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World J Psychiatry. Aug 19, 2025; 15(8): 107780
Published online Aug 19, 2025. doi: 10.5498/wjp.v15.i8.107780
Fluctuating course of attention-deficit/hyperactivity disorder across development: Multifactorial influences
Xi-Wen Zeng, Lan-Fang Hu, Xiao-Lan Cao, Bin-Rang Yang, Zhao-Min Wu
Xi-Wen Zeng, Lan-Fang Hu, Zhao-Min Wu, Children's Healthcare and Mental Health Center, Affiliated Shenzhen Children's Hospital of Shantou University Medical College, Shenzhen 518026, Guangdong Province, China
Xi-Wen Zeng, Lan-Fang Hu, Xiao-Lan Cao, Bin-Rang Yang, Zhao-Min Wu, Children's Healthcare and Mental Health Center, Shenzhen Children's Hospital, Shenzhen 518026, Guangdong Province, China
Author contributions: Zeng XW designed the review, wrote the initial draft, and participated in manuscript revision; Hu LF was responsible for literature collection; Cao XL and Yang BR contributed to the manuscript revision; Wu ZM co-designed the review, participated in drafting the initial manuscript, provided critical revisions, and approved the final version; all authors have approved the final version.
Supported by the Shenzhen Science and Technology Program, No. RCYX20221008092849069; and The Guangdong High-Level Hospital Construction Fund.
Conflict-of-interest statement: All authors declare no conflict of interest in publishing the manuscript.
Open Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: https://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Zhao-Min Wu, MD, PhD, Associate Chief Physician, Children's Healthcare and Mental Health Center, Affiliated Shenzhen Children's Hospital of Shantou University Medical College, No. 7019 Yitian Road, Futian District, Shenzhen 518026, Guangdong Province, China. zhaomin.wu@foxmail.com
Received: April 1, 2025
Revised: April 22, 2025
Accepted: June 17, 2025
Published online: August 19, 2025
Processing time: 132 Days and 13.5 Hours
Abstract

Attention-deficit/hyperactivity disorder (ADHD) is increasingly conceptualized as a dynamic neurodevelopmental condition, marked by fluctuating symptom trajectories across development rather than the traditional static patterns of persistence or remission. This review synthesizes empirical evidence on the varied trajectories of ADHD symptoms-including late-onset, partial remission, and recurrent fluctuation patterns-and underscores their clinical significance in long-term functioning. We adopt a multifactorial framework to explore how genetic, environmental, and gene–environment interactions contribute to the emergence and evolution of ADHD symptoms over time. In addition, we consider how medication-related variables-particularly tolerance and adherence-may influence symptom fluctuation. Characterizing these developmental dynamics offers critical guidance for designing flexible, personalized interventions that align with individual trajectories and transitional vulnerabilities.

Keywords: Attention-deficit/hyperactivity disorder; Symptom fluctuation; Developmental trajectories; Longitudinal studies; Gene-environment interaction

Core Tip: This review shifts the focus from static views of attention-deficit/hyperactivity disorder (ADHD) persistence to the developmental fluctuation of symptoms over time. Instead of focusing on prevalence or average trajectories, it emphasizes individual-level variability and synthesizes longitudinal evidence on late onset, partial remission, and recurrent fluctuation patterns. Through a multifactorial perspective, the review discusses the independent and interactive roles of genetic and environmental factors in shaping these trajectories. This lens offers a refined understanding of ADHD heterogeneity and informs developmentally tailored clinical approaches.