Navigating ADHD: A Lifelong Journey from Childhood to Adulthood

Attention-Deficit/Hyperactivity Disorder (ADHD) is a neurodevelopmental condition with a course that often extends beyond childhood. Prevalence estimates suggest that 2–16% of children meet criteria for ADHD (Boshomane, Pillay, & Meyer, 2020; Botha & Schoeman, 2023). In adulthood, rates decline to 2.5–4.2% (Schoeman & Leibenberg, 2017), yet research shows that 60–70% of children diagnosed with ADHD continue to experience symptoms into adulthood (Belanger et al., 2018). This continuity highlights the importance of recognising ADHD as a lifespan condition. For practitioners, an accurate and nuanced understanding of how ADHD evolves is critical for supporting children, adolescents, and adults alike.

Challenges in Diagnosis

Prevalence estimates vary widely due to differences in methodology, assessment tools, and practitioner expertise. Overdiagnosis in children, underdiagnosis in adults, and limited training in ADHD assessment contribute to these discrepancies (Schellack & Meyer, 2016). Given the impact of an ADHD diagnosis on an individual and their family, assessment should not be made hastily. A holistic approach, integrating developmental history, collateral information, and careful differential diagnosis, is essential before assigning the ADHD label.

ADHD Across Development: Children and Adults

ADHD is not static; its presentation changes with age. Symptoms that are visible and behavioural in children may become more internalised and functional in adults. The DSM-5-TR accommodates these shifts by adjusting diagnostic thresholds and providing developmentally relevant examples.

Increasing Demands, Decreasing Supports

Children often benefit from external structure, parental oversight, and consistent school routines. Transitioning into adulthood, however, brings greater demands—academic, occupational, financial, and relational—alongside a decrease in support. For individuals with ADHD, this can create a “perfect storm” where difficulties become more pronounced.

Opportunities in Adulthood

Despite these challenges, adulthood offers new possibilities for adaptive functioning. Adults can select environments that align with their strengths—roles that value creativity, movement, or rapid problem-solving. They may also develop personalised strategies, such as flexible scheduling, seeking supportive relationships, or outsourcing tasks that are consistently challenging (e.g., administrative tasks).

Areas of Vulnerability

Across the lifespan, ADHD is associated with a higher risk of impairment compared to the general population. In adulthood, consequences often become more significant and wide-ranging:

• Social: Interpersonal conflict, higher rates of separation and divorce.
• Emotional: Stress reactivity, emotional dysregulation, co-occurring depression, anxiety, and substance use disorders.
• Behavioural: Risk-taking, earlier initiation of substance use, higher relapse rates.
• Legal: Increased traffic offences, arrests, and recidivism.
• Academic/Occupational: Lower academic attainment, higher dropout rates, inconsistent employment, and negative performance reviews.
• Financial/Health: Lower lifetime earnings, impulse spending, increased rates of obesity, sleep disturbance, chronic illness, and a reduced life expectancy (by an estimated 9–10 years).

Best Practice in Diagnosis

A robust ADHD assessment should include:

1. Comprehensive History: Clinical interview, developmental history, and input from multiple informants.
2. Differential Diagnosis: Ruling out conditions that can mimic ADHD, including sleep deficits, vision problems, nutritional issues, epilepsy, trauma, anxiety, depression, or learning disorders.
3. Application of DSM-5-TR Criteria: Symptoms must be persistent, developmentally inappropriate, present in multiple settings, and impairing.
4. Consideration of Trauma: Adverse childhood experiences and traumatic stress can exacerbate or resemble ADHD symptoms. Careful screening is essential.

Managing ADHD: A Multimodal Approach

Treatment planning should be holistic and individualised, often combining:

• Medication: Stimulants and non-stimulants remain first-line pharmacological options. Regular monitoring for side effects and interactions is essential.
• Psychological Interventions: Cognitive behavioural therapy, psychoeducation, and skills training to address emotional regulation, planning, and interpersonal functioning.
• Environmental Supports: Classroom accommodations for children, workplace adaptations for adults, and structured routines across the lifespan.
• Lifestyle Factors: Adequate sleep, balanced nutrition, hydration, and physical activity significantly influence symptom management.
• Support Systems: Parents, teachers, therapists, mentors, and support groups can all play a vital role in scaffolding functioning.

Reframing ADHD

While ADHD presents challenges, it is equally important to acknowledge its strengths. Creativity, innovation, high energy, and unique problem-solving skills are common among individuals with ADHD. By moving beyond a deficit-focused perspective, practitioners can help clients harness these strengths while managing difficulties, thereby fostering resilience and self-efficacy.

ADHD does not simply “end” with childhood. It is a lifelong condition that evolves across developmental stages. For registered counsellors, psychometrists, and other health practitioners, recognising these changes is vital for effective screening, supportive intervention, and timely referral for diagnosis and treatment by psychologists or psychiatrists. By combining early identification, holistic support, and a strengths-based approach, practitioners can play a critical role in empowering individuals with ADHD to move beyond survival and toward thriving.