Navigating an ADHD Diagnosis in Your 50s or 60s

When Judy Sandler retired from her teaching position at 56, she had a dream of becoming a writer and a plan to achieve it. But things changed when Sandler left her full-time job. Instead of taking steps toward realizing her goal, she found herself unmotivated and stuck.

"I didn't know where to start when I woke up in the morning," says Sandler. "I no longer had the daily structure that teaching gave me for 18 years — or the daily praise and motivation that comes with being a good teacher. I couldn't get started."

Sandler felt unproductive and became depressed. She knew something wasn't right, so she saw a doctor to figure out what was holding her back. After a detailed evaluation, Sandler was diagnosed with ADHD (attention deficit hyperactive disorder).

Adults in their late 50s and 60s who are on the cusp of retirement think about many things — leaving behind the daily grind of a full-time job, spending time with grandchildren, traveling. Few, if any, imagine being diagnosed with ADHD.  

Most people think that ADHD is a disorder of grade-school boys who have trouble sitting still and paying attention in the classroom. But the disorder affects more than young boys and girls. According to a 2022 study, ADHD symptoms affect 2.2% of adults over the age of 50, but only 0.23% of them have a clinical diagnosis. 

"ADHD develops in childhood or adolescence, but sometimes the disorder is missed by a clinician or mistaken for another condition, and left untreated for decades," says David W. Goodman, M.D., assistant professor of Psychiatry and Behavioral Sciences at Johns Hopkins University School of Medicine and clinical associate professor of psychiatry and behavioral sciences at State University of New York. 

"In most cases, ADHD symptoms don't go away as you age," he says. "They persist through adulthood and during the course of a person's life."

Most adults don't walk into a doctor's office thinking they have ADHD. Many show symptoms of anxiety or depression arising from impairments due to their undiagnosed ADHD. 

Patients often complain about difficulties with memory or distraction. They forget things like a lunch with friends or a business appointment. They often leave the front door unlocked or the refrigerator door open. They have trouble getting to places on time or meeting deadlines. 

A spouse, tired of living with a partner's symptoms, often encourages him or her to be evaluated. Or an adult child casually mentions the possibility of having ADHD to their mom or dad: "Your granddaughter just got diagnosed with ADHD, and you share many of her symptoms. Maybe you want to check it out." 

ADHD tends to run in families, and, in most cases, it's thought the genes you inherit from your parents are a significant factor in developing the condition. However, environmental factors may play a role as well.

Making an ADHD diagnosis in patients in the 50s and 60s is difficult for doctors without training in ADHD symptoms and treatment.

"Doctors receive only a few hours of instruction in ADHD in adults in medical school, and almost none of them has training in recognizing ADHD in older adults," says Goodman. So when a patient complains about cognitive impairments, most doctors reflexively assume the cause is age-related. 

"A clinician can't find what he doesn't inquire about," adds Goodman. What makes a definitive diagnosis even more difficult is the fact that a patient can have ADHD and mild cognitive impairment.

The onus is on the clinician to identify the cause of the symptoms, says Peter Jaksa, Ph.D., author of "Life with ADHD" and a licensed clinical psychologist with more than 30 years of experience working with children, adolescents, and adults with ADHD. 

In addition to age-related cognitive difficulties, many people in their 50s and 60s take multiple medications, some of which may have cognitive symptoms associated with them. 

An ADHD diagnosis should include an extensive history. "It should go back to childhood behavior — developmental history, academic history, social history, job history, health history," says Jaksa. The most important and valid diagnostic indication for ADHD is a consistent pattern of behavior over time, he explains.  

A doctor should also screen for common coexisting conditions, such as oppositional defiant disorder (ODD), conduct disorder (CD), depression, learning disorders and anxiety, all of which can adversely affect ADHD symptoms. More than two-thirds of individuals with ADHD have at least one other coexisting condition, according to Children and Adults with Attention Deficit/Hyperactivity Disorder (CHADD). 

"The most effective treatment for ADHD is what I call 'pills and skills,'" says Goodman. "Stimulant or non-stimulant ADHD medication combined with, in some cases, cognitive behavioral therapy (CBT) and perhaps ADHD coaching to help develop organizational skills."

Many adults who agree to take ADHD medication for six weeks start to see positive shifts in their day-to-day life. "Patients often tell me, 'I had no idea this is how everybody else lives,'" says Goodman.

According to Goodman, in the first month of taking medication, a person often thinks more clearly and can better focus without distraction. By six months, a person is no longer late for work and meets deadlines. At home, they are more patient and less frustrated with a spouse or grandchildren. 

"As with any medication, current health issues — heart problems or high blood pressure, for example— should be taken into account to determine choices of medication and which one can be taken safely," says Jaksa. A prescribing doctor should review a patient's health history and medications and talk with the patient's doctor or cardiologist before writing a script for ADHD medication.

Medication will not necessarily improve a person's organizational skills or attention challenges. "There is substantial research that suggests cognitive behavioral therapy (CBT) can address those deficits," says Goodman.

CBT — a talking therapy that enables a person to manage problems by modifying thinking and behavior — can help develop such critical skills as managing time, getting organized at work and home, and prioritizing tasks.

"Before treatment, I remember keeping a notebook for each area of my life," says Sandler. "The therapist I worked with told me to put them in a drawer and use only one notebook for all home, work and school tasks. That tip alone helped me so much." 

There are two other critical issues for patients diagnosed later in life. Many talk about lost opportunities, regrets, what-ifs and how their life would have improved if they had been diagnosed earlier. 

"Some adults tell me they have low self-esteem and a negative self-image, believing for most of their life that they are lazy, not dependable or just screw-ups," says Goodman. Counseling works to clear up these misconceptions. After treatment, many patients learn to distinguish who they are and what they have. 

"Being diagnosed later in life is an 'a-ha' experience for most people," says Jaksa. "People now understand behaviors that previously made no sense or were attributed to negative reasons — 'I'm lazy, stupid, odd or broken.' They're grateful to have an explanation finally."

That was Sandler's experience. "The diagnosis gave me a tool to look back and say, "Oh, that was what was going on back then" or "That's why people were looking at me oddly," she says. "It was enlightening."

And empowering. When Sandler started ADHD medication and worked with a licensed psychologist to develop organizational strategies, her dream fell into place. She earned an MFA from Stonecoast at the University of Southern Maine University in 2021. 

She is now a successful non-fiction writer, contributing articles and personal essays to many newspapers and magazines. She has plans to write a book about raising a child with bipolar disorder.

"Some people come into my office and say, 'I've spent my whole life this way. Is it really worth treating ADHD now?'" says Goodman. "I tell them ADHD is worth treating at any age. I explain that it's like living with blurred vision your whole adult life and suddenly you get a prescription for eyeglasses. Imagine how much better you will see." 

Wayne Kalyn is a long-time magazine editor and freelance writer. He has written for Parade, Health Magazine, Good Housekeeping, Parenting, GQ, Esquire, People, Spry, The New York Times, Entertainment Weekly, Parenting, Arthritis Today, and Parents, among others. He is the former editor of ADDitude magazine, a publication for adults and children diagnosed with ADHD. Read More