Did you know that about 3.3 percent of adults between 44 and 85 years have attention-deficit/hyperactivity disorder (ADHD)? What this means is that about 70 million adults may not be aware that they have ADHD until the challenges and demands of life become overwhelming and unbearable. Adults who may be facing the challenges of caring for their aged parents or managing life after a bitter divorce could find their coping mechanisms to be lagging in such situations. Unfortunately, most adults who find themselves in this kind of situation hardly consider the possibility that ADHD might be the cause of their predicament.
As humans begin to age, several aspects of our lives, such as our normal cognitive function, auditory attention, crystallized intelligence (acquired knowledge), and implicit memory, will remain stable. We still have the ability to handle things that are automatic such as riding a bike, tying our shoes, etc. We can also recall people’s faces even though we may sometimes forget their names.
Although we may sometimes forget our passwords, we can still repeat a string of numbers that someone told us. But as we age, there are certain types of attention and memory slow-down that we’re expected to experience, such as:
- Selective attention (our ability to shut out distractions)
- Processing speed
- Inhibition of responses (blurting)
- Executive function (this includes planning, organizing as well as executing)
- Episodic memory (this includes our autobiographical events)
- Working memory (our ability to retain things in our memory as we engage in something else)
- Visual construction skills (this includes things like putting together a dresser)
- Driving skills (increase in the likelihood of having accidents)
- Conceptual thinking
- Divided attention (ability to multitask)
Interestingly, ADHD and normal aging overlap with all these symptoms except that of “episodic memory.” This implies that it’s quite difficult to differentiate the symptoms of aging and ADHD because of all these commonalities.
What ADHD Looks Like in Teenagers
When the disorder hasn’t been diagnosed and managed in teens, they tend to perform poorly in school for years. This manifests in poor grades as teens with ADHD find it hard to catch up even when they did well while in elementary school. Also, teens with untreated ADHD have challenges with keeping relationships.
Consequently, they are likely to experience issues getting along with their parents, and when it comes to friends, they may have just a few of them and may struggle with dating, too. When teens with ADHD are not treated, the chances of indulging in dangerous behaviors such as smoking, drinking, doing drugs, and indulging in risky sexual choices may also increase.
For girls with untreated ADHD, the challenges they face often include eating disorders, which are believed to be linked with low self-esteem and depression.
ADHD in Adults
While some of the common symptoms of ADHD fade with age, others could be lifelong issues. Some individuals with the disorder are not diagnosed until they become adults. Adults with untreated ADHD are likely to have issues with employment, and even when they get a job, they face the problem of keeping it. Also, they may experience the following challenges:
- Difficulty in accepting criticisms calmly
- They may not always get to work on time
- They may have trouble staying organized
- Completing work by set deadlines may be difficult
- They find it difficult to get along with their co-workers
It’s often hard to diagnose older adults, and there is no existing tool that has been created for this population. This means that the best way to determine if an adult has ADHD is how he or she functions daily. Also, there is no specific training for professionals to help them diagnose and treat “senior ADHD” even when there is an increasing number of individuals requesting to be tested for mild cognitive impairment or dementia when what they are actually experiencing is just undiagnosed ADHD.
Women with ADHD are affected differently by the disorder. They may start to experience changes during their mid-40s in perimenopause and even bigger changes when they are close to 50. Experts in the field have mentioned that a good number of women disclosed becoming “dumb” as the level of hormones in their body declines.
How Does ADHD Affect Adults in Their Midlife?
Unlike our stamina and hairline, which diminish as we age, ADHD doesn’t lessen with age. The truth is that there might be a significant increase in the symptoms of the disorder after midlife, especially when other normal age-related cognitive declines are involved.
Based on preliminary research on what ADHD looks like in adults who are over 60 years, there are indications that the disorder may look remarkably different all through a person’s lifetime. Some of the symptoms may shift as people move from childhood to adolescence and then when an individual enters young adulthood, midlife, and during the senior years. Although every individual has unique symptoms, there is a pattern that’s fairly consistent in older adults having the disorder:
- Having working memory issues like being easily distracted in the middle of a task.
- Difficulty learning new things.
- Having a memory that may not be consistently failing but can’t be depended on reliably – some things are easily remembered while others escape through the cracks.
- The brain going blank periodically.
- Talking too much without even realizing it most of the time.
- Forgetting names or words.
- Interrupting other people.
- Always misplacing items.
- Finding it difficult to follow conversations.
- Finding it extremely difficult to make ends meet financially due to a lifetime of poor money management.
- Finding it hard to maintain relationships.
- Experiencing difficulty in maintaining order at home.
Some of these symptoms are not always present in teens with ADHD, but they always have pervasive negative effects on older adults with the disorder. Adults with the disorder find it challenging to manage their time and behave themselves appropriately in social settings. It’s also difficult to accomplish both short and long-term goals, especially when they retire without a reliable daily routine. Among the things that older adults with ADHD complained to be their biggest challenges are:
- Experiencing out-of-control emotions and frequently feeling more irritable than before while struggling with anxiety or mood disorders.
