After more than 40 years of psychoanalysis, behavioral therapy, and bitter frustration, it was a 2006 TV talk show that finally pointed 63-year-old Zophia in the right direction.
“Everyone told me there was nothing wrong with me,” she said. “But I had such yearning, such anguish inside. I wanted to excel, but something was holding me back.” Zophia flipped on the TV one Saturday morning, and the host launched into a frank confession about her own ADHD. “The more I heard, the more I knew she was talking about me, too,” said Zophia.
She made an appointment with a local psychologist, who ordered a battery of eight one-hour tests. The conclusion was unambiguous: ADHD. “After I found out about ADHD, I thought, ‘Gee, Zophia, why didn’t you come up with that answer a long time ago?’”
For John Washbush, the road to diagnosis took seven decades. “For 70 years, I lived my life day-by-day in the dark, totally clueless,” he said. “I got the same instructions as everyone else, I went through the same motions as everyone else, but rarely did I get the same results.”
In his early 60s, he suspected he had ADHD, but it was still a long road to the official verdict. “I was diagnosed at 70 and took my first dose of Ritalin on my 72nd birthday,” he said. “I knew within 20 minutes that I was on a path to discovering the real me.”
Your Brain on Attention Deficit
Zophia and John are among a growing number of older adults who are being diagnosed with ADHD at 40, 50, 60, and beyond. Clinicians report a steady increase in requests for ADHD testing by bewildered yet determined adults who grew up in the 1940s, 1950s, and 1960s, when ADHD was rarely recognized in children, let alone adults.
There is a lack of hard data on the aging ADHD population. Most researchers are reluctant to add the confounding factor of age (50+) to ADHD studies. A few pioneering studies from around the world indicate that the prevalence of ADHD among older adults (ages 45-85) is probably about 3 percent, slightly lower than the estimated 4.4 percent prevalence among adults up to age 44. The prevalence for children is estimated at 8 to 9 percent.
Like Zophia and John, most older ADHD adults have spent years trying to answer a question: “What’s wrong with me?” Most have been previously diagnosed with other psychological disorders, most frequently depression, anxiety, bipolar disorder, and learning difficulties. ADHD coexists with several other conditions, so the original diagnoses were probably accurate but were incomplete.
Identifying ADHD can be tricky at any age. There is no blood test or brain scan that reveals latent ADHD. Instead, behavioral markers gathered through in-depth intake interviews are the gold standard for clinicians evaluating ADHD (as well as depression and other psychological disorders). For a clinical diagnosis of ADHD, the Diagnostic and Statistical Manual of Mental Disorders (DSM-V) requires six impairing symptoms in children and adolescents age 17 and younger. For adults over the age of 17, only five symptoms are required. ADHD may present differently in older adults, leading some researchers to suggest that even fewer symptoms might be appropriate for diagnoses of the 40-plus crowd.
It is challenging to evaluate older adults for ADHD because the normal aging process mimics some classic ADHD symptoms. ADHD symptoms, in turn, overlap with some telltale signals of mild cognitive impairment and early dementia. A clinician has her hands full sorting out the differences.