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ADHD Remains Massively Undertreated Among Older Adults

PsychCentral 2020-08-18 14:12:52

Perhaps no group of people with ADHD suffer from underdiagnosis and undertreatment as much as older adults. After all, ADHD “wasn’t a thing” when they were growing up. Now that they’re older, they don’t fit the ADHD stereotype and might even get misdiagnosed with dementia.

A new systematic review of the literature on ADHD in older adults shows just how widespread the problem of undertreatment seems to be.

In that review, a team of researchers surveyed 20 previously published studies that encompassed over 20 million participants. The researchers asked a deceptively simple question: how common is ADHD among older adults?

There are three different ways of approaching this question that the researchers took into account. You can:

  1. Give older adults ADHD symptom questionnaires to see how many have clinical levels of ADHD symptoms, regardless of whether they’ve been diagnosed
  2. Count how many older adults have been diagnosed with ADHD
  3. Count how many older adults are being treated for ADHD

As it turned out, these three methods gave vastly different results.

The researchers found that 2.18 percent of older adults screened as having possible ADHD when validated questionnaires were used. However, only .23 percent of older adults had been clinically diagnosed with ADHD, and a minuscule .09 percent were being treated for ADHD.

Those exact numbers shouldn’t be taken as holy writ because it’s not clear that the participants in these studies are representative of the entire population. The really interesting part isn’t the estimated prevalence of ADHD in itself but the massive discrepancy between rates of elevated symptoms, clinical diagnosis, and actual treatment.

Just to drive that point home: the number of older adults who screened as having elevated symptoms of ADHD was more than nine times as high as the number who had been diagnosed. Even among those who were lucky enough to be diagnosed, less than half were receiving treatment!

In their paper, the researchers write that this pattern “highlights the need for increased awareness of ADHD clinical diagnosis and treatment in older adults.”

That might be a bit of an understatement. If these numbers are anywhere near accurate (and the anecdotal experiences of ADHDers would suggest that they are), it means huge numbers of older ADHDers are going without diagnosis or treatment.

Those adults are dealing with all the negative effects ADHD has on work, finances, home life, relationships, safety… the list goes on. Meanwhile, they aren’t receiving support, and in many cases they probably don’t even know that their struggles stem from ADHD to begin with.

Clearly, there’s a lot of work to be done to raise awareness around ADHD in older adults. The more of that work we can get done, and the sooner we can get it done, the better!

Image: Flickr/Pedro Ribeiro Simões