ADHD and: Aging

As women get older, they often notice changes in their body and mind that can be difficult to adjust to. And for women with ADHD, these changes can be even more challenging.

In this episode, Dr. Monica Johnson breaks down how ADHD uniquely impacts women as they age. Listen as she offers valuable insights on how to thrive with ADHD at any stage of life. And find out how small changes can lead to big improvements in daily well-being.

We love to hear from our listeners. Email us at podcast@understood.org.

Related resources

• ADHD and menopause

• A guide to hormones and ADHD

• ADHD and: Hormones

Timestamps

(00:41) What happens to the ADHD brain as you age?

(03:35) How ADHD impacts aging in women

(06:53) How to manage challenges of aging

Episode transcript

Dr. J: We often talk about ADHD in childhood and adulthood. But what happens as we continue to age? Are the issues with ADHD exacerbated? What about the gender and hormonal shifts? How do they play into that? If you're feeling your age and trying to be kind to your future self, girl, me too.

This is "ADHD and," where we talk about everyday life and ADHD. I'm Dr. J, a licensed psychologist who works with people with ADHD. Today, we're talking about ADHD and aging.

(00:41) What happens to the ADHD brain as you age?

As we age, a lot changes in the body. But what happens to the brain when you have ADHD? The ADHD brain doesn't just disappear with age. In fact, women with ADHD often experience a shift in how their symptoms manifest or how they experience them as they get older. We're going to hop into the research, and I will try to make practical sense of it for you.

To start, there are not enough controlled studies on what happens with ADHD as we age. ADHD does persist in older adults, but the number of those still meeting full criteria for ADHD above the age of 50 is largely unknown. There is reason to believe that the prevalence is falling gradually with age and that the level of ADHD symptoms is significantly lower in the age group of 70 to 80 years old versus the age group of 50 to 60. But again, we don't have the data.

One study found that more men than women report ADHD symptoms in older age. For instance, in this study, it was 5.1% of men and 2.9% of women, which is significant. Inattention scores in women improved, which means they went down in middle age, and then they went back up again as they got into older age. Hyperactivity scores tended to go down for both sexes.

Higher ADHD scores were correlated with lower life satisfaction scores, but only high-scoring women were found in the poor satisfaction category.

Stimulants may still be helpful, however. There's limited research on stimulant use in older adults. There doesn't appear to be a clear link between ADHD and dementia at this time. The bigger issue is that mild cognitive impairment, or MCI, is something many older adults may experience due to medical issues or degenerative diseases, and those symptoms look very similar to ADHD.

What I'm saying is that it's normal and natural that as we age, for us to, for example, have memory and inattention issues. Therefore, it's hard to know what's causing the problem when so many things look alike. We need more research to be able to distinguish between normal aging and ADHD, so that we can continue to properly treat people as they age.

You should expect that certain executive functioning issues will continue to decline as you age, because it is normal for us to have diminished capacities as we grow older, however, utilizing the old "use it or lose it" mentality, there are things that we can do to offset it. More on that later. Let's get into how having ADHD specifically impacts the aging process for women.

(03:35) How ADHD impacts aging in women

It's not just forgetfulness or being overwhelmed, though those are definitely a part of it. There are some nuanced effects ADHD can have on people's lives as they continue to age. Shortened lifespans may be associated with having ADHD, which is likely mediated by related behavioral and socio-demographic factors, which are also associated with accelerated physiological aging.

Such factors include exhibiting more depressive symptoms, more cigarette smoking, higher body mass index, lower educational attainment, lower income and adulthood, and more challenges with cognitive processes compared to the general population. What does this mean? It looks like ADHD itself wasn't tied to poor health outcomes, but the behaviors such as smoking and less education may be associated with poorer outcomes.

Keep in mind that these types of correlations are not solely due to people with ADHD across the board. When you look at mental illness and substance abuse, those issues are linked with poor health outcomes because of the types of behaviors that people typically engage in when they struggle with these issues. For example, if you struggle with mental illness, you're going to be more likely to eat poorly, smoke, etc. All of these things lead to a bad time as we age.

If you're a woman with ADHD, the hormonal shifts that can occur in perimenopause and menopause can exacerbate your symptoms as well because, as estrogen decreases, it can increase the impact of ADHD and other issues. Here is an important fact to keep in mind, regardless of your starting point in life, generally speaking, things tend to get harder as we age.

For example, if you listen to Doctor Peter Attia, who talks about increasing your health span, he'll say things like, "If you can't open a jar at 30, you're not going to magically be able to do it when you're 60". If you're not specifically doing things to improve your grip strength, it will continue to decline as you age.

I am a person who has been obese my entire life, officially given that marker at six months old. If I had a bad metabolism at six months old, and I know that metabolism is something that continues to get worse as we age, I need to engage in actions now to counteract and improve these areas of my life. Or else, there's simply going to continue to decline. So what do I do?

A lot of different things. I work out at least five days a week on most weeks, I have one meal a day that I eat each day that doesn't involve meat, and there's a hundred different things that I do in order to help myself maintain my health span as I age. Keep in mind, I've never not been designated as obese based on my BMI, and there are things that I can do with my body that you would never imagine.

I'm telling you this because I do not want to cause you any dismay. Everyone has a hill or two that they need to climb. And the good news is that for most of it, it's the fundamentals that make it all happen. So, what can we do about it? How can women with ADHD manage the challenges of aging without losing hope and feeling overwhelmed? Let's talk about some practical strategies that can help.

