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Attention Deficit Hyperactivity Disorder (ADHD) is often associated with hyperactive children and young people, but it's a condition that can persist into adulthood and even older age. Many adults are only diagnosed with ADHD later in life, often after years of struggling with symptoms that have been misunderstood or misattributed to other conditions.
Some have developed coping mechanisms and supportive systems, such as relying on a spouse to handle administrative tasks or focusing on specific, interesting tasks. However, these strategies can lead to misunderstandings in personal relationships, as individuals with undiagnosed ADHD may have unique ways of approaching tasks, such as perfectionism or a strong preference for routine.
Older adults, particularly women are often overlooked when it comes to ADHD. In this blog, we will explore the common presentations of ADHD in older adults seeking help and discuss strategies to sustainably improve quality of life. We'll also emphasise the importance of seeking professional help, as it's never too late to receive a diagnosis and start receiving support.
Recent research suggests a potential link between ADHD and other neurological conditions, such as Lewy body disease and cognitive impairment. As our understanding of ADHD in older adults continues to evolve, more research is needed to fully explore this complex relationship.
Why is ADHD Often Overlooked in Older Adults?
The most common reason for the late diagnosis of ADHD in older people is historical. Born in the 1950s, 1960s, or 1970s, individuals grew up in an era with non-existent resources for ADHD. The condition was first named in the US in the 1980 as "attention deficit disorder with or without hyperactivity" more commonly known as (ADD/ADHD). It took years for professionals to become educated, trained, and equipped to diagnose and treat this condition. In the UK, ADHD was first recognised as a valid condition in 2000, but it wasn't officially recognised as an adult condition until 2008.
Currently, it is relatively rare for mental health professionals to have experience diagnosing and treating ADHD in older people. Symptoms like poor short-term memory can overlap with other age-related cognitive issues, making accurate diagnosis challenging. Recent research has indicated that individuals with ADHD may be at an increased risk of developing Parkinson's disease. Our understanding of ADHD in older adults is still evolving, and it may take many years to fully comprehend the complexities of this condition.
Lack of Awareness
Many healthcare providers may not be aware of ADHD in older adults, leading to missed opportunities for diagnosis and treatment. While we can anticipate a future where individuals diagnosed with ADHD in their earlier years will transition into older adulthood, this change will take time. It's important to remember that it's never too late to seek support if you suspect you may have undiagnosed ADHD.
Stigma and Stereotypes
An important reason for the late diagnosis of ADHD in older adults is the stigma associated with the condition. Many people still believe that ADHD is a childhood disorder that should resolve with age. Individuals with ADHD may face discouragement from others, including family members, when seeking support for the condition. Some may also struggle with anxiety difficulty forming friendships, relationship issues and disordered eating, such as binge eating, despite trying various approaches with limited success.
Mistaken diagnosis
Symptoms of ADHD in older adults can mimic those of other age-related conditions, such as dementia or depression. This can lead to misdiagnosis and ineffective treatment. For example, forgetfulness, difficulty concentrating, and disorganisation, which are common ADHD symptoms, can also be signs of dementia. While individuals with dementia often struggle with short-term memory but may retain long-term memories, older adults with ADHD may exhibit the opposite pattern. For example, they may retain the immediate short-term memories, but the early childhood memories appear muddled.
Similarly, restlessness and impulsivity, hallmark symptoms of ADHD, can be mistaken for symptoms of anxiety or bipolar disorder. Accurately diagnosing ADHD in older adults can be particularly challenging, especially given the potential for overlapping symptoms with other conditions. Continuity of care is essential for effective diagnosis and management.
Recognising Symptoms of ADHD in Older Adults
It's important to recognise that older adults may perceive their unique way of functioning as normal. Seeking help to address potential ADHD symptoms can be a courageous step. Over time, individuals may develop coping mechanisms that can mask underlying ADHD symptoms, leading to burnout or strained relationships. The presentation of ADHD can vary widely among individuals, but common symptoms in older adults include:
- Inattention:
- Difficulty focusing on tasks: from admin work to day-to-day mundane tasks such as cleaning, finding items, replying to emails ending up easily getting distracted
- Forgetfulness in omitting what others said to you, be it the loved one, friends or children. Forgetting important events, gatherings leading to missed opportunities.
- Poor time management in staying late to finish work, not finishing your long-term projects be it writing a book, or arranging the house, renovation. Attending meetings late, or sometimes on the wrong day of the week or date.
- Easily distracted and sensitive to noises, you are the first hearing around you if something is not right. This can be a noise outside, daydreaming or simply the mobile phone.
