Does Aging Affect ADHD?

Aging and all the things that can come with it- natural cognitive changes, menopause, retirement, and empty nesting- can have a significant impact on our ADHD brains, making symptoms worse and harder to manage at times.  But there are research-backed strategies for managing it all.  Read on to discover more.

Getting older impacts ADHD brains—here’s what we can do about it.

Are the missed appointments, forgotten keys, and “why did I come in here” moments escalating as the years roll by?

Has your brain fog gone from a light haze to an overwhelming cloud since menopause hit?

Have you had a really hard time getting going and staying motivated since the kids moved out and you cut the cake at your retirement party?

As we age (glamorously and gracefully, of course), the 'I forgot where I put my glasses' moments can happen more often. But is it a natural aspect of aging, or just the same ol’ ADHD brain shenanigans we’ve been dealing with since childhood?

If so, you are not alone. Let’s explore why and what research-backed tools and strategies we can use to help us manage the twin challenges of ADHD and aging.

        Normal cognitive decline vs. Mild Cognitive Impairment vs. ADHD

When you suddenly notice that the dial on your distraction meter seems to have slammed over to “chase every passing thought and squirrel with abandon,” you might start asking yourself if this is what all those white coats call normal cognitive decline, mild cognitive impairment or is it just that your ADHD has gone into hyperdrive.

The truth is that it’s not always easy to tell in part because the symptoms have a lot of overlap but also because while cognitive impairment might get the spotlight in our neurotypical culture, that doesn’t mean our ADHD brains aren’t flouncing around backstage, causing some big diva drama behind the scenes.

So let’s look at them all separately first and see how they differ:

Mild Cognitive Impairment vs. Normal Cognitive Decline:

The experiences we all have as we age- forgetting a word here or there, not knowing why we walked into a room, or forgetting to pay a bill. These are all normal aging experiences, and they are caused by the mild breakdown of our brain’s memory center, the Hippocampus. What differentiates that from Mild Cognitive Impairment (MCI) is a matter of frequency and degree. So, forgetting a date or important birthday here or there? That’s normal aging. But when it’s happening on a day-to-day basis and starting to interfere with your life, that’s when it makes sense to reach out to your doctor and get assessed for MCI.

Mild Cognitive Impairment vs. ADHD:

While memory is often implicated in both Mild Cognitive Impairment and ADHD, recent research has shown that there is a distinct difference between the two, which we can see both inside the brain as well as in how we function.

Researchers from the University of Calgary and Toronto paired up to look at brain scans and cognitive testing of almost 100 older adults with ADHD or MCI and found that the memory difficulties of the two differed in terms of which aspect of the memory process was most impacted. People with ADHD struggle to encode new information- so they have a hard time entering that information into their memory. Those with MCI struggled with retention, meaning they got it into their memory, but then it quickly fell out again. (1)

Not only was this all observed through cognitive testing, but the brain scans then showed that those with MCI who had difficulty with retention had smaller hippocampi (memory center), and those with ADHD had thinning in their frontal cortex (executive functioning centers). (1)

Wading through it all: Is it Mild cognitive impairment, normal aging, or ADHD?

Ok, so that was a lot of white coat mumbo-jumbo. Let’s get a quick visual of how this shows up in our lives:

* adapted from www.myalzteam.com

The effects of aging on ADHD

While ADHD begins in childhood, we all know (all too well, in fact) that it continues to impact us in a variety of different ways throughout our lives (2),  waltzing into the grand ballroom of old age with us.  In fact, ADHD can change as you get older—so even if you think that you’ve become a seasoned pro at managing it, you might find yourself facing new or different challenges as you move through the decades. This can include an increase—or change — in issues with attention, memory, and planning.

Research has shown that ADHD is a ‘waxing and waning’ condition that can be affected by your environment—and what’s going on in your life in general. (3) This means that big life shifts like retirement or becoming an empty-nester can aggravate your symptoms. Losing the structure of a nine-to-five job—or the routine of caring for children—can send your ADHD spiraling, resulting in a worsening of time management and problems with procrastination (and the associated anxiety, guilt, and shame that so many of us grapple with as a result).

