ADHD
Did you know that about 3.3 percent of adults between 44 and 85 years have ADHD? What this means is that about 70 million adults may not be aware that they have attention deficit hyperactivity disorder until the challenges and demands of life become overwhelming and unbearable. Adults who may be facing the challenges of caring for their aged parents or managing life after a bitter divorce could find their coping mechanisms to be lagging in such situations. Unfortunately, most adults who find themselves in this kind of situation hardly consider the possibility that ADHD might be the cause of their predicament.

As humans age, several aspects of our lives, such as our normal cognitive function, auditory attention, crystallized intelligence, and implicit memory, will remain stable. We still can handle automatic things like bike riding, tying our shoes, etc. We can also recall people's faces even though we sometimes forget their names.

Although we may sometimes forget our passwords, we can still repeat a string of numbers that someone told us. But as we age, there are certain types of attention and memory slow-down that we're expected to experience, such as:
  • Selective attention (our ability to shut out distractions)
  • Processing speed
  • Inhibition of responses (blurting)
  • Executive function (this includes planning, organizing, and executing)
  • Episodic memory (this includes our autobiographical events)
  • Working memory (our ability to retain things in our memory as we engage in something else)
  • Visual construction skills (this includes things like putting together a dresser)
  • Driving skills (increase in the likelihood of having accidents)
  • Conceptual thinking
  • Divided attention (ability to multitask)
Interestingly, ADHD and normal aging overlap with all these symptoms except that of "episodic memory." This implies that it's pretty challenging to differentiate the signs of aging and ADHD because of all these commonalities.

What ADHD Looks Like in Teenagers

When the disorder hasn't been diagnosed and managed in teens, they tend to perform poorly in school for years. This manifests in poor grades as teens with ADHD find it hard to catch up even when they did well while in elementary school. Also, teens with untreated ADHD have challenges with keeping relationships.

Consequently, they are likely to experience issues getting along with their parents, and when it comes to friends, they may have just a few of them and may not do well when dating. When teens with ADHD are not treated, the chances of indulging in dangerous behaviors such as smoking, drinking, doing drugs, and indulging in risky sexual choices may also increase.

For girls with untreated ADHD, the challenges they face often include eating disorders, which are believed to be linked with low self-esteem or depression.

ADHD in Adults

While some of the common symptoms of ADHD fade with age, others could be lifelong issues. Some individuals with the disorder are not diagnosed with ADHD until they become adults. Adults with untreated ADHD are likely to have employment issues, and even when they get a job, they face the problem of keeping it. Also, they may experience the following challenges:
  • Difficulty in accepting criticisms calmly
  • They may not always get to work on time
  • They may have trouble staying organized
  • Completing work by set deadlines may not always be easy
  • They find it difficult to get along with their co-workers
It's often hard to diagnose older adults, and no existing tool has been created for them. This means that the best way to determine if an adult has ADHD is how they function daily. Also, there is no specific training for professionals to help them diagnose and treat "senior ADHD," even when there is an increasing number of individuals requesting to be tested for mild cognitive impairment or dementia when what they are actually experiencing is just undiagnosed ADHD.

Women with ADHD are affected differently by the disorder. They may start to experience changes during their mid-40s in perimenopause and more significant changes when they are close to 50. Experts in the field have mentioned that a good number of women disclosed becoming "dumb" as the level of hormones in their bodies declines. 

How does ADHD Affect Adults in their Midlife?

Unlike our stamina and hairline, which diminishes as we age, ADHD doesn't diminish. The truth is that there might be a significant increase in the symptoms of the disorder after midlife, especially when other average age-related cognitive decline earlier mentioned is involved.

Based on preliminary research on what ADHD looks like in adults who are over 60 years old, there are indications that the disorder may look remarkably different all through a person's lifetime. Some of the symptoms may shift as people move from childhood to adolescence and then when an individual enters young adulthood, midlife, and senior years. Although every individual has unique symptoms, there is a pattern that's pretty consistent in older adults having the disorder:
  • Having working memory issues like being easily distracted in the middle of a task.
  • Difficulty learning new things.
  • Having a memory that may not be consistently failing but can't be depended on reliably – some things are easily remembered while others escape through the cracks.
  • The brain goes blank periodically.
  • Talking too much without even realizing it most of the time.
  • Forgetting names or words.
  • Interrupting other people.
  • Always misplacing items.
  • Finding it difficult to follow conversations.
  • It is difficult to make ends meet financially due to a lifetime of poor money management.
  • Finding it hard to maintain relationships.
  • Experiencing difficulty in maintaining order at home.

