Skip to main content
SpringerLink
Log in

Clinical Presentation, Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in Older Adults: A Review of the Evidence and its Implications for Clinical Care

  • Review Article
  • Published:
Drugs & Aging Aims and scope Submit manuscript

Abstract

Although previously considered a disorder of childhood, studies in the last decade have demonstrated that attention-deficit hyperactivity disorder (ADHD) continues to impair function into adulthood and responds to pharmacotherapy. Due to age-specific changes in roles and challenges, it is possible that presentation and response to intervention may differ between older and younger adults. A literature search for papers that identified older adults with ADHD, including papers describing its epidemiology, manifestation, and treatment, was the basis for this paper. There is a paucity of data on ADHD in older adults; however, small observational studies have characterized the presence, impact, and treatment of ADHD in adults over the age of 50 years, and larger epidemiologic studies have demonstrated that ADHD symptoms exist in older adulthood. Optimal criteria for diagnosis of ADHD and methods of treating ADHD in older individuals have not been systematically explored. In light of the limited data, this review discusses considerations for differential diagnosis and safe pharmacotherapy of ADHD in older adults.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Vincent GK, Velkoff VA. The next four decades: the older population in the United States: 2010 to 2050. Washington, DC: US Census Bureau; 2010.

    Google Scholar 

  2. Akutagava-Martins GC, Salatino-Oliveira A, Kieling CC, Rohde LA, Hutz MH. Genetics of attention-deficit/hyperactivity disorder: current findings and future directions. Expert Rev Neurother. 2013;13(4):435–45.

    Article  PubMed  CAS  Google Scholar 

  3. Klein RG, Mannuzza S, Olazagasti MA, Roizen E, Hutchison JA, Lashua EC, et al. Clinical and functional outcome of childhood attention-deficit/hyperactivity disorder 33 years later. Arch Gen Psychiatry. 2012;69(12):1295–303.

    Article  PubMed  PubMed Central  Google Scholar 

  4. Goodman DW. The consequences of attention-deficit/hyperactivity disorder in adults. J Psychiatr Pract. 2007;13(5):318–27.

    Article  PubMed  Google Scholar 

  5. Bernardi S, Faraone SV, Cortese S, Kerridge BT, Pallanti S, Wang S, et al. The lifetime impact of attention deficit hyperactivity disorder: results from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Psychol Med. 2012;42(4):875–87.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  6. Michielsen M, Semeijn E, Comijs HC, van de Ven P, Beekman AT, Deeg DJ, et al. Prevalence of attention-deficit hyperactivity disorder in older adults in The Netherlands. Br J Psychiatry. 2012;201(4):298–305.

    Article  PubMed  Google Scholar 

  7. de Zwaan M, Gruss B, Muller A, Graap H, Martin A, Glaesmer H, et al. The estimated prevalence and correlates of adult ADHD in a German community sample. Eur Arch Psychiatry Clin Neurosci. 2012;262(1):79–86.

    Article  PubMed  Google Scholar 

  8. Guldberg-Kjar T, Johansson B. Old people reporting childhood AD/HD symptoms: retrospectively self-rated AD/HD symptoms in a population-based Swedish sample aged 65–80. Nord J Psychiatry. 2009;63(5):375–82.

    Article  PubMed  Google Scholar 

  9. Kessler RC, Adler LA, Gruber MJ, Sarawate CA, Spencer T, Van Brunt DL. Adult ADHD Self-Report Scale (ASRS) symptom checklist. Int J Methods Psychiatr Res. 2007;16(2):52–65.

    Article  PubMed  PubMed Central  Google Scholar 

  10. Simon V, Czobor P, Balint S, Meszaros A, Bitter I. Prevalence and correlates of adult attention-deficit hyperactivity disorder: meta-analysis. Br J Psychiatry. 2009;194(3):204–11.

    Article  PubMed  Google Scholar 

  11. American Psychiatric Association. Diagnostic and statistical manual of mental disorders. 5th ed. Arlington: American Psychiatric Publishing; 2013.

