ADHD

Podcast Transcript

Neuro Pathways Podcast Series

Release Date: March 15, 2026
Expiration Date: March 14, 2027

Estimated Time of Completion:  30 minutes

ADHD
Cynthia Seng, MD

Description
Each podcast in the Neurological Institute series provides a brief, review of management strategies related to the topic.

Learning Objectives

• Review up to date and clinically pertinent topics related to neurological disease
• Discuss advances in the field of neurological diseases
• Describe options for the treatment and care of various neurological disease

Target Audience

Physicians and Advanced Practice providers in Family Practice, Internal Medicine & Subspecialties, Neurology, Nursing, Pediatrics, Psychology/Psychiatry, Radiology as well as Professors, Researchers, and Students.

ACCREDITATION

In support of improving patient care, Cleveland Clinic Center for Continuing Education is jointly accredited by the Accreditation Council for Continuing Medical Education (ACCME), the Accreditation Council for Pharmacy Education (ACPE), and the American Nurses Credentialing Center (ANCC), to provide continuing education for the healthcare team.

CREDIT DESIGNATION

• American Medical Association (AMA)
  Cleveland Clinic Center for Continuing Education designates this enduring material for a maximum of 0.50 AMA PRA Category 1 Credits™. Physicians should claim only the credit commensurate with the extent of their participation in the activity.
  
  Participants claiming CME credit from this activity may submit the credit hours to the American Osteopathic Association for Category 2 credit.

• American Nurses Credentialing Center (ANCC)
  Cleveland Clinic Center for Continuing Education designates this enduring material for a maximum of 0.50 ANCC contact hours.

• Certificate of Participation
  A certificate of participation will be provided to other health care professionals for requesting credits in accordance with their professional boards and/or associations.

• American Board of Surgery (ABS)
  Successful completion of this CME activity enables the learner to earn credit toward the CME requirements of the American Board of Surgery’s Continuous Certification program. It is the CME activity provider's responsibility to submit learner completion information to ACCME for the purpose of granting ABS credit.
  
  Credit will be reported within 30 days of claiming credit.

Podcast Series Director

Andreas Alexopoulos, MD, MPH
Epilepsy Center

Additional Planner/Reviewer

Ari Newman, BSN

Faculty

Cynthia Seng, MD
Center for Behavioral Health

Host

Glen Stevens, DO, PhD
Cleveland Clinic Brain Tumor and Neuro-Oncology Center

Agenda

ADHD
Cynthia Seng, MD

Disclosures

In accordance with the Standards for Integrity and Independence issued by the Accreditation Council for Continuing Medical Education (ACCME), The Cleveland Clinic Center for Continuing Education mitigates all relevant conflicts of interest to ensure CME activities are free of commercial bias.

The following faculty have indicated that they may have a relationship, which in the context of their presentation(s), could be perceived as a potential conflict of interest:

Glen Stevens, DO, PhD

DynaMed Consulting

All other individuals have indicated no relationship which, in the context of their involvement, could be perceived as a potential conflict of interest.

CME Disclaimer

The information in this educational activity is provided for general medical education purposes only and is not meant to substitute for the independent medical judgment of a physician relative to diagnostic and treatment options of a specific patient's medical condition. The viewpoints expressed in this CME activity are those of the authors/faculty. They do not represent an endorsement by The Cleveland Clinic Foundation. In no event will The Cleveland Clinic Foundation be liable for any decision made or action taken in reliance upon the information provided through this CME activity.

HOW TO OBTAIN AMA PRA Category 1 Credits™, ANCC Contact Hours, OR CERTIFICATE OF PARTICIPATION:

Go to: Neuro Pathways Podcast March 15, 2026 to log into myCME and begin the activity evaluation and print your certificate If you need assistance, contact the CME office at myCME@ccf.org.

Copyright ©2026 The Cleveland Clinic Foundation. All Rights Reserved.

Introduction: Neuro Pathways, a Cleveland Clinic podcast exploring the latest research discoveries and clinical advances in the fields of neurology, neurosurgery, neurorehab, and psychiatry.

Glen Stevens, DO, PhD: Attention deficit hyperactivity disorder is one of the most common and most misunderstood neurologic conditions, often dismissed as a childhood issue or overlooked entirely in adults.

In this episode of Neuro Pathways we'll explore how ADHD shows up across the lifespan. I'm your host Glen Stevens, neurologist neuro-oncologist in Cleveland Clinic's Neurological Institute. And joining me for today's conversation is Dr. Cynthia Seng. Dr. Seng is a psychiatrist in Cleveland Clinic's Neurological Institute's Department of Psychiatry and Psychology. Cindy, welcome to Neuro Pathways.

Cynthia Seng, MD: Thank you so much. It's a pleasure to be here.

