Late-diagnosed ADHD is becoming increasingly common, with more adults receiving a diagnosis in their 50s or 60s. ADHD can often come as a surprise diagnosis in later life, and symptoms may be difficult to spot, particularly as the individual will have lived undiagnosed for many years and likely developed strong coping strategies.
Understanding ADHD in older adults
For clinicians testing and treating older people for ADHD, here are some key questions and answers.
Q. Why are we seeing an increase in later-life ADHD diagnoses?
Our understanding of ADHD back in the 1960s and 1970s wasn’t as advanced as it is today. Testing methodologies were less developed, and symptom presentations of ADHD in women, girls, and Black Indigenous and Persons of Color (BIPOC) were often missed. The increase in ADHD diagnoses in the over-50s is because people whose symptoms have been missed all this time are now finally being recognized.
Q. Can ADHD present for the first time in older age?
One of the DSM-5 criteria for an ADHD diagnosis is the presence of symptoms before age 12. So, ADHD doesn’t develop for the first time in adulthood, but it may only become apparent in older age, especially if symptoms have been overlooked or masked. Later life stresses and major life transitions such as divorce, bereavement, retirement, ill health, and menopause may exacerbate ADHD symptoms and make coping strategies less effective. This can lead to burnout that triggers an investigation into an ADHD diagnosis.
Explore patient psychoeducation at different stages
We’ve developed a psychoeducation pack for clinicians to share with patients. The pack examines experiences of ADHD at different life stages and the conversations that may come up in the clinic between parents, children, teens, and adults with ADHD and their clinician.
Diagnosing ADHD in patients over 50
In older adults, looking for evidence of ADHD symptoms across the lifespan, particularly when masking and coping strategies are a factor, comes with several challenges.
Q. Is developmental history still important when diagnosing ADHD in older citizens?
Identifying whether ADHD symptoms have always been present (DSM-5 uses before age 12) is important for an ADHD diagnosis. It helps distinguish symptoms from conditions that may develop later in life, such as dementia or Alzheimer’s.
Q. How can I adapt clinical interviews for older adults whom I suspect may have ADHD?
Masking or coping strategies are more common in adults who have had undiagnosed ADHD for many years. These coping mechanisms can make rating scales and questionnaires less effective at identifying ADHD symptoms. Asking open-ended questions about times throughout the patient’s life where they struggled with stress, overwhelm, achieving tasks, and the circumstances around those triggers may help to identify if there is past evidence of ADHD symptoms.
Q. Do ADHD symptoms present differently in adults over 50?
We know that ADHD symptoms can vary with age. Research on older adults with ADHD suggests that while all three core symptoms of hyperactivity, impulsivity, and inattention can still be present, inattention is often the most visible and may present as forgetfulness, disorganization, and procrastination.
Q. Can digital ADHD tests help diagnose ADHD in adults over 50?
Objective data from a digital ADHD tool can help to fill in some of the gaps that may exist in developmental history and education records when assessing older patients. A study of adults aged 55–79 found that an objective test correctly identified ADHD in around 70% of cases. When results were combined with patients’ self-reports of their symptoms, accuracy increased to about 91%.
ADHD titration and treatment for older patients
Older patients may have more reservations about starting ADHD treatments. They’ve lived a long time without medication and may feel more able to cope independently – this can make non-pharmacological interventions and psychoeducation important tools for clinicians when treating patients in later life.
According to guidance from NICE and the British National Formulary (BNF), stimulant medications are not contraindicated for older adults when prescribed appropriately. While careful consideration should be given to comorbid conditions and potential cardiovascular risks, both sources note that age alone is not a limiting factor for ADHD medication use.
A cautious, individualized approach of starting at a low dose and titrating slowly remains best practice.
Q. Are stimulants safe for ADHD patients over 60?
Stimulant medications are often used as first-line treatments for ADHD in younger adults and can work quickly and effectively to treat symptoms. However, many commonly prescribed stimulants do not have FDA-approvals for use in older adults, with Adderall and Concerta only approved up to age 65. This can present challenges with medical insurance.
Despite these considerations, medication, including stimulants, remains an effective and commonly prescribed treatment for older patients with ADHD.
A study of adults aged 50+ with ADHD found that 63.8% received pharmacological treatments resulting in better attention and more favorable outcomes.
Q. How quickly should I titrate medications in older adults?
Before starting treatment in older people, there are some additional considerations. Older adults are more likely to be taking medications for other conditions and are more prone to cardiac or hypertensive conditions.
A safety-first approach is important in titration at all ages, but is particularly relevant in ADHD patients over 50. A ‘start low and go slow’ methodology can help to test dosages alongside existing medications and conditions and help to find a minimum viable dose.
