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Data were obtained from the NeuroIMAGE cohort which includes 485 individuals with ADHD, their 665 siblings, and 399 typically developing children. Trajectories were based on scores of the Conners Parent Rating Scale Revised and estimated over seven homogeneous age bins (from 5 to 28\u00a0years) using parallel process latent class growth analysis on data collected across 2\u20134 time points. Multilevel multinomial logistic regression was used to identify characteristics that differentiated between the derived classes. A seven-class solution revealed \u201csevere combined stable\u201d (4.8%), \u201csevere combined decreasing\u201d (13%), \u201csevere inattentive stable\u201d (4.8%), \u201cmoderate combined increasing\u201d (7.5%), \u201cmoderate combined decreasing\u201d (12.7%), \u201cstable mild\u201d (12.9%), and \u201cstable low\u201d (44.3%) classes. Polygenic risk for depression, ADHD diagnosis, ADHD medication use, IQ, comorbid symptom levels (foremost oppositional behaviour), and functional impairment levels differentiated classes with similar ADHD symptom levels in childhood but a diverging course thereafter. The course of ADHD is highly heterogeneous, with stable, decreasing, and increasing trajectories. Overall, severe symptom levels in childhood are associated with elevated-to-severe symptom levels in adolescence and young adulthood, despite substantial symptom reductions. 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JO has been on the advisory board of Shire and UCB and received unrestricted investigator initiated research Grants from Shire. SVF received income, travel expenses, and\/or research support from and\/or has been on an advisory board for Akili Interactive Labs, Alcobra, CogCubed, Impax, Ironshore, NeuroLifeSciences, Neurovance, Pfizer, Shire, and VAYA Pharma and has received research support from the K.G. Jebsen Centre for Research on Neuropsychiatric Disorders, University of Bergen, Bergen, Norway. With his institution, he has US patent US20130217707 A1 for the use of sodium-hydrogen exchange inhibitors in the treatment of attention-deficit\/hyperactivity disorder. In previous years, he received consulting fees or was on advisory boards or participated in continuing medical education programmes sponsored by Alcobra, Eli Lilly, Janssen, McNeil, Novartis, Otsuka, Pfizer, and Shire. SVF receives royalties from books published by Guilford Press (Straight Talk about Your Child\u2019s Mental Health), Oxford University Press (Schizophrenia: The Facts), and Elsevier (ADHD: Non-Pharmacologic Treatments). JKB has been a consultant to\/member of advisory board of\/and\/or speaker for Janssen Cilag BV, Eli Lilly, Lundbeck, Shire, Roche, Medice, Novartis, and Servier. He has received research support from Roche and Vifor. He is not an employee of any of these companies, and not a stock shareholder of any of these companies. He has no other financial or material support, including expert testimony, patents, and royalties. All other authors report no biomedical financial interests or potential conflict of interest.","order":2,"name":"Ethics","group":{"name":"EthicsHeading","label":"Conflict of interest"}},{"value":"All study waves were approved by the responsible ethics committees and have therefore been performed in accordance with the ethical standards laid down in the 1964 Declaration of Helsinki and its later amendments. Additionally, all participants signed an informed consent.","order":3,"name":"Ethics","group":{"name":"EthicsHeading","label":"Ethical standards"}}]}}