ADHD Over 50: Old Age, ADHD, or Something Else? (with David Goodman, M.D., FAPA)

In this hour-long ADDitude webinar, David W. Goodman, M.D., FAPA, leads a discussion for clinicians on how to identify ADHD symptoms in adults over age 50, how stimulants fit into a treatment regimen for patients who are taking multiple medications, and more.
A note: This episode is designed for ADHD clinicians, but open to adults with ADHD. Although all are welcome to view the replay, non-clinicians may want to notify the professionals with whom they work of this opportunity and share the audio and slide materials.
Download the slides associated with this webinar here:
www.additudemag.com/webinar/a...
5:19 ADHD in Older Adults
8:09 Diagnostic and Statistical Manual 5 (DSM 5)
10:51 Onset of Symptoms vs. Time of Diagnosis
12:10 Diagnostic Overlap
14:19 Prevalence: How Common Is It?
16:21 Adult ADHD Prevalence Longitudinal Aging Study Amsterdam
16:54 Identification and Assessment of Late-Life ADHD in Memory Clinics
23:44 Psychopharmacological Treatment of ADHD in Adults Aged 50+
24:53 Medical Illness Considerations in Older Adults
26:37 Impairment: How Does ADHD Affect Daily Functioning?
31:16 Monitoring
35:00 Comprehensive Role of the Therapist
36:10 Take-Away Points
38:24 Q&A
Related Resources:
1. Read: A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60
www.additudemag.com/adhd-in-s...
2. Read: Menopause, Hormones & ADHD: What We Know, What Research is Needed
www.additudemag.com/menopause...
3. ADHD in Older Adults: Distinct Diagnostic and Treatment Considerations
www.additudemag.com/old-age-a...
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[@ExkupidsMom]

I was finally diagnoseed at 61, and my entire life looks diffeerent post-dx. I no longer beat myself up; in fact, I see my successes in life as heroic, because I overcame immense obstacles through my own determination, being completely unsupported. It changed my life.

[@annsan1722]

I was diagnosed at 56 when I was looking for help because of huge anger issues, road rage, increased forgetfulness and massive sleeping problems. Turns out that I obviously compensated my ADD to a good degree in former times (costing me chronic exhaustion and the feeling of not reaching my potential because of it) and then wasn‘t able to do so any more under changing conditions: - much less sports because of orthopedic problems - severe sleep deprivation due to additional OSAS (having chronic sleeping problems since I can remember) - a huge chance in my working place due to a new boss leading to very chaotic and unpredictable conditions with which I can‘t cope that well (my collegues have difficulties too but are better in coping) Now I‘m with APAP at nights and under stimulant medication and my life quality and also skills improved a lot. Being a woman in post menopause I was thinking about additionally taking hormons too, but I‘m not convinced yet. Still have to talk to my GYM, but I guess this won‘t be helpful because most physicians here in Germany simply don‘t believe in ADD, especially in adults (as my GP doesn‘t either)

[@richardmarshall159]

Thank you, Doc🧑🏼‍🦲

[@SN-sz7kw]

In Germany - could not get ANYONE to diagnose me as I was female & over 50. Was told ADHD & menopause have the same symptoms. Seriously? My menopausal sisters did not struggle as I did and did not have the same history. I finally flew back to the US to a clinic specializing in adults. Diagnosis was straightforward. Changed my life - I now have a psych who trained in the UK who gets it. It also facilitated the diagnosis of my daughters. The school resisted because they were well-behaved. Infuriating. My diagnosis opened doors. Treatment changed their lives almost instantly and very dramatically.

[@craftylilhandses]

Gut zu hören - I'm 36 and was very recently diagnosed which caused the question whether my dad might have ADHD, too. I live in Scotland, he lives in Germany and will turn 70 tomorrow. I'm being told help for 50+ up is near enough totally unavailable, not least thanks to shitty old stereotypes. In our cases we both present with significantly more of the inattentive than the hyperactive symptoms. I'm flying to Germany to visit today and will have to have a long conversation with him... I don't believe you can ever get 'too old' to try to make your life easier but I do worry about the the psychological impact of a potential diagnosis at this really quite advanced age and after a lifetime of comorbidities smashing the shit out of him more than the underlying ADHD. Fingers crossed.

