As a psychologist who has spent the past several decades thinking and writing about ADHD in its various manifestations, I have always tried to focus on segments of the ADHD population that have been under-served – adults when most thought ADHD was a disorder of childhood; girls and women when most thought it was a disorder primarily affecting males. Now, I have turned my attention to a large and growing group that is remarkably underserved - those over age 60 with ADHD– a topic about which there is almost no research. My hope is that by focusing on issues of aging, my preliminary research will spur interest in how best to diagnose and treat people with ADHD in their later years. I hesitate to call them the “retirement years” because many older adults with ADHD are woefully unprepared for retirement due to a lifetime of poor money management and under-employment.
I have launched into a project to individually interview older adults with ADHD and will share with you some of my preliminary findings, having interviewed approximately 50 older adults to-date. The themes they present to me include:
Difficulty finding someone to treat them. Psychiatrists and primary care physicians need to become more aware that ADHD is often a disorder that needs to be treated over a lifetime. Many physicians either “don’t believe” that a 60-something or 70-something could have ADHD or are simply not experienced enough to be comfortable prescribing stimulants to older adults given the likelihood of more complex health concerns. And yet the majority of adults that I have spoken to have reported finally, after much effort, finding a more enlightened physician and benefitting greatly from stimulant medication.
Appreciation that someone is paying attention to older adults I have found people to interview largely through advertising in Additude Magazine – a small classified ad announcing that I am studying older adults with ADHD and am looking for people to interview. The response from my interviewees has been one of excitement and appreciation. While I offer each interviewee complete confidentiality, most that I interview are excited to be part of this exploration of uncharted territory and tell me they are eager to share their experiences with others.
Stories of brave re-invention One of the unexpected patterns I’ve come across are repeated stories of huge risk-taking and determination to remake their lives. As some older adults have come to understand and accept their ADHD they begin to reject the circumstances in which they had lived due to low self-esteem and lack of confidence. For example:
A man, long-married to a dominant and critical wife upon whom he depended to manage all aspects of his small, struggling business. He told me of being diagnosed with ADHD, taking stimulant medication, having bariatric surgery to combat his chronic obesity, and starting a business that is enormously successful. His new business grew out of one of those quirky “ah-hah moments” that so often occur to people with ADHD; his wife no longer dominates him nor manages his business and he has a new lease on life.
A wife, psychologically trammeled by a very dominant husband who had been repeatedly unfaithful to her. She was diagnosed with ADHD, received medication and support. Because her children were older, she was able to return to school to complete the college education she had abandoned when she entered her early marriage. She left her marriage and struck out on her own in her late 40’s. Years later, she has a satisfying career and enjoys her life as a single woman.
In both of these cases, the diagnosis and treatment of ADHD was the trigger for a cascade of changes that led to self re-invention in mid-life.
Stories of regret and loss In contrast to these stories of re-invention, I have come across stories of loss and regret – stories of people whose lives have gone downhill as their job demands or supervisors changed in ways incompatible with their ADHD. Stories of jobs that were ADD-friendly until technological changes or changes in management led their job to become untenable; stories of people forcibly “retired” as a result of these changes who were living in very financially challenging circumstances as a result.
Does ADHD get better or worse? Not surprisingly, the answer depends upon the individual and his or her circumstances. Some people have told me that they have never been happier since retirement. They no longer have the daily pressure of their job and are enjoying a life in which they are well integrated into their community through volunteer work and creative outlets. In sharp contrast, others tell me of multiple health concerns, social isolation and struggles to simply keep up with the demands of their daily life. Not surprisingly, those that seemed to feel and function better had structure and social interaction in their daily lives.
Little support or information about ADHD available to older adults Almost universally, people I’ve interviewed have told me that they have found little support or information for older adults with ADHD. Support groups are largely focused on helping parents of children with ADHD. Almost nothing has been written for older adults with ADHD to help them understand and cope with the challenges that come with later life.
Next steps for the professional community We need to make a focused effort to educate physicians about the viability and effectiveness of treating older adults with psychostimulant medication. We need to educate coaches and psychotherapists about the particular challenges facing older adults with ADHD and how to address those challenges. In the US alone, over 10,000 baby-boomers fall off the workplace assembly line into the land of Medicare each day. If we conservatively estimate that 3 percent of them have ADHD (I believe it’s higher), then over 100,000 Americans enter the world of older adults with ADHD each year, with no services, support groups or information to guide their way. Perhaps APSARD can play a pivotal role in increasing awareness of the needs of this rapidly growing population.
Dr. Nadeau will be presenting at the 2018 APSARD Annual Meeting on “Outside the Pill Bottle: Assessment and Management of Adult ADHD.”