Forgetfulness, distractibility, and impulsivity are common symptoms of attention deficit hyperactivity disorder (ADHD). As an older adult with ADHD, how will these traits manifest? We find out from Dr. Tay Kai Hong, Consultant Psychiatrist at Private Space Medical, Farrer Park Medical Centre.
About half of the children with ADHD will have symptoms that persist into adulthood; though less pronounced. The key identifiable traits are inattention, impulsivity, and hyperactivity.
The symptoms of inattention include carelessness, forgetfulness, distractibility, and persistently having difficulty sustaining attention. There is a chronic tendency to procrastinate on tasks that require sustained mental effort and great difficulty in organizing tasks, activities, and physical spaces. Because of poor time management, deadlines are often missed. The person may appear to be daydreamy and often preoccupied with their thoughts.
“The most common ADHD presentations which I see are severe difficulties in concentration and sometimes a disabling tendency to procrastinate on important tasks despite great effort,” Dr. Tay says.
The traits of hyperactivity and impulsivity include restlessness, being unable to stay in one’s seat or remain in queue, excessive talkativeness, frequently interrupting others, and appearing to be tactless and impatient in social interactions.
“The person with ADHD may blurt out answers even before the question is asked, because he or she is not able to resist the impulse to talk,” he says.
"While children with ADHD tend to show all the core symptoms, the adults with ADHD tend to struggle most with inattention. Hyperactivity symptoms get better with age, perhaps because it is easier to manage our behaviors than it is to manage our wandering thoughts," Dr. Tay explains.
“For some of my patients with ADHD, the novelty and variety of experiences which school life offered sustained their interests and performance in school," Dr. Tay says.
Since the ADHD brain is driven by novelty, interest, and a sense of challenge, the wide range of school subjects, co-curricular activities, yearly changes in class and teachers, and constant assignments and assessments helped them stay engaged.
In contrast, life in adulthood may follow a more repetitive, more mundane routine, with family commitments and work responsibilities. It could partially explain why some people with ADHD only present in adulthood.
Typically, adults with ADHD may seek professional help when they are no longer able to cope with the demands at work.
“While they may have compensated for their ADHD symptoms through sheer effort and intellect, there comes a time when demands overwhelm their ability to cope,” he explains.
For a child with ADHD, parents and educators may work together to provide a routine and structure throughout their growing years. When they progress to university or start employment, support systems (such as direct parental supervision or receiving out-of-school tuition) are less available and they may begin to struggle.
“Adults with ADHD also seek help for common mental health challenges such as anxiety, depression, insomnia, or addictive behaviors,” he adds.
Indeed, people with ADHD are at higher risk of developing these conditions, which could be a secondary consequence of their ADHD.
ADHD is a neurobiological disorder which starts in the developmental stages of childhood and can persist into adolescence and adulthood. It can affect a child’s learning ability, emotional regulation, and impulse control.
The symptoms may improve with age. Adults with ADHD would implement new habits and put in place routines to manage the symptoms. Over time, they learn by trial and error what works and what does not.
However, changes to the brain continue as the person gets older. Sometimes, neurodegenerative processes will set in late in life and deteriorate over time. The examples of these processes are Parkinson's disease, Alzheimer's disease, and various types of dementia. These disorders would affect learning, processing speed, and memory.
“Years before developing dementia, older adults may experience increased forgetfulness. They may lose their train of thought more easily or become more impulsive in their actions," Dr. Tay explains. “Doctors call this stage mild cognitive impairment (MCI) and it may progress to dementia but this is not always the case.”
“A handful of recent scientific studies have shown early evidence linking ADHD to an increased risk of developing neurodegenerative disease. It may sound alarming, but the findings are far from conclusive. More research and studies are much needed in this area," he advises.
In that context, the link between ADHD and late-onset dementia remains intriguing, as both disorders primarily affect cognition but lie on opposite ends of the age spectrum.
“Crucially, the studies are unable to determine a cause-and-effect relationship, but the researchers have presented several possible explanations. This could be genetic or due to family-wide environmental risk factors such as smoking, alcohol use, or dietary or lifestyle factors; or health conditions such as stroke, diabetes, consequences from a head injury, sleep disorders, and depression – all of which increase the risk of dementia and could be conceivably related to the impact of ADHD on one’s life,” Dr. Tay elaborates.
While the vast majority of adults with ADHD learn to manage their symptoms more effectively as they age, a small minority may be at higher risk of neurodegenerative disorders and cognitive decline in old age. If you find yourself having to care for an older person with cognitive decline, it is important to learn some caregiving tips.