When Does It End? Attention-Deficit/Hyperactivity Disorder in the Middle Aged and Older Populations

Background: Attention-deficit/hyperactivity disorder (ADHD) is estimated to affect 4% to 6% of the adult population. In recent years, more and more middle-aged and older adults (> 55 years) turn to the ADHD unit at Geha Mental Health Center suspecting ADHD. Yet, a literature search resulted in very few relevant studies. Methods and Results: This study, approved by the Geha Mental Health Center ethics committee, presents 11 patients, 55 years or older, diagnosed and treated by the unit. The patients underwent complete clinical evaluation for ADHD according to Diagnostic and Statistical Manual of Mental Disorder, Fourth Edition. The data-collection phase included demographic and clinical data; Test of Variables of Attention scores used as indicators of methylphenidate (MPH) response; Clinical Global Impression scores of both severity and improvement were used. Because the sample is very small, allowing only limited statistical analyses, nonparametric statistics were used. Eleven patients, aged 61.64 +/- 3.87 years (male-female ratio, 9: 2), were assessed. The follow-up was conducted for more than 2 months. Fifty-five percent had ADHD, predominantly inattentive, and 45% had ADHD combined type. All patients indicated suffering (Clinical Global Impression-Severity score range: mild = 27.3%, moderate = 45.4%, severe = 27.3%). Fifty-four percent showed at least 1 psychiatric comorbidity. Test of Variables of Attention scores showed significant improvement in 90% (8/9 patients) with MPH dosages similar to those used in younger adults. All patients attended the follow-up visits. Ninety-one percent (10/11) continued with the medication. Clinical Global Impression-Improvement scores showed significant improvement in 73%. No adverse effects were reported. Conclusions: This pilot study described 11 adults 55 years or older, diagnosed with ADHD for the first time. Attention-deficit/hyperactivity disorder characteristics seemed to persevere; middle aged or older ADHD patients had similar clinical-demographic characteristics and a similar response to MPH as younger adults. No significant adverse effects were noted.