So, as you move towards the senior league, you might start to feel like growing older has activated a ‘’highlight reel’ of everything you’ve struggled with all your life--task completion, feeling distracted during conversations, or relationships that somehow turn into overwrought telenovelas.

Just when you want to kick back, enjoy your life post-retirement, and maybe book a cruise to Honolulu, all these issues suddenly appear and do a victory lap around your living room.

Aging issues that can impact on ADHD symptoms

The hormonal changes of perimenopause and menopause can affect ADHD(4), as well as retirement, big life changes, and the age-old favorite (no pun intended) “normal cognitive decline” all have the ability to crank up the ADHD volume— sometimes to the max.

But whether the root of your ADHD’s recent insistence on playing center stage of your life is biological, cognitive, genetic, chemical, hormonal, situational, or a combination of them all, the question is—what can you do about it? Is aging just a slippery slide that you must accept, or can you find ways to feel better and more focused? Can you thrive with ADHD in your 50s, 60s, 70s, and beyond?

The answer is ‘yes’—but of course, there’s going to be a good deal of trial and error involved in working out which strategies work best for you right now. So let’s check out some ones to start trailing and erroring with...

7 tips for Dealing with ADHD aging

1. Explore ADHD medications

At its heart, ADHD is a difference with the regulation system of our brains. It makes our brains prefer the extremes- its natural spots are all in or all out (hyperfocus/no focus, ebullient energy/ can’t drag me off the couch, etc.)

And there’s a lot that’s cool about on/off brains. But life sometimes requires something in the in-between, and meds have been proven to be a wonderful way of offering just that- the ability to do the in-between (5).

Even if you’ve tried medication before and weren’t so thrilled, it’s often worth a second shot. So many new medications have come on the scene in recent years, with fewer side effects and more targeted delivery mechanisms.

But of course, meds aren’t for everyone, and they don’t do all the things, so let’s keep exploring what other options we have.

2. Consider therapy

Maybe meds are helping you focus in or interrupt less, but you notice that they still don’t answer the entire picture.

Or perhaps, you’ve tried meds and couldn’t manage the side effects or perhaps meds just aren’t for you.

That’s ok.

Because while meds are a wonderful option that can often be incredibly useful, particularly when dealing with the compounding effects of age and ADHD, we’ve got other tools in the toolbox too- one of the best of which is ADHD-informed psychotherapy.

ADHD-informed psychotherapy (AIP) uses a blend of evidence-based psychological techniques and coaching to address the practical, emotional and regulatory aspects of living with an ADHD. AIP helps you to make shifts in the behavioral, thinking, and relational patterns of your life, helping you craft a life that works for your brain, not the other way around.

This type of therapy has been found to be helpful at not just reducing the “core symptoms” (i.e., inattention or impulsivity) of ADHD but also at reducing the impact that those symptoms can have (i.e., task completion or relational disruption) as well as the emotional implications of ADHD (6).

If you are considering therapy, check out our post on ‘5 Questions to Ask Your Therapist Before Starting ADHD Therapy’ to help you make sure that the therapist you are working for is really the best fit for you and your brain.

3. Get moving

As our bodies age, and don’t move the same way they used to, it can become pretty darn tempting to become a regular fixture on our recliner. But research is resoundingly definitive (in a way that it rarely is for most things) that moving our bodies does as much for our brains (if not more) than our bodies. In fact, exercise is one of the most effective strategies for managing the many ways our ADHD brains wreak havoc in our lives(7).

But like all ADHD strategies- it’s essential that we work with our ADHD brain rather than fighting as we integrate something like exercise into our lives. Trying to force ourselves to do something that bores us is a recipe for avoidance and shame— so if treadmills sound like a tedious chore, how about checking out some cha-cha lessons instead?

