Milder cases of ADD and non hyperactive ADD may go unnoticed until middle school years when they are faced with increased workload and less structure and supervision compared with elementary school. By middle school, basic academic skills are assumed to be in place and, typically, little remediation is offered. ADD children may have developmental lags in several areas.

These may have had minimal impact until middle school years. Reading, writing and math skills are often a year or so behind peers. Previously diagnosed ADD children may development resistance to ongoing medication, tutoring or help at school. Acceptance and management of ADD is a challenge for many adolescents.