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Child Psychiatrist /Adult Psychiatrist

ADHD Underappreciated in Older Adults

Updated: Dec 15, 2023

ADHD in Older Adults

Adult ADHD is a condition that is often underappreciated in older adults, with less than half being diagnosed and many never receiving treatment. Negative consequences can include job loss, suppressed income levels, low educational attainment, and difficulty maintaining relationships. Primary care physicians or family medicine clinicians are often best placed to diagnose ADHD in older adults, but they may struggle to distinguish ADHD symptoms from other conditions of aging such as mild cognitive impairment.

Although no formal US guidelines exist on diagnosis of adult ADHD, adults usually present with symptoms such as chronic forgetfulness, distractibility, or procrastination. Hyperactivity is more internalized as a feeling of internal restlessness in this age group, rather than the more visible hyper behavior seen in children.

To assess the possibility of ADHD, clinicians can use a six-item screening test or a longer 18-item screening tool developed by the World Health Organization. To make an ADHD diagnosis definitively, a patient needs to report sustained difficulties in at least two aspects of life: work, home, or social situations, and indicate that these troubles began before age 12.

Undiagnosed adults may develop coping mechanisms without being aware of them, such as avoiding socializing, being overly punctual, studying in a cold basement, having structured checklists, and finding ways to work without paper.

ADHD symptoms result from brain differences of disordered self-regulation and executive functioning, and people with ADHD need to learn to think and act differently. On average, three-fourths of adults with ADHD never receive an accurate diagnosis or effective treatment, despite having the condition since childhood.

Over their lifetimes, undiagnosed adults may develop coping mechanisms and compensations, some more helpful than others, without being aware of why they are doing so. Some coping mechanisms may look like obsessive-compulsive behaviors, but the difference between true OCD and ADHD is that true OCD is a more complex condition that requires a combination of medication and lifestyle changes.

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