Did you know ADHD is now recognized as one of the most common psychiatric diagnoses in adults with a prevalence of approximately 5% in the US?
Approximately 10 million adults have attention-deficit/hyperactivity disorder (ADHD). Many do not know they have it. Studies on ADHD have given more insight into how our brains work. People living with ADHD can experience challenges when they try to focus on tasks, transition from one task to another, make decisions about safe behavior, cope with pressure to meet expectations or deadlines, and difficulty following directions.
ADHD in older adults can look very different from what most people picture. We’re not talking about a hyperactive child running around and disrupting a classroom. In seniors, ADHD more often shows up as forgetfulness, disorganization, restlessness, procrastination, or a pattern of missing steps in routines—not because they’re confused, but because their brain struggles with executive function. I have also observed that the struggles the brain is having to manage sensory input and accomplish daily tasks can also cause gaps in memory, even though the person does not have memory loss.
There is evidence of anatomical differences in the brains of children with ADHD in comparison to other children without the condition. For instance, children with ADHD have reduced grey and white brain matter volume and demonstrate different brain region activation during certain tasks (Pliszka, 2007). Further studies have indicated that the frontal lobes, caudate nucleus, and cerebellar vermis of the brain are affected in ADHD (Tripp & Wickens, 2009). Of the children who are diagnosed with ADHD, 65% will continue to have this condition in adulthood.
There are three types of ADHD:
Predominantly hyperactive, predominantly inattentive, and a combination of both. Most adults with ADHD are predominantly inattentive.
ADHD predominantly inattentive presentation
- Fails to give close attention to details or makes careless mistakes
- Has difficulty sustaining attention
- Does not appear to listen
- Struggles to follow through with instructions
- Has difficulty with organization
- Avoids or dislikes tasks requiring sustained mental effort
- Loses things
- Is easily distracted
- Is forgetful in daily activities
Treatment for ADHD can include medication and behavioral therapy.
Medication does not cure ADHD; however when medication is effective, it eases ADHD symptoms. Medications that most effectively improve the core symptoms of ADHD seem to primarily to affect certain neurotransmitters (brain molecules that facilitate the transmission of messages from one neuron [brain cell] to another). The neurotransmitters involved are dopamine and norepinephrine. Both neurotransmitters appear to play a role in the attentional and behavioral symptoms of ADHD.
When older adults with ADHD also have sensory impairment (like blindness) and physical challenges from a stroke or other condition, their ADHD symptoms can worsen.
Here is what one expert in caregiving for adults with ADHD shared at a workshop:
[This brings us to a critical point: coexisting conditions like blindness or physical impairments intensify ADHD symptoms. A blind resident with ADHD is not just missing structure—they’re also missing visual feedback. That’s two strikes against their ability to self-manage. A resident with limited mobility may want to follow a hygiene routine but gets so overwhelmed by the steps involved, or frustrated by their physical limitation, that they abandon the task altogether.
Now, let’s talk about what we, as care providers, can actually do about it.
The first strategy is structure. Daily routines should be consistent, clearly communicated, and broken down into manageable steps. Don’t say, “Let’s get ready for bed.” Say: “First, we’ll brush your teeth. Then we’ll change into your pajamas. Then we’ll sit in your chair for a minute before bed.” Give one instruction at a time, and use sensory anchors whenever possible—like a familiar smell or a calming voice to signal the start of bedtime.
For blind residents, auditory and tactile cues are essential. Use talking clocks. Use texture labels on drawers. Create routines that rely on sound, tone of voice, or even time-based alarms. For residents with physical disabilities, make sure that instructions are both cognitively and physically manageable. Ask yourself: are we assuming they can carry out a step just because we gave the instruction?
Another strategy is emotional regulation support. ADHD affects not just attention, but emotion. A resident may become irritable, impulsive, or seem “dramatic.” But they’re likely reacting to sensory overload or internal chaos. Keep your tone calm, your instructions clear, and your expectations realistic. Don’t assume they’re being difficult—assume they’re overwhelmed.
This also applies to ourselves. When a resident snaps at us, or forgets the same thing five times in a row, we can respond in frustration—or with empathy. If we remember this is neurological, not intentional, we can reframe the situation: not “Why are they giving me a hard time?” but “They’re having a hard time.”
