Did you see the recent New York Times article that said ADHD diagnoses are surging among older Americans? Okay. Let's do a little reality check. Since when are 30 to 60 year olds or 30 to 64 year olds considered older adults? In the world of research and mental health and aging, even physical health and aging, it tends to be that people 65 and older, are the age group that are older adults, not people under 65.

And the reason for that is we use markers like social security and Medicare.

That's likely to change given that Social Security age is changing. We'll see how that goes. But it definitely isn't 30 year olds or 40 year olds or even 50 year olds. In this New York Times article, the journalist tells stories about people in midlife or mid age, from 30 to late 50s, who describe their experiences of long time symptoms with ADD and ADHD symptoms who were not diagnosed until they were adults. And this is important because people are living for a long time with symptoms that could be managed and that may interfere with work and relationships and all sorts of things, quality of life, access to resources. However, the title suggests that we're going to be talking about older adults When in fact the study that the New York Times is getting this data from don't show trends with older adults.

And so here is the graph and I'm going to zoom into this graph to show you more closely what I'm talking about.

What you'll see over the years from 2018 to 2024 in this graph is that Indeed, this green age group here, which is people 30 to 44, have had an increase in diagnoses of ADHD as have the age group of 45 to 64, however, when we look above at 65 We're not seeing the same surge, but the New York Times is suggesting that the surge in ADHD diagnosis is happening for older people, which it's not.

And this leads me to the conversation today, why this is so important. So the headline that says ADHD diagnoses are surging among older Americans, it's not only misleading, It misses a really critical opportunity to focus on a real and often overlooked issue, this fact that mental health needs of older adults are overlooked and misrepresented, undiagnosed and untreated.

So here are the questions that we should be asking why aren't we seeing a rise in ADHD symptoms in people 65 and older when it's happening in ages 30 to 64? Why does it stop there? That's the question we should be asking.

Could it be that ADHD, as well as all other mental health conditions, are grossly underrepresented, unidentified, and undertreated among older adults? Might that be the answer? Let's look a little deeper. I'm Dr. Regina Koepp. I'm a board certified clinical psychologist, geropsychologist, and the CEO of the Center for Mental Health and Aging.

Let's answer these questions now. So why is it that we're not seeing the same surge in people 65 and older? There are a lot of reasons. I'm going to list six. One is ageism. Ageism is bias and discrimination based on age and it disproportionately affects older people in individual ways and in systemic ways.

In systemic ways, it keeps older people out of the system. clinical trials, which would have us learn about ADHD among older adults and how symptoms might be similar or different compared to younger age groups. And so because of this exclusion from clinical trials, we don't have as much information about older adults as we do younger adults.

There are not enough mental health and medical providers who are trained to identify what's typical in older adulthood and not, and to differentiate mental health versus physical health conditions. So we need to be doing better with training professionals. And this is professionals across the board.

In the field of psychology, less than 2 percent of psychologists specialize with older adults. This is not enough to meet the mental health needs of older adults as the older population is growing. Another example: ageism would have us make the needs of older adults irrelevant, unimportant, and not high priority compared to other age groups. As a result, mental health conditions go undiagnosed and untreated among older adults, so what happens when mental health conditions are not treated among older adults? This has all sorts of negative consequences, like medical problems worsen. The amount of medication required to manage medical problems increases. The rate of hospitalization increases. Emergency room visits increase, the length of hospital stay increases , when people have more hospitalizations and need more medications, there's more of a financial burden and demand, which also causes more strain in the family, not to mention caregiving strain.

Then there's worse quality of life and a higher risk for suicide and feeling and fearing that you will be a burden on your family. And all of these things might be diminished or mitigated if we identify and treat mental health concerns. That's how ageism plays out. It leads us to believe that the needs of older adults are irrelevant or not as important as other age groups, which is incorrect.

Another is misdiagnosis. We often misattribute. mental health concerns for medical concerns or physical health concerns instead of looking further for mental health concerns. Or perhaps if we identify mental health concerns, we believe older adults won't benefit from mental health care because after all, people don't change.

Is that correct? No, that's another myth of ageism that's getting in the way of people getting care or even diagnosed. Moving down the list is stigma. Stigma that keeps older adults from accessing mental health care or even sharing if they're experiencing mental health symptoms. If you were reared in a generation that saw and was told that mental health concerns were a weakness or a defect, you'd be less likely to talk about them.

Thankfully, that's shifting and changing in society as it should, but that stigma still persists. plagues many older people who would otherwise benefit from mental health care. And providing misinformation in articles like this, like with the New York Times, can contribute to that stigma because it's not sharing accurate information.

Because of that stigma and lots of other conditioning, older adults are more likely to describe mental health concerns as physical complaints. And so if we're only looking at presenting problems or physical complaints that face value, we might not be digging deeper and looking deeper at mental health suffering or mental health needs.

And so that, again leads to the importance of making sure that mental health and medical providers are trained to adequately identify and meet the mental health needs of older adults. And finally, this is one under discussed topic as we talk about older people, that's people 65 and older, to be clear.

One under discussed topic is resilience. So if people who are older have ADHD, they might have been living with ADHD for 80 years and have built structures and resources around them to help navigate living with this condition without the necessary supports. And this might have helped them to develop resilience which is grit and determination and moving through and rising above the adversity of living with a mental health condition like ADHD for a lifetime.

And that resilience may give them not only fortitude, they might have found a very productive way of navigating the ADHD symptoms. And so it might be at this stage in life, it's not the primary concern anymore, as it might have been in earlier stages of life. And of course, these examples are just scratching the surface of what keeps older adults from being diagnosed and treated with mental health conditions, but it's a start.

And so thanks for being here and doing this important work together. you to take away from this conversation today. The surge in ADHD diagnoses among middle aged adults. is a story that's worth telling and a conversation worth having. And so is the silence around mental health for people 65 and older.

These are also stories that need telling and conditions that need healing and repair with accuracy and compassion, not misleading headlines like the recent one in the New York Times. Christina Caron, who is the author of that New York Times article, or New York Times, if you want to dive deeper into this conversation about mental health challenges that older adults are facing, I'd be honored to collaborate on a article with you.

I've been featured twice before in the New York Times. It wouldn't hurt to have me on again. Let's spotlight the real issues and make sure no one is left out of the mental health conversation.