Glen Stevens, DO, PhD: So, Cindy, for our listeners out there who don't know you, tell us a little bit about yourself, where you grew up, where you came from, trained, how you made your way here, and what you do here.

Cynthia Seng, MD: I grew up on the west side of Cleveland in Amherst, which is where I practice now. I graduated from Kent State University, and from what they used to call Northeast Ohio University College of Medicine. I know it's got a new name now. And I did my residency at the Cleveland Clinic. I started in internal medicine, and then moved to psychiatry. I was in a large multidisciplinary outpatient psychiatric practice on the west side for many years. Worked at the VA for a few years and came back to the Clinic about 15 years ago. I'm an outpatient psychiatrist, and I work in the Center for the Treatment of Adult Attention Deficit Disorder.

Glen Stevens, DO, PhD: Well, it sounds like you're the person for the task today then.

Cynthia Seng, MD: I'll do my best.

Glen Stevens, DO, PhD: So why don't you define for us ADHD in terms of how you look at it?

Cynthia Seng, MD: So, ADHD is a neurodevelopmental disorder of the brain. It almost always is first identified in childhood but not identified to the point where it may be seen as a full diagnosis or treated. It has traditionally been seen as mostly a childhood disorder until recently when we've recognized that it's actually very common in adulthood. About 6% of adults in the United States are currently diagnosed with adult attention deficit disorder. So that's one in 14 or one in 15 adults. A lot of people. And 56% of them were not diagnosed until adulthood. About 10% were not diagnosed until they were over 45 years old, which is a lot of people.

Glen Stevens, DO, PhD: And what are the common characteristics that define ADHD?

Cynthia Seng, MD: ADHD is defined as a disorder that affects both attention and focus and impulsivity. So, we normally see things like people who have difficulty focusing on things, they make careless mistakes, have difficulty with word finding, with paying attention. They're easily distracted, they have difficulty completing tasks. They procrastinate, can't manage their time. The physicians who can't get their notes done. They often lose things and are generally forgetful. Those are the attention kinds of symptoms.

And then in terms of impulsivity or hyperactivity, these folks are frequently fidgety. They need to move. They always need to be doing something. It's difficult for them to relax. They may talk too much, they may interrupt people when they're talking. They may have trouble waiting in line at the grocery store or in traffic. Those are the most common symptoms.

Glen Stevens, DO, PhD: Well, Cindy, I would like to make a confession, and that is that I do my notes every day on time.

Cynthia Seng, MD: Good.

Glen Stevens, DO, PhD: So, I take that as a positive check.

Cynthia Seng, MD: I think that is.

Glen Stevens, DO, PhD: All right. So how does ADHD typically present in adults versus children? I know you mentioned that it may be present as a child but not diagnosed. But how would it present as an adult, differently than what you just said or its predominance of certain issues?

Cynthia Seng, MD: They're the same general symptoms, but there's usually less easily identifiable hyperactivity in adulthood. So, children who are in school all day are in an environment where it may be difficult for them to express their inability to stay seated or to not be disrupted. And children are often identified as potentially having attention deficit disorder in a school setting because they're the kids who are disruptive, they can't stay in their seat, their mind is wandering, they're bothering other children, they're blurting out things in class, and are sometimes quite disruptive. We see that less often in adulthood, but it's often because adults have learned how to moderate those symptoms a little better and frequently gravitate toward environments where they can express those symptoms without getting into trouble.

Glen Stevens, DO, PhD: So, the patients that you see, how do they come to you? Who are they typically seeing first, and how do they make their way to you?

Cynthia Seng, MD: That's fascinating. We are seeing a broad, broad range of patients. Some of them are direct referrals from the child psychiatry department. They were diagnosed as children. They've turned 18. They need follow up. There's that whole population. There are young adults who were diagnosed in childhood, felt like they were doing better when they were teenagers, stopped their medication, and now they're in college or graduate school or applying for medical school or getting ready to take the MCATs or the GREs. And they're noticing that, as the material gets more difficult, as they need to sit longer, as they need to concentrate more robustly, they're having more difficulty, and they would like to be reevaluated and get back on medication.

We see a lot of people who are diagnosed when their children are diagnosed with ADHD. They will come in and say, "Oh, I found out my son has ADHD. I'm exactly like him. Maybe I've got it too." We see a lot of women in midlife who are diagnosed at that point, and that may have something to do with hormonal changes. But it's fascinating to me the number of older adults we're seeing 65 and older who have had symptoms their whole life and have managed them sometimes really well, sometimes actually not all that well. And it will be, again, often a family member who says, "My husband retired, he can't sit still. He's constantly blurting things out and interrupting me. He can't relax. He can't read a book. He can't finish a movie. What's wrong with this guy? Is he getting dementia. Is he depressed? What's the story?" And not infrequently, it's untreated ADHD.

