ADHD, Aging, and Retirement: A Conversation with Kathleen Nadeau

By Doug Harris

ADHD and aging is an emerging and important topic of discussion and research. We interviewed clinical psychologist and ADHD specialist, Kathleen Nadeau, to learn more about the effects of ADHD on lifestyle, finances, cognitive functioning, and relationships with age. Dr. Nadeau is an internationally recognized authority on ADHD, maintains an ADHD specific practice in Washington, D.C., and has served on the Professional Advisory Board of ADDA.

Q: What spurred your interest in ADHD, Aging and Retirement?

A: Issues relating to aging and retirement are getting completely overlooked.

I’m always looking to see who is getting neglected, and why, and how can I bring issues to the forefront so they get more attention. We’ve seen all these people who are now in their 60’s who know about their ADHD but nobody is telling them what their issues are going to be now; what to anticipate, better ways of coping. There’s just been absolutely no research.

There are some neuropsychologists who have speculated that if you have ADHD to begin with, and are going into your 60’s and 70’s and experiencing mild cognitive decline, that the combination of the two is going to be much more challenging than if you did not have ADHD. I think it’s really important to talk to seniors about lifestyle choices and what they can do to keep their brains functioning optimally as well as how ADHD affects couples in retirement.

 

Q: What do you see as the biggest challenge for people with ADHD in retirement?

A: One of the big challenges at any time in life when you have ADHD is to lack structure.

If you were going to design the most dysfunctional situation possible for someone with ADHD, an unstructured environment would be it! I remember one of the first seniors that I worked with who has ADHD. She had been an art teacher and had just recently retired. She had functioned reasonably well for a long time. She raised two kids and had been an art teacher. She said the structure of her kids’ days and her work helped to keep her on track, although she certainly had a somewhat messy, cluttered house and may not have been the most organized in bill paying.

Then she retired. Not only did she retire, she moved close to one of her grown daughters to a completely different, unknown environment. Suddenly her life just fell apart! There were no set mealtimes, no set bedtime, no set getting-up time, and her nights and days got turned around. She had packed up all her stuff and brought it with her but she never unpacked. So here’s this capable woman with cardboard boxes lining the walls of her new apartment, living in complete chaos at a time in life when she meant to relax and enjoy herself! I think her health was significantly at risk as a result.

I met with her and we discussed the importance of creating structure. Her daughter even participated. Whether you want to teach art classes or take art classes or volunteer in the community, it’s really important that you have a place to go, a time to go there, and the opportunity to interact with other people. She’d become extremely socially isolated because she’d lost the core structure of her life that had led her to be around people all day long. And so I think one of the questions that people with ADHD need to ask themselves is: “What living situation or community am I going to function best in?”

 

Q: What are the financial challenges of retirement for someone with ADHD?

A: A lot of things are risk in retirement, especially finances.

One element to consider is that almost all of us are on a much more limited budget than we were on before retirement, which means being a lot more careful with our money. This isn’t easy for a person with ADHD in the first place. Then, they have all this free time on their hands and if they’re living alone they’re more likely to go out to eat, which is much more expensive than eating in. They may be entertaining themselves by doing online shopping that they can ill afford.

I remember working with one couple in which the husband was in his late 50’s or early 60’s and had retired on physical disability. He nearly went bankrupt. The mailman was constantly bringing packages to the house. He had no idea how much he was spending. He couldn’t even remember what he had ordered. It was all impulsivity and boredom. There are a lot of financial issues that people with ADHD need to deal with, especially retirees.

 

Q: How does retirement change the dynamic of ADHD relationships?

A: It is not uncommon for martial issues to come into play that weren’t there before.

I remember working with a couple and the husband had ADHD. He was a very bright guy, an engineer, and was very talkative, active, and “go-go-go”. He had a job for which he traveled a great deal and he worked long hours. So his wife had developed a very quiet and satisfying lifestyle for herself while her husband was working. She liked to garden and had a special place she liked to sit in the morning and watch her birdfeeders while she had her morning coffee. And then suddenly here is this surge of stimulation, her hungry husband in the house seemingly disrupting everything she was used to; turning on the TV when she when she just wanted to watch her birds in the morning or saying “Let’s go somewhere!” when she didn’t want to go somewhere. She just wanted him to find something to do without her and return to her peaceful routine. This led them into couples’ counseling with me. She wondered:

“How do I make this adjustment? My husband is driving me crazy! How do I manage all this ADHD stuff that I didn’t have to live with all day, every day?”

