The Science Behind Diagnosing and Treating ADHD in Older Adults (with David Goodman, M.D.)

Older adults have unique needs and characteristics - including age-related cognitive changes, co-existing psychiatric and medical conditions, and more - that influence evaluation and treatment for ADHD. To better serve this population, clinicians must anticipate and understand these myriad factors. In this hour-long ADDitude webinar, Dr. David Goodman will explain the nuances of diagnosing and treating ADHD in older adults.
Download the slides associated with this webinar here: www.additudemag.com/webinar/a...
4:01 "Why Is ADHD in Older Adults a Concern?"
9:31 The Life Transition Model Identifies Sensitive Transition Periods
10:23 Childhood Diagnosis vs. Adult Diagnosis
18:21 Neuropsychological Studies
19:50 Comorbidity in ADHD Adults Aged ≥50 years
21:51 Psychopharmacological Treatment of ADHD in Adults Aged 50+
23:06 Drug-Approved Ages for Stimulants
26:09 Treatment Guidelines
31:30 ADHD Medication Sequencing
32:12 Side Effects With Stimulant Medication
33:39 Psychotherapy
36:10 Takeaway Points
38:17 Q&A
Related Resources
1. ADHD in Older Adults: Distinct Diagnostic and Treatment Considerations: www.additudemag.com/old-age-a...
2. A Critical Need Ignored: Inadequate Diagnosis and Treatment of ADHD After Age 60: www.additudemag.com/adhd-in-s...
3. Is It ADHD, or Is It Age?
www.additudemag.com/adhd-late...
4. eBook: "Secrets of the ADHD Brain"
www.additudemag.com/product/s...
Subscribe to the ADDitude KZbin Channel: / @additudemag
Follow ADDitude on Facebook: / additudemag
Follow ADDitude on Instagram: / additudemag
Follow ADDitude on Twitter: / additudemag
Visit the ADDitude web site: www.additudemag.com

[@jakebrookesactor]

I thought I was mentally challenged my whole life. After I was diagnosed with ADHD and started taking medicine, the real me came out: I became an actor. This is from spending my whole life introverted and having an immense amount of shyness.

[@wendyhannan2454]

Great positive story, well done .

[@johneaston6523]

James, thank you for sharing your et opening story and for your courage to seek a diagnosis. Your pivot is remarkable.

[@debbiedebbie9473]

Which kind of medicine worked for you ?

[@jakebrookesactor]

Dextroamphetamine. My focus is improved 70 to 80%. Positive side effect is that it has a calming effect.

[@kathleenbeltz7566]

I'm not shy, but I always felt as if there was something wrong with my brain also that no one told me about. I'm on the same medication after trying several different kinds. It's the one I'm sticking with.

[@katella]

I will be 69 yrs old in a couple of weeks. All my life I've had something like a sensory overload with the only option for me being withdrawal. As a result i was described as shy, inconsistent, antisocial, depressed, avoidant, excentric, strange, weird, incompetent, lazy, etc. Now I live alone and have found that I am unable to consistently do what needs to be done. My house is always a mess,as is my garden. My hobbies rarely get attention. I do manage to give my animals the care they need, but am unable to do the same for myself. I have always needed a great deal of downtime. Now I spend hours every day just lying down doing nothing while the work piles up. I can't force myself to attend to anything but the simplest paperwork. My life is just sliding past, when in fact life conditions are better for me now than they've ever been. Ihave been on antidepressants for many years but I don't feel that i am depressed. I feel like I just don't have any energy.

[@barbarafairbanks4578]

Katella- this sounds alot like me. I am just now becoming aware that my inability to consistently initiate things that need doing as a part of daily living may be ADHD and that there may be a med & therapy solution that can help. I have task lists that have sublists with sublists, LOL 😅, and yet the tasks that get done are the ones that MUST be done (or else) - but, usually only at the eleventh hour and pretty much half-arsed 🙄 I think that your contradictory behavior, i.e., taking care of your animals - but not yourself or your environment - & certainly not tackling tasks you know you can 'slide' on, is because the life demands that you know you must do (or your pets suffer the consequences) you do actually feel motivated to do. But, for most everything else...the motivation just isn't there. This is me, also. I have to do everything by sheer will and often feel just worn down, worn out, and de-energized by trying to live this way. I am to the point where I've been able (with alot of hard work just this year) to develop a sort of self-discipline to follow (most days) a regular rise & morning routine that includes grooming (selfcare) eating on schedule, exercising on schedule (this one is still sketchy), and bedtime on schedule...all of this by sheer will. BUT, everything else pretty much falls by the wayside. I am basically force-feeding a strict schedule to myself and it is very hard bc none of it feels enjoyable, or easy (except for my 30min in the sun with my morning coffee, getting early a.m. outdoor light into my retinas to help regulate my circadian rhythm)...which helps with energy regulation and sound sleep. ...AND a very fragile schedule, at that, to the point that any little adverse event, any little thing to disrupt this schedule (life, for instance🤣) upsets the apple cart, and the whole shebang comes tumbling down. 🙄... my little 'successes' all shattered and fallen at my feet, for maybe even a couple of days - because, like you, - I withdraw...from life :-( Takes alot of self-talk to get the gumption to pick myself up, dust off & begin again with 'the schedule'. I happen to know that 'normal' people do not have to try to live their lives like this 🤯 How great it would be, to be like 'normal' people, Right? To just take life as it comes and power through anything thrown our way... So, I am going to try to find help from a professional in the way of ADHD meds & therapy and/or read books on practicing mindfulness ans/or self- tools to help manage - whatever it takes. And I do hope you will do the same, Katella ;)) Wishing you the best💜 please reach out for any assistance you can find. I will do the same👍😀