    Google Scholar 

  12. Kessler RC, Adler L, Barkley R, Biederman J, Conners CK, Demler O, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–23.

    Article  PubMed  PubMed Central  Google Scholar 

  13. Surman CB, Hammerness PG, Pion K, Faraone SV. Do stimulants improve functioning in adults with ADHD? A review of the literature. Eur Neuropsychopharmacol. 2013;23(6):528–33.

    Article  PubMed  CAS  Google Scholar 

  14. da Silva MA, Louza M. Case of a 67-year-old woman diagnosed with ADHD successfully treated with methylphenidate. J Atten Disord. 2008;11(6):623.

    Article  PubMed  Google Scholar 

  15. Henry E, Jones SH. Experiences of older adult women diagnosed with attention deficit hyperactivity disorder. J Women Aging. 2011;23(3):246–62.

    Article  PubMed  Google Scholar 

  16. Manor I, Rozen S, Zemishlani Z, Weizman A, Zalsman G. When does it end? Attention-deficit/hyperactivity disorder in the middle aged and older populations. Clin Neuropharmacol. 2011;34(4):148–54.

    Article  PubMed  Google Scholar 

  17. Michielsen M, Comijs HC, Aartsen MJ, Semeijn EJ, Beekman AT, Deeg DJ, et al. The relationships between ADHD and social functioning and participation in older adults in a population-based study. J Atten Disord. 2015;19(5):368–79.

    Article  PubMed  Google Scholar 

  18. Michielsen M, Comijs HC, Semeijn EJ, Beekman AT, Deeg DJ, Kooij JJ. Attention deficit hyperactivity disorder and personality characteristics in older adults in the general Dutch population. Am J Geriatr Psychiatry. 2014;22(12):1623–32.

    Article  PubMed  Google Scholar 

  19. Semeijn EJ, Kooij JJ, Comijs HC, Michielsen M, Deeg DJ, Beekman AT. Attention-deficit/hyperactivity disorder, physical health, and lifestyle in older adults. J Am Geriatr Soc. 2013;61(6):882–7.

    Article  PubMed  Google Scholar 

  20. Brod M, Schmitt E, Goodwin M, Hodgkins P, Niebler G. ADHD burden of illness in older adults: a life course perspective. Qual Life Res. 2012;21(5):795–9.

    Article  PubMed  Google Scholar 

  21. Lensing MB, Zeiner P, Sandvik L, Opjordsmoen S. Quality of life in adults aged 50+ with ADHD. J Atten Disord. 2015;19(5):405–13.

    Article  PubMed  Google Scholar 

  22. Barkley RA, Murphy KR, Fischer M. ADHD in adults: what the science says. New York: Guilford Press; 2010.

    Google Scholar 

  23. Anstey KJ, Christensen H, Butterworth P, Easteal S, Mackinnon A, Jacomb T, et al. Cohort profile: the PATH through life project. Int J Epidemiol. 2012;41(4):951–60.

    Article  PubMed  Google Scholar 

  24. Murphy K, Barkley R. Prevalence of DSM-IV symptoms of ADHD in adult licensed drivers: implications for clinical diagnosis. J Atten Disord. 1996;1(3):147–61.

    Article  Google Scholar 

  25. Guldberg-Kjar T, Sehlin S, Johansson B. ADHD symptoms across the lifespan in a population-based Swedish sample aged 65 to 80. Int Psychogeriatr. 2013;25(4):667–75.

    Article  PubMed  Google Scholar 

  26. Kooij JJ, Buitelaar JK, van den Oord EJ, Furer JW, Rijnders CA, Hodiamont PP. Internal and external validity of attention-deficit hyperactivity disorder in a population-based sample of adults. Psychol Med. 2005;35(6):817–27.

  27. Michielsen M, Comijs HC, Semeijn EJ, Beekman AT, Deeg DJ, Sandra Kooij JJ. The comorbidity of anxiety and depressive symptoms in older adults with attention-deficit/hyperactivity disorder: a longitudinal study. J Affect Disord. 2013;148(2–3):220–7.