- Experiencing social challenges – feeling judged or misunderstood, missing social cues, and speaking impulsively.
- Not being able to get things done because of the lack of self-discipline and procrastination.
- The “remnants” of hyperactivity – talking too much, feeling restless, and having random thoughts whirling in their head.
- Challenges with time management – setting and adhering to a daily routine and being conscious that time is passing.
Many adults who are diagnosed at the age of fifty and above feel a deep sense of regret. They are of the view that if only they had known about the disorder, they could have done things differently. A combination of this regret, several years of self-abuse, and thinking of themselves as lazy, stupid, or even a total failure often affects them significantly.
Diagnosing and Treating ADHD in Older Adults
The primary reason why it’s often hard to separate the symptoms of ADHD from common signs of aging is that the existing diagnostic questionnaires, as well as symptom criteria, are mainly used for the diagnosis of children, not adults.
Most older adults without a formal diagnosis may have ADHD symptoms that are quite different from the ones listed in the Diagnostic and Statistical Manual of Mental Disorders (DSM). In addition, they may find it hard to remember when they began to experience their symptoms or how their symptoms have changed. This means that there is a need for an ADHD screening tool specially tailored for older adults to help identify their symptoms.
There are several ways that adults with ADHD can get the kind of help they have always needed. But it’s also important for older adults with the disorder to visit an ADHD clinic because a formal diagnosis is required for insurance coverage for psychotherapy, the treatment of symptoms, testing pharmaceutical treatment as well as any behavioral interventions that may be required. Age shouldn’t stop the evaluation or treatment of ADHD because the right treatment can transform the life of an older adult.
ADHD specialists evaluating the symptoms of the disorder in older adults need to have a full medical history of their patients – this includes their family background. It’s also crucial to find out whether the symptoms are new or have been with them for long. Another challenge with the medication for older adults has to do with concerns regarding side effects, cardiac issues, and conflicting medications.
The first-choice ADHD therapy is always a stimulant medication, and most adults with the disorder often respond well to stimulants. There are also other non-stimulant medications, and the FDA is considering a new drug application for adult ADHD. After the ADHD diagnosis, an ADHD specialist will monitor your treatment for possible problems and come up with a treatment plan that suits your needs. Some of the medications that doctors recommend include:
- Lisdexamfetamine dimesylate (Vyvanse)
- Methylphenidate/dexmethylphenidate (Daytrana, Focalin, Concerta)
- Amphetamine/dextroamphetamine (Adderall)
Doctors often start with lower doses before moving up, and they need to ensure that the ADHD drug does not in any way interfere with other medications a patient may be taking. They also monitor possible changes in pulse and blood pressure just to be sure that an individual doesn’t have an adverse reaction. Available data from a study that was published in the Journal of Attention Disorders has shown the effectiveness of mindfulness meditation for ADHD in adulthood.
Standard treatments for ADHD in older adults involve therapy, psychological counseling, medication, skills training, and mindfulness meditation. But a combination of all these treatment options has proven to be the most effective. Apart from getting the right medication from doctors, older adults with ADHD can also seek the help of an ADHD coach or therapist to help them identify and address areas in their life that require attention.
About the Author: Andrea Conn is a freelance author, a mother of two daughters, and a teacher who writes stories and articles based on her personal experiences on how to cope with ADHD and living her life freely.
Sources
- Bell, T. (November 2, 2017). What to Know About ADHD If You’re Over 50. Retrieved on June 10, 2020, from https://www.nextavenue.org/know-adhd-50/
- McDowell, J. D. (December 4, 2019). 3 Rules for Evaluating and Treating ADHD in People Over 50. Retrieved on June 10, 2020, from https://www.additudemag.com/adhd-in-adults-treatment-evaluation/
- Nadeau, K. (April 9, 2020). A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60. Retrieved on June 10, 2020, from https://www.additudemag.com/adhd-in-seniors-diagnosis-and-treatment-after-60/
- Robinson, K. M. (October 10, 2016). Just Diagnosed: ADHD Later in Life. Retrieved on June 10, 2020, from https://www.webmd.com/add-adhd/features/aging-and-adhd
- Schwartz, M. A. (October 2002). Adult ADHD: Less hyperactivity, but lingering inattention and distress. Retrieved on June 10, 2020, from https://www.mdedge.com/psychiatry/article/59648/neurology/adult-adhd-less-hyperactivity-lingering-inattention-and-distress
- WebMD. (October 15, 2019). Risks of Untreated ADHD. Retrieved on June 10, 2020, from https://www.webmd.com/add-adhd/childhood-adhd/risks-of-untreated-adhd
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Much of the content is accurate. However, there are absolutely “best practices” used by clinical psychologists for diagnosing adult ADHD that include a clinical interview, collateral interview(s), and standardized testing instruments appropriate for adults. While the examples in the DSM-5-TR are aimed at childhood and adolescent ADHD, the symptoms are also relevant for adults and easily identifiable by a trained psychologist. .