We know ADHD rarely disappears from childhood to adulthood. So why should it not be found in 2-5% of older adults, as it is for younger adults? Do we grow out of ADHD in our 60’s?
Definitely not! Although It may not look quite the same, ADHD can appear differently in children to adults.
Managing ADHD can be more challenging for older adults.
Misdiagnosed as early Dementia.
As the brain ages, there is a normal cognitive decline. This is especially in the brain’s ability to sustain attention, meaning it has to work harder to stay focused and on task. If you don’t pay attention you are unlikely to remember what you have been doing.
With retirement comes a loss of structure and routine which we know is so important to feeling in control and achieving goals. It’s an excellent coping strategy. So if you have ADHD and are considering retirement, make sure you have enough activities planned to keep your active ADHD brain occupied.
Misdiagnosing the underlying cause of Depression.
If the ADHD brain has not had enough action to keep it healthy, it is likely to get depressed. And if it is struggling with the stress of trying to keep up as before, or adjusting to major life changes, depression and anxiety are risks.
For women, there are hormonal changes with age. Which can affect cognition and which we know are more challenging to adapt to if you have ADHD. Sleep can be disturbed which will impact a person’s ability to manage ADHD symptoms.
Could it be a turning point in older adults ADHD Research and Treatment?
A new meta-analysis of studies from the last 15 years, involving more than 3.9 million participants, concluded that “ADHD medication use was not statistically significantly associated with the risk of any CVD (cardiovascular disease) among children and adolescents, young and middle-aged adults, older adults, or overall.”
The analysis, published in JAMA Network Open, was the most comprehensive to date on the association between ADHD medication and CVD risk. According to William Dodson, M.D. clinicians should not outright disallow ADHD Medication.
Kathleen Nadeau, the author of “Still Distracted After All These Years”, has studied ADHD in Older Adults and recommends that we have specific guidelines to identify and treat ADHD in the over 60s.
Her articles and podcasts are available on the ADDitude website.
The need to take self-reporting seriously.
One major stumbling block may be how to prove a patient had ADHD in childhood. There are unlikely to be school reports. And there may not be family around who knew you back then. We have to accept the patient’s word.
It was hoped that the recently published Australian Evidence-Based Guidelines for the Diagnosis and Treatment of ADHD would be able to provide guidance on the diagnosis and treatment of older adults. However, NHMRC only accepted one research paper. And essentially it found no difference in treatment outcomes for older adults. Dr David W Goodman, an Associate Professor of Psychiatry from John Hopkins University who specialises in ADHD in adults, has the same message.
GPs refusing to refer patients on to a Psychiatrist.
And we are aware of how difficult it is to find a Psychiatrist who will diagnose ADHD.
Then there are roadblocks, especially in NSW. As anyone first diagnosed at 70 or over needs to see another Psychiatrist for a second opinion before medication can be prescribed on the PBS. Some Psychiatrists who diagnose and treat adult ADHD, refuse to do so after the age of 70. Why?
Diagnosis and treatment in older adults are more rather than less important. It can, as in many cases can lead to many years of a productive and satisfying life. Those with ADHD can contribute to society rather than be a burden.
Symptoms that can be managed with a younger brain, may need the added help of ADHD medication as the brain ages.
If only every Geriatrician could add ADHD to their professional toolkit, Neuropsychologists may not be blinded by age.
If you are someone who is having difficulties or you have a loved one who may be asking for a diagnosis or they have been refused treatment, please let us know.
This information will support our work on increasing awareness within relevant government agencies.
Reference:
Zhang L, Yao H, Li L, et al. (2022).
Risk of Cardiovascular Diseases Associated with Medications Used in Attention-Deficit/Hyperactivity Disorder: A Systematic Review and Meta-Analysis. JAMA Netw Open.
https://doi.org/10.1001/jamanetworkopen.2022.43597