Attention-deficit hyperactivity disorder (ADHD) was once — and sometimes still is — viewed as a condition that affects only children and young adults. But many adults have ADHD, too, and experience symptoms that can impact their health, relationships, and careers.
New research published on September 19 in the Expert Review of Neurotherapeutics shows there are major gaps in knowledge and recommendations on how to screen, diagnose, and treat ADHD among older adults 50 or older in particular.
That’s partly because existing screening tools aren’t always effective for identifying ADHD in older adults, per the review. There’s also very little national and international guidance for health providers on how to treat older adults with ADHD.
This is problematic because as many as 90 percent of adults who meet the diagnostic criteria for ADHD didn’t have ADHD during childhood, according to a review published in 2020 in the Harvard Review of Psychiatry.
It’s also estimated that fewer than 20 percent of adults with ADHD are currently diagnosed or treated, per a review published in January 2023 in the Journal of Health Service Psychology.
“Our analysis concludes that better approaches are urgently required to screen and diagnose people aged from around age 50 to 55,” said lead author Maja Dobrosavljevic, PhD, a postdoctoral researcher at the University of Orebro in Sweden, in a press release.
In the United States, ADHD affects an estimated 4.4 percent of U.S. adults, according to the National Institute of Mental Health.
ADHD Symptoms in Older Adults Are Often Missed or Misdiagnosed
To evaluate ADHD screening, diagnosis, and treatment guidelines in older adults, the authors reviewed nearly 100 studies that included more than 20 million adults, including 41,000 people with an ADHD diagnosis.
Highlights of the findings include the following:
- No research has been done to observe people with ADHD as they reach older age. Most research on ADHD diagnosis in adults has focused on retrospective assessment of childhood symptoms or self-reporting of symptoms, which can be unreliable due to age-related and ADHD-related memory issues.
- Sometimes, older people may not be diagnosed because the symptoms of ADHD can resemble the natural process of aging or early stages of dementia.
- Although the current diagnostic criteria for ADHD in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5), and the World Health Organization’s International Classification of Diseases (ICD) have shifted to include more information on diagnosing adults with ADHD, these criteria haven’t been studied in older adults. As a result, researchers don’t know how effective they are at identifying ADHD in older adults.
- Most screening tools for ADHD don’t work as well for identifying ADHD in most people over 50. It’s likely that only the most severe adult ADHD would be picked up by these tools.
- ADHD in adulthood is associated with mental health issues like anxiety and depression, illnesses such as cardiovascular disease and dementia, and increased risk of death from unnatural causes like accidents, which is why diagnosis and treatment is so important.
The authors of the review also emphasize the importance of knowing how ADHD symptoms may appear in older adults, adds Frances R. Levin, MD, the Kennedy-Leavy Professor of Psychiatry at Columbia University in New York City, and an internationally recognized expert in adult ADHD.
“When [older adults] have problems with concentration or focusing or procrastination, don’t assume that it's because they're older and they have cognitive deficits,” says Dr. Levin, who was not affiliated with the review. “They could — and that's a possibility — but they also may have unrecognized ADHD.”
Only 1 in 5 Adults With ADHD Are Diagnosed or Treated
Among people with ADHD who were diagnosed in childhood, it’s estimated that between one-half and two-thirds will continue to have symptoms into adulthood, according to the aforementioned Journal of Health Service Psychology review.
And as mentioned earlier, fewer than 20 percent of adults with ADHD are currently diagnosed or treated. That percentage may be even higher in older adults.
In addition, for people who are now in their fifties or sixties, ADHD was not a common diagnosis when they were younger, Levin points out. Health providers may more often consider conditions like depression or anxiety for this age group rather than ADHD, she adds.
Even though the rates of ADHD diagnosis in adults are growing, many experts believe ADHD still remains underdiagnosed in adults because diagnostic criteria for ADHD were originally developed for children, and because adults with ADHD often have cooccurring psychiatric disorders that may mask the symptoms of ADHD, says Levin.
This is also true in addiction medicine, she says, adding that mental health professionals who treat people with addiction should also consider coexisting ADHD. That’s because ADHD is linked to a greater risk of developing a substance use disorder, according to the American Academy of Pediatrics.
“It's often the diagnosis that people forget to think about or talk about,” says Levin.
Getting an accurate diagnosis is important if you have the condition because, if untreated, it’s associated with a lower quality of life for adults. “For example, it can cause someone to miss career opportunities, get fired from jobs, and have difficulty in relationships, says Levin.
Adults with ADHD are also at increased risk of accidents and injuries and death from unnatural causes, according to a review published in June 2021 in Neuroscience and Biobehavioral Reviews.
First U.S. Guidelines on Adult ADHD to Be Released by Next Year
This review is timely given that the American Professional Society of ADHD and Related Disorders (APSARD) has announced plans for developing and publishing guidelines for diagnosis and treatment of ADHD in adults.
“The absence of guidelines in the U.S. will be answered by our organization under the parameters of the Institute of Medicine,” said Ann Childress, MD, President of APSARD, in a press release. “Our evidence-based guidelines will advance the care of patients everywhere in this country. Doctors are often surprised to hear that there are no guidelines for adult ADHD in the U.S.”
Levin, who serves as co-chair of the committee creating the guidelines, says she expects the new guidelines to be released within the next year.
Symptoms of Adult ADHD? Talk to Your Doctor
If you suspect you have ADHD that has gone undiagnosed or you were diagnosed as a child but ADHD continues to negatively impact your life, know that there are health providers throughout the country who focus on adult ADHD who can help you, says Levin.
“If you don’t have an expert in your area, ask your doctor to refer you to a general psychiatrist,” Levin advises. “Many are trained and comfortable in diagnosing and treating ADHD in adults.”
In adults, the symptoms of ADHD may include:
- Frequent interrupting
- Impulsiveness
- Difficulty concentrating
- Inability to stay organized and follow through on tasks
- Difficulty meeting deadlines
- Restlessness
- Frequent mood swings
- Trouble coping with stress