- Impulsivity:
- Making hasty decisions which you may regret later such as buying things, starting or ending friendships abruptly
- Difficulty planning and organising, often leading to procrastination and reliance on others. Decision-making processes, such as choosing a vacation destination, can become overwhelming and time-consuming.
- Restlessness not being able to sit and relax at the beach, enjoying the breeze, while you would rather keep doing something, exploring, reading or checking the technology
- Impatience to stay in a queue shopping, impatient when waiting for documents, or having a significant effort and disturbance when sitting in staying in traffic, airports or public transportation
- Hyperactivity:
- The symptoms of hyperactivity have the tendency to improve with age, therefore in older adults, these may be non-existent or significantly diminished which doesn't disturb anymore.
- More commonly seen is the excessive restlessness, difficulty sitting still and less fidgeting. Some may develop over the years coping mechanisms, such as chewing gum, vaping or smoking.
When Older Adults Seek an ADHD Diagnosis and Treatment
Everyone's journey is unique. Here are some of the more common scenarios that may lead older adults to seek help for ADHD:
Mature students at university
Many older adults decide to pursue higher education later in life. Those who suspect they may have ADHD often seek a diagnosis to optimise their academic performance. They may feel that a formal diagnosis and treatment plan will provide the necessary support to succeed. In some cases, individuals may be unaware of their struggles until prompted by a university advisor or counsellor. Seeking help can be a challenging but rewarding decision.
Recent family history
A family history of ADHD can prompt older adults to question their own experiences. If a child or a grandchild has been diagnosed with ADHD, individuals may wonder if they too have been silently struggling with the condition. They may reflect on past challenges, such as academic difficulties, relationship problems, or career setbacks, and seek answers to long-standing questions.
ADHD in Business Professionals
Well established individuals in business roles may struggle with tasks such as sudden changes, maintaining regulatory demands, meeting deadlines, tax matters or maintaining detailed records. The stress and frustration associated with these challenges can lead them to seek professional help. By understanding their ADHD symptoms, they may be able to implement strategies to improve their productivity and reduce stress.
Via friends and self-awareness
While less common, some older adults may seek support after a friend is diagnosed with ADHD. However, the stigma associated with ADHD in older adults can be more pronounced than in younger individuals. Some older adults may recognize patterns in their own lives, such as difficulty maintaining relationships frequent moves, or a history of impulsive career changes. These patterns may lead them to question whether they too may have ADHD.
Stumbled upon a diagnosis
Unfortunately, individuals with existing mental health conditions are less likely to consider an ADHD diagnosis. This may be due to the stigma associated with ADHD, particularly in older adults, or because their symptoms are attributed to their primary diagnosis. As a result, many people continue to silently struggle with ADHD, hindered by societal stereotypes. A diagnosis may emerge incidentally when an individual with a mental health condition consults a psychiatrist who specialises in neurodevelopmental disorders.
The Impact of ADHD on Older Adults
ADHD can significantly impact the quality of life of older adults. Some common challenges include:
- Social Relationships: Longstanding difficulties in establishing or maintaining friendships due to inattention, impulsivity, becoming bored or simply feeling different
- Physical Health Issues: People suffering from ADHD may postpone or forget attending important medical appointments and having difficulty following medical advice.
- Mental Health: perfectionism coping mechanisms, increased risk of anxiety, sleep problems depression or in some situations self-medication with alcohol or substances
- Managing Finances: Poor decision-making, difficulty in long-term financial planning, impulsive spending and challenges with financial management. Some individuals may develop rigid financial habits as a coping mechanism.
How is the ADHD assessment different in older adults?
Diagnosing ADHD in older adults can be particularly complex due to several factors:
- Comprehensive Assessment: Given the need to explore a lifetime of experiences, assessments for older adults often require more time than those for younger individuals. Multiple sessions may be necessary to delve into their developmental history and current functioning.
- Limited Collateral Information: Challenges may arise in obtaining collateral information, such as school reports or parental accounts, as these individuals may no longer have access to such records. Reliance on self-report and information from close family members becomes crucial.
- Cognitive Differences: Individuals with ADHD often have difficulties with memory, particularly with memories around the childhood period. This can impact their ability to recall past experiences and provide detailed information about their history. It's important to distinguish these memory issues from those associated with dementia.
- Comorbid Conditions: Older adults with ADHD often have co-existing mental health conditions, such as anxiety or depression. Accurately diagnosing ADHD requires careful consideration of these comorbidities and their potential impact on symptoms.
