By Brian Wu, MD, PhD
When many people think about ADHD, school-aged children or teenagers most often come to mind. However, ADHD often follows children into adulthood, including older adulthood.
The Nordic Journal of Psychiatry notes that ADHD has a prevalence rate of 2.8%-3.3% in adults older than 55. In addition, the American Psychological Association notes that older adults are seeking ADHD treatment in greater numbers.
But people need to be aware of special considerations for this population, especially for the most optimal plan of care.
Little Research on How ADHD Affects Older Adults
Currently, there is little research on how ADHD affects older adults specifically; the research that does exist clearly shows the negative impact of this condition.
The Nordic Journal of Psychiatry notes that research has found that older adults with ADHD have many of the same challenges as younger adults with this condition: lower education levels, higher rates of divorce or of never being married, and higher rates of depression and loneliness. Research has also found that older ADHD patients have more quality of life issues, including self-care, mobility, pain and discomfort, and anxiety and depression.
Pros and Cons of Medication Treatment for ADHD in Older Adults
There is also a paucity of research on the effects of ADHD medications on older patients. One study from the journal Clinical Neuropsychology looked at the effects of the stimulant medication methylphenidate on 11 older adults. Methylphenidate is the generic name for Ritalin, a common stimulant treatment for both children and adults with ADHD. The study found 10 of the older adults remained on the stimulant treatment for at least two months and that eight of them reported improvement in ADHD symptoms with only mild side effects.
Another study, published in the Journal of Attention Disorders, surveyed 149 people aged 50 and older who self-reported their ADHD. The study found that 88% of them had tried medications in the past and 64% were on medications at the time of the survey. Survey respondents who were currently taking medications reported more symptom improvement than those who had stopped or never started treatment.
However, there are some potential challenges when prescribing for older adults with ADHD, David Goodman, M.D., writes in ADDitude magazine. To begin with, older adults are often excluded from clinical trials because they have pre-existing conditions or are already taking other medications. This lack of clinical data means that there is not always sufficient knowledge of the effects of ADHD medications in older patients. Currently, Vyvanse is approved for adults up to age 55, while Adderall and Concerta are approved for adults up to age 65.
The APA notes another problem: The side effects from the medications or somatic issues they may cause — where people excessively obsess over physical symptoms — can make taking them more challenging for older people.
In order to reduce this risk, the APA recommends that a thorough history and a physical be part of a patient assessment prior to the patient starting any medication. It also recommends that if medication is used, the patient starts with a low dose. The patient’s physician can gradually raise the dose if there are no problems.
People Should Consider Non-Medical Treatments
Because of the potential issues involving medications for ADHD treatment, the APA recommends that non-medication treatments — including psychological therapies — be considered for older adults. A review in the journal Psychological Medicine found that cognitive behavioral therapy had the strongest evidence for an effective therapy as an alternative to ADHD medicine. The review found weaker evidence for mindfulness training, dialectical behavioral therapy and cognitive remediation. Dialectical behavior
therapy is a type of talk therapy, based on cognitive behavior therapy — but is especially for people who experience very intense emotions. Cognitive remediation focuses on helping people’s “thinking skills.”
The bottom line: While there is an overall lack of research on how ADHD affects older adults, studies have shown the condition does negatively impact adults over 55. While medicines can be a part of treatment for ADHD patients at any age, older adults may be at greater risk for side effects and other complications.
In order to reduce these risks, patients should have a thorough medical history taken, along with a physical. They can start on lower doses of any medication, or use non-medication therapies that might help.