    Article  PubMed  Google Scholar 

  28. Surman C, Biederman J, Spencer TJ, Faraone SV, Monuteaux MC, Petty CR, et al. Representativeness of participants in a clinical trial for attention-deficit/hyperactivity disorder? Comparison with adults from a large observational study. J Clin Psychiatry. 2010;72(12):1612–6.

    Article  Google Scholar 

  29. Goodman D. Adult ADHD and comorbid depressive disorders: diagnostic challenges and treatment options. CNS Spectr. 2009;14(7 Suppl 6):5–7 (discussion 13–4).

    PubMed  Google Scholar 

  30. Goodman DW, Lasser RA, Babcock T, Pucci ML, Solanto MV. Managing ADHD across the lifespan in the primary care setting. Postgrad Med. 2011;123(5):14–26.

    Article  PubMed  Google Scholar 

  31. Ivanchak N, Fletcher K, Jicha GA. Attention-deficit/hyperactivity disorder in older adults: prevalence and possible connections to mild cognitive impairment. Curr Psychiatry Rep. 2012;14(5):552–60.

    Article  PubMed  PubMed Central  Google Scholar 

  32. Langa KM, Levine DA. The diagnosis and management of mild cognitive impairment: a clinical review. JAMA. 2014;312(23):2551–61.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  33. Rascovsky K, Hodges JR, Knopman D, Mendez MF, Kramer JH, Neuhaus J, et al. Sensitivity of revised diagnostic criteria for the behavioural variant of frontotemporal dementia. Brain. 2011;134(Pt 9):2456–77.

    Article  PubMed  PubMed Central  Google Scholar 

  34. Roman GC, Tatemichi TK, Erkinjuntti T, Cummings JL, Masdeu JC, Garcia JH, et al. Vascular dementia: diagnostic criteria for research studies. Report of the NINDS-AIREN International Workshop. Neurology. 1993;43(2):250–60.

    Article  PubMed  CAS  Google Scholar 

  35. Tuite PJ, Krawczewski K. Parkinsonism: a review-of-systems approach to diagnosis. Semin Neurol. 2007;27(2):113–22.

    Article  PubMed  Google Scholar 

  36. Geschwind MD, Shu H, Haman A, Sejvar JJ, Miller BL. Rapidly progressive dementia. Ann Neurol. 2008;64(1):97–108.

    Article  PubMed  PubMed Central  Google Scholar 

  37. Beh SC, Muthusamy B, Calabresi P, Hart J, Zee D, Patel V, et al. Hiding in plain sight: a closer look at posterior cortical atrophy. Pract Neurol. 2015;15(1):5–13.

    Article  PubMed  Google Scholar 

  38. McAllister TW, Arciniegas D. Evaluation and treatment of postconcussive symptoms. NeuroRehabilitation. 2002;17(4):265–83.

    PubMed  Google Scholar 

  39. Bucks RS, Olaithe M, Eastwood P. Neurocognitive function in obstructive sleep apnoea: a meta-review. Respirology. 2013;18(1):61–70.

    Article  PubMed  Google Scholar 

  40. Surman CB, Thomas RJ, Aleardi M, Pagano C, Biederman J. Adults with ADHD and sleep complaints: a pilot study identifying sleep-disordered breathing using polysomnography and sleep quality assessment. J Atten Disord. 2006;9(3):550–5.

    Article  PubMed  Google Scholar 

  41. Shpirer I, Elizur A, Shorer R, Peretz RB, Rabey JM, Khaigrekht M. Hypoxemia correlates with attentional dysfunction in patients with obstructive sleep apnea. Sleep Breath. 2012;16(3):821–7.

    Article  PubMed  Google Scholar 

  42. Fischer BL, Gunter-Hunt G, Steinhafel CH, Howell T. The identification and assessment of late-life ADHD in memory clinics. J Atten Disord. 2012;16(4):333–8.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  43. Golimstok A, Rojas JI, Romano M, Zurru MC, Doctorovich D, Cristiano E. Previous adult attention-deficit and hyperactivity disorder symptoms and risk of dementia with Lewy bodies: a case–control study. Eur J Neurol. 2011;18(1):78–84.