(06:53) How to manage challenges of aging

Do an inventory of yourself. Be honest. I tell my patients all the time that the first step is to stop lying to yourself, and the second is to figure out how to trick yourself. Where do you naturally struggle? How can you support yourself in that struggle? And what do you want to be able to do in the future?

I hate exercise. It's a natural struggle for me, but I want to be mobile when I'm older, so it's also a requirement. The way I support myself through it is by using accountability. Like it or not, I'm a dependable person. If I say I'm going to do something, I do it. If I sign up for a workout class, I'm going. We all have inherent strengths along with our limitations. Use those to your advantage.

For example, one of my patients with ADHD really enjoys body doubling. Body doubling involves working alongside another person while completing tasks. These can be things you need to do for work or household chores. Ever since my patients started utilizing this strategy, they have had a higher success rate with many of their goals. In fact, they're seeing increased success outside of their body, doubling because they have more confidence and more practice in utilizing the skills because they have an accountability partner.

We all know that consistency is imperative, and that is often the thing that is lacking and create space for us to give up. If you struggle with consistency, it's OK. I do, too. What is important is to meet yourself where you're at. If you need a bike with training wheels, that's OK. The point is to get from point A to point B without running into a tree.

If you're utilizing medication, please keep in mind that your experience of it may change over time. It's important to have a team that knows your baseline and can help you with making adjustments across your lifespan. I know I speak a lot about getting professional help, and that's not just lip service. If you have a psychologist like myself or a psychiatrist, we can often do testing, keep track of your baseline, and changes that occur over time.

We can also help you to engage in preventative measures if necessary and make informed decisions about any necessary adjustments that you will need to make during your life. Ongoing cognitive behavioral therapy or ADHD coaching can help with emotional regulation, self-acceptance, and coping strategies and have you be ready to face whatever challenges arise for you in life.

Practices like meditation, deep breathing, and yoga can help with emotional regulation and impulsivity. Clear communication strategies are paramount for getting and maintaining relationships. Better boundaries setting, which includes learning to say no, reducing your commitments, and prioritizing tasks to avoid burnout are also going to be helpful along the way.

Having a consistent sleep schedule is necessary. Whenever you talk to Huberman or Brian Johnson or whoever, they're always talking about sleep. If they're asked the question of what is the one thing you would recommend if you could only recommend one? It's sleep. ADHD often disrupts sleep, so maintaining good sleep becomes crucial. This is stuff like having the same bedtime, limiting screens, utilizing white noise, an eye mask, whatever is needed for you to get some Zs.

Regular physical activity helps to regulate dopamine levels and improve focus, emotional regulation, etc. Prioritizing protein-rich meals, avoiding excessive sugar or caffeine, and staying hydrated to maintain steady energy and focus is a good idea. Using reminders, planners, and task management apps like Google Calendar or Notion to compensate for executive functioning challenges is necessary. Find the tools that work for you and then actually use them.

The next thing I'm going to mention is structured routines. If my patients know anything, they know that creating routines is not optional if you actually want to live a healthy life. Sticking to consistent daily schedules will minimize forgetfulness and impulsivity, among other executive functioning issues. The last thing I'm going to mention here is breaking task into manageable steps. So, when you break down projects into manageable parts with clear deadlines, it does actually decrease your overwhelm over time.

Most of the problems you're dealing with in life, or the tasks that you need to complete, are multi-step endeavors that require a certain time horizon to accomplish. It would be great if life was full of one-and-done to-do list items, but it's not. However, there's not much that you can't handle if you divide it into manageable, bite-sized pieces. You're probably actively working on all of these things right now and thinking, "I'm doing all of that, and things are still hard."

The first thing that I'd say to that is, "Are you doing all of that? Or do you do it all one time and then get frustrated and stop for a while?" It's OK if that happens to you, but if you need to do something a thousand times in order to get good at it and you've only done it 99, you have to keep going. Remember what I said earlier? Know your struggle and support yourself through it.

Secondly, if you've been doing these things and it still feels hard, ask yourself, "Is it supposed to?" Some things are never meant to be easy. It never feels easy for me to go to the gym. It never feels easy for me to choose brussel sprouts over ice cream. What does feel easy is the fact that I don't have to deal with diabetes or high blood pressure on top of whatever else I have going on in my life.

Which brings me to my final point on aging: find your community. We all need support, whether that's through our family, close friendships, our church, our care team, or a support group. When times are hard, you need people that can lift you up and hear you out. And when times are good, it's always fantastic to have people around who are cheering for you. You're not going to see me, but I'm in the audience rooting for you.

That's it for today. If you're feeling your age or you figured out a good hack, let me know in the comments. If you enjoyed this episode, I'd highly recommend our episode on ADHD and hormones. This is where I talk about the menstrual cycle's impact on your ADHD symptoms, and I give you a few ideas on what can help. Don't forget to subscribe to our channel, and I'll see you on the next episode of "ADHD and."

This show is brought to you by Understood.org, a nonprofit organization dedicated to empowering people with learning and thinking differences like ADHD and dyslexia. Learn more at Understood.org.

"ADHD and" is produced by Tara Drinks and edited by Alyssa Shea. Our video producer is Calvin Knie. Ash Beecher is our supervising producer. Briana Berry is our production director. Neil Drumming is our editorial director. Our audio engineer and music composer is Justin D. Wright. Our executive directors are Laura Key, Scott Cocchiere, and Seth Melnick. And I'm your host, Dr. J.