Why is ADHD Being Overlooked & Misdiagnosed in Older Adults?
More often than not, doctors mistake ADHD in older (over 50) adults for dementia or having had mini-strokes…
Some people think that just because you’re in your 50s, 60s, or 70s (or older) ADHD doesn’t matter. And, while seniors will often find it difficult to obtain stimulant medication because of its impact on blood pressure, there are still many ways people who discover their ADHD later in life can use that knowledge to achieve success at work and in relationships.
These include everything from finding the right profession to using ADHD-friendly therapeutic interventions like I talk about in several of my books for adults (Adult ADHD, Living with ADHD, ADHD Secrets of Success, and Walking Your Blues Away) and will be diving deeper into here with future posts.
Thus, as an “older adult” myself with ADHD, it perked my interest when I read a new study out of Sweden published in the peer-reviewed journal Expert Review of Neurotherapeutics titled The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults.
The article is primarily for physicians and the lead author, Dr Maja Dobrosavljevic from the University of Orebro in Sweden, argues that older adults are less likely to recognize their own ADHD and their physicians are less likely to correctly diagnose it. More often than not, Dr. Dobrosavljevic argues, doctors mistake ADHD in older (over 50) adults for dementia or having had mini-strokes.
“Our analysis concludes that better approaches are urgently required to screen and diagnose people aged from around age 50 to 55,” writes Dr. Dobrosavljevic. “As we gain deeper insights into the challenges faced by older adults living with ADHD, a comprehensive and tailored approach is crucial for their well-being. We therefore urge the medical community, researchers, and policymakers to collaborate in refining diagnostic criteria, treatment guidelines, and research initiatives that are inclusive of all age groups affected by ADHD.”
The research team reviewed almost 100 different studies, including those on the prevalence, diagnosis, health outcomes, and efficacy and safety of treatment protocols for older adults. What they found was a surprising lack of good data.
“Our results show no studies have observed people over a long time period into older age,” said Professor Henrik Larsson, Professor of Psychiatric Epidemiology at Orebro University. “Research has instead focused on retrospective assessment of childhood symptoms, and this can be unreliable because of age-related memory issues.”
He argues for more trials and studies on how ADHD medications affect older people, because often our response to drugs changes as we age. This is particularly true for the stimulant medications because of their tendency to spike blood pressure, which presents a risk of stroke and heart attack in later ages.
“Essentially,” he added, “this means that more trials are needed into the safety and efficacy of current ADHD medication, including the maximum recommended doses, used to treat this age group — who are at increased risk of other health conditions such as heart problems.”
The team points out adults with ADHD have higher death rates and confounding health issues, although they don’t speculate about whether these are the result of the underlying ADHD or are simply associated with people having a non-typical neurochemistry that causes them to take risks or abuse substances in ways that can harm them because they haven’t properly come to terms with their own “difference.”
The bottom line here is that ADHD is a neurological difference that lasts a lifetime, although some of the symptoms — particularly impulsivity and hyperactivity — can tend to mellow with age.
For example, when I met Wilson Harrell back in 1993 he was 74 years old and still a bundle of energy.
I was sitting in my office at the company Louise and I owned at the time — an advertising agency in Atlanta — when this well-dressed gray-haired guy marched in and announced in a friendly but loud voice: “You wrote a book about me!”
The founder of multiple successful companies and the publisher of the business magazine Inc., he’d tracked me down in Atlanta, where we both lived and worked, after reading my take on ADHD in my 1993 book that’s now been updated and re-titled as ADHD: Hunter in a Farmer’s World.
He was writing his own book that year, For Entrepreneurs Only: Success Strategies for Anyone Starting or Growing a Business, and, when it came out a year later, I discovered he’d included our meeting and conversations in a chapter titled Are Entrepreneurs Born or Made?
Wilson shared my belief that most successful entrepreneurs “have” ADHD, and wrote:
“For the last decade I have wrestled with a very provocative question: Are entrepreneurs born or made? Over and over the question is asked of me when I address entrepreneurs. My answer has been that they are made. I go on to say that the quest for freedom, which we inherited from our forefathers, is the motivational force that sparks entrepreneurship.
“I have never been entirely satisfied with that conclusion, because it left unanswered the undisputed fact that entrepreneurs breed entrepreneurs. There was also the unexplained reality that most entrepreneurs have inherently different instincts, personalities, and characteristics than their fellow man or woman.
“Then I met Thom Hartmann and read his book, Attention Deficit Disorder, A Different Perception, which boggled my mind — as it will yours. If you are an entrepreneur, particularly if you have children, you must read Thom’s book. If you want to know whether you’re born an entrepreneur, read the book and find out. It’s incredible reading for anyone.”
