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ADHD in Older Adults: Diagnosis and Treatment

If memory and focus problems are plaguing you at midlife, it could be undiagnosed ADHD. Here’s how to tell

ADHD
STUART BRADFORD

I hit midlife feeling totally overwhelmed. I couldn’t concentrate, couldn’t prioritize. I chalked it up to menopause, or maybe just a series of “senior moments.” But then I found a therapist who understood exactly my problem: I had attention deficit hyperactivity disorder (ADHD).

In fact, I’d been living with it all my life — but the drop in estrogen caused by the onset of menopause amplified its impact, and the coping methods I’d always relied on could no longer keep my racing mind in check.

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If focus and memory issues have been dogging you, especially if you’ve experienced menopause and noticed that they’ve gotten worse, read on.

Hormones, ADHD and the older brain

Three-quarters of adults ages 18 to 44 who are found to have ADHD were never diagnosed as children; among adults 60 and older, that number is 100 percent, says David Goodman, M.D., assistant professor of psychiatry and behavioral sciences at the Johns Hopkins University School of Medicine. That’s primarily because, half a century ago, clinicians simply didn’t know to screen for it in children.

“It’s a neuropsychiatric disorder that starts in childhood and continues your whole life,” he says. “It doesn’t go away when you get your AARP card.”

Hyperactivity, distractibility and executive function challenges (among them time management and impulse control) are all classic symptoms of ADHD. And when women reach perimenopause and menopause, the drop in estrogen can make ADHD symptoms significantly worse.

“Plunging estrogen levels affect short-term memory and the ability to focus, and contribute to the brain fog so many women going through menopause describe,” says psychologist Kathleen Nadeau, author of Still Distracted After All These Years: Help and Support for Older Adults With ADHD.

When estrogen drops at menopause, even ADHD stimulants may lose their efficacy, says Bill Dodson, M.D., a Denver psychiatrist who specializes in adults with ADHD. But the issue seems to affect women specifically. “The level of male hormones such as testosterone seems to have no effect on either the impairments of ADHD or the effects of ADHD medications in males,” he notes.

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Doctors in the dark

ADHD is seldom taken into consideration when assessing older people with cognitive complaints. Only 1 in 5 memory disorder clinics actively screen for ADHD. “People can have ADHD their whole life and they are now developing dementia,” Goodman says. “At that point, you have two processes contributing to cognitive difficulty.”

Menopausal women experiencing cognitive decline should be screened for ADHD, Goodman says, even if they have never been diagnosed with the disorder. Those who test positive have several avenues to explore, often a combination of behavior strategies, counseling and medication.

Stimulants such as Adderall, Dexedrine and Ritalin are typically used to treat ADHD in young people, but many doctors are hesitant to prescribe them to older people. “We were all trained that stimulants cause serious cardiovascular problems,” Goodman says. But he questions how common that is.

A 2020 review of studies in the Journal of the American College of Cardiology found a link between stimulant use and “modest elevations in resting heart rate and blood pressure,” as well as other symptoms, so it’s important that older adults using ADHD medications be regularly monitored by a physician. But the review concluded there’s a paucity of evidence addressing long-term effects of such medication, urging more studies. Dodson argues that the effects observed in the 2020 study were “minuscule” and “of no clinical significance.”

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Some clinical trial results published more than a decade ago cast a shadow on the safety of hormone replacement therapy, but subsequent evaluations have found its dangers to be overstated — while the health risks of plummeting estrogen are well established. Before upping your dose of ADHD stimulants, Goodman recommends asking your gynecologist about a three-month trial of hormone replacement therapy to see if it makes an impact on your cognitive function.

Managing your symptoms

Slowing cognition at middle age and beyond can come from a number of sources, and not all of them are medical in nature.

“Our bandwidth goes down as our stress level goes up. If there’s a family crisis, if there are health problems, our bandwidth is being strained,” Nadeau says. ADHD, whether diagnosed or not, can increase our struggles. People with ADHD have a tendency to overcommit themselves, she says. When you start dropping balls, “that is a sign you need to simplify.”

Those who struggle to reach their goals could benefit from an ADHD coach or a group that helps them stay focused. CHADD (Children and Adults with Attention-Deficit/Hyperactivity Disorder), an education and advocacy nonprofit, offers a network of regional support groups at CHADD.org.

The many symptoms of adult ADHD

Adults with ADHD tend to have a unique mix; there is no cookie-cutter set of experiences. Symptoms may include:

  1. Easily distracted
  2. Leaving tasks unfinished
  3. Disorganizaton
  4. Inability to focus
  5. Physical, verbal and/or emotional hyperactivity
  6. Losing things
  7. Forgetfulness
  8. Trouble relaxing
  9. Poor time management/lateness
  10. Difficulty starting a task
  11. Interrupting others
  12. Mood swings
  13. Difficulty prioritizing tasks
  14. Trouble multitasking
  15. Extreme impatience
  16. Impulsivity or recklessness, with little or no regard for personal safety

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