[@tbainbridge]

ADHD has ruined my life for 40 years , the damage is immense. I wonder if I can fix it despite and have some happiness before I die.

[@ANNEMARGARET0319]

I really didn’t notice the symptoms until later in life just thought that’s how I was… didn’t go to college, it’s now as a post menopausal woman who is divorced, with a house, and a teenaged daughter, I realized I couldn’t handle it all… but didn’t understand why

[@ANNEMARGARET0319]

Very informative, extremely validating. I finally went to see a psychiatrist at age 56, only a couple of years prior did I start to suspect that maybe I had ADHD. I had an idea in my mind of what ADHD was so it never occurred to me that I may have it… But once I explored the possible symptoms… I realized I’ve had it my whole life and things that have happened in my life, and the way I am now make such more sense!

[@fascistscansuckit]

My story too!

[@dianaNfernando]

Just got a diagnosis today of ADHD as a woman of 50 yrs of age. This was so helpful. Thank you so much.

[@flowersunshinemtn]

I’ve experienced and read about ADHD becoming more obvious for women in menopause. I’m now looking back and I see adhd throughout my life but it did not negatively impact -I had a lot of good coping skills and a hi iq but it is very negatively impacting for past five years! I’ve also read about the challenge of dx adhd in hi achieving kids. I’d say I was a hi achiever and post grad I’ve very underperformed and either avoided jobs requiring what I’m unable to do or failed at jobs with too much responsibility and need for follow through and detail work. It seems to me that menopause made me lose all my exec fxn and coping skills. Seems more likely to be ADHD revealed than just aging. I’m YOUNG, at 55.

[@claravitale4510]

I was diagnosed by a teacher friend, and treated by the Psychiatrist that treated my depression and PTSD. I slept almost 24 hours on Concerta, even now I get drowsy sleepy, my mind so rested!!! My self steem was nil.

[@patriciajump9511]

This is so excellent for older patients. I am 72, and although now I am back on generic Adderall and doing okay, there was a miserable five years preceeding this point. Most or all of the turmoil was due to estrogen changes and diagnostic inaccuracies just like you are talking about, plus ineffective and sometimes detrimental medication. It feels like I just am always waiting for the other shoe to drop, where something will change and some doctor won't listen or else does listen but still doesn't know how or doesn't want to help me.

[@yarntoast]

On the mention of primary physicians being prescribers in the US, I have a better relationship with my primary and he is far more accessible than psychiatrists through my HMO, Kaiser. I also see that ADHD is physiological, not psychological, now that I have started medication. I’ve spent my life trying to will and think myself out of what was ultimately a missed diagnosis and my first day of stimulant medication showed me that it was never a matter of willpower, though, or trying harder.

[@parscreationsstapp8419]

I got diagnosed officially at the tail end of getting my Master's degree. I was in my 40s. I feel as if my ability to learn, retain, and remember things, have diminished greatly. I have always had difficulty, so I don't know if it is, or if I worry about it more due to getting older.

[@NotSoNormal1987]

I did do telehealth when I got diagnosed for adhd. And I was initially booked for an hour long apointment. I only got seen because I was getting my son seen and we seemed to have a lot in common as far as the struggles we have. Telehealth makes it much easier to have apointments. I don't have to worry about getting child care for instance. But I also went in open to what the psychiatrist had to say. I wanted screened for adhd. But I what I was after was the right diagnosis so whatever was the apropriate treatment was what I got. Since my diagnosis, I take my adhd meds daily. And I go to therapy to learn skills to manage my adhd in daily life. Pills don't give you skills after all. But they do make it easier to learn those skills that us adhd'rs struggle with. I think that a lot of women are finally being diagnosed after being overlooked in childhood. And that might account for some of the increases in diagnosises. I'm not sure why I was overlooked when my childhood symptoms seem so obvious. But when I was young a lot of people didn't think girls had adhd. I'd say that when my meds are in my system, it almost feels like my brain has a filter when it didn't before. I can organize my thoughts more easily. And every little thing doesn't distract me any more. I also find my meds to be highly beneficial when I'm driving. I've always been anxious about driving since my ability to maintain focus on things has been suspect. But my meds make it much easier to pay attention and keep track of what's happening on the road. There are so many little daily things that adhd effects. And I'm thankful for meds that make it easier to tackle those hurdles. And I'm thankful for therapy to teach me how to get started and through tasks that seem daunting.