[@fascistscansuckit]

'What they believed was them, was in fact a treatable disorder.' Louder, for those in the back.

[@storm1968eu]

as time passes and life progresses the challenges shift too. so some difficulties fade to the background because of experience and more refined coping strategies, but new ones emerge. at 53, and in great health, i still talk to my ADHD-coach every month for an hour. i concluded about 5 years ago that this routine would be essential to keep me on a safe and healthy track for the rest of my life, in addition to medication (Methylphenidate 18mg MR). although, i decreased the dose over the years (54mg at one point) but even one day on 27mg can exhaust me nowadays. i am a bit anxious about getting old and losing my grip 'again' on memory, organising, communication and social skills. i guess it will be a work in progress untill the very end.

[@wendypulaski5000]

I have had symptoms all my life, recently dx at 60, I was the day dreamer, able to do hard problems not the easier questions, what made me seek dx I could point out how I dealt it compensated etc. I just want to be successful,

[@newn0z]

I can't remember 20 years ago. We tend to live in the moment and forget yesterday IMHO. :)

[@michelebence4308]

Nora Watts Hi Nora. I agree about the memory problems. Im 61, only diagnosed last year. Explains so much of my life. Im from Australia. Cheers Michele Bence

[@mkm8149]

yes, I live very much in this very moment, Life is Grand, life is so interesting! I remember the past, but it is not part of my present. I am not who I was a moment ago before I wrote this. Love to all, its all that really matters.

[@sherrisolomon8673]

@newn, 😮Never had that problem. I guess because I have more the ADD type of adhd.

[@bronwenperry2245]

wonderful! Thank you so much Dr. Goodman 🙏🏽

[@bruji2001]

Thank you for this very informative video! 🇬🇧

[@jwiki1]

Having to travel to a different pharmacy every month for med refills is very annoying to those of us who need meds for ADHD. Over the course of a year I went to 7 different pharmacies in order to refill my medications. It was a pain in the a&& for me as a 57 year old who is super busy between work and outside life. I finally decided I was sick of being told to check other pharmacies in crappy neighborhoods and stopped taking the stimulants for my ADHD. The stigma and difficulty getting meds for those of us with this diagnosus sucks!!

[@stoneneils]

Same everywhere, in fact some countries don't even prescribe stimulants for adhd. I have to go through hoops everytime i lose my doctor...see a social worker, psychologist, doctor THEN psychiatrist who just writes it out and says good luck. Its not even the psychiatrist who decides, its everyone else. I guess because the psych knows it works and want to give it.

[@PVVI2015]

Thank you!

[@autisticexpressiongenx]

amazing expose thanks

[@Poemeloentje3310]

Great info!

[@fascistscansuckit]

Plan, organize, anticipate: my persistence and the high value stuff of parent demands meant that I persisted, learned compensatory do-arounds in order to get sh*t done. But if it weren't for my high energy level, I would have driven myself to exhaustion in my early life as a parent.

[@jimwilliams3816]

10:50: I don’t completely agree with the notion that symptoms must remain unchanged over time. If by that you mean have the behaviors been present throughout life, that’s one thing. But if the means the issues remain static in their severity, I disagree. ADHD is a condition that affects executive functioning, and my understanding is that this can be one reason it can present less once a person has reached adulthood and the PFC has fully developed. If so, by the same token, the effects of age and stress on the PFC may cause behaviors that became more manageable in adulthood to worsen again in later life - executive function can decline in older people without reaching the threshold of dementia. I believe this to be the case with me. My ability to manage certain traits has gradually diminished since age 50, and became truly problematic after about age 58. Those traits were always there. But I could manage them better before. My parents had the same experience. I am also a little appalled at how blithely the topic of “faking it to get stimulant medication” was touched on. I am well aware of college students taking stimulants to cram. Is there a basis for believing older adults are trying to game the system to get these drugs? I’m pursuing an assessment, and my interest is in understanding what is happening to me. From other mental health forums, I have observed that to be the primary concern of most people.

