Attention deficit hyperactivity disorder (ADHD) is a mental health condition typically associated with young boys. Most people don’t realize that ADHD is a lifelong condition with a strong hereditary component, meaning there are many (often undiagnosed) adults with this condition. Medicine is now catching up, but still, up to 75% of all adults and nearly 100% of seniors are undiagnosed according to the AARP.
Why is this significant? Given that most of these adults are undiagnosed, one may think they wouldn’t benefit from a diagnosis. However, that is not the case, namely because many adults end up being misdiagnosed and mistreated. Crucially, ADHD is often confused with Mild Cognitive Impairment (MCI) and even dementia in senior adults.
How does ADHD manifest in older adults?
Preliminary research suggests that the symptoms of ADHD can change throughout one’s lifetime. Drastic life changes, such as illness, menopause, and retirement, can upset one’s coping mechanisms, and further exacerbate the symptoms of ADHD. As one ages, this can lead to serious challenges, such as:
- Trouble with time management, maintaining a daily routine, and time awareness.
- Procrastination and difficulties with self-discipline and prioritizing.
- Irritability, anxiety, and moodiness.
- Excessive talkativeness, inability to understand social cues, and other social challenges.
Individuals with ADHD are also more likely to get into traffic accidents, have marital disagreements, and get divorced more often than their peers, and they are at a higher risk of developing complications or being diagnosed with physical illness later due to problems with self-organization.
In a piece for The American Association of Retired Persons (AARP), writer Theresa Sullivan Barger describes a typical story for an adult with ADHD: “I hit midlife feeling totally overwhelmed. 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 ADHD,” Sullivan Barger writes. “I’d been living with it all my life — but the drop in estrogen caused by the onset of menopause amplified its impact, and the coping methods I’d always relied on could no longer keep my racing mind in check,” she continues.
Some adults may only seek a diagnosis or begin suspecting that something is up once their kids or grandkids get diagnosed with ADHD. They may recognize the same patterns and symptoms in themselves. That said, older adults have some unique symptoms that may not appear in kids or young adults.
What symptoms are prevalent in older adults who have ADHD?
Additude Magazine, a leading information source about ADHD, outlines the following symptoms in older people with ADHD:
- So-called “Swiss cheese memory,” where a person can remember some things but not others. This is unpredictable and renders one’s memory completely unreliable.
- Your brain goes “blank” from time to time.
- Forgetting specific words and names.
- Not finishing a task because you are distracted by other tasks or events.
- A disorganized home
- Losing items
- Trouble learning new information
- Being distracted in a conversation
- Interrupting others in a conversation
- Not keeping in touch with close friends and relatives
- Poor time- and money management.
What are the differences between ADHD, MCI, and dementia?
As previously mentioned, particular ADHD symptoms in seniors, especially those related to executive functioning and memory, are treated as red flags for MCI or dementia by most doctors. This, in turn, can result in a misdiagnosis.
Mild cognitive impairment (MCI) is a state between dementia and normal cognitive changes in aging adults. It can cause gaps in memory, impulsivity, and a drop in executive functions. All of these symptoms can also appear in seniors with ADHD who don’t have MCI. Even patients with an existing ADHD diagnosis are often diagnosed with MCI – either because the two conditions coexist, or the patient is misunderstood by the diagnosing clinician. The Mayo Clinic reports that over 10% of MCI patients end up developing dementia.
In order to understand if the symptoms are attributed to dementia and MCI or ADHD, a qualified professional will look at the timing of the symptoms. Are the issues with focus and memory new, or have they persisted throughout one’s life? “Of utmost importance, to further rule out ADHD, clinicians should determine whether symptoms are new or span a lifetime — which is certainly not indicative of mild cognitive decline,” writes Kathleen Nadeau, Ph.D., a psychologist and one of the leading ADHD specialists in the world.
Your medical family history may also be a valuable clue. “ADHD is one of the most heritable disorders in medicine, so having children, grandchildren, or siblings with this diagnosis should increase a doctor’s suspicion that their patient’s symptoms may be the result of ADHD,” wrote Dr. Stephanie Collier, the director of education in the division of geriatric psychiatry at McLean Hospital, in an article for Harvard Health Publishing.
Diagnosis and treatment
If you suspect that your symptoms may be related to ADHD, especially if you have a family member with the condition, discuss it with your physician or a specialist. Note, however, that many clinicians are not well-versed in the area because there are currently no guidelines for what ADHD looks like later in life.
It’s also crucial to keep in mind that not all ADHD medications may be available to seniors, even if they were known to take them earlier in life. Stimulant medications, in particular, may increase the risk of cardiac issues and may not mix well with other prescription medications. Still, there are now a few alternative non-stimulant treatments that may be available to adults over 60 as well.
Tips for managing ADHD in middle age and beyond
1. Use tools to get organized. Your phone, calendar, daily planner, and alarm clocks may be really helpful in getting more organized. Use them.
2. Try behavioral therapy or ADHD coaching. These professionals can help you cope with anxiety and boost your productivity and self-organization.
3. Exercise can help restore the levels of brain chemicals involved in ADHD, such as dopamine and norepinephrine.
4. Stick to a steady sleep schedule.
5. Don’t hesitate to get help from friends and family members. They can restore a sense of control and structure in your daily life.
6. Feed your brain plenty of protein and healthy fats from fish and nuts, vegetables, and fiber. Nutrition will both reduce the risk of dementia and help ADHD. Read more on the topic here - 10 Super Foods That Will Protect and Boost Your Brain Power.
7. Exercise the brain too with quizzes, crossword puzzles, learning new skills, and active reading.
8. Maintain connections. Social interactions have been shown time and again to boost brain health. Stay in touch with close friends and family, even if you have to add writing to them to your weekly planner. You can also join a new club or hobby to meet new people.
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