Some of these symptoms are not always present in teens with ADHD, but they always have pervasive adverse effects on older adults with the disorder. Adults with the disease find it challenging to manage their time and behave appropriately in social settings. It's also difficult to accomplish short- and long-term goals, especially when they retire without a reliable daily routine. Among the things that older adults with ADHD complained to be their most significant challenges include:
  • Experiencing out-of-control emotions and frequently feeling more irritable than before while struggling with anxiety and/or mood disorders.
  • Experiencing social challenges – feeling judged or misunderstood, missing social cues, and speaking impulsively.
  • Not being able to get things done because of the lack of self-discipline and procrastination.
  • The "remnants" of hyperactivity – talking too much, feeling restless, and having random thoughts whirling in their head.
  • Challenges with time management – setting and adhering to a daily routine and being conscious that time is passing.
Many adults who are over 50 years old who were diagnosed usually feel a deep sense of regret. They believe that if they had known about the disorder, they could have done things differently. A combination of this regret, several years of self-abuse, and regarding themselves as lazy, stupid, or even a total failure often affects them significantly.

Diagnosing and Treating ADHD in Older Adults

The primary reason why it's often hard to separate the symptoms of ADHD from common signs of aging, which we earlier saw, is that the existing diagnostic questionnaires, as well as symptom criteria, are mainly used for the diagnosis of children and not adults.

Most older adults without a formal diagnosis may have ADHD symptoms that are pretty different from the ones listed in the DSM. In addition, they may find it hard to remember when they began to experience their symptoms or how they have changed. This means that there is a need for an ADHD screening tool specially tailored for older adults to help identify their symptoms.

There are several ways that adults with ADHD can get the kind of help they have always needed. But it's also essential for older adults with the disorder to visit an ADHD clinic because an ADHD diagnosis is compulsory for psychotherapy, the treatment of symptoms, testing pharmaceutical treatment, as well as any behavioral interventions that may be required. Age shouldn't stop the psychiatric evaluation or treatment of ADHD because the right treatment can transform the life of an older adult.

ADHD specialists evaluating the symptoms of the disorder in older adults need to have a complete medical history of their patients – this includes their family background. It's also crucial to determine whether the symptoms are new or have been with them for a long time. Another challenge with the medication for older adults has to do with concerns regarding side effects, cardiac issues, and conflicting drugs.

The first-choice ADHD therapy is always a stimulant medication, and most adults with the disorder often respond well to stimulants. There are also other non-stimulant medications, and the FDA is considering a new drug application for adult ADHD. After the ADHD diagnosis, an ADHD specialist will monitor your treatment for possible problems and come up with a treatment plan that suits your needs. Some of the medications that doctors recommend include:
  • Lisdexamfetamine dimesylate (Vyvanse)
  • Methylphenidate/dexmethylphenidate (Daytrana, Focalin, Concerta)
  • Amphetamine/dextroamphetamine (Adderall)
Doctors often start with lower doses before moving up, and they need to ensure that the ADHD drug does not in any way interfere with other medications a patient may be taking. They also monitor possible changes in pulse and blood pressure to ensure that an individual with the disorder doesn't get an adverse reaction. Available data from a study that was published in the Journal of Attention Disorders has shown the effectiveness of Mindfulness meditation for ADHD in adulthood.

However, standard treatments for ADHD in older adults involve therapy, psychological counseling, medication, skills training, and mindfulness meditation. But combining all these treatment options has proven to be the most effective. Apart from getting the proper medication from doctors, older adults with ADHD can also seek the help of an ADHD coach or therapist to help them identify and address areas in their lives that require attention.

Sources
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  • McDowell, J. D. (December 4, 2019). 3 Rules for Evaluating and Treating ADHD in People Over 50. Retrieved on June 10, 2020, from https://www.additudemag.com/adhd-in-adults-treatment-evaluation/
  • Nadeau, K. (April 9, 2020). A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60. Retrieved on June 10, 2020, from https://www.additudemag.com/adhd-in-seniors-diagnosis-and-treatment-after-60/
  • Robinson, K. M. (October 10, 2016). Just Diagnosed: ADHD Later in Life. Retrieved on June 10, 2020, from https://www.webmd.com/add-adhd/features/aging-and-adhd
  • Schwartz, M. A. (October 2002). Adult ADHD: Less hyperactivity but lingering inattention and distress. Retrieved on June 10, 2020, from https://www.mdedge.com/psychiatry/article/59648/neurology/adult-adhd-less-hyperactivity-lingering-inattention-and-distress
  • WebMD. (October 15, 2019). Risks of Untreated ADHD. Retrieved on June 10, 2020, from https://www.webmd.com/add-adhd/childhood-adhd/risks-of-untreated-adhd