Just look to four common, but significant, early childhood diagnoses: Asthma, allergies, autism, and attention-deficit hyperactivity disorder. How are parents to know what to expect long-term for these wide-ranging diagnoses? How are they to plan the future? A closer look at the science can help parents make sense of such moments.
Can You Grow Out of Asthma?
One in twelve U.S. kids suffers from asthma, making it the most common chronic condition among children and teens. This incurable respiratory disease usually starts young, even during infancy, and can range from fairly mild to very scary, even becoming life-threatening if not managed properly. Although kids don’t outgrow asthma per se, it often becomes less severe as they move into middle and high school. With asthma, the airways of the lungs easily become swollen, giving air less space to move in and out. Triggers such as dust mites, smoke, pollen, and pet dander—or even just breathing in cold air or exercising—can cause asthma flare-ups or full-blown attacks, where the airways close up even more, the muscles outside of them constrict, and breathing becomes extremely difficult. Kids may also cough, wheeze, or feel tightness in their chest, often requiring a rescue inhaler or, for severe cases, a trip to the hospital to get their breathing under control. Most asthma comes from an allergen trigger, the most common culprits are dust mites and cockroaches, especially for city kids, says Benjamin Gaston, M.D., a pediatric pulmonologist at Indiana University School of Medicine. But most childhood asthma cases aren’t tied to allergies at all—they’re brought on by viral infections. “Even in two- and three-year-olds, when they have asthma and it’s exacerbated, it tends to be because of a virus,” Gaston says. “In fact, during COVID-19, there have been a lot fewer asthma exacerbations because kids are staying at home, indoors, and away from school, limiting their exposure to viruses.” Unfortunately, virus-triggered asthma doesn’t always go away once the infection is treated. “There may be some permanent changes to the lungs, called remodeling, after the virus, and it’s possible to get chronic obstruction,” Gaston says. As kids approach adolescence, many see their asthma symptoms resolve or even go away completely. This is most likely due to the development of testosterone and estrogen during puberty, explains Gaston, as research suggests sex hormones act on immune cells to lessen inflammation. Still, some teens continue to struggle, and it’s not always apparent why, though Gaston says asthma is more likely to persist in those who were diagnosed as infants or toddlers, since they started life with less breathing capacity. But for those teenagers who do get a break, asthma frequently comes back later in life. “I see it all the time: a drop in the late teens and early adult years and then a resurgence later on in adulthood,” Gaston says. However, for many adults—especially men—their symptoms are less severe than when they were kids. Interestingly, childhood asthma is more common among boys than girls, possibly because girls’ airways tend to be bigger, says Gaston. But then in adulthood, it flips, with women becoming twice as likely as men to struggle with asthma. Because the severity of this disease commonly cycles, Gaston cautions parents against thinking their kid’s asthma is “cured” if ever it seems to have cleared up. It’s more accurate to say their “symptoms are no longer present,” he says, meaning moms and dads should keep a close eye out for a resurgence.
Can You Grow Out of Allergies?
Allergies are fickle and hard to predict, sometimes popping up in childhood, sometimes not emerging until adulthood. Some allergies go away naturally over time; others pester people for life. This is the case for all types, including indoor, industrial, insect, seasonal, skin, food, and medication allergies. So, for parents wondering whether their kid will always be allergic to birch pollen, peanuts, or penicillin, the simple (and frustrating) answer is that it’s TBD — and impossible to know for sure. “There are certainly allergies that kids can outgrow, but it’s not always clear who outgrows them and who doesn’t,” Gaston says. “There are also things we can do for kids, such as food allergy desensitization, seasonal allergy shots, or medications, that can help make their response to an allergen less.” All allergies involve the immune system recognizing a foreign compound, deeming it hazardous (even though it’s usually not), and mounting an attack to protect the body. This prompts the production of antibodies called immunoglobin E, triggering the release chemicals that cause classic allergy symptoms like runny nose, watery eyes, scratchy throat, swelling, or hives. Severe allergic reactions can result in anaphylaxis, which can be deadly. Although it’s never certain whether kids’ allergies will persist, there are some clear trends — at least with food allergies. Research shows about 80 percent of kids who are allergic to eggs, milk, wheat, and soy outgrow them by age 16, oftentimes much sooner. Allergies to tree nuts, fish, and shellfish, on the other hand, typically last for life. Peanut allergies are an interesting case. Currently, 20 percent to 25 percent of children outgrow them eventually, 80 percent of them by age 8. But in recent years, oral immunotherapy—which involves a medical professional feeding kids increasing amounts of peanut protein in attempt to desensitize them—has yielded good results and become more widely available. The longevity of environmental and indoor allergies is much harder to forecast. But even if a child outgrows a dust mite allergy, for example, they might develop a ragweed or cat dander allergy down the road. “It’s not clear why people develop new allergies as adults, but we do know allergies become more common with age,” Gaston says. “The standard explanation is because we are chronically exposed to allergens, and our reaction to them can increase over time.”
