Experts have warned of an ADHD “diagnosis gap” in people aged 65 and over.

ADHD, or attention deficit hyperactivity disorder, is a form of neurodivergence characterised by a pattern of symptoms such as inattention, hyperactivity or impulsivity.

It’s estimated 2.6 million people in the UK have ADHD, almost 700,000 of which are children.

A study published in The Lancet Regional Health Europe highlighted there’s been a substantial rise in ADHD diagnoses across the UK.

But despite this, there remains a significant under-recognition of the condition in the over-65s, with just 0.05% of this age group diagnosed with ADHD.

Study author Dr Gavin Stewart said the findings “mirror what we see in other types of neurodivergence, such as autism, where upwards of 90% of middle-aged and older people are likely to not be formally recognised as being autistic”.

Dr Hugo de Waal, consultant psychiatrist at Berkeley Psychiatrists, said the findings “reflect something many clinicians have observed for years: ADHD does not disappear with age, but recognition of it has historically been much lower among older adults”.

He highlighted that many people in this age bracket grew up during a time when ADHD was poorly understood and also largely viewed as a childhood behavioural condition.

“As a result, countless individuals may have spent decades attributing difficulties with organisation, attention, emotional regulation or task management to personal shortcomings rather than an underlying condition,” he said.

Harvard Health noted that older adults with ADHD might struggle with attention issues, poor memory, and planning. What once might’ve been considered hyperactivity can evolve into inner restlessness. They might find themselves struggling to recognise social cues or manage their emotions.

“They may struggle with finishing projects or remembering information consistently, and they may become distracted during conversations and experience difficulty maintaining relationships,” added Harvard Health.

The risk of remaining undiagnosed

Experts are increasingly seeing what they’ve dubbed “late-life decompensation” in older adults, who have successfully compensated for ADHD traits throughout their lives, often supported by the external structure of a demanding career, established routines, or a partner who helps manage day-to-day responsibilities.

But retirement, bereavement, declining health, or other major life transitions can remove that structure.

“When this happens, long-standing coping strategies may become less effective, leaving individuals feeling unexpectedly overwhelmed by planning, decision-making and everyday tasks,” said Dr de Waal.

“This can sometimes present as severe anxiety, low mood or treatment-resistant depression, where ADHD may be an underlying contributing factor.”

Dr Stewart added that diagnosis “often acts as a gatekeeper to receiving timely help and support” which may be particularly important as people age and their support needs change.

“However, the majority of ageing neurodivergent people will not have received a diagnosis and be unsupported, which needs to be urgently addressed,” he warned.

The tide is turning, slowly

While diagnosis rates among this age group remain low, Dr Shevonne Matheiken, older adults’ consultant psychiatrist at Care ADHD, said what they’re witnessing in practice tells a more encouraging story.

“More people over 65 are coming forward for assessment – some even in their 70s and 80s,” she said.

The realisation and desire to seek diagnosis usually comes after a child or grandchild has received their own diagnosis.

“Older adults can also present when perimenopause or age-related cognitive changes unmask or mimic undiagnosed ADHD,” she added.

“It’s important that clinicians involved in screening, referrals and onward care don’t dismiss older people due to outdated thinking – ‘isn’t it too late?’ or ‘what’s the point of knowing now?’,” said the expert.

“An assessment can provide validation and answers at any age – irrespective of whether they can trial medication.”

Dr Hugo de Waal noted that receiving a diagnosis – even later in life – can be “transformative”.

“Failing to identify ADHD can have significant long-term consequences for mental health, physical wellbeing and quality of life,” he said.

Yet a diagnosis can provide an explanation for challenges that may have affected education, employment, relationships and self-esteem for decades, while opening the door to appropriate support and treatment.

“The findings highlight the need for greater awareness among both the public and healthcare professionals, alongside assessment pathways that recognise ADHD can affect people at every stage of life,” he continued.

“No one should reach later adulthood without answers simply because the condition was less understood when they were younger.”