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By Aakanksha Singh, MD, and Narpinder K. Malhi, MD, members of the Committee on Family at the Group for the Advancement of Psychiatry
When a young adult struggles with inattention, difficulty managing tasks, and trouble completing responsibilities, attention-deficit/hyperactivity disorder (ADHD) is often one of the first diagnoses that comes to mind.
However, what happens when these same challenges appear in an older adult, someone who is forgetful, disorganized, and has difficulty recalling names? Should it be thought of as ADHD, or should it be assumed it is simply a part of aging?
Eleanor, a 72-year-old retired teacher, had always been organized and dependable, but had to put in extra effort and work long hours to maintain this level of functioning. In recent years, however, she began misplacing items, missing appointments, and struggling with routine tasks.
At first, she attributed these changes to aging, but her daughter encouraged her to seek help. Despite two prior evaluations for memory concerns, both with normal results, her difficulties persisted. A more comprehensive assessment revealed a different explanation: ADHD, a diagnosis she had never imagined having at her age.
Eleanor’s story raises an important question: When older adults experience forgetfulness and disorganization, these symptoms might reflect more than normal aging—perhaps a lifelong condition that has gone unnoticed?
Diagnosing ADHD
ADHD is a neurodevelopmental condition characterized by patterns of inattention, impulsivity, and hyperactivity. Although often associated with onset in childhood, ADHD can persist across the lifespan. Increasing recognition of ADHD in the general population likely reflects a combination of improved health literacy, greater public awareness through media and social platforms, and changes in diagnostic practices.
Research estimates that approximately 2.18 percent of older adults meet criteria for ADHD, highlighting a growing need for clinical awareness and appropriate care. Emerging evidence also suggests that ADHD may be more common in older adults than previously thought, although it remains underdiagnosed in this population.
Despite this increasing recognition, identifying ADHD in older adults is a challenge. Many of the diagnosis’ core features present differently with age and can overlap with typical cognitive changes. For example, instead of overt hyperactivity, symptoms often appear as difficulties with executive functioning, the latter being a term referring to the mental skills used to plan, organize, manage time, and complete tasks. These challenges may appear as forgetfulness, trouble following instructions, or difficulty keeping track of daily responsibilities.
For individuals like Eleanor, these symptoms can be misattributed to normal aging or early cognitive impairment. Even after extensive testing, persistent inattention may continue to be interpreted primarily as a memory problem rather than part of a broader pattern of ADHD. This misattribution can delay appropriate diagnosis and treatment, affecting a person’s quality of life and day-to-day functioning.
The Hidden Burden of ADHD in Older Adults
ADHD in older adults rarely exists in isolation. It is often accompanied by a range of other mental health conditions that can complicate making a diagnosis and contribute to overall impairment. Substance use, including alcohol, nicotine, and other drugs, is frequently reported in individuals with ADHD.
Psychological well-being is also affected. Lower self-esteem, reduced confidence, and diminished quality of life are frequently reported, often shaped by years of unrecognized and untreated symptoms. Social and interpersonal relationships may be similarly affected. Individuals with ADHD often describe feeling misunderstood, socially isolated, or in conflict with others, sometimes leading to smaller support networks and greater emotional loneliness.
Despite these challenges, individuals with ADHD often possess unique strengths and abilities. Many individuals describe creativity, enthusiasm, and the ability to focus intensely on topics of interest as positive traits. Over time, adaptive coping strategies may emerge, contributing to resilience and continued engagement in meaningful activities in later life.
How Can Mental Health Professionals Help?
Things mental health professionals can do to support older individuals with concerns for ADHD include:
- Prior to making a diagnosis of ADHD, clinicians should consider other conditions such as mild cognitive impairment, anxiety, substance-related factors, and behavioral factors. Clinicians should also inquire about the onset and persistence of symptoms as well as obtain a detailed developmental and family history.
- Perform a comprehensive medical workup to rule out other causes, such as thyroid dysfunction and seizure disorders, before establishing the diagnosis.
- Medications such as stimulants and nonstimulants can be considered after careful evaluation of cardiovascular health and potential drug interactions.
- Psychotherapeutic interventions such as cognitive behavioral therapy (CBT), when adapted for ADHD, can help individuals develop organizational strategies and improve emotional regulation while also addressing longstanding patterns of self-doubt that may accompany years of unrecognized symptoms.
- ADHD coaching may provide additional practical support, focusing on skills such as time management, prioritization, and task completion.
- Environmental and lifestyle modifications, including structured routines, regular physical activity, and the use of reminders or simplified schedules, can further enhance daily functioning
Once she had a diagnosis in place, Eleanor began treatment with Vyvanse 20 mg, and she gradually noticed improvement. She became more organized, kept track of appointments, and felt less overwhelmed. More importantly, knowing the diagnosis helped her make sense of lifelong challenges she had once blamed on herself. For Eleanor, understanding her condition brought clarity and a renewed sense of control, highlighting that even later in life, recognizing ADHD can lead to meaningful change.
