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ADHD Institute Register

30 Jun 2020

Nyström A et al. Issues Ment Health Nurs 2020; Epub ahead of print

Adults aged ≥50 years are increasingly seeking initial assessment for ADHD such that the manifestation of ADHD amongst older adults is of growing interest (Torgersen T et al, 2016). The purpose of this qualitative study was to examine the day-to-day life experience of individuals aged ≥50 years with ADHD.

Participants were recruited via personal contacts, through social media platforms (e.g. Facebook) and by using “snowball sampling”.* Information regarding participants’ feelings, thoughts and challenges associated with day-to-day life was gathered using individual interviews. Participants were also asked how they handled any challenges, what had changed over the years and if anything had become better or easier with age. Demographics, factors related to diagnosis of ADHD and complementary questions were asked at the end of each interview. The participants’ interviews were interpreted using a three-phase process, and themes and sub-themes were developed to reflect the impact of ADHD on the participants’ day-to-day lives.

In total, 10 adults (age range, 51‒74 years; n=7 female) agreed to participate in the study; all participants spoke Swedish (n=9/10 were native Swedes). All participants were single (unmarried or divorced) and nine had children. Four participants had attended university; in terms of occupation, participants were either unemployed/pension (n=3), on sick-leave (n=3), working part-time/retired (n=2), self-employed (n=1) or retired (n=1). Most participants were diagnosed with ADHD when they were aged 40‒50 years (n=4) or aged 50‒60 years (n=4), and had an awareness of being different since school (n=4) or for their entire life (n=4). Seven participants were taking ADHD medication and six found this enabled them to better self-regulate and become calmer. All participants had ≥1 psychiatric comorbidity (depression, n=6; anxiety/panic disorder, n=4; sleeping disorder, n=4; alcohol/substance abuse, n=3; burn out syndrome, n=3; bipolar disorder, n=2) and a family history of ADHD or psychiatric disorder (children, n=6; parent(s), n=5; sibling(s), n=4; grandparents, n=2; grandchildren, n=1).

The following themes and sub-themes were identified:

Being different and trying to manage my inner self

Managing feelings of being different, being disorganised and forgetful: Participants highlighted that living with ADHD meant that they felt different or inferior to other people, or that something was wrong. Shame and embarrassment were common feelings that persisted over time, especially in areas where performance was measured. Although participants were aware of their problems, they had difficulty in asking for and accepting help. Those with a higher level of cognitive functioning typically received their ADHD diagnosis later in life as they could manage their difficulties for longer. Following their diagnosis, participants expressed relief and their problems became less severe with age. As participants grew older, they felt safer and life became easier and more understandable.

Developing strategies to handle the difficulties of being different: Having strategies to manage day-to-day life made the participants’ lives easier but did not eliminate the difficulties, and could mask a need for help. A positive relaxing environment and very structured and detailed instructions seemed to help participants’ well-being. Poor working memory and making plans was a problem for many participants with many using memo notes and calendars to aid forgetfulness. The expectation from others to be organised was also a struggle. Compared with fathers, mothers seemed to create more structure around their children; however, when their children left home, life reportedly became more chaotic. Medication for ADHD was helpful in reducing negative feelings, calming down, slowing down thoughts and allowing more time to think before acting.

Having to control impulses and energy: Although a lack of impulse control had negative consequences (e.g. speeding tickets, driver’s licence suspension, car accidents, running away from home, getting into sexual relations too quickly and getting pregnant early), low impulse control enabled participants to be creative (e.g. start up new projects or be hyper-focused). However, participants felt they had less energy than required, meaning that they were unable to do complete tasks when they needed to and needed more recovery time than individuals without ADHD.

Trying to adapt to fit in with people around me

Struggling to adapt to social relationships: A major concern for participants was social situations as they struggled to understand social norms, to adjust their behaviour in accordance with situational expectations or to adapt their communication to the individual they were talking to (e.g. speaking too much/little, being too emotional, saying things they shouldn’t or coming across as imbalanced). Many participants chose to be alone to avoid social problems; however, a lack of social skills caused adverse effects on quality of life and relationships with family and friends were affected. Participants were very grateful for the family relationships they did have; however, noted that contact with family and friends could deteriorate due to misunderstandings and feelings of being hurt on both sides.

Dealing with work and personal finances: Achieving a functional work-situation was a struggle for participants who were employed, and they were fearful of being excluded from workplace groups. An inability to control impulses caused problems at work and in personal relationships. Failure to pay bills and household expenses was particularly difficult for participants as it could have serious financial consequences. Problems in school were experienced by all participants and higher education was difficult to cope with due to a lack of concentration. Creating routines and asking for help with making plans and accepting support seemed to be an effective solution in mitigating financial problems.

The inclusion of only 10 adults with ADHD is a limitation of this study. Additionally, while the aim of this study, which was based on anecdotal evidence, was to examine the experiences of adults aged ≥50 years with ADHD, other psychiatric or physical comorbidities may have influenced their accounts and therefore these findings.

The authors state that this study provided adults aged ≥50 years with ADHD an opportunity to express, in their own words, the advantages and disadvantages of the disorder. Although medications for ADHD are available, social and financial problems might exist for older adults with ADHD, suggesting that a multidisciplinary and more holistic approach to managing ADHD in older adults may be required.

Read more about ADHD in adults aged ≥50 years here

 

*‘Snowball sampling’ was performed using the Swedish special interest group for people with neuropsychiatric disorders, Attention, which was contacted and asked to reach out to their members. Emails were sent to Attention districts in four counties in southern Sweden, and personal phone calls were made to people in these counties to spread the information. Emails were also sent to lecturers who had spoken at conferences about ADHD, and invitations to participate were also extended to members of an ADHD Facebook group
The first phase began with an initial read-through of the interview, which were recorded and transcribed verbatim, enabling the meaning of the information to be naïvely understood. An explaining structure analysis was then conducted during the second phase to validate or invalidate the naïve understanding. The third phase involved interpretation of individual phrases from the interview, which could be summarised in relation to the interview as a whole

Nyström A, Petersson K, Janlöv A-C. Being different but striving to seem normal: The lived experiences of people aged 50+ with ADHD. Issues Ment Health Nurs 2020; Epub ahead of print.

Torgersen T, Gjervan B, Lensing, MB, et al. Optimal management of ADHD in older adults. Neuropsychiatr Dis Treat 2016; 12: 79-87.

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