And, of course, if you have health concerns that make exercise difficult, risky, or painful, then consult with your doctor or an experienced fitness instructor to work out a program that’s safe for you.

4. Become a sleeping beauty

As we are all increasingly aware, a quality 40 winks is the VIP pass to better cognitive function and emotional calm (especially for the ADHD brain). Even if you could get away with a janky sleep routine in your 20s and 30s, things change the big time when you hit midlife and beyond.

And as much as our brains thrive on nice, orderly, full sleep routines- it gets harder and harder to get them with every year that passes. Illness, biology, hormones, and of course our ADHD brains all start to conspire as we get older to make sleep more and more elusive. And that’s not even taking into account the many, non-age related, struggles that ADHD brains already have with sleep.

Which is why it’s so essential to be intentional about helping ourselves slip off to dreamland. Things like establishing a bedtime ritual that you enjoy, avoiding caffeine after noon, and saying goodbye to screens before snooze time? These are all sleep upgrades that can give your brain the rest it craves and offer your awake brain the relief it needs.

Sound a whole lot easier said than done? Yup! It is! So check out our ‘How To Quiet Your Brain and Get To Sleep’ for the inside scoop on how to make all of those sleep tips you’ve heard over and over actually work for you and your brain.

5. Find your people (they’re out there)

Getting older can be extremely isolating. (8) One of the most difficult realities of aging in our society these days is how quickly it can empty our lives of the people and relationships that bring our lives meaning. As we age, people start to depart from our lives, one by one- we retire from our jobs, our friends and partners die, our children move out, or our relationships end. And without these people, it can be easy to lose our sense of purpose and pleasure as well.

What happens when we lose purpose, pleasure, and community? Our health, productivity, and general well-being take a major nosedive. This is why building a support network of understanding family and friends is such an essential tool for managing ADHD as we get older.

So, if you notice your life is a bit less peopled now than it used to be, are there ways you can start to layer some back in through hobbies, volunteering, or fitness?

A good starting point is finding an ADDA support group in your local area. After all, who better to help you than people who are going through similar issues? A rock-solid gang of wise and sympathetic buddies is your path to a life well-lived with ADHD.

6. Reminders—your roadies for life

Calendars, alarms, journals, diaries, notes, stickies, productivity apps—there are lots of options out there to help keep you organized and on track. And no doubt you’ve tried a full laundry list of ADHD brain hacks over the years.

Sometimes, even old systems you shrugged off because they didn’t work in your life before are often worth reviewing to see if they might fit back into our lives now. And then there are always new strategies, systems, and hacks that we come across every day.

**But, big ‘ole Red alert**—with systems comes the classic ADHD trap of enthusiastically downloading three or four productivity apps or new shiny systems, juggling all of them simultaneously, then feeling overwhelmed and promptly abandoning them.

Try picking just one app or strategy to try to stick to it for 2 months (the average amount of time it takes to form a new habit) (9).

And ss always—the goal here is resiliency, not consistency. ADHD brains aren’t innately built to put something into action and then stick to it each and every day thereafter. That’s okay and to be expected. When we focus on getting back on the horse—rather than the fact that we fell off it, to begin with—that’s when we give ourselves the gifts of opportunity and growth.

7. Menopause and ADHD—let’s talk hormones

For us women, we get the added wallop of major hormonal changes added to the kooky cocktail of aging with ADHD. The gigantic shifts that occur during perimenopause and menopause influence, in turn, neurotransmitters like dopamine, which can make our ADHD brains feel like we have sugar-crazed toddlers running amuck inside our heads.

Because of this extra layer of neurotransmitter/ hormone chaos happening inside our brains, it can be helpful to have a conversation with our doctors about the various treatment and support options we have, including HRT, ADHD medications, therapy, and regulatory strategies. It’s all about finding the strategies that work for you.

 Aging with ADHD—you’ve got this.