Can You Grow Out of Autism?
Although autism always begins in childhood, the associated behaviors and patterns are not always apparent. Especially if the signs are subtle, parents might assume they are just part of the child’s neurotypical development. Complicating matters, autism is actually a cluster of developmental conditions that impact communication and behavior, so one child on the spectrum may present very differently than the next. “When autism is actually diagnosed is highly dependent on how obviously it presents and what behaviors are exhibited,” says Adam McCrimmon, Ph.D., an autism researcher and psychology professor at the University of Calgary. “The average age of diagnosis is four to four-and-a-half, but some kids are diagnosed at one-and-a-half. People who present less obviously until later in life may go through their whole life never receiving a diagnosis.” So can a child ever grow out of autism? “No, it never goes away,” McCrimmon says. “Autism is not like anxiety or depression where you feel anxious one minute and not the next. It is a genetic neurological disorder that they’ll continue to experience throughout their lives.” However, he notes that some children are initially misdiagnosed with autism and then later have the diagnosis reversed by a different clinician. Unlike other mental and behavioral health diagnosis, when diagnosing autism, McCrimmon says both current and historical behaviors and symptoms carry equal weight. To receive a depression diagnosis, for instance, someone must be experiencing depressive symptoms right now. If the symptoms go away, the diagnosis does too. But with autism, if a child ever displays the pattern of behavior consistent with autism, the diagnosis holds for life, even if those behaviors change over time. “Every child grows and develops, and we hope early intervention helps reduce or eliminate behaviors and their impact,” McCrimmon says. “But the underlying neurological and genetic ‘things’ that led to the diagnosis in the first place are still there. So, the diagnosis stays, even though many individuals may not present with the required amount and type of behaviors throughout their life.” This is why early intervention is key. “The vast majority of research shows the earlier the intervention and the more intense it is, such as more hours per week, the greater impact it will have on the child’s developmental trajectory,” McCrimmon says.
Can You Grow Out of ADHD?
ADHD affects 9.4 percent of kids in the U.S. and three times as many boys as girls are diagnosed with the condition. The gender imbalance is partly because the type of ADHD most boys are diagnosed with — predominantly hyperactive-impulsive presentation — becomes apparent at a younger age, with signs that are pretty obvious: fidgeting, interrupting, bouncing off the walls, blurting out whatever’s on their brain. Girls, on the other hand, are more likely to have ADHD with predominantly inattentive presentation, marked by spaciness, forgetfulness, and disorganization. These signs typically take longer for parents and teachers to recognize. “Most boys are active, so a hyperactive boy sticks out like sore thumb,” says Scott Benson, M.D., a pediatric psychiatrist in Pensacola, Florida. “They are more likely to hit someone, which gets them sent to the principal’s office, whereas as a child who is daydreaming and not doing their work won’t necessarily get in trouble. That’s why I tend to see boys in kindergarten and first grade and girls in third and fourth grade.” Although ADHD is a genetic neurological condition that never goes away, with the right interventions and ongoing management, kids can absolutely thrive. These may include behavioral interventions such as talk therapy and coaching on organizational skills, as well as medications like Ritalin. Although ADHD medication is sometimes stigmatized, Benson says that if it helps a child reach their full potential, it’s often the best strategy. “I look at medication as helping to protect a kid’s self-image,” he says. “I want every child to get invited to birthday parties, to have a report card that reflects how smart they are, and to experience all the things make kids feel good about themselves. If medication can help them achieve that, I say let’s do it.” But as kids turn into teens, Benson says they often begin resisting meds and other interventions, even if they’ve worked well. “As they get older, they don’t want to be told what to do, and they’d rather do things themselves,” he explains. “So, it is fairly typical for kids in middle school and early adolescence to refuse to take their medication or participate in treatment.” This is not unique to ADHD, by the way. He says tweens and young teens with seizure disorders, diabetes, and other conditions do the same thing. “Then when they get to be 16 and 17, they, like most teens, start looking at their future,” Benson says. “When they realize their grades are not up to snuff, they often raise their hand, admit they’re having trouble, and want to get back into treatment.” As kids grow older and learn certain skills, they may do just fine taking their meds less often or even not at all. “There is no requirement to take medicine — these are not curative treatments,” Benson says. “They are more like eyeglasses, in that if you take them off, you’re just as smart as when wearing them. So I wouldn’t say kids outgrow ADHD, but they can get into situations where careful attention to detail is not needed.” But, Benson notes, parents should keep in mind that ADHD is a lifelong condition — which they may know full well because they deal with it themselves. “When evaluating children and explaining that ADHD generally runs in families, it’s very common for one or both parents to point to the other or themselves,” he says. “More and more adults who had attention problems as a child, when they see their kid struggling like they did, are eager to get them help. But then as we’re discussing symptoms, they realize they still have these issues and they’re causing them problems at work.”
