Dr. Grossi's Blog
The diagnosis of ADHD requires defects in three areas. Those areas are inattention, hyperactivity, and impulsivity. I am often asked how these manifest in adult and elderly populations. This is not made clear in DSM-IV-TR, which cites childhood criteria only. About 65% of children who meet criteria for ADHD continue to meet criteria as young and older adults.
The inattention criteria in childhood include poor attention to details, careless with homework, trouble sustaining attention, not listening, problems with follow-through, forgetful, distractible, looses things, avoids tasks requiring sustained concentration, and difficulty getting organized. In adults with ADHD the manifestations include problems keeping the household clean and organized, late payment of bills and taxes, tardiness in mealtimes, taking kids to school and appointments, meetings often missed or forgotten, and problems with maintaining attention in work-related tasks or paperwork. In the elderly, inattention manifests in difficulty managing medications or doctor's appointments, disorganized taking of medications, misplacing items in the household, forgetfulness, and problems in managing finances or running the household.
Hyperactivity in childhood involves fidgeting, not staying seated, runs or climbs excessively, noisy when playing, talks excessively, and acting as if driven by a motor. In adulthood the symptoms can be similar, and also selecting employment that requires being active or on the go and being easily overwhelmed. In the elderly there is an increase in falls and injuries and difficulty sitting in group activities.
Impulsivity in childhood includes blurting out answers, difficulty awaiting turn, interrupting or intruding on others. In adulthood these are manifest in reckless driving, impulsive comments or sexual behavior, frequent job changes and irritability or anger episodes. In the elderly, I often see frequent changes in health providers and easily provoked agitation.
(Consider a related blog Gender Differences in ADHD.)