[@hanskraut2018]

Thank u for the lecture. Everyone i recommend the adhd science channel playlist from russel barkley like crazy if ur very impressed here your head will explode once you watch that (he is cited a lot not some pseudo science guy, respected)

[@ANNEMARGARET0319]

And thank you for saying the part about distinguishing what you have with who you are. ❤️

[@richardmarshall159]

Thank you Doc,I hope to see you soon👍

[@johndeal4381]

I am 66. I've been treated for depression and anxiety all my adult life. I haven't been able to hold down jobs and ended up on disability. I believe, after watching your video, I have suffered from ADHD my entire life. My psychiatrist is not open to the idea and continues to treat me with Prozac and klonopin. I have always been ambitious but have not known what to do with my life. I can't concentrate to read a book or newspaper, as my mind just wanders off. Sometimes I think I have a brain tumor. I'm going to see a neurologist. Can he diagnose ADHD?

[@wendyhannan2454]

I think maybe you need to see a psychiatrist who specialise’s in ADHD. Good luck 😉

[@johndeal4381]

@@wendyhannan2454 They all say I don't have it. There are no specialists in this rural are. My current psychiatrist says I'm too old to take the meds. I've never had a mental health professional who has ever really helped me. Most of it is prescribing meds, and seeing doctor for 15 minutes. It's a scam in genera as far as I'm concerned.

[@battfamily435]

@@johndeal4381 maybe look for a psychiatrist who can see you vis zoom. Keep looking until you find one you trust and feel they understand you. Don't give you up. There are also some holistic treatments that I'm hesting about like Thetis. Do some research. Good luck.b

[@swim610]

Try finding a psychitrist nurse practioner in your state that does telemedicine and specializes in adhd. They will take time with you

[@3monkeysandamoose]

Neurologists can diagnose ADHD. There is a lot of info about ADHD in older adults and age has nothing to do with stimulant meds. Don't let anyone tell you otherwise.

[@archiebunker4108]

Valuable information and excellent presentation.

[@lovejoy333]

Very helpful and informative information and not sleep inducing at all. Thank you!

[@richardives5526]

Much appreciated, thank you.

[@fascistscansuckit]

Thank you Dr Goodman!!

[@johnries5593]

Curiously enough, I've never been able to remember sequences of digits, except by repeatedly using them (but I am diagnosed with ADHD).

[@patriciajump9511]

:-) Yes! Validating! Thank you!!!

[@johneaston6523]

As is the case the divergence (I avoid the term "disorder") runs in my family and my sister was diagnosed with ADHD and Aspergers decades ago before across-the-board awareness and efficacious treatment were widely available. Given a number of challenges I had in school at the time (focus, working memory, masking, etc.) I suspected I might have it as well but my incredibly stressed single-parent mother angrily and quickly shut me down. Fast forward 30 years my daughter was diagnosed in elementary school with an extreme inattentive/hyperactive presentation. Intellectually I know I should get evaluated but emotionally therapy of any type is extremely triggering for me to the point of inaction.

[@parscreationsstapp8419]

psychiatric? Isn't that a side effect? I really thought and feel like it is neurological, maybe even something to do with the synaptic gaps/ misfiring signals and receivers?

[@robinwhitman8840]

Butterflies

[@drunkrtard]

Zambia. I pick Zambia.

[@debbiedebbie9473]

28:18

[@deniseotoole6776]

Would any ADDH person stay with this introduction??

[@karenscott612]

I'm going to be 65 next month. Unmedicated, unhelped, struggling worse than ever.

[@chrisbuhler3686]

I put the video onto 1.75x and then skipped ahead to the content. Not sure whether I have adhd but there are cures for slow starting videos (and for slowish presenters).

[@badhabits25]

So if your 70, your out of luck?

[@wendyhannan2454]

badhabits I was diagnosed at 75, you need to research the professionals who specialise in ADHD. Go to the best, it will cost you, but it’s well worth it. I found a specialist, and was diagnosed within 20 min of telling my story. Good luck every one never give up.