Signs of Adult ADHD? Or Old Age?

3.3 percent of adults between ages 44 and 85 have attention deficit disorder (ADHD or ADD). That's 70 million adults, 80 percent of whom don't know they have attention deficit — until life's demands become unbearably overwhelming.

Maybe you are taking care of aging parents and children at the same time. Or feeling lost and listless in your empty nest. Maybe you are grieving a divorce or the loss of a relative. Whatever the cause, your life has veered off track and your normal coping mechanisms aren't working.

ADHD doesn't even cross your mind. More importantly, it doesn't occur to your doctors — and that causes big problems. Here, we’ll explain the signs of adult ADHD in old age, and how to separate it from other cognitive decline.

In normal cognitive aging, implicit memory, crystallized intelligence, and auditory attention remain stable. We continue to remember things that are automatic, like tying our shoes or riding a bike. We remember and recognize faces, even if we can’t always remember names. We can repeat a string of numbers someone tells us, though passwords may escape us.

The following types of attention and memory slow down and decline with age:

• Processing speed
• Executive function (planning, organizing, and executing) 
• Working memory (holding things in our memory while doing something else)
• Selective attention (ability to shut out distractions) 
• Episodic memory (your own autobiographical events)
• Visual construction skills (e.g., putting together a dresser)
• Inhibition of responses (blurting)
• Conceptual thinking  
• Divided attention (multi-tasking) 
• Driving skills (more likely to have accidents)

The italicized symptoms are where ADHD and normal aging overlap. With all of those commonalities, differentiating the two is often difficult.

[How Is ADHD Diagnosed? Your Free Guide]

ADHD symptoms may trace back to your childhood, though they were never diagnosed as such. Think back. Did you lose or forget your homework often enough to exasperate your teachers? Were you branded a daydreamer? Is clutter a way of life? For many years, you addressed these symptoms with personal coping strategies that worked — until life got too complicated and/or hormones tipped the balance.

However, if you look at your life, and think, “I’ve never had any trouble. I got to school on time. I got my papers turned in, it’s just lately I’ve been having problems,” that could be a sign you need further testing for Alzheimer's disease and other progressive cognitive decline issues.

While they often share similar symptoms, there is no known connection between mild cognitive impairment, Alzheimer’s disease and ADHD. If you have any question about ADHD, don’t try to diagnose yourself, see a professional. Your provider will know whether you need to be tested — and for what.

Estrogen sits on the receptor site of the synapse. As neurotransmitters jump the synapse, it acts as a sticky mitt that helps catch them. During monthly cycles and after conception, higher levels of estrogen can help suppress symptoms. During menopause, estrogen drops and can create changes in the brain.

For men, testosterone also declines with age. This drop is not as precipitous or dramatic as the decline in estrogen, but lower levels influence sleep quality, create mood swings, and cause cognitive function decline. When the perfect storm of life stress, changing hormones, and natural aging combine, our life-long compensation systems fall apart. ADHD roars to life even in midlife when you’ve never had a diagnosis.

Dr. Anthony Rostain says, "When an older adult comes in looking for an ADHD evaluation, he or she deserves the same workup as anyone else at any age." You can’t treat the condition without a diagnosis. Treating ADHD, even late in life, can make a difference. Fewer than half of adults with ADHD ages 45+ have ever sought any kind of treatment and only 25% have tried medication.

Before starting a stimulant medication, know that they can cause cardiac issues. Also, as your metabolism slows, you might need a lower dose than is typically prescribed. Their effectiveness is diminished by other medications like antacids and citric acids.

With your doctor, consider whether your ADHD medication plays nicely with your other prescriptions. Bring all of your medications and discuss how they interact with your doctor. Read the inserts that come with the medications to find out more. Ask your pharmacist to weigh in as well.

[The Ultimate Guide to ADHD Medication]

The strategies for improving ADHD symptoms later in life overlap with strategies for improving cognitive function.

1. Use Your Brain: Do intellectually stimulating puzzles. Go back to school. Play a variety of computer games, in moderation. Use your mind in innovative and new ways so that it continues to be challenged.

2. Move Your Body: Exercise is good for everything. It’s easy to forget or to put off because "I'm too busy today.” But it's important; being active helps your brain function.

3. Connect with other people and avoid isolation — whether it’s at home, at work, or wherever you are.

4. Take fish oil and vitamin D supplements. They improve attention, and protect reaction time.

Shock. Confusion. Sadness. Guilt. Relief. All of these emotions — overlapping — are normal following at diagnosis at any age. For older adults, there is often also regret. “If only I’d known about my ADHD earlier, I could have….” ...started my own business.

...finished college.
...learned to forgive my mistakes.

Life is short. The longer you live, the less time there is for do-overs. But that doesn't mean you should give up on dreaming. As a matter of fact, being diagnosed with ADHD can be a fresh start, a brand new way of looking at yourself and your life. You still have the opportunity to live the life you’ve always wanted to live. Rethink your priorities. What do you really value? Maybe it’s spending more time with family, or going back to school. It might be too late to climb Mount Everest, but many of your wildest dreams are still within grasp.

The choice is yours to embrace life with ADHD without letting it define who you are. Letting ADHD goad and guide us to something even more magnificent than we already are — that is the trick.

Go with your flow – not anyone else’s, yours – because you are the only one who has any control over your feelings and reactions. If you struggle with low self esteem, talk therapy can help you change your negative self-talk. It can help you change your attitude toward yourself, understand what has gone on in the past, and begin to give yourself a hug.

Cognitive behavioral therapy is also very good for ADHD. It is practical, and can help you learn the behaviors that let you clean up the piles on your desk or help you be on time. Coaching can help you get on track and stay there.

[What Your Doctor Needs to Know About Diagnosing Adult ADHD]