This gentleman was pretty typical of people with ADHD. We respond to whatever is in front of our noses, and what was in front of his nose was his wife. And so rather than organizing activities or initiating things, he would ask her to do something with him. A lot of the work that I did was helping him do some research on activities, clubs, organizations, and volunteer opportunities that he could get involved in. He was a very social guy while she was an introvert. He was hyperactive while she was quiet and liked to sit and read. I had to really coach him through the process of finding a post-retirement life that was stimulating enough.

 

Q: What can couples do to better prepare for the realities of retirement?

A: It is really important for both members of the couple to become educated about ADHD and, specifically, how it impacts their particular spouse.

There can be a lot of anger if you don’t understand your partner. “Why do you keep doing this when I’ve asked you not to a hundred times?” It’s hard to believe the partner with ADHD just keeps forgetting. “How do you keep locking your keys in the car? Wouldn’t one time be bad enough to remember not to?”

I think it’s extremely important to understand each other and then to start creating an environment where those snafus are less likely to happen. A lot of it is just a matter of getting a better understanding of what’s going on. It’s not willful behavior or intentional disregard.

It is also important to teach the person with ADHD that it is their responsibility to find solutions. We can’t just say, “Whoops! That’s my ADHD!” Okay, so that is your ADHD. How are you going to fix it? How are you going to send yourself a reminder or have a backup system? I think that’s such an important message to the spouse of someone with ADHD: this isn’t a free pass and you can’t say, “I can’t help it, I have ADHD.” ADHD is a way to explain why these things are happening, and this understanding needs to be followed by a solution, an ADHD friendly solution.

 

Q: Beyond education, what can someone with ADHD do to be better prepared for their senior years?

A: If you were going to prescribe something for anyone over the age of 50 to improve cognitive functioning it would be half an hour of aerobic exercise every day.

A fair body of research is being amassed on brain functioning and memory enhancement in the senior years. It’s important to understand the implications. There was an article about this in the New York Times sometime in the past year. Researchers tested participants’ memory abilities and then divided them into groups. One group was just trying to stay mentally alert by doing crossword puzzles and reading. A second group was a yoga, mindfulness, meditation, and relaxation group because, of course, stress causes our brains to not function well cognitively. And the third group was an aerobic exercise group. There was no competition. Far and away the people in the exercise group improved memory more than the other two groups!

This is an important message to get across to seniors because aerobic exercise in your late 60’s or 70’s, or even 80’s, it doesn’t have to be something hugely vigorous. All it has to do is get your heart rate pumping at 80% of your maximum heart rate for your age. That’s a really important factor: for your age! We don’t want anyone getting hurt, and checking with your doctor first is important, but aerobic exercise seems to be the very best thing you can do.

 

Q: Do you see many people getting diagnosed as seniors?

A: I think, really, what we’re dealing with are people that were diagnosed as adults who are getting older.

Personally, I’m not coming across that many people seeking and getting a diagnosis in their 70’s so much as I’m finding that the older end is gradually creeping up. For example, at my clinic we have not accepted Medicare for years. We are changing that policy and we’re going to start accepting Medicare because we are finding that more people covered by Medicare want to come to our ADHD specialty clinic. We really need to help them think about and address the set of issues that they’re going to be facing.

 

Q: Do you find that people with ADHD have any advantages when it comes to aging and retirement?

A: I think in some ways retirement years are the pot of gold at the end of the rainbow for a lot of people with ADHD!

Many people have lived their lives feeling that most of their waking hours were taken up doing something they don’t really like to do at all just because that’s what paid the rent. There is certainly that high-energy, high-curiosity ADHD’er that suddenly gets to lead that stimulating, active life that their working years didn’t afford them. Also, many have come to manage their challenges. Many people with ADHD have struggled with forgetfulness and having trouble remembering names and facts and dates for a long time, and now they’ve sort of adapted or developed ways to deal with these challenges after experiencing them their whole lives.

 

Q: Are there any other common ADHD pitfalls to watch out for in the senior years?

A: The tendency to not structure or manage time can sometimes lead to a crazy over-commitment in the immediate post-retirement years.

Many want to do things and they want to go places and it doesn’t all fit together financially or in terms of time commitment. I think it can be very, very helpful to work with a coach for a little while as you make the transition from working to retirement.

Ideally, you wouldn’t have such an abrupt change. I consider myself very, very fortunate; I’ve had the kind of career where I can work five days a week or four days a week or three days a week. I can gradually retire and there doesn’t have to be such a sudden transition from working full time on Friday to having nothing to do and nowhere to go on Monday morning. I think it is very hard transition for anyone.

 

Q: What do you think the future holds for the topic of ADHD and Aging?

A: Public awareness is going to grow.

Awareness has grown significantly over the last twenty years. Look at the demographics, a lot of Baby Boomers are going into retirement. I really think this is going to be one of the big issues moving forward.