    Article  PubMed  CAS  Google Scholar 

  44. Ivanchak N, Abner EL, Carr SA, Freeman SJ, Seybert A, Ranseen J, et al. Attention-deficit/hyperactivity disorder in childhood is associated with cognitive test profiles in the geriatric population but not with mild cognitive impairment or Alzheimer’s disease. J Aging Res. 2011;2011:729801.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  45. Seidman LJ. Neuropsychological functioning in people with ADHD across the lifespan. Clin Psychol Rev. 2006;26(4):466–85.

    Article  PubMed  Google Scholar 

  46. Durell T, Adler L, Wilens T, Paczkowski M, Schuh K. Atomoxetine treatment for ADHD: younger adults compared with older adults. J Atten Disord. 2010;13(4):401–6.

    Article  PubMed  Google Scholar 

  47. Brod M, Pohlman B, Lasser R, Hodgkins P. Comparison of the burden of illness for adults with ADHD across seven countries: a qualitative study. Health Qual Life Outcomes. 2012;10:47.

    Article  PubMed  PubMed Central  Google Scholar 

  48. Lensing MB, Zeiner P, Sandvik L, Opjordsmoen S. Psychopharmacological treatment of ADHD in adults aged 50+: an empirical study. J Atten Disord. 2015;19(5):380–9.

    Article  PubMed  Google Scholar 

  49. Turner DC, Robbins TW, Clark L, Aron AR, Dowson J, Sahakian BJ. Relative lack of cognitive effects of methylphenidate in elderly male volunteers. Psychopharmacology. 2003;168(4):455–64.

    Article  PubMed  CAS  Google Scholar 

  50. Herrmann N, Rothenburg LS, Black SE, Ryan M, Liu BA, Busto UE, et al. Methylphenidate for the treatment of apathy in Alzheimer disease: prediction of response using dextroamphetamine challenge. J Clin Psychopharmacol. 2008;28(3):296–301.

    Article  PubMed  CAS  Google Scholar 

  51. Hayashi M, Shimizu W, Albert CM. The spectrum of epidemiology underlying sudden cardiac death. Circ Res. 2015;116(12):1887–906.

    Article  PubMed  CAS  Google Scholar 

  52. Ermer J, Haffey MB, Richards C, Lasseter K, Adeyi B, Corcoran M, et al. Double-blind, placebo-controlled, two-period, crossover trial to examine the pharmacokinetics of lisdexamfetamine dimesylate in healthy older adults. Neuropsychiatr Dis Treat. 2013;9:219–29.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

  53. Huang CC, Sandroni P, Sletten DM, Weigand SD, Low PA. Effect of age on adrenergic and vagal baroreflex sensitivity in normal subjects. Muscle Nerve. 2007;36(5):637–42.

    Article  PubMed  Google Scholar 

  54. Martinsson L, Yang X, Beck O, Wahlgren NG, Eksborg S. Pharmacokinetics of dexamphetamine in acute stroke. Clin Neuropharmacol. 2003;26(5):270–6.

    Article  PubMed  CAS  Google Scholar 

  55. Kraemer T, Maurer HH. Toxicokinetics of amphetamines: metabolism and toxicokinetic data of designer drugs, amphetamine, methamphetamine, and their N-alkyl derivatives. Ther Drug Monit. 2002;24(2):277–89.

    Article  PubMed  CAS  Google Scholar 

  56. Adderall XR [package insert]. Wayne: Shire Pharmaceuticals Inc.; 2015.

  57. MTA Cooperative Group. A 14-month randomized clinical trial of treatment strategies for attention-deficit/hyperactivity disorder. The MTA Cooperative Group. Multimodal Treatment Study of Children with ADHD. Arch Gen Psychiatry. 1999;56(12):1073–86.

    Article  Google Scholar 

  58. Knouse LE, Safren SA. Current status of cognitive behavioral therapy for adult attention-deficit hyperactivity disorder. Psychiatr Clin North Am. 2010;33(3):497–509.

