Why Older Adults with ADHD Remain Invisible

More than 10,000 people in the United States turn 65 every day. By 2030, there will be more Americans over age 65 than under age 18. Yet despite this demographic shift, we continue to overlook the needs of one rapidly growing population: older adults with ADHD.

Psychiatrists—except for the relatively few who specialize in geriatric psychiatry—receive little training in treating older adults with stimulant medications. Many are understandably cautious about prescribing stimulants to patients who may have cardiac risk factors. Yet in my research for Still Distracted After All These Years, most of the older adults I interviewed had taken stimulant medication and reported significant benefits.

 

Neurologists evaluating older adults who complain of forgetfulness, memory retrieval problems, or sleep difficulties are typically focused on identifying cognitive decline or dementia. ADHD is rarely part of the diagnostic conversation.

 

Psychotherapists who work with older adults often focus on issues such as grief, loss, caregiving, and social isolation. As a result, ADHD may not be considered as a possible contributor to persistent difficulties with daily functioning.

 

Family members may casually remark, “I’m sure my dad had ADHD,” when discussing younger relatives who have been diagnosed. Yet there is often little recognition that Dad’s chronic lateness, inability to find his glasses, or overwhelming clutter may be causing significant impairment. These behaviors are often treated as family jokes rather than concerns worthy of attention.

 

Older adults themselves frequently dismiss the possibility of ADHD. They may say, “If I were a kid today, I’d probably be diagnosed with ADHD,” implying that the diagnosis is no longer relevant. Others wonder, “If I’ve made it this far, does it really matter?”

Many older adults worry that their difficulties may be early signs of cognitive decline or dementia. That concern is common—and understandable.

 

Unfortunately, ADHD is often overlooked in memory clinics. Even when it is considered, assessment tools may rely heavily on recollections of childhood symptoms, which can lead to missed diagnoses. We now understand that ADHD does not always present clearly in childhood and may become more apparent later in life as life circumstances and coping strategies change.

 

Compounding the problem, most neurologists and geriatric specialists receive little or no formal training in identifying ADHD in adults.

An older adult might ask: “If I’ve made it this far, does it really matter?” The answer is yes—more than many people realize.

 

Without understanding ADHD, retirement can become unexpectedly challenging. Days may feel unstructured and unproductive. Long-held dreams remain unrealized. Projects are started but never completed. Social isolation can increase. Sleep patterns may become irregular, and excessive screen time can gradually replace more meaningful activities.

 

Over time, these patterns can affect both mental and physical health.

 

The encouraging news is that change is possible. With the right understanding, support, and treatment, life can become more organized, fulfilling, and connected at any age.

 

I have spent years studying ADHD in older adults and speaking with individuals who were diagnosed later in life. Their experiences point to a powerful conclusion: it is never too late to understand yourself better and make meaningful changes.

Because ADHD is now one of the most common psychiatric conditions for which adults seek treatment, it is essential that psychotherapists receive training and develop confidence in both diagnosing and treating the condition.

 

The primary mission of the Institute for Lifespan ADHD Training (ILAT) is to equip clinicians with the knowledge and skills needed to accurately diagnose and effectively treat ADHD across the lifespan.

 

Fortunately, diagnosing ADHD does not have to be complicated, time-consuming, or expensive. In many cases, a thorough clinical interview conducted by an experienced clinician is sufficient.

 

 

ADHD is highly heritable. Clinicians should ask detailed questions about family members who have been diagnosed, as well as relatives who may have exhibited ADHD symptoms but were never formally identified.

 

Clinicians should explore whether the individual has experienced the following difficulties throughout life:

 

• Difficulty falling asleep at night or waking up in the morning

• Losing track of time

• Forgetting important tasks or responsibilities

• Frequently misplacing personal items

• Running late for appointments or other time-sensitive commitments

• Over-promising and under-delivering

• Talking excessively or interrupting others

• Being easily distracted from the task at hand

 

When these patterns have been present across decades and across different settings, ADHD should be considered as a possible explanation.

At the virtual ILAT Global Summit, October 29–30, I am pleased to announce that David Goodman, MD, and I will be discussing how psychotherapists and ADHD prescribers can develop the knowledge and clinical skills needed to serve this rapidly growing population of older adults with undiagnosed ADHD.

 

Dr. Goodman, who is affiliated with Johns Hopkins School of Medicine in Baltimore, has spent decades specializing in the treatment of ADHD in adults and older adults. Together, we will explore practical approaches to assessment, diagnosis, and treatment for a population that has remained overlooked for far too long.