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Age-related Decline of ADHD Symptoms Disrupted by Middle School

Science Update

Although symptoms of attention deficit/hyperactivity (ADHD) can last into adulthood, typically they decline as a child gets older. But a new study indicates that the stressful transition from elementary school to middle school complicates this pattern and may even disrupt it. The study, which analyzed data from the NIMH-funded Multimodal Treatment Study of ADHD (MTA), was published July 2008, in the Journal of Clinical Child and Adolescent Psychology.

Research has shown that ADHD symptoms, especially hyperactivity and impulsivity, tend to decline during a child’s adolescent years, although these symptoms do not necessarily disappear. Also, studies have indicated that simplifying and structuring a child’s environment and routine can impact ADHD symptoms. But when children enter middle school, their environment and routine change dramatically —they have multiple classes with multiple teachers; more homework, planning and organizational demands; and become more responsible for their own success.

Joshua M. Langberg, Ph.D., and Jeffery Epstein, Ph.D., of the University of Cincinnati and Cincinnati Children’s Hospital Center, and colleagues analyzed data from 258 children in the MTA study who completed elementary school and went on to middle school while enrolled in the study. Using reports from the children’s parents and teachers, the researchers found that while ADHD symptoms lessened as the children aged, the transition to middle school interrupted this trend. Parents reported greater disruption in symptoms than teachers, likely because the impact of the transition may have been more evident at home, according to the researchers.

The researchers also found that children taking medication for their ADHD symptoms fared no better than those not taking medication during the transition. Langberg and colleagues suggest that while medication is highly effective in treating ADHD symptoms, it is unlikely to help a child develop the specific skills needed to succeed in middle school, such as time management, organization, planning, and study skills.

For comparison, Langberg and colleagues tracked the experience of a control group of children without ADHD, who transitioned into the same schools at the same time as the children enrolled in the MTA study. They found that the children without ADHD were less likely to experience the same level of distress or difficulty as the children with ADHD, as they entered middle school, according to parent and teacher ratings.

The study provides the first research data to support the assertion that the environmental changes associated with the transition to middle school can worsen a child’s ADHD symptoms or disrupt the typical pattern of decline.


Langberg JM, Epstein JN, Altaye M, Molina BSG, Arnold LE, Vitiello B. The transition to middle school is associated with changes in the developmental trajectory of ADHD symptomatology in young adolescents with ADHD. Journal of Clinical Child and Adolescent Psychology. 2008; 37(3): 651-663.