center (NL)
- Instituto de Salud Carlos III (ES)
- SUNY Upstate Medical University (US)
- Karolinska Institutet (SE)
- Haukeland University Hospital (NO)
- Sechenov University (RU)
- Semmelweis University (HU)
- University Hospital Frankfurt (DE)
- Corresponding author
- Franke, Barbara
- ORCID
- Venue
- European Neuropsychopharmacology
- Publisher
- Elsevier BV
- Published
- 2018-10
- Volume
- 28
- Issue
- 10
- Pages
- 1059-1088
- ISSN
- 0924-977X (ISSN-L)
- PMC
- PMC6379245
- OpenAlex
- W2891070637
- Cited by
- 643
- References
- 285
- Citations by year
- 2026: 73 · 2025: 88 · 2024: 92 · 2023: 91 · 2022: 86 · 2021: 90 · 2020: 81 · 2019: 37 · 2018: 2
- FWCI
- 7.98
- Type
- journal article
- Language
- en
- Open access
- hybrid
- doi.org
- Licence
- Locations
- European Neuropsychopharmacology (publishedVersion, cc-by)
- Europe PMC (PubMed Central) (publishedVersion, cc-by)
- PubMed Central (publishedVersion, cc-by)
- PubMed (publishedVersion)
- Radboud Repository (Radboud University) (submittedVersion)
- Research Publications (Maastricht University) (submittedVersion, cc-by)
- Dipòsit Digital de Documents de la UAB (Universitat Autònoma de Barcelona) (submittedVersion, cc-by)
- Dipòsit Digital de la Universitat de Barcelona (Universitat de Barcelona) (submittedVersion, cc-by-nc-nd)
- LA Referencia (Red Federada de Repositorios Institucionales de Publicaciones Científicas) (submittedVersion, cc-by)
- Research Portal (King's College London) (submittedVersion, cc-by-nc-nd)
- Online Publication Service of Würzburg University (Würzburg University) (submittedVersion, cc-by)
- Publication Server of Goethe University Frankfurt am Main (Goethe University Frankfurt) (submittedVersion, cc-by)
- Semmelweis University Repository (Semmelweis University) (submittedVersion)
- Radboud Repository (Radboud University) (submittedVersion, other-oa)
- Research Publications (Maastricht University) (submittedVersion, other-oa)
- Funders
- European Community's Seventh Framework Programme (n° 602805 (AGGRESSOTYPE), 603016 (MATRICS), 278948 (TACTICS), 602450 (IMAGEMEND))
- European Community's Horizon 2020 Programme (n° 643051 (MiND) and 667302 (CoCA))
- Netherlands Organization for Scientific Research (NWO), i.e. the Vici Innovation Program (016-130-669)
- Hungarian Brain Research Program (NAP-B KTIA_NAP_13-2014-0011)
- Topics
- Health Sciences › Medicine › Psychiatry and Mental health › Attention Deficit Hyperactivity Disorder
- Social Sciences › Psychology › Clinical Psychology › Child and Adolescent Psychosocial and Emotional Development
- Life Sciences › Neuroscience › Cognitive Neuroscience › Autism Spectrum Disorder Research
- Keywords
- attention deficit hyperactivity disorder, ADHD persistence, remission, comorbidities, substance use disorders, depression, anxiety, accidents, age of onset, cognitive trajectories, treatment effects, lifespan development, neurodevelopmental disorders, biological factors
- MeSH terms
- Aging, Attention Deficit Disorder with Hyperactivity, Humans, Comorbidity
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