[@RavenVapor873]

Who decides whether a person is self-medicating or abusing a medication? Just because the drug isn't prescribed doesn't make taking it abuse. We have some very restricted medications because they have been abused. So restricted that we now have shortages due to DEA restricting production. This hasn't been addressed and it's harming a lot of people, young and older people. We rely on these meds but they are labeled and treated differently because some people have abused them. College kids using them to enhance their ability to study doesn't constitute abuse. Abuse is taking more than necessary and it continues for a length of time. Why not say legally prescribed instead? People will abuse anything if that is their goal. People self medicate with alcohol but it is not considered to be like using stimulants without a prescription. Alcohol is a drug and it's responsible for a very high rate of deaths and accidents leaving people disabled. But it's legal (thanks to their lobbyists and greed of the industry) so it's not looked at the same way. The drugs that are legally prescribed and labeled as a scheduled 2 drug (or a 1) can be very addictive and cause serious side effects. Look at drugs like gabapentin and Cymbalta for instance. I know personally how harmful and these drugs are. I weaned off both of them very slowly and I still suffered with horrible withdrawal symptoms. I can't take them and I won't. I know many others who have had very similar experiences. So, we're talking about the law and how meds are classified. It's called abuse if they are not prescribed by a physician. That doesn't constitute abuse. It's because of their classifications. Addiction is poorly understood and that label is misused constantly. Dependece is very different from addiction. Why are people so confused about that word? It's not interpreted the same way consistently. I think the word abuse is the same way. If a drug helps a person and they can't get a script for it or they can't afford it what are they supposed to do? We have mislabeled and misinterpreted words that are very helpful for millions of people - so they are much more difficult to obtain. Self medicating is one of the only options. More restricted drugs create "abusers" simply because they weren't legally prescribed. So, I don't buy that term. Also, at what point are substances considered to be addictive or highly abused? I think it's time to reevaluate those terms. I have a very difficult time listening to certain podcasts that use those terms and just accept them without question. I've been adversely affected by terminology involving medications for established conditions. Hasn't anyone else looked at this as a serious problem with treatment and life in general? I've been mislabeled my entire life. I'm not going to be quiet about it anymore. Especially now when the government (especially the DEA) have vilified many drugs that DO help people with different types of conditions. They don't look at the individual as a whole. Instead, we're seen as viable abusers or addict's. How on earth is that helpful for anyone ⁉️🤔 On the whole I do find many of these podcasts are extremely helpful to get a much better understanding of what is affecting me. I just can't believe that I didn't know anything about ADHD in regards to myself for my entire life. Do I want a do over?? - No. Or maybe. It's not possible so I'm not going to ponder it for more than a sec. I already constantly waste my time lol 😂

[@ammabee3693]

It seems like short term memory stability over time could help identify Comorbid or differential conditions. It’s a pretty easy measure

[@SoldierOfTheRose]

This makes me feel like I've never really known me.

[@fascistscansuckit]

I am finally getting to know myself after being diagnosed mid 50's, about a year ago. Stimulants have been light flipping a switch: never knew how much compensating took out of me, until I didn't have to do it any more. Look into youtube vids by a top researcher, Dr. Barkley.

[@mauricefemenias9752]

I am 53 just knew 5 years ago wjth accident i discoverd plus ptsd ..on meds 2 years gave ot taking supplements and meditation etc

[@fascistscansuckit]

And too bad that the half baked barely trained "professionals" that **might** take your insurance have no training in recognizing neurodivergence, but DO have training in mood and personality disorders. Yep. Very typical of especially older adult women, to have gone lengthy periods of their adult life being told they have anxiety/depression/bipolar, etc. and do not respond to typical meds for those things...and then one day get before a practitioner who actually does listen, gets prescribed stimulants, and then a freaking switch is flipped. And then they are getting to know themselves in middle life. Yes, medical misogyny is a thing, too, in why this happens. ***Ask me how I know.***

[@RavenVapor873]

💯💯💯‼️ I hear you! It's absolutely true! So many doctors are afraid to prescribe a scheduled 2 med - they're flagged as being a prescriber of "highly abused meds" and the DEA keeps an eye on them. It's the same way when prescribing opiates. We're all considered to be at risk. It is so absurd. Then the idea that ADHD people are very prone to drug abuse and addiction. I resent being treated like cattle. I've been on both and I've never abused them. I mean NEVER and I've been using opioids since I was 11yrs old. It's such nonsense 🤦‍♀️