ADHD in Older Adults: What We Know (and Don’t Know)

ADHD in Older Adults: What We Know (and Don’t Know)

When people think about ADHD, they usually picture kids bouncing off the walls or teens struggling in school. But ADHD is not just a childhood condition. In fact, research suggests that a meaningful number of older adults—people over 50—still live with ADHD symptoms. The problem is that ADHD in this age group is rarely recognized or treated, leaving many people struggling without answers.

Why This Matters

ADHD affects about 5–7% of kids worldwide and around 2.5% of adults. But when it comes to older adults, research has been surprisingly limited. For decades, studies focused almost exclusively on children and young adults, leaving a major knowledge gap when it comes to understanding ADHD later in life. This matters because untreated ADHD in older age doesn’t just affect focus or organization—it can pile onto health problems, lower quality of life, and increase risks of psychiatric conditions, physical illnesses, and even accidents.

As the global population ages, ignoring ADHD in older adults becomes a bigger issue. Raising awareness among doctors and researchers is key to making sure older adults with ADHD are correctly diagnosed and get safe, effective treatment.

Prevalence and Persistence

Earlier reviews found almost no research on ADHD in people over 50. But more recent studies and meta-analyses suggest that around 2% of older adults may meet criteria for ADHD when tested with validated tools. However, the number who actually receive a diagnosis or treatment is far smaller—less than 1%. This gap between who has ADHD and who gets treated is striking.

Long-term studies also show that while ADHD symptoms may decline somewhat with age, functional impairments often remain. In other words, even if the hyperactivity fades, challenges with attention, organization, memory, and daily functioning often continue. Many older adults report “subthreshold” symptoms—just below the official diagnostic cutoff—but still experience life-disrupting effects.

Impact and Comorbidities

ADHD doesn’t happen in isolation. For older adults, ADHD is linked to:

• Mental health conditions like depression, anxiety, and sleep disorders.

• Cognitive decline including increased risk of mild cognitive impairment (MCI) and possibly dementia.

• Physical health issues, from cardiovascular disease and diabetes to autoimmune and metabolic conditions.

• Higher mortality risk, often due to accidents or unmanaged comorbidities.

Studies also show that lifelong ADHD struggles—like unstable employment, relationship problems, poor sleep, and unhealthy lifestyle habits—add up over decades, further increasing risks in later life.

Diagnosis Challenges

Diagnosing ADHD in older adults is tough for several reasons:

• Symptoms change over time. Hyperactivity in youth may look more like restlessness or mental fatigue later on, while inattention becomes the dominant issue.

• Diagnostic systems (DSM-5 and ICD-11) were updated to include adults, but they haven’t been validated specifically for older adults.

• Screening tools exist (like the ASRS and DIVA interviews), but only one has been validated for people over 60—and even then, it wasn’t a perfect fit. Some questions simply don’t capture how ADHD shows up in older adults.

All of this means many older adults with ADHD are either missed, misdiagnosed (sometimes as depression or early dementia), or dismissed entirely.

Treatment and Safety

Pharmacological treatments for ADHD (like stimulants) can be effective, but for older adults there are extra concerns. Many already take medications for other health conditions, and interactions or side effects can be more risky with age. Non-medication approaches, like cognitive-behavioral therapy, coaching, and lifestyle modifications, may also be important tools—but research on these in older adults is still scarce.

Moving Forward

Experts expect future versions of the DSM and ICD to add more age-specific guidance. There’s also a push for more clinical trials testing both medication and non-medication treatments for this age group. With better data, clinicians will be able to make clearer, safer, and more effective treatment decisions for older adults with ADHD.

Dobrosavljevic, M., Larsson, H., & Cortese, S. (2023). The diagnosis and treatment of attention-deficit hyperactivity disorder (ADHD) in older adults. Expert Review of Neurotherapeutics, 23(10), 883–893. https://doi.org/10.1080/14737175.2023.2250913

My Take

ADHD in older adults is one of the most overlooked areas in mental health. Many people over 50 grew up at a time when ADHD wasn’t even recognized, so they’ve gone decades without support. What’s striking is how often ADHD symptoms in later life get confused with “normal aging” or even early dementia, when in reality, they’re part of a lifelong condition that could benefit from targeted treatment.

Getting diagnosed at 60 or 70 doesn’t erase the struggles of the past—but it can provide an explanation, reduce shame, and open doors to strategies that improve everyday life. More importantly, recognizing ADHD in older adults could help reduce the risks of comorbid conditions, improve quality of life, and give people a sense of clarity after years of confusion.