Occasionally forgetting to pay a bill or misplacing your keys is considered a sign of aging. But for an older adult who has always misplaced things, or who as a child continually forgot to hand in homework, these could be signs of ADHD.
It was once thought that ADHD was only a disorder of childhood and that symptoms would resolve as a child matured into adulthood. Today we understand that ADHD is a lifespan condition and that many adults deal with symptoms every day.
“I hit midlife feeling totally overwhelmed,” says Theresa Sullivan Barger, a writer for AARP. “I couldn’t concentrate, couldn’t prioritize. I chalked it up to menopause, or maybe just a series of ‘senior moments.’ But then I found a therapist who understood exactly my problem: I had attention deficit hyperactivity disorder.”
Barger’s experience is common for older adults who never received an ADHD diagnosis in childhood, but whose symptoms have been there the whole time.
Lack of research
A 2022 review of research on adults over age fifty, found a lack of studies on ADHD in this stage of life. The review concluded that more knowledge of how ADHD affects older adults is needed for proper assessment and effective treatment. The lack of research presents challenges for those living with the condition. Older adults often have a hard time finding a doctor who understands ADHD and, because of the lack of studies on the effects of ADHD medications in this population, some doctors are hesitant to prescribe medication as a treatment option.
“Many physicians either ‘don’t believe’ that a sixty-something or seventy-something could have ADHD, or simply are not experienced enough to be comfortable prescribing stimulants to older adults, given the likelihood of more complex health concerns,” writes Kathleen Nadeau, PhD. Dr. Nadeau has spent years more than thirty years diagnosing and treating ADHD. She is the founder of the Chesapeake ADHD Center of Maryland and author of Still Distracted After All These Years: Help and Support for Older Adults with ADHD (Hachette, 2022).
Dr. Nadeau says some signs of ADHD in older adults include challenges with executive functioning including poor working memory, forgetfulness, problems with time management, organization, and procrastination. What complicates an ADHD diagnosis in this age group is determining if symptoms are related to age or ADHD.
David W. Goodman, MD, is assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine and director of the Adult Attention Deficit Disorder Center of Maryland. He has worked with adults in all stages of life.
“As we age, we will notice some forgetfulness, difficulty in recalling information quickly, losing a train of thought, and getting distracted,” says Dr. Goodman. “What distinguishes this from ADHD is the fact that the symptoms started much later in life and not in childhood.”
In other words, if you’ve suddenly noticed you are more distracted or forgetful, these symptoms may be part of aging and not ADHD. For an ADHD diagnosis, your symptoms must have first shown up in childhood, or at least the early teen years. If you’ve experienced symptoms most of your life, you may consider getting an ADHD evaluation.
Getting an evaluation after forty
If you’ve never been diagnosed before, it’s not too late. It’s important to find a specialist who understands ADHD and who offers a comprehensive evaluation, which should take forty-five to fifty minutes or longer. The ADHD professional will ask you to do a series of paper and pencil tests, talk with you about current and past history in terms of ADHD symptoms, and a comprehensive mental health assessment since there are several common co-occurring conditions, says Martin Wetzel, MD. Dr. Wetzel is a psychiatrist and medical director at Healthy Blue of Nebraska and associate clinical professor of psychiatry at the University of Nebraska Medical Center.
A comprehensive evaluation for older adults, he says, should also include “a medical evaluation which includes past medical history, current medications, [and] any history of head injury.” Dr. Wetzel also reviews a patient’s family history since studies indicate that ADHD is genetic.
Some older adults may wonder what is the use of getting a comprehensive evaluation or seeking treatment for ADHD if they have managed for decades without a diagnosis.
“I think knowing that you have this diagnosis is the most powerful part of the treatment, because once you know you have it and you’re fairly confident you have it then you and your provider can map out a treatment plan that’s individualized that works for you and you can move forward,” says Dr. Wetzel.