Do you have difficulty concentrating, organizing tasks or completing work? You may be suffering from attention deficit hyperactivity disorder. Here are some signs, symptoms and treatments available.
By Wendy Haaf
Several years ago, a Florida journalist contacted Kathleen Nadeau, a prominent US psychologist, for an expert opinion on whether his mother’s socalled dementia might have been misdiagnosed. The writer’s father, an apparently domineering man, had insisted his wife see a male neurologist, reporting, “she forgets things and she loses her keys.” This led the woman to be labelled as having Alzheimer’s disease. After her husband died, however, “the mother said to her son, the freelance journalist, ‘I don’t think I have Alzheimer’s—I never thought I had Alzheimer’s,’” Nadeau recounts. At Nadeau’s urging, the son took his mom to be assessed by a younger, female neurologist, who agreed with the older woman. The doctor’s conclusion? “You’re right, you don’t have Alzheimer’s—you have ADHD,” says Nadeau.
We’re most familiar with attention-deficit hyperactivity disorder in kids, and boys in particular. Yet in recent years, it’s become increasingly clear that while ADHD (or its counterpart without hyperactivity, ADD) starts in childhood, it often continues to affect people across the lifespan. Since the diagnosis didn’t come into existence until 1968 and the criteria for making it have been based entirely on how the condition typically manifests in young boys, many people 55 and older may well be living with unrecognized ADHD. (This is why, while research suggests ADHD affects roughly 3 percent of older adults, versus 5 percent of younger adults, Nadeau disagrees. “I don’t think that’s true,” she says.)
Chances are, people living with these conditions see their history of problems such as difficulty following through on tasks, ruptured relationships, and career stops and starts due to personal failings like laziness or lack of discipline rather than “one of the five most common psychiatric conditions,” says Nadeau. She is the founder and clinical director of The Chesapeake Center: ADHD, Learning & Behavioral Health in Bethesda, Md., and a leading authority on ADHD. (She is also the author of an upcoming book on ADHD in older adults called Still Distracted After All These Years.) ADHD is “much more common than bipolar disorder,” Nadeau notes, yet psychiatrists who treat adults typically receive far more education about the latter.
As certain events that typically occur around age 50 and beyond can worsen symptoms of ADHD, people with the condition who have gone undiagnosed may experience increasing difficulties that, if unaddressed, can lead to problems ranging from social withdrawal and isolation to disordered eating, anxiety, and depression. For example, former broadcaster Russ LeBlanc of Oshawa, Ont., now 63, has spoken publicly about the bouts of deep depression he experienced prior to learning at age 49 that he has ADHD. (LeBlanc also hosts the podcast Club ADHD.) As LeBlanc looked around at peers whose careers had progressed steadily, he noticed that “I was always starting back at square one. If you can’t explain [why], that’s where the depression sets in.”
For women who’ve been living with the condition, knowingly or not, the hormonal upheaval of menopause can significantly exacerbate ADHD-related problems. For example, while something Nadeau terms “Swiss cheese memory” is a lifelong feature of ADHD. It shows itself as forgetting things you’re about to do, misplacing items like keys, having problems retrieving words, or having brief episodes where your mind goes blank. This can become much more noticeable in the years immediately prior to menopause. (Other common ADHD traits include avoiding or disliking most tasks requiring sustained mental effort, having problems with organization, being distracted easily, and making careless mistakes. For a list of five traits that older adults with ADHD typically find troublesome, see sidebar.)
Why? Estrogen, the hormone that starts tailing off before menopause, affects the production and activity of chemical messengers that are involved in ADHD. For example, there’s a drop in levels of dopamine, which plays a key role in attention and short-term memory; an undersupply of dopamine has been implicated in ADHD. Norepinephrine, which helps enhance mental focus and executive function (this governs abilities such as planning ahead), also declines. As a result, “Women often start feeling, I’m dumb, what’s wrong with me?” Nadeau says. This can even happen to women who have been diagnosed with ADHD and whose symptoms have been well controlled for years with drug therapy. “They can start to think, I’m taking my medication, but I’m not getting any better, so it must be a memory problem now,” explains Dr. Sarah Cook, a Toronto family physician who specializes in adult ADHD. “They start to get worried about Alzheimer’s.”