Q. What non-pharmacological treatments help older adults manage ADHD symptoms?
Many of the behavioral and lifestyle adaptations used to help with ADHD symptom management throughout the lifespan are likely to still have benefits for older people. These can include practices like taking regular exercise, adopting healthy sleep patterns, minimizing distractions, and developing routines, etc.
A study of older adults also found Cognitive Behavioral Therapy (CBT) to be effective, with older patients being equally as responsive to the intervention as younger adults.
Q. Why are non-pharmacological interventions and psychoeducation more important for older ADHD patients?
There is some evidence that beyond age 65, the benefits of pharmacological interventions for ADHD reduce, and problems with side effects increase to a point that prescribing medication becomes more difficult and less desirable.
For these older patients, non-pharmacological interventions and psychoeducation become increasingly important. These tools continue to help patients understand and manage their ADHD symptoms, without the complications of medication.
Differentiating ADHD from aging and other conditions
As we get older, our bodies and minds can function differently. Here are some key questions and answers about ADHD and comorbid conditions in older patients.
Q. How do I know if it’s ADHD or ‘old age’?
It’s common for older people to be more forgetful, mislay and misplace items more often, struggle with new tasks, and lose focus or concentration. The difficulty for clinicians is determining whether these are common experiences of an older person, symptoms of a medical condition like dementia, or ADHD.
Q. How do I tell ADHD apart from early dementia?
Symptoms of ADHD vs dementia can have significant overlap. However, there is evidence to suggest that adult ADHD symptoms are often more severe in middle age than at older age. This means that ADHD symptoms are likely to have presented before old age, whereas dementia symptoms will develop (for the first time) in later life.
The challenge for clinicians is that older patients may not be able to remember whether these symptoms were present earlier in life, as recall bias and forgetfulness can be significant problems. In these cases, input from a partner, child, family friend, or referring to school records and reports may be necessary to identify whether symptoms are newly present due to dementia or were in evidence earlier in life and therefore more likely to be ADHD.
Key takeaways:
Living with ADHD in later life
Diagnosing ADHD in older adults comes with several challenges. This will often mean adopting a wider testing strategy – using objective tests and input from friends and family to fill any gaps in data. Treatment plans may also need to be adapted, and after 65 non-pharmacological interventions and psychoeducation is likely to become increasingly important.
What remains consistent into later life is that diagnosing ADHD is a critical first step to helping patients get the support they need and being able to live well with ADHD.
Citations
- Abdelnour, E., et al. “ADHD Diagnostic Trends: Increased Recognition or Overdiagnosis?” Mo Med, 2022. https://pmc.ncbi.nlm.nih.gov/articles/PMC9616454/
- Antoniou E., et al. “ADHD Symptoms in Females of Childhood, Adolescent, Reproductive and Menopause Period. Mater Sociomed. 2021. DOI: 10.5455/msm.2021.33.114-118
- Teuchert, C., et al. “Uncovering Functional and Dysfunctional Masking Strategies: A Qualitative Approach toward Improving Diagnostic Assessment for Adult ADHD.” ResearchGate. 2025. https://www.researchgate.net/publication/396016978
- Fischer, S., & Nilsen, C. “ADHD in older adults – a scoping review.” Aging & Mental Health, 2024. https://doi.org/10.1080/13607863.2024.2339994
- Bijlenga D, et al., “Objective assessment of attention-deficit/hyperactivity disorder in older adults compared with controls using the QbTest.” International Journal Geriatric Psychiatry. 2019. https://pubmed.ncbi.nlm.nih.gov/31243809/
- “ADHD in Older Adults: Distinct Diagnostic and Treatment Considerations.” Additude Magazine, 2025. https://www.additudemag.com/old-age-adhd-diagnosis-treatment/ Accessed 29/10/2025
- Lensing, M. B., et al., “Psychopharmacological Treatment of ADHD in Adults Aged 50+.” Journal of Attention Disorders. 2015. https://doi.org/10.1177/1087054714527342
- Torgersen T, et al., “Optimal management of ADHD in older adults.” Neuropsychiatric Disease and Treatment. 2016 https://pmc.ncbi.nlm.nih.gov/articles/PMC4712975/
- Solanto MV, et al., “The efficacy of cognitive-behavioral therapy for older adults with ADHD: a randomized controlled trial.” AttentionDeficit/Hyperactivity Disorders. 2018. https://pubmed.ncbi.nlm.nih.gov/29492784/
- Beehuspoteea, N. and Badrakalimuthu V.R., “Exploring the relationship between ADHD and dementia.” Progress in Neurology and Psychiatry. 2023. https://onlinelibrary.wiley.com/doi/full/10.1002/pnp.784