Glen Stevens, DO, PhD: Now, Cindy, you're concerning me. I'm over 65 and I'm getting near retirement age. I'm getting concerned. I'm just curious, what's the oldest patient you've diagnosed for a new diagnosis?

Cynthia Seng, MD: For a new diagnosis? The oldest one is 74.

Glen Stevens, DO, PhD: What about the old wives' tale that you just grow out of it?

Cynthia Seng, MD: Definitely an old wives' tale. About two-thirds of children who are diagnosed with ADHD continue to have symptoms as adults. Now those symptoms don't always need to be treated, and symptoms may wax and wane depending on other things that affect attention. In mental health and in other parts of medicine too, but especially in mental health, we frequently see a symptom. A patient comes in with a symptom, and there may be a Venn diagram of diagnoses to explain that. So for instance, a person who comes in feeling depressed, they may have major depression, but they may also have circumstances going on in their environment. They may have chronic pain. So there may be a number of things that are affecting their mood.

And the same is true with ADHD. We're really looking at the symptom of attention. So a person may have ADHD, but everything else is fabulous, and they're in an environment where attention and focus may not be needed to the level that they underperform. They may be in relationships with people who don't care so much that they're all over the place, and the house is cluttered and they get hyper focused on D&D games and things like that, and they may not need treatment. But there may be times in their life where they do, a job that's really important. They have children, and all of a sudden they also have sleep deprivation and things like that going on. So it may not always need to be treated, but two-thirds of people do persist with symptoms when they're diagnosed in childhood.

Glen Stevens, DO, PhD: I assume D&D is Dungeons-

Cynthia Seng, MD: Dungeons and Dragons.

Glen Stevens, DO, PhD: ... and Dragons, right?

Cynthia Seng, MD: Sorry.

Glen Stevens, DO, PhD: That's okay. I don't play that either, so I think I'm doing okay here. I got my checklist going.

Cynthia Seng, MD: We hear a lot about video games in this population.

Glen Stevens, DO, PhD: Well, and the percentage of people with ADHD that have some other comorbid neuropsychiatric disorders, it high, is it low? It's in between?

Cynthia Seng, MD: It is high. So, comorbidities with ADHD are an interesting topic, and we're actually doing a study right now among the patients that we've diagnosed in the first two years of our program to look at medical and psychiatric comorbidities. Definitely we see major depression anxiety is probably the most common. Anxiety major depression, bipolar disorder, post-traumatic stress disorder and trauma. Those things are very, very common from a psychiatric point of view.

But more interesting to me are the medical comorbidities. We frequently see migraine disorder, hypermobility disorders like Ehlers-Danlos and syndromes like that, POTS, mast cell activation disorders. And something that all of those disorders may have in common is some level of neuroinflammation. So, there's a good deal of research going on right now trying to look at some common root for some of these disorders that pop up frequently together.

Glen Stevens, DO, PhD: For those that aren't sure, POTS is postural orthostatic-

Cynthia Seng, MD: Postural orthostatic tachycardia syndrome, which is very, and you look at any of those, they're all common together, right? POTS goes along with mast cell activation disorder and hereditary alpha-tryptasemia quite frequently those things run together. There are dyads within that group of comorbidities, but it's fascinating the number of times we see those together.

Glen Stevens, DO, PhD: So as we get older, our testosterone goes down, our estrogen goes down. Both involved with this, have a relationship, neither one does, only one does?

Cynthia Seng, MD: Yes, both are involved. There's more research about women and there's not very good research about women. So there's definitely not good research yet about men and testosterone. We've known for a long time that ADHD symptoms are worse during the luteal phase. So when estrogen is low. So frequently there are menstrual exacerbations of ADHD, and that happens even in childhood. And often with girls, the first diagnosis is made at puberty, where with boys it tends to be a little earlier than that.

And we do see another bump in the late 30s, early 40s when women are beginning to have some early perimenopausal symptoms. Definitely at menopause. So that's certainly part of the issue. Quite frequently in our perimenopausal women, we strongly encourage them to see someone in women's health to consider hormone replacement therapy, especially now that we have such wonderful research about that and good outcome studies.

Glen Stevens, DO, PhD: So it can help the ADHD?

Cynthia Seng, MD: It can. Absolutely.

Glen Stevens, DO, PhD: When you evaluate, it sounds like you have a population of older patients,is the workup for them different I assume than younger patients? What do you look at specifically in them?

Cynthia Seng, MD: We do a basic screening for everyone, for all of the potential other things that can be adding to the Venn diagram of causes for attentional disorders. But in older folks, once we crest 35 and then again once we crest 55, we tend to look for different kinds of things. So, sleep disorders can cause attention problems all by themselves. But people with ADHD tend to have sleep disorders, often phase disorders, so they tend to be vampires. They go to sleep later, they may still get there eight hours, but it's phase shifted.