Team collaboration is key. Share what works across shifts. Maybe you’ve found that Terry listens better when the TV is off during medication rounds. Or that Lillian likes to hum when she’s brushing her teeth—it helps her focus. Share those details. Small insights make a big difference in ADHD care.
I will add that spreading out daily care tasks in a structured way and maintaining our role as partners in care can really help. For example:
- Brushing teeth— have supplies already organized and ready to set up on a tray directly after breakfast so that the transition to this care step is easier.
- Have supplies already organized and easy to reach to help with care in the moment (scheduling times for care may help but may also back fire if they are having difficulty attending to the care task needed).
- Shower in the afternoon after a fun social activity to avoid being overwhelmed with the morning routine and improve the experience of showering. Get the water and room temperature right first! Have soft towels to wrap around upper body for comfort. Aromatherapy products can also improve the experience. These steps take into consideration the sensory experience of showers and reduce the stress that can be associated with showering. The shower couldn’t happen? No problem: do a sponge bath! They work very well when you have the right products like no rinse shampoo and pretreated bath cloths. The important point here is to maintain a positive relationship as a caregiver and avoid creating pressure that can lead to less cooperation.
- Be consistent with timing of prescribed medications to help with reducing pain and for emotional stability.
- Help with sleep at night by engaging in activities during the day and maintaining a good nighttime routine.
- Set an upbeat tone from the start of the care routine. Play favorite music and facilitate conversation about things to look forward to for the day. Take a few moments to connect first before care.
Medications for ADHD Symptoms
Psychostimulant compounds are the most widely used medications for the management of ADHD symptoms. The two stimulants most commonly used, methylphenidate (MPH) and amphetamines (AMP), are regulated as Schedule II drugs by the Drug Enforcement Administration (DEA) because they have a potential for abuse when not used as prescribed by a medical professional. ADHD medications approved for adults include methylphenidate; Focalin, Focalin XR; Concerta; Daytrana; Metadate CD; and the amphetamines, Adderall XR and Vyvanse (generic: lisdexamfetamine).
These medications vary in the length of their effectiveness from 4 to 12 hours depending on the medication. Contrary to some reports, the stimulants are well tolerated in therapeutic doses without any abuse. There is no evidence to substantiate the fear that stimulant use leads to substance abuse or dependence. On the contrary, studies indicate that successful treatment of ADHD with stimulants lowers the chances of substance use disorders, compared to adults with untreated ADHD. It is imperative that a person who is prescribed a stimulant for the treatment of ADHD never share their medication with others.
What are the serious side effects of lisdexamfetamine?
While less common, the most serious side effects of lisdexamfetamine are described below, along with what to do if they happen.
- Increased heart rate (if over 100 beats per minute, call the physician right away).
- Increased blood pressure
- Fast breathing
- Sweating
- Trouble sleeping
- Feeling very energetic or restless
- Decreased appetite
- Shaking
- Trouble with coordination
- Flushed skin
- Stomach pain
- Vomiting
- Dilated (unusually large) pupils
- Feeling anxious
- Feeling angry or aggressive
- Thoughts of hurting yourself or others
- Dramatic increase in energy
- Significant trouble sleeping
- Your thoughts are racing and fast-paced
- Engaging in reckless behavior
- Having unusually grand ideas
- Feeling excessively happy or irritable
- Talking more or faster than usual
- Trouble thinking clearly
- Suspiciousness of others
- Changes in emotions (you feel emotions very strongly or you do not feel emotions at all)
- Hallucinations (you hear or see things that others do not)
- Delusions (you believe things that do not make sense to others, like you have special powers)
- You stop taking care of yourself
If someone is experiencing these serious side effects they need to contact their healthcare provider right away and describe their symptoms clearly. Take vital signs and make notes so that the medical professionals can better understand and take action.
I appreciate the insights that studies on ADHD have given us about the complexity of our brain and how we can better approach caregiving with understanding and compassion.
Resources used for this training:
Created with the support of Matt Ivey, LM Lab AI + Dyslexic AI
Attention-Deficit/Hyperactivity Disorder (ADHD) | More To ADHD
Cleveland Clinichttps://my.clevelandclinic.orgADHD Medications: How They Work & Side Effects