More and more older adults are coming to therapy, often for the first time. They want to understand how their brains work and discover new ways to enjoy their golden years.

They want to talk about their relationships with their adult children, their spouse, their in-laws, life directions not taken, and coping increasingly with chronic illness and grief. 

Woven throughout their stories are repeated examples of forgetting things, not being able to ever prioritize themselves, not remembering to take care of themselves, finding the steps involved in quarterbacking their own healthcare unbearably burdensome, and usually a childhood trauma history. 

Other symptoms that should be a flag for a clinician to look deeper include:

• Difficulty learning new things,
• Talking too much, often without realizing it,
• Interrupting others,
• Trouble following conversations,
• Difficulty maintaining relationships and keeping in touch,
• Difficulty maintaining order within their homes,
• Social challenges like still feeling misunderstood or judged, speaking impulsively, missing social cues,
• Tremendous struggles to make ends meet financially after a lifetime of poor money management.

For the therapist, a common experience I hear in consultations with other therapists is that every session (or at least every few weeks), it feels like they are starting all over again, despite the work agreed upon in the previous 10-15 sessions.

The therapist listens carefully, considers their age, considers cognitive complaints, and lands on the most familiar explanation: ‘normal’ aging, maybe early mild cognitive impairment, possibly the beginning of something more serious, or worsening of a chronic physical health condition. 

Maybe assessments are conducted, and maybe a referral gets made. And despite it being one of the most common comorbidities alongside anxiety, depression, or complex trauma, the possibility of ADHD never enters the conversation.

We (as a collective treatment community) have just started to figure out that adults, especially middle-aged women, continue to be significantly burdened by the fluctuating symptoms of ADHD, well into adulthood. 

Are we ready to do a better job supporting our seniors? 

The Research Gap Is Real

Here is what the evidence actually tells us: ADHD does not reliably stop at 65.

Symptoms persist into older adulthood for many people, often shifting in how they look rather than disappearing altogether. And yet, the research base for assessing and diagnosing ADHD in adults over 70 is sparse enough that there are currently no consensus guidelines, in Canada or internationally, that speak specifically to this population.

Canada’s own gold standard, the CADDRA Canadian ADHD Practice Guidelines (4.1 Edition, 2020), provides detailed guidance for children, adolescents and adults. It does not include age-specific direction for older adults. The ASRS is the most widely used adult screener, and was normed on younger adults. There are no adjusted cut-off scores for someone who is 73.

Finding treatment is another roadblock as well. Even after being diagnosed, many adults with ADHD frequently report trouble getting a doctor or psychiatric nurse practitioner trained to prescribe them ADHD medication, even if they’d taken it without incident earlier in life. Concerns about cardiac issues, conflicting medications (‘polypharmacy’), or side effects make some doctors reluctant to prescribe stimulants to adults over 60.

What Gets Missed and Why

Only one in five memory disorder clinics actively screen for ADHD (Goodman, 2024). Older adults presenting with cognitive complaints are far more likely to be assessed for dementia or mild cognitive impairment than to have anyone ask whether these difficulties have been present since childhood.

The overlap between ADHD and MCI is genuine and clinically tricky. Both can produce forgetfulness, difficulty multi-tasking, disorganization and trouble with planning. The key distinguishing feature is chronicity. ADHD symptoms are lifelong and fluctuate around major life transitions and external stressors. Cognitive decline represents a change from a previous baseline. Asking “to some extent would you have been describing these same struggles ten or twenty years ago?” can be more diagnostically useful than a neuropsychological battery, because research tells us those tests are not reliable for diagnosing ADHD in older adults (ADDitude Editors, 2025).

The clinical interview, the developmental history and collateral information from people who have known this person across their lifetime remain the most defensible tools available. The clinical interview is an invitation to do the kind of deep, relational, curious assessment that good mental health practice has always been built on.

The stakes are higher than you might think

A 2023 study published in JAMA Network Open followed over 109,000 adults across nearly two decades and found that those with ADHD carried a significantly elevated risk of developing dementia, nearly 2.77 times the risk of those without ADHD, after controlling for a wide range of factors (Levine et al., 2023). Notably, this elevated risk was not observed in those who received psychostimulant treatment.