Another common life transition can also trigger an increase in symptoms. Trading the stimulation of the workplace for endless leisure isn’t good for ADHD brains. “People who have ADHD have an intolerance to boredom,” Cook explains. “So that’s when I sometimes see people come in. They’re complaining about being depressed, but it’s actually not depression, it’s untreated ADHD.” (In fact, ADHD is often misdiagnosed as depression or anxiety, Cook says.)
Boredom is just part of the picture. A job typically imposes structure and routine on an individual’s life. A sudden unmooring from these things can be detrimental to someone with an easily distracted brain. That’s because many of the same habits that help us keep that organ, and the rest of our bodies, healthy as we age are doubly important in managing ADHD.
For starters, not sticking to consistent times for going to bed, getting up, or eating meals can lead to disrupted and insufficient sleep, “and adequate sleep is one of the most important ways to reduce ADHD symptoms,” Nadeau explains.
Organizational difficulties can interfere with an individual’s ability to plan and prepare healthy meals, leading to a tendency to rely on fast food or grab-and-go snacks that can cause blood-sugar levels to boomerang back and forth between extremes. Not only do plunges in blood glucose spark hunger and cravings for empty carbs, these highs and lows interfere with mental focus. Similarly, with no set timetable, exercise—which helps ameliorate ADHD symptoms— often falls by the wayside.
If you think you may have undiagnosed ADHD, it might take some persistence to find a health care provider with expertise in this area. Even many psychiatrists “don’t like to diagnose ADHD,” Cook says. And it’s not uncommon for clinics that do assess people for the condition to charge $1,000 or more than the amount covered by provincial health insurance. Family doctors can often connect you with the resources available in your community.
Once a diagnosis has been made, you and your treating health-care practitioner can discuss what kinds of supports you might find helpful. Many people benefit from medication: either long-acting stimulants or drugs that increase levels of norepinephrine. Each has a different side-effect profile and carries slightly different risks; those risks and any medical conditions you may have will help guide the decision of which treatment might be most appropriate for you. (That said, some physicians are reluctant to prescribe stimulants “because they are controlled drugs,” Cook explains. This means the body that governs physicians has strict guidelines around the use of these drugs, just as they do for opioid pain medications.) Your doctor may also order tests to ensure you don’t have any health issues that could be worsened or complicated by one of the medications. For instance, an overactive thyroid gland is considered a contraindication for stimulant drugs. It is worth noting, too, that many of the medications are expensive, Cook adds. Even if you qualify for provincial drug benefits, some options may not be covered.
However, medication is just one tool for managing symptoms and the practical challenges of living with ADHD. “A psychiatrist named Dr. Lidia Zylowska has found in her research that mindfulness meditation is just as effective at reducing ADHD symptoms [in adults] as stimulant medication,” Nadeau says.
Support groups can also be valuable. “I find a lot of older adults [with ADHD] feel socially rejected, like they don’t fit in anywhere,” Nadeau observes. The shorthand that comes from shared experiences can create a feeling of belonging, and group members can share tips on tactics they’ve found useful. “I think one of the most healing experiences you can have is to find your tribe,” says Nadeau. (Centre for ADHD Awareness Canada maintains a list of support groups in the Resources section of its website: caddac.ca. The organization also offers recordings of past webinars, including one on older adults and ADHD featuring Nadeau.)
Specialized group classes that teach strategies to strengthen so-called executive-function skills (such as time management) and personalized coaching can help people cope with the daily challenges of living with ADHD. Tailoring strategies to the individual is important, notes Cook, since “there’s no one size fits all.” For example, a giant wall calendar with different-coloured entries for different activities might work for one person, while someone else might benefit from a digital version with alarms that play specific tones.
A Radical Guide for Women with ADHD: Embrace Neurodiversity, Live Boldly, and Break Through Barriers, by Sari Solden and Michelle Frank, New Harbinger Publications, 2019