- Physical Health Considerations: Research suggests that individuals with ADHD may be at increased risk of certain physical health conditions, including cardiovascular disease, injuries, gastrointestinal issues, obesity, fibromyalgia, and migraines. A thorough assessment of physical health is essential to identify and manage these potential comorbidities.
To address these complexities, we typically allocate up to 2.5 hours for an initial assessment of older adults with suspected ADHD. This extended time allows for a comprehensive evaluation of their history, symptoms, and overall functioning.
At the conclusion of the assessment, we will provide a clear understanding of your difficulties, regardless of a formal ADHD diagnosis.
Avoiding the Post ADHD Diagnosis Blues
While many younger individuals experience relief and optimism upon receiving an ADHD diagnosis, older adults may have a more complex emotional response. Feelings of remorse and emptiness can arise due to the realisation of missed opportunities and a lifetime of misunderstood struggles. It's important to remember that a diagnosis does not define you, and that you are capable of living a fulfilling life.
Receiving an ADHD diagnosis in older adulthood can sometimes trigger feelings of sadness. Therefore, it's crucial to seek support from a mental health professional such as psychiatrists experienced in working with adults with ADHD. They can provide guidance, therapy, and support.
Rather than seeking drastic life changes, focus on making small, sustainable adjustments. Consistency and patience are key. A strong therapeutic alliance with a qualified ADHD specialist can provide invaluable guidance and support throughout your journey.
Does ADHD get worse with age?
While research suggests that some ADHD symptoms may naturally decrease with age, it's important to note that the condition itself doesn't disappear. Many adults with ADHD continue to experience challenges throughout their lives, particularly those with co-occurring mental health conditions.
Approximately half of adults diagnosed with ADHD also have additional mental health conditions, such as anxiety, sleep disorders or depression. These co-occurring conditions can complicate the course of ADHD and may lead to fluctuations in symptoms over time. The severity and frequency of symptoms can vary, and some individuals may experience periods of remission followed by exacerbations. That's why it's crucial to seek support from a qualified mental health professional who can address both ADHD and any co-occurring conditions.
Treatment for ADHD in Older Adults
Given the potential for medication side effects and the presence of co-existing conditions, non-pharmacological interventions play a significant role in managing ADHD in older adults. It's important to focus on sustainable lifestyle changes and therapeutic strategies that promote overall well-being. The goal is to help individuals maintain their personality while achieving subtle but valuable improvements in their lives.
Treatment for ADHD in older adults needs to be holistic and may include:
- Therapy: Personalised and discreet 1:1 therapy, goal oriented can help develop coping strategies and improve organisational skills.
- Lifestyle Changes: Optimising diet, dedicated exercise, adequate sleep optimisation, technology and positive digital hygiene, exploring new hobbies and interests
- Coaching: develop a sustainable task management system, transform abstract goals into actions, learning practical skills to maintain focus and motivation
- Physical health management: Staying up to date with routine health checks, collaborating with other healthcare professionals, considering hormone management options, if appropriate
- Medication: Pharmacological treatment may not be suitable for everyone. Some individuals may prefer non-medication options due to concerns about potential side effects or changes in personality. We are committed to providing holistic support to all our patients.
Are you an older adult struggling with undiagnosed ADHD?
No matter where you are in life, ADHD doesn't have to hold you back. Contact us today to schedule a consultation and embark on a journey towards a more fulfilling life.
Contact Dr. Ivantu's Secretary at ADHD Specialist.
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References
ADHD IN OLDER ADULTS: A CASE REPORT LITERATURE AND REVIEW OF THE - ScienceDirect
People with ADHD may be at increased risk of Parkinson's | Parkinson's UK
Can Adult ADHD and Perfectionism Coincide | ADHD Specialist
5 Things About ADHD in Older Adults You May Not Know
Increased risk of dementia in adults with ADHD | BPS
ADHD in older adults - a scoping review - PubMed
Pictures source Pexels.com Free Stock Photos, Royalty Free Stock Images & Copyright Free Pictures · Pexels
Disclaimer: The information is not intended nor implied to be a substitute for professional medical advice, diagnosis or treatment. All content, and information, contained in this article is for general information purposes only and does not replace a consultation with your own doctor/health professional. Information about mental health topics and treatments can change rapidly and we cannot guarantee the content's currentness. For the most up-to-date information, please consult your doctor or qualified healthcare professional. For more information, you can check the Royal College of Psychiatrists (rcpsych.ac.uk)
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