We are not yet at the point of drawing firm causal conclusions from that finding. But it adds urgency to an already urgent question: what are the downstream consequences of leaving ADHD unidentified and untreated in older adults? And who bears the cost of that gap?

Older adults with ADHD are not a niche population

A Dutch epidemiological study found a prevalence of nearly 3% symptomatic ADHD in adults aged 55 to 85 (Halmøy et al., 2016). In Canada, that translates to a meaningful number of people (roughly 360,000 of 12 million seniors in that age bracket) whose neurodevelopmental profile has likely shaped their relationships, their work histories, their mental health trajectories and their quality of life, and who have never once had it named.

Many of them were children in an era when ADHD was poorly understood, rarely diagnosed and routinely missed in girls. They developed coping strategies. They compensated, masked and adapted. And now, in later life, when those strategies are less available and the demands of aging bring new cognitive load, the symptoms surface in ways that clinicians are not trained to recognize. And for older women, entering perimenopause and then post-menopausal, the loss of estrogen (the largest catalyst of dopamine in our brains) is a common stage of life where previously missed ADHD is finally revealed.

The solution is not complicated in principle, even when it is complex in practice.

We need age-sensitive screening tools, and guidelines that extend their reach across the full lifespan. We need clinicians who are trained to ask about ADHD before defaulting to a neurodegenerative explanation.

And we need a culture that takes seriously the possibility that a 75-year-old can receive a meaningful, life-changing diagnosis.

What an Assessment Looks Like Right Now

While we wait for the research and the guidelines to catch up, best practice for assessing older adults with suspected ADHD includes a thorough lifelong symptom history, corroboration from family members or others who knew the person earlier in life, careful differential diagnosis that considers MCI, depression, anxiety, sleep disorders and polypharmacy, and a functional lens, not just symptom counting, but understanding how these patterns have played out across a lifetime.

The ASRS is a reasonable starting point. A score above the threshold in both Parts A and B in a 70-year-old deserves more weight, not less.

A thoughtful clinical and family history from a psychotherapist or family physician trained to detect and distinguish ADHD symptoms from other similar symptoms could help plan a more accurate treatment plan to help unpack how the person got as far as they did, and to build the scaffolding around them that they deserve. 

Learn more about the screening, assessment and diagnostic pathways for mental health in Canada, including ADHD HERE.

Not sure where to start? Fill out a no-obligation and confidential intake form HERE and our team will get back to you and set you up with a therapist who can help.

References

ADDitude Editors. (2025, November 3). ADHD in older adults: Distinct diagnostic and treatment considerations. ADDitude Magazine. https://www.additudemag.com/old-age-adhd-diagnosis-treatment/

Canadian ADHD Resource Alliance. (2020). Canadian ADHD practice guidelines (4.1 ed.). CADDRA. https://www.caddra.ca/canadian-adhd-practice-guidelines/

Goodman, D. W. (2024, October 14). ADHD in older adults: Diagnosis and treatment. AARP. https://www.aarp.org/health/conditions-treatments/adhd-in-older-adults-symptoms-diagnosis-treatment/

Halmøy, A., Fasmer, O. B., Gillberg, C., & Haavik, J. (2016). Optimal management of ADHD in older adults. Neuropsychiatric Disease and Treatment, 12, 79–87. https://pmc.ncbi.nlm.nih.gov/articles/PMC4712975/

Levine, S. Z., Rotstein, A., Kodesh, A., Sandin, S., Lee, B. K., Weinstein, G., Schnaider Beeri, M., & Reichenberg, A. (2023). Adult attention-deficit/hyperactivity disorder and the risk of dementia. JAMA Network Open, 6(10), Article e2338088. https://doi.org/10.1001/jamanetworkopen.2023.38088
Rönngren, Y., Björk, A., Hellzen, O., & Kristiansen, L. (2024). ADHD in older adults: A scoping review. Aging and Mental Health, 28(9), 1189–1196. https://doi.org/10.1080/13607863.2024.2339994