ADHD and Remission
ADHD and Remission: Do Some Children Truly “Grow Out of It”?
For decades, ADHD was thought of as something children simply outgrew. Then research shifted, revealing that many individuals continue to experience symptoms into adulthood. Now, the field has entered a more nuanced phase: instead of asking whether ADHD persists, researchers are asking why some children remit while others do not.
Understanding remission is not just academically interesting. It could reshape treatment, improve prediction, and deepen our understanding of brain development itself.
What Does “Remission” Actually Mean?
Most studies define remission as no longer meeting full DSM diagnostic criteria for ADHD in adulthood. That’s a practical, clinical definition—but it has limits.
Under categorical criteria, a person could still have several symptoms that cause impairment yet be labeled “remitted.” Newer terminology includes “partial remission,” acknowledging lingering symptoms that fall below diagnostic thresholds.
There is also growing support for a dimensional view of ADHD. Rather than thinking in yes/no terms, symptoms like inattention and impulsivity exist along a continuum. From this perspective, remission may not mean disappearance—but movement toward the typical range.
That distinction matters. Because improvement in symptom dimensions may tell us more about the brain than a simple diagnostic switch.
How Common Is Remission?
Longitudinal studies suggest that ADHD follows an age-related decline for many individuals.
By early adulthood, roughly 55–70% no longer meet full diagnostic criteria.
By later adulthood, rates approach ~80% syndromic remission.
However, a substantial proportion of “remitters” continue to experience impairing symptoms that fall below diagnostic thresholds.
In other words, ADHD often softens—but does not always vanish.
Importantly, baseline symptom severity and comorbidities explain only about 15–20% of outcome variance. That means we still cannot reliably predict which child will remit and which will persist based on routine clinical data.
This is why researchers have increasingly turned toward the brain.
Three Models of Remission
Neuroimaging research, though still developing, has proposed several broad models to explain why remission occurs.
1. Normalization
In this model, brain development gradually converges toward typical patterns. Studies show that adults whose childhood ADHD has remitted often resemble never-affected individuals in:
Prefrontal cortical activation during cognitive tasks
Default Mode Network (DMN) connectivity
Response preparation and vigilance electrophysiology
Some fronto-parietal and posterior cingulate development
This suggests that, for some, brain maturation may “catch up.”
Interestingly, large cross-sectional analyses show that structural differences (like reduced subcortical volume) are more prominent in younger children and diminish in adolescence and adulthood. That pattern is at least compatible with early convergence toward typical development.
2. Compensation
This model proposes that the brain reorganizes—developing alternative neural pathways to manage symptoms.
Evidence for compensation is less robust so far. Some studies find no strong markers of active neural reorganization driving remission. However, subtle adaptive mechanisms may still exist and remain difficult to detect.
It’s possible that behavioral compensation—strategies learned over time—plays a larger role than dramatic structural brain rewiring.
3. Fixed Anomalies
Some neural differences appear to persist regardless of outcome. For example:
Posterior brain structure differences
Thalamo-striatal function differences
These may represent early “fixed” features associated with childhood ADHD onset that do not necessarily determine adult symptom persistence.
This model suggests that some neurobiological differences remain, even if clinical symptoms improve.
Why Symptom Type Matters
ADHD is not uniform. Inattention, hyperactivity, and impulsivity follow different developmental trajectories.
Hyperactivity-impulsivity tends to decline more sharply into adulthood.
Inattention often persists longer.
Neuroimaging findings reflect this divergence:
Anomalous inhibitory control networks are more strongly tied to persistent hyperactive-impulsive symptoms.
DMN anomalies are more often linked to persistent inattentive symptoms.
Remission may therefore depend on which symptom domain is most prominent and how its underlying networks develop over time.
Remission and Comorbidity
Insights into remission may extend beyond ADHD.
If inattentive neural systems normalize, improvement might also occur in conditions where inattention plays a role. Conversely, persistent impulsivity-related neural anomalies could increase risk for later substance misuse.
Understanding these pathways could inform not only ADHD prognosis but broader developmental psychopathology.
Why This Research Matters
There are three major implications:
1. Treatment Innovation
Current treatments—especially stimulant medications—have clear short- and medium-term efficacy. But long-term impact remains less certain. If we understand mechanisms of remission, we may design interventions that accelerate or promote these developmental processes.
2. Biomarkers for Prediction
We currently cannot accurately predict long-term outcomes using clinical and demographic data alone. Brain-based biomarkers could help identify children likely to remit or persist—allowing earlier, tailored interventions.
3. Broader Developmental Insight
Remission research may illuminate recovery processes in other neurodevelopmental conditions such as Tourette’s or oppositional defiant disorder.
A Field in Its Early Days
Despite exciting advances, the science is still young. Many studies are small, use different imaging paradigms, and lack longitudinal brain data beginning in childhood. Adult-only imaging cannot determine whether remitters converged toward typical development—or were always closer to it.
Future progress depends on:
Longitudinal neuroimaging from childhood through adulthood
Symptom-domain specific reporting
Large multi-site collaborations
Imaging embedded within randomized controlled trials
The mechanisms of remission are unlikely to be singular. Just as ADHD has multiple developmental pathways, remission may also reflect multiple “undoings” of individual neurocognitive vulnerabilities.
The Bottom Line: Remission Is Not Magic—It Is Development
ADHD remission is not a sudden disappearance. It is often a gradual reshaping of symptom expression across development.
For some, brain maturation converges toward typical patterns.
For others, strategies and environment scaffold improvement.
For many, symptoms soften but never fully vanish.
The real shift in thinking is this: remission is not simply “growing out of it.” It is a dynamic interplay between brain development, cognitive systems, environment, and time.
And understanding that interplay may eventually help us move from waiting for remission… to fostering it.