Difficulty paying attention. Risky, impulsive behavior. Frequently losing track of possessions. Irritability. Mood swings. Angry outbursts. Trouble with planning and prioritizing.
That laundry list constitutes many of the symptoms of Attention Deficit Hyperactivity Disorder, ADHD. Once thought to be an issue limited to children and young adults, it’s being increasingly diagnosed in those who are much further down life’s road.
“The oldest patient I had come in for a new diagnosis was 82,” said Dr. Cynthia Seng, a psychiatrist at the Cleveland Clinic. “It was clear he had it his whole life.”
A 2023 study published in the Journal of Attention Disorders found that medication combined with cognitive behavioral therapy was more effective than medication alone in improving ADHD symptoms. Still, they should be carefully prescribed in older adults.
Challenges of diagnosis
Doctors, counselors and other mental health professionals said there are several challenges that make it tough to even diagnose those beyond age 60 — let alone treat them.
One such barrier is what’s historically been a stigma surrounding attention deficit as well as other mental health maladies. And researchers said that those who grew up decades ago when that attitude was more pronounced are sometimes reluctant to get checked out.
“Some older people are going to be like, ‘I don’t want to talk about it,’” said Dr. Nina Joy Mena, an Atlanta-area board-certified psychiatrist. But she and others said older adults are increasingly exploring the issue with mental health workers, citing symptoms they’ve struggled with for many years.
Psychiatrists like Mena said what might appear to be attention deficit can be a range of other conditions, from normal aging to mild cognitive impairment to depression to even Parkinson’s disease or menopausal symptoms.
“Most of the time if you listen to the patient, they’ll tell you what’s wrong,” said Seng.
She said medical professionals look for the very specific criteria on symptoms as well as medical history. Laboratory examinations can be drawn, a neuropsychologist may examine how their brain works, and supporting information from family members is also helpful.
Seng said they also look for at least some suggestion that symptoms were present in childhood. Mena agrees that getting a good diagnosis is tough, adding that another hindrance is the lack of testing specifically tailored to older adults.
“There needs to be a more refined screen for geriatrics, people above 60, so we can be able to tease out, ‘Is this dementia or is it ADHD?’” she said.
Little senior research available
Another problem is a lack of study data involving older adults. That frustrates Seng.
“Historically this was considered to be a developmental disorder of childhood, and we used to think people outgrew it and it’s very apparent that that’s not true,” she said. “But the research has lagged and because it was considered a disorder of childhood, most of the questions we ask and the testing we do is directed at children. We don’t have good valid data and questions for older adults.”
A synthesis of studies involving adults with the issue seems to bear that out. Published in The American Journal of Psychiatry, the analysis concluded that while ADHD persists into adulthood for many, its prevalence is unknown. It also concluded that it appeared that ADHD showed up less in people age 70-80 than in somewhat younger groups.
And then there’s ADHD’s frequent tie-in with depression and anxiety. Researchers said that those with attention issues more commonly suffer from both disorders, and that the symptoms can overlap, requiring further groundwork.
A study published online by the Cambridge University Press suggested that ADHD increases the risk of depression later in life and that the findings are consistent with a causal genetic liability on later major depression.
“Anytime I’m diagnosed with ADHD in adults I am looking at whether there’s a mood disorder in play, “said Mena. “So, I typically treat the mood disorder first and then what’s left over after treatment I’m like ‘OK, maybe that’s real ADHD.’”
‘The million dollar question’
And consider this: there’s a limited but growing body of research suggesting that attention issues can first surface later in life. A 2016 study tracking patients in Brazil and the United Kingdom showed apparent adult onset in Brazil of more than 10%. It also suggested adult ADHD may be a distinctly different syndrome.
So, is the incidence of ADD going up or are more older adults simply getting checked, diagnosed and then treated?
“That’s the million dollar question because we’re seeing more ADHD in general. As we try to put mental health awareness out there more people are stepping forward,” Mena said.
Dr. Kathleen Nadeau, lauded as a pioneer in ADHD research and treatment, summed it up this way in ADDitude magazine.
“The status quo is not working for older adults with ADHD, we need new protocols,” she said. “Drastic clinical changes must take place to improve outcomes for underdiagnosed, undertreated and overlooked older adults.”
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