    Article  PubMed  PubMed Central  Google Scholar 

  59. Young S, Khondoker M, Emilsson B, Sigurdsson JF, Philipp-Wiegmann F, Baldursson G, et al. Cognitive-behavioural therapy in medication-treated adults with attention-deficit/hyperactivity disorder and co-morbid psychopathology: a randomized controlled trial using multi-level analysis. Psychol Med. 2015;45(13):2793–804.

    Article  PubMed  CAS  PubMed Central  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Psychiatry and Behavioral Sciences, Johns Hopkins School of Medicine, Baltimore, USA

    David W. Goodman

  2. Adult Attention Deficit Disorder Center of Maryland, Lutherville, USA

    David W. Goodman

  3. Suburban Psychiatric Associates, LLC Johns Hopkins at Green Spring Stations, 10751 Falls Rd, Suite 306, Baltimore, MD, 21093, USA

    David W. Goodman

  4. Department of Neurology, Massachusetts General Hospital, 15 Parkman Street, WAC 815, Boston, MA, 02114, USA

    Sara Mitchell

  5. Clinical and Research Program in ADHD and Related Disorders, Massachusetts General Hospital, 55 Fruit Street, Warren 631, Boston, MA, 02114, USA

    Lauren Rhodewalt & Craig B. H. Surman

  6. Harvard Medical School, 25 Shattuck St, Boston, MA, 02115, USA

    Craig B. H. Surman

Authors
  1. David W. Goodman
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Sara Mitchell
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Lauren Rhodewalt
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Craig B. H. Surman
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to David W. Goodman.

Ethics declarations

Funding

No sources of funding were used for this publication.

Conflicts of interest

Dr. David W. Goodman has received consulting fees and honorarium from WebMD, Medscape, Temple University, American Professional Society of ADHD and Related Disorders, Neuroscience Education Institute, Children and Adults with ADHD Association, McNeil, Teva Pharmaceuticals, Lundbeck, Janssen (US and Canada), OptumInsight (Ingenix Pharmaceutical Services, Inc.), Sunovion, Otsuka Pharmaceuticals, Novartis, Ironshore Pharmaceuticals, Rhodes Pharmaceuticals, Neos Therapeutics, Thomson Reuters, GuidePoint Global, Med-IQ, Avacat, Pontifax, Healthequity Corporation, American Physician Institute for Advanced Professional Studies, LLC, Prescriber’s Letter, Consumer Reports, Major League Baseball, and National Football League.

Dr. Craig Surman has received, in his lifetime, consulting fees or honorarium from McNeil, Nutricia, Pfizer, Rhodes, Shire, Somaxon, and Takeda. He has also received payments for lectures from Alcobra, McNeil, Janssen, Janssen-Ortho, Novartis, Shire, and Reed/MGH Academy (funded by multiple companies). Royalties have been given to Dr. Surman from Berkeley/Penguin for FASTMINDS: How to Thrive if You Have ADHD (or Think you Might) and from Humana/Springer for ADHD in Adults: A Practical Guide to Evaluation and Management. Additionally, Dr. Surman has conducted clinical research at Massachusetts General Hospital with Abbott, Cephalon, the Hilda and Preston Davis Foundation, Eli Lilly, Magceutics, Johnson & Johnson/McNeil, Lundbeck, Merck, Nordic Naturals, Nutricia, Pamlab, Pfizer, Organon, Shire, and Takeda.

Sara Mitchell and Lauren Elaine Rhodewalt have no conflicts of interest to disclose.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Goodman, D.W., Mitchell, S., Rhodewalt, L. et al. Clinical Presentation, Diagnosis and Treatment of Attention-Deficit Hyperactivity Disorder (ADHD) in Older Adults: A Review of the Evidence and its Implications for Clinical Care. Drugs Aging 33, 27–36 (2016). https://doi.org/10.1007/s40266-015-0327-0

Download citation

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s40266-015-0327-0

Keywords

Search

Navigation