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ADHD in older adults

ADHD in older adults: First published review of world-wide literature

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On December 16, 2015, our article reviewing the world’s English scientific literature on ADHD in adults over age 50 years was published online in Drugs and Aging, an international journal. While there is a paucity of research, there are enough publications to merit pulling this literature together into one paper. Most of research comes out of the Amsterdam ADHD research group under the direction of Dr. Sandra Kooji. Some preliminary findings:

  1. Prevalence estimated at 3%. To put this into perspective, ADHD prevalence rate for children in the U.S. is approximately 8%, and 4.5% for adults. We know that for most children ADHD symptoms persist into adulthood. While we have prospective, longitudinal studies of ADHD children for 30 years, we do not have this information as the children age past 50 years old.
  2. Only 1 of 5 memory clinics actively screen for ADHD. This will leave many with ADHD misdiagnosed and likely mistreated
  3. Older adults on stimulant medication report better attention and greater ability to manage daily tasks compared to ADHD older adult not on medication.

Our paper reviews a broader range of findings and will be helpful to researchers and clinicians seeking to broaden their knowledge and polish their clinical skills as these patients present for evaluation of cognitive complaints. We look forward to participating in the expansion of this knowledge.

David W. Goodman, M.D.

Dr. David W. Goodman to speak at the American Professional Society for ADHD and Related Disorders in Washington, DC on January 16, 2015.

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This Society is an internationally represented organization of ADHD researchers and clinicians whose goal is to discuss and disseminate the state-of-the-art in ADHD diagnosis and treatment.

I am honored to be invited to present my findings from our publication on ADHD in adults over age 50. The link is brief interview highlighting our upcoming discussion of the topic.

Our paper is the first review of the world-wide English research papers and was published online Dec 16, 2015 in Drugs and Aging, an international journal. This age population with ADHD is a poorly studied group of people. The estimated prevalence of ADHD in people over age 50 years is approximately 3%. In the U.S., this prevalence rate translates to 1.2 million that will grow to 2.5 million by 2050. These numbers don’t include those children and adults now diagnosed with ADHD who will age. Only 1 in 5 memory clinics actively screen for ADHD in their evaluations of people complaining of cognitive difficulties. Therefore many older adults with ADHD are misdiagnosed and provided ineffective treatments.

Physicians are not trained to consider ADHD in older adults so cognitive symptoms may be dismissed as normal age related decline or worse, as early dementia. We know from some limited research that older adults with ADHD treated with medication report better attention and improved ability to manage daily tasks.

Given the paucity of research in this area, I believe that ADHD in older adults will be the next frontier for clinical treatment and research. It will be important to identify how ADHD symptoms manifest in older adults and how symptoms impair daily functioning and quality of life.

My presentation with Dr. Craig Surman, co-author and faculty member at the Massachusetts General Hospital, will highlight the need to focus attention on older adults with ADHD.

David W. Goodman, M.D., FAPA

The New York Times: Older Adults with ADHD

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On September 30, 2015, The New York Times ran an article in the Tuesday Science section on ADHD in older adults. I was interviewed for the article and discussed a former patient age 73 who was first diagnosis with ADHD by me and successfully treated. The article is an introduction into an important clinical area for ADHD heretofore ignored. As we discovered, 60% of children will continue to have ADHD symptoms to an impairing degree into adulthood. The presumption is that ADHD in adults will simply continue throughout one’s life. However, the research is only just accumulating to support this assumption. The largest collection of research in this age group is published by my colleagues in Amsterdam and additional research from other research groups around the world.

Early this year I  wrote an article for CHADD’s Attention Magazine on issues related to diagnosis and treatment of ADHD in older adults. The diagnostic issues and treatment considerations in older adults are more complex. In brief, diagnosis needs to consider medical illnesses, medications, history of head trauma, and other medical illness that worsen thinking ability. Treatment consideration are complicated by the presence of medications and medical illnesses that might limit the use of ADHD medications. Older patients and families considering an evaluation for possible ADHD should see a psychiatrist or mental health professional who has expertise and experience treating adults with ADHD.

Remember, while attentional changes occur in those of us over age 50, the cornerstone for the diagnosis of ADHD is the presence of symptoms since childhood that are relatively chronic and unchanged over one’s life and that these symptoms cause impairment in daily functioning. A comprehensive evaluation of all possible psychiatric and medical is critical for the accuracy of the diagnosis.

David W. Goodman, M.D., FAPA

Dr. David W. Goodman featured as ADHD expert in The Washington Post article’s December 17, 2013

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The Washington Post took the initiative to write an article in today’s (December 17) paper on ADHD in adults ages sixty and older. This article is also accompanied by a sidebar article discussing adult ADHD Older adults with ADHD are a group that has not been specifically researched and about whom very little is written. The Washington Post article includes two or three people with ADHD who were diagnosed much later in life. They speak about their lifetime experiences with untreated ADHD and the positive change they and others have noticed with treatment.

Imagine that you spent 60 years of your life distracted, disorganized, forgetful, and chronically tardy.  Imagine that you have dropped out of school, lost jobs, or were divorced as a direct consequence of that state of mind.  Imagine that you seek help from  a professional and you are told that you have a disorder that can be effectively treated.  Imagine your reluctance and hopefulness that these experiences can diminish. Imagine that you agree to treatment and discover that all of these experiences were symptoms of the disorder and not you as a person.  I know, that’s a lot to imagine. At this age, the goal of treatment is not only to treat ADHD  but to help a person understand the difference between what they have (disorder) versus who they are (person).  In my experience helping people, this process helps resurrect a person’s self-image.

I invite you to read these two articles and seek professional help if these  symptoms resonate with your experience. If you are an older adult with possible ADHD, I recommend that you see an expert in ADHD who will be able to make an accurate diagnosis. Because older adults may have both medical and psychiatric disorders in addition to taking medications, it’s critical that an expert be able to distinguish multiple disorders and  evaluate the presence of ADHD accurately. Effective treatment is completely dependent on the accuracy of the diagnosis.
Thank you for your interest.
David W. Goodman, M.D.