ADHD certainly throws us a few curveballs in our golden years, but it’s never too late to find new and creative ways to work with our brains. In fact, there has never been a better time to understand the unique strengths and peccadilloes of our brains than right now—because knowledge of how ADHD works and what we need to function best is increasing every day.

So go ahead—reach out to that ADHD-informed provider, explore treatment and therapy options, and seek support when you need it. ADHD brains shift with age and situation, but the years also bring experience, wisdom, and maturity (meaning that you might find yourself able to draw upon your strengths and protect yourself against your vulnerabilities better than ever before).

And if you’re new to the sparkly world of ADHD—welcome! We’re so glad to have you aboard. I know it can seem overwhelming and daunting at first, but this new knowledge could be just the thing to unlock the most fulfilling years of your life yet.

Sources:

1. Callahan BL, Ramakrishnan N, Shammi P, et al. Cognitive and Neuroimaging Profiles of Older Adults With Attention Deficit/Hyperactivity Disorder Presenting to a Memory Clinic. Journal of Attention Disorders. November 2021. doi:10.1177/10870547211060546

2. Sibley MH, Arnold LE, Swanson JM, Hechtman LT, Kennedy TM, Owens E, Molina BSG, Jensen PS, Hinshaw SP, Roy A, Chronis-Tuscano A, Newcorn JH, Rohde LA; MTA Cooperative Group. Variable Patterns of Remission From ADHD in the Multimodal Treatment Study of ADHD. Am J Psychiatry. 2022 Feb;179(2):142-151. doi: 10.1176/appi.ajp.2021.21010032. Epub 2021 Aug 13. PMID: 34384227; PMCID: PMC8810708.

3. Xu, G., Strathearn, L., Liu, B., Yang, B., & Bao, W. (2018). Twenty-year trends in diagnosed attention-deficit/hyperactivity disorder among US children and adolescents, 1997-2016. JAMA Network Open, 1(4), e181471. doi:10.1001/jamanetworkopen.2018.1471

4. Pines A. Midlife ADHD in women: any relevance to menopause? Climacteric. 2016 Oct;19(5):423-5. doi: 10.3109/13697137.2016.1152536. Epub 2016 Feb 25. PMID: 26914101.

5.  Chang Z, Ghirardi L, Quinn PD, Asherson P, D'Onofrio BM, Larsson H. Risks and Benefits of Attention-Deficit/Hyperactivity Disorder Medication on Behavioral and Neuropsychiatric Outcomes: A Qualitative Review of Pharmacoepidemiology Studies Using Linked Prescription Databases. Biol Psychiatry. 2019 Sep 1;86(5):335-343. doi: 10.1016/j.biopsych.2019.04.009. Epub 2019 Apr 17. PMID: 31155139; PMCID: PMC6697582.

6. Liu, C., Hua, M., Lu, M., & Goh, K. (2023). Effectiveness of cognitive behavioral‐based interventions for adults with attention‐deficit/hyperactivity disorder extends beyond core symptoms: a meta‐analysis of randomized controlled trials. Psychology and Psychotherapy Theory Research and Practice, 96(3), 543-559. https://doi.org/10.1111/papt.12455

7. Xie Y, Gao X, Song Y, Zhu X, Chen M, Yang L, Ren Y. Effectiveness of Physical Activity Intervention on ADHD Symptoms: A Systematic Review and Meta-Analysis. Front Psychiatry. 2021 Oct 26;12:706625. doi: 10.3389/fpsyt.2021.706625. Erratum in: Front Psychiatry. 2021 Dec 06;12:806241. Erratum in: Front Pediatr. 2023 Jan 09;10:1095727. PMID: 34764893; PMCID: PMC8575983.

8. Lally, P., van Jaarsveld, H. M., Potts, H. W. M., & Wardle, J. (2009). How habits are formed: Changing habit, habit change. European Journal of Social Psychology, 39(6), 943-953. https://doi.org/10.1002/ejsp.674