Wilson then proceeded over the next few pages to summarize my Hunter/Farmer theory of ADHD, and added:
“As I examined that list of characteristics, I saw myself and all the other entrepreneurs I have known. In other words, entrepreneurs are endowed with a big dose of hunter genes. …
“The comparison of the traits of individuals with ADD and the traits of hunters are astoundingly alike, which means, if I’m right, that most entrepreneurs could be clinically diagnosed as having Attention Deficit Disorder. All these years I’ve wondered what was wrong with me. Now I know. I have ADD. Not only that, but I passed it on to my children. …
“But back to the ‘born or made’ question. I have always contended that entrepreneurs come from every walk of life. I still believe that without an insatiable desire for freedom, the entrepreneurial bud will never bloom.
“Let me pose an interesting question: Since so much of our lives are affected by heredity, isn’t it perfectly logical that our forefathers also passed some of their “freedom” genes down to us? Would that explain why some dyed-in-the-wool farmers end up being incredible entrepreneurs.
“Then, of course, there’s been a lot of blending and melding of genes over countless generations. So, we end up with farmers who have varying degrees of hunter and freedom genes, hunters who are part farmers, and so on. But it is noteworthy that ADD and entrepreneurship flourish in America, yet ADD is rare in Japan- and so are entrepreneurs. Could that be because Japan has historically been an agricultural society, with little need to fight for freedom?
“To say that Thom Hartmann’s book has seriously affected my life is a masterpiece of understatement. When I think of what I might have been, I am eternally grateful that somehow I survived.
“I cringe when I think of the millions of people who may have become criminals, addicts, and/or failures because they were hunters unable to cope in a world dominated and ruled by farmers. Their self-confidence fatally destroyed by parents, teachers, employers — even friends — who simply don’t understand. I am profoundly humbled when I realize that there but for the grace of God go I — and a lot of you.”
So, as Wilson demonstrated, one of the biggest benefits of discovering ADHD and having a meaningful, functional story about what ADHD is and how you can handle it (like the Hunter/Farmer story) is that it gives you permission to forgive yourself for past errors and impulsive actions that you might not have made if you’d had a better level of insight into your own neurobiology at the time.
Also, as Wilson learned, it’s possible to discover one’s own ADHD at any age, and then use that knowledge to make life both better and easier, even in your mid-70s. One of the first steps, for example, is to make sure that your work life or your retirement activities align with the way your brain is wired.
Another is to exercise more as you age. Studies find that exercise oxygenates the brain, improving focus and concentration abilities, particularly for older adults with ADHD. The form that exercise takes can range from workouts in a gym or at home with weights or machines to simply briskly walking a mile or two every day.
As noted at WebMD, daily exercise helps older adults with ADHD:
“Ease stress and anxiety.
“Improve impulse control and reduce compulsive behavior.
“Enhance working memory.
“Improve executive function. That’s the set of skills needed to plan, organize, and remember details.
“Increase levels of brain-derived neurotrophic factor. That’s a protein involved in learning and memory. It’s in short supply in people with ADHD.”
Similarly, researchers who were published in a peer-reviewed medical/psychiatric journal and reprinted by the National Institutes of Health noted:
“Physical exercise is known to have positive effects on general health and well-being, to bear potential to improve mood and quality of life, and to reduce stress responses. In addition, a growing body of literature suggests beneficial effects of exercise on symptoms of attention deficit hyperactivity disorder (ADHD).
“Improvements in neurobehavioral functions have been demonstrated, including reduced impulsivity and hyperactivity, improved attention, and enhanced performance on executive functioning tasks. Moreover, an association between increased exercise levels and alleviated ADHD symptoms in the general population has been found. Interestingly, the neurophysiological changes found to be induced by exercise considerably overlap with the neuropathological mechanisms implicated in ADHD.”
An old friend and Harvard professor of psychiatry once told me that before he would write prescriptions for ADHD adults he required them to begin a regular exercise regimen. He noted that frequently, after really engaging in serious exercise for a few weeks, his patients would come back to him and say they no longer needed medication or only needed a very small dose compared to what they were expecting to need or had been using.
Louise and I have found this to be a big help in our lives (although she’s the farmer in the couple). We walk about 2 miles every day and climb a small mountain near Portland on weekends.
We often get our best ideas while walking, the same as Charles Dickens noted (he’d sometimes walk for hours when stuck on a writing problem or to get inspiration).
This match-yourself-to-your-life-concept and lifestyle will be a topic — across all ages — that I’ll write about at length and in detail here in future articles. Thanks for joining us!
November will be our first workshop for paid subscribers on ADHD via Zoom. It will be about understanding and working with time and setting goals.