Many people mistakenly think of attention-deficit/hyperactivity disorder (ADHD) as a childhood disorder. But kids don’t necessarily “outgrow” ADHD. And the common misconception that they do can make it difficult for adults with ADHD to get diagnosed if they aren’t already getting support for their neurodivergence.

“Research has proven that [ADHD] symptoms can persist through an individual’s life,” says Sussan Nwogwugwu, PMHNP, regional nurse practitioner lead for Done, an online platform providing treatment and support options for adults with ADHD.

So why the myth that it ends in adolescence? Because the symptoms, and how they show up in different life circumstances, can change. For instance, the telltale fidgetiness and hyperactivity that we associate with kids diagnosed with ADHD tend to decrease as people get older, says Nwogwugwu. “Symptoms in adulthood can be more subtle and varied, and often include disorganization, impulsive decision-making, internal restlessness, wandering attention, and procrastination,” she says.

Why does it sometimes feel like ADHD gets worse with age?

For many people who live with adult ADHD, it can sometimes feel like symptoms grow worse as they get into their 20s. Some of this may be perception, but there can also be lifestyle factors that can exacerbate the challenges of ADHD.

“The increased professional and academic demands that come with age make ADHD symptoms more apparent in some people,” explains Nwogwugwu. “Significant factors that play a role in exacerbating ADHD include entering into new stages of development, such as adolescence or adulthood; increased stress levels; and competing demands on time, such as work and family responsibilities.”

In addition to environment—and genetics—Nwogwugwu says that there are also some lifestyle choices that may make ADHD symptoms worse. Think: lack of exercise, eating out often or eating too much highly-processed food, skipping breakfast, having a messy home or office, getting too much screen time, or not logging enough sleep.

Yet even if you live as optimally as possible, Nwogwugwu says that adults with ADHD may experience fluctuations in their symptoms over time, particularly worsening during the menopausal transition. In fact, a new survey of 2,700 patients found that a majority of women and men with ADHD experienced their most severe symptoms during menopause and andropause, respectively.

“Hormonal fluctuations during menopause play a key role and are the number-one reason people experience severe ADHD symptoms. These fluctuations impact brain chemicals to trigger mood disorders such as anxiety and depression that can co-occur along with ADHD and worsen the situation,” explains Nwogwugwu. “It’s not uncommon for people to experience difficulty focusing, irritability, and low mood during menopause alongside depression and anxiety.”

Aside from this life period, overall ADHD does not typically worsen with age, Nwogwugwu says. And in fact, with the right supports, awareness, and management strategies, adults with ADHD can learn how to better handle the challenges of ADHD so that it is less impactful than it may have been in younger years.

“Generally, symptoms are different in adulthood, but do not grow worse with age,” she notes. “Adults also have more resources and coping skills to manage their symptoms as they age.”

How ADHD differs in women

Nwogwugwu says that currently, significantly more biological males are diagnosed with ADHD compared to biological females. However, this disparity is not necessarily because men are more likely to have ADHD. It’s just that symptoms of ADHD often appear differently in women than the “classic ADHD” symptoms of men.

“Male ADHD is more likely to be presented externally, whereas female ADHD symptoms are often internalized and therefore not as noticeable,” explains Nwogwugwu. “Contemporary assessment still focuses on external behaviors, since ADHD was first defined based on the behavior of hyperactive boys.” That means many women go undiagnosed—both in childhood and adulthood.

Tips for managing adult ADHD

If you feel like your ADHD is harder to manage than it was when you were a kid, don’t give up. There are a variety of ways you can take charge of your symptoms.

“Evidence-based medication and psychotherapy may help manage ADHD but there are also effective behavioral strategies that can foster management of symptoms in the moment,“ says Nwogwugwu. She says the five optimal strategies to control ADHD include:

• Getting organized
• Following a routine
• Making big tasks more manageable
• Minimizing distraction
• Respecting your limits

If you are having difficulty managing adult ADHD symptoms or have concerns that you may have undiagnosed adult ADHD, speak with your healthcare provider. They should be able to get you the support you need, and help you find the best ways to manage your individual symptoms, however they show up for you.