What to Know About ADHD If You're Over 50

Contrary to popular belief, attention-deficit/hyperactivity disorder (ADHD) is not just a kids' disease. An estimated 3.4 percent of adults worldwide have it. And though it affects fewer women than men, menopause can make symptoms worse, experts say.

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Many adults are not even aware they have had the disorder since childhood.

"I just got a new client who was diagnosed at 63," says Elaine Taylor-Klaus, cofounder of ImpactADHD, an attention-deficit/hyperactivity disorder consultancy.

Contrary to its name, "attention-deficit" doesn't mean you can't pay attention. Instead, you pay too much attention. When you have ADHD, it's hard to focus on individual tasks because you can't stop focusing on everything else that's going on.

Take work, for example: Maybe the person you share an office with types loudly or you can't zone out hallway conversations. Maybe you keep hearing the phone in the next room ringing through the wall. Whatever it is, you simply can't screen out the noise the way that other people can. And when you finally do focus, you zone in so tightly that hours pass before you know it.

Here's why: The ADHD mind has an undersupply of dopamine and norepinephrine, two neurotransmitters essential to filtering out stimuli the brain doesn't need from stimuli it does. Without them, your mind becomes flooded by every piece of information before it. You feel unable to pay attention because your attention goes to everything you encounter.

"Adults over 50 who are diagnosed often feel a huge sense of regret," Taylor-Klaus says, "like if they'd only known, imagine what they could have done differently. That regret that they were not able to achieve what they wanted in their lives — coupled with years of self-abuse, treating themselves as if they were stupid or a failure or lazy — can pack quite a wallop."

ADHD manifests in two core ways: Inattention and hyperactivity/impulsivity.

Men tend to exhibit the hyperactivity/impulsivity symptoms more than women, who often show greater inattention. Taylor-Klaus' client spent decades unable to focus on work and came to her after getting fired — yet again. While children with ADHD often make low grades or take frequent trips to the principal's office, adults experience job underperformance and disciplinary write-ups.

Then menopause complicates things further.

During menopause, estrogen drops by 65 percent, says Dr. Nwayieze Ndukwe, a psychiatry resident at Mount Sinai Beth Israel. This drop in estrogen means even less dopamine production, so as women age, ADHD symptoms often get worse.

Ritalin — a common ADHD prescription — helps the brain make dopamine, so when levels drop, it's tempting to increase the dose. But since the decline stems from menopause and not ADHD, the right solution may be adjusting hormones instead.

That's why Ndukwe recommends finding the right drug/dose mix for women before perimenopause: "It's very important if you have ADHD to stay on top of your symptoms — to stay on top of your medication — because other processes are happening that may well affect it. If you don't have your ADHD under control then you don't know which one it is."

Sadly, many ADHD women weren't diagnosed in youth. Attention-deficit itself wasn't identified until 1980 and was then mainly thought to affect boys. It was 1994 before focus shifted to equally identifying ADHD in girls.

Taylor-Klaus says the result is an entire generation of women misdiagnosed with "anxiety, sometimes depression, and often both."

"I once worked with a 70-something year-old," Taylor-Klaus continues, "who had been treated throughout her life with electric shock treatments for depression and who knows what else because they didn't recognize it was ADHD."

ADHD is not a mental illness, but a neurological disability. And while it makes it hard to focus, the condition does come with its perks: Having ADHD means you don't miss much. Unfiltered input means more data at the brain's disposal to develop inventive solutions or discover new ways to do things. Comedian Joan Rivers, Pulitzer Prize-winner Katherine Ellison and Harry Potter actress Emma Watson are great examples of people with ADHD.

Taylor-Klaus even has it herself: "I was diagnosed around 40, and conscious treatment completely changed my life and my relationships... When [women] call and say, 'I was just [diagnosed],' I always say 'Congratulations — now, you know what you're dealing with and you can do something to manage it!'"

See this previous Next Avenue story for insights on how to make the most of your ADHD.

Do you have ADHD? The National Institute of Mental Health lists these symptoms, which must have been present prior to age 12:

Inattention:

• Fails to give close attention to details or makes careless mistakes at work or with activities
• Has trouble focusing on tasks
• Does not seem to listen when spoken to directly
• Does not follow through on instructions and fails to finish chores or workplace duties (often side-tracked)
• Has trouble organizing
• Avoids doing tasks requiring mental effort over a long period of time
• Loses things necessary for tasks and activities (tools, wallets, keys, paperwork, eyeglasses, cell phones)
• Easily distracted
• Forgetful

Hyperactivity/Impulsivity:  

• Fidgets
• Leaves seat when remaining seated is expected
• Restless
• Unable to take part in activities quietly
• "On the go," acting as if "driven by a motor"
• Talks excessively
• Blurts out answers before questions are completed
• Trouble waiting her turn
• Interrupts or butts into conversations