Can ADHD get worse with age?

How ADHD symptoms change over time

ADHD presents itself in three key ways:

• Predominantly inattentive behavior
• Predominantly hyperactive-impulsive behavior
• Combined inattentive and hyperactive-impulsive behavior

Children are more likely to present as hyperactive-impulsive, while adults are more likely to present as inattentive, according to Mayo Clinic, though both can have difficulty concentrating and experience impulsivity. Adults with ADHD may experience emotional dysregulation, relationship difficulties and social isolation, and they may have co-occurring conditions like depression, anxiety or bipolar disorder.

In some cases, adults may not know they have ADHD and may attribute their symptoms to other factors. However, when these symptoms are sustained (lasting more than six months) and interfere with one or more areas of life like work, school, health, relationships or finances, an ADHD screening might be in order.

ADHD symptoms can also change over time. For instance, hyperactivity in children tends to manifest itself physically (e.g., running around, impulsive behavior), while adults tend to have more internal symptoms (e.g., inability to relax, talking a lot or feeling restless). However, research is unclear on whether ADHD actually gets worse with age.

One study found that ADHD symptoms generally stay stable throughout a person’s lifetime — and that symptoms like impulsivity and hyperactivity may actually decrease with age.

You may also notice symptoms abating with age because you’ve learned effective coping skills over time. You also may have adjusted your expectations as you’ve gotten older.

Can untreated ADHD worsen over time?

If left untreated, symptoms of ADHD could get worse over time due to outside factors. The following can exacerbate symptoms in adults:

• Life demands: Those who’ve been able to handle their symptoms as a child may find them hard to manage after they take on adult responsibilities.
• Changes in support structure: Parents may have put in place structures and supports at home, like managing medications and establishing daily routines, to help with ADHD symptoms — this support may be lost once someone with ADHD enters adulthood.
• Hormonal changes in women: Perimenopause and menopause cause estrogen and dopamine levels to drop in women in their 40s and 50s. Since ADHD is already associated with low dopamine levels, age-related hormonal changes can make symptoms worse and lead to more intense mood swings, inattentiveness and anxiety.
• Retirement: ADHD symptoms that were once managed by the day-to-day routines, schedules and social interactions associated with a regular job may present more strongly in a post-retirement life. According to the American Journal of Managed Care, retired individuals can also experience a disruption to their sleep routines and eating habits after losing the daily structure of their jobs, both of which can make ADHD symptoms worse. On the other hand, some retired adults with ADHD report a reduction in symptoms due to fewer stressors in their lives.

What if I never seek treatment for ADHD?

Unmanaged ADHD can make it harder to control impulses and think about long-term consequences, putting you at a higher risk of losing your job or getting a divorce, according to the group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). It’s also been shown to impair executive functioning in adults, contributing to issues with job and academic performance.

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Aging and cognitive decline with ADHD

When older adults are diagnosed with ADHD, their symptoms can overlap with those of other age-related conditions. For example, adults with ADHD are more likely to be diagnosed with conditions like mild cognitive impairment (MCI), which is accompanied by symptoms like forgetfulness, inattention and difficulty completing tasks, Alzheimer’s disease and dementia.

Older adults with ADHD may also experience issues with their working memory, forget common words or names, misplace things and/or have trouble following conversations. Additionally, activities like driving can become dangerous for people with ADHD due to inattentiveness.

Although there’s no cure for ADHD, there are steps older adults can take to manage their symptoms and preserve their cognitive health:

• Taking ADHD medication
• Getting regular sleep
• Managing blood pressure
• Limiting the use of caffeine and alcohol
• Maintaining a healthy diet
• Keeping the mind engaged by learning new skills and activities
• Staying connected with family and friends
• Getting regular physical exercise
• Using memory aids like mnemonic devices, color-coded labels, calendars and wall charts to stay organized
• Ensuring phones or other electronics are out of reach and avoiding eating, drinking and other distractions while driving

Maintaining a structured lifestyle and sticking to a routine can help manage many ADHD symptoms as adults age.

When to seek help for worsening ADHD

It can be hard to know exactly when to get help for ADHD, especially if you only have a mild case. However, if you’re noticing issues in at least two areas of your life, it may be time to seek professional help.

ADHD could impact your life in several ways. You may experience any of the following:

• Trouble holding down a job
• Relationship troubles
• Poor money management
• Trouble managing and prioritizing day-to-day tasks
• Constant worrying that you can't stay on top of your responsibilities
• Consistent underachieving at work or school

The two main treatments for ADHD are medication and psychotherapy, and these are often used in conjunction. However, older adults who take stimulant medication for ADHD may experience more cardiac risks, like rapid heart rate and high blood pressure, than other adults. These concerns should be discussed with your provider. Because older adults are more likely to be taking other medications, care should be taken to ensure there are no contraindications.

In addition to drugs and therapy, adults can also try working with a life coach, joining a support group or implementing healthy lifestyle changes, like improving their diet or increasing physical activity.

Managing ADHD symptoms as you age

Managing ADHD symptoms is an ongoing task. Fortunately, there are several strategies to help you manage your symptoms more effectively. Use daily planners or to-do lists to stay organized. Some other helpful tips include:

• Organize and declutter your home and office space.
• Reach out to family and friends for support.
• Improve the quality of your sleep with the help of a guided meditation app.
• Join a support group (online or in-person).
• Use timers to help you stay on task.
• Educate your friends and family about your condition and how it manifests itself in relationships (e.g., inattentiveness, forgetfulness, impulsivity) so they can try not to take it personally.
• Work with a therapist or life coach to improve your social skills.
• Schedule regular consultations with your medical provider to adjust your treatment plan.

Bottom line

ADHD is a lifelong condition, and you may need to change your management strategies as you age. While more research needs to be done about the specific needs of adults with ADHD, we do know that if ADHD is not properly managed, symptoms can cause problems with careers, relationships and everyday life.

If you’ve already been diagnosed with ADHD or suspect you have ADHD and you’ve noticed symptoms like inattentiveness, impulsiveness or poor time management getting in the way of your life, schedule an appointment with your doctor to discuss your options. There are ways to treat and manage this condition, and a health care provider can help you better understand your ADHD and how to effectively control it.