Polypharmacy, especially in older adults, we see it all the time. So many medications that can affect attention, pain medications, sleep medications, anxiety medications. Everybody's on gabapentin these days for something. All sorts of medications that can affect attention. And if you put a bunch of those together, absolutely. So sometimes that's all we find.

Sometimes someone comes in looking to be treated for ADHD because their grandchild was diagnosed with it. And what we can say is the first thing we need to do is talk to your other physicians and try and pare down these medications to make sure that that's not the cause. Mild cognitive impairment and dementia syndromes are frequently on the minds of people who come in. They may not tell you unless you ask them. But frequently our perimenopausal women always come in and say, "I'm afraid I'm either losing my mind or I'm getting dementia, and here's why." So we evaluate that, we look at it. And if we're really, really concerned, we will refer for brain health consultation or neuropsych testing to make sure that's not part of the issue.

Interestingly though, there are a couple of wonderful studies, and there's one by a guy named Mendonca in 2021. And he found that performance on neuropsych testing is comparable for age matched women with ADHD and MCI. So, ADHD looks like mild cognitive impairment on neuropsych testing in perimenopausal women. Yeah, interesting finding. We definitely look at that.

There are a lot of other kinds of neurological disorders too that can present early with attention problems like Parkinson's disease for instance. There are a number of those things. Endocrine diseases, thyroid disorder. Hyperparathyroidism, that's a big one and we miss that quite often. If a calcium is high normal or just barely high in a post-menopausal woman, where calcium should be starting to go down, it's time to look at a PTH because there's a reasonable chance they may have hyperparathyroidism, and that can cause significant brain fog and memory issues. Like we talked about a minute ago, immune disorders, and connective tissue disorders. Things like lupus, mixed connective tissue disorder, mast cell activation syndrome.

Recently we've seen a number of people with long COVID. There's not a lot of good data about that yet. And a lot of these people, we can't identify a childhood history, but they definitely meet criteria now. So we're just starting to see some literature coming out about those things. But long COVID and other post-infectious syndromes like Lyme disorder, chronic fatigue syndrome, ME, can look like that as well. So there are lots of things to look at as we go through the lifespan.

Because not everything is ADHD. If you just listen to TikTok and just read People Magazine, every time you lose your keys, you've got ADHD. But that's not true. There are lots of things that can affect attention. And that's what we try to do really robustly is take a look at all of the potential causes and come up with a rational approach to evaluation and treatment.

Glen Stevens, DO, PhD: Yeah, I love that. I love the fact that you're looking at all these other options. So, let's say there's not a treatable disorder as you've just gone through. When do you use stimulant medication?

Cynthia Seng, MD: Stimulant medication is incredibly effective, and very, very safe. There's been a huge stigma against stimulant medication that I compare to the stigma we've had until recently about hormone replacement therapy. There's been this thought that stimulant medication is going to, number one, everybody's going to get addicted to it, everybody's going to divert it and sell it on the streets. Everybody's going to have cardiac side effects to it. None of those things are really true. The amount of diversion is minimal. It happens. So you need to be careful. You need to have a controlled substance agreement with patients and you need to be aware of it, but it doesn't happen as often as you think it might. The chance of it becoming habit-forming when it's used appropriately at the right doses to treat a disorder also historically have been very low. So that's not as big a concern as people tend to think it is.

But the idea of potential for cardiac cardiovascular complications is still something that really hangs people up, especially at a large institution like ours where we have a lot of sick patients with really difficult cardiovascular issues. So there have been several big studies, big papers over the last several years. A lot of them by Zhang and his group out of Sweden. And he published in JAMA three or four articles in 2022 and 2023. And they were incredibly promising and made everybody I hope feel better about it. In 2022, he published a paper that was a meta-analysis, and he looked at 19 studies with a total of almost four million total participants.

So this is big. Children and adults. And he looked at both stimulant and non-stimulant medication. So not just the traditional methylphenidates and dextroamphetamines but also atomoxetine and bupropion and guanfacine, other medications that are sometimes used to treat ADHD. And he found absolutely no association between ADHD medication and cardiovascular disease in the long run. No difference between stimulants and non-stimulants. And there was only a small in what was considered statistically insignificant increase in cardiovascular disease, mostly blood pressure in patients who had preexisting issues with blood pressure to begin with.

The next year he published a study in JAMA again that got people a little concerned because it seemed to show that there was more of a concern for high blood pressure than it had looked like before. But he was using odds ratios, which is different than looking at absolute risk. And what he found was there is a small, he found what we already knew, there is a small risk for increase in blood pressure. And that small risk, compared to what your risk might've been anyway in the general population for age-matched controls, does increase a little bit over the first three years you use stimulant medication, and then it completely levels off.

So, although there is some increase, it's still very small because it's an odds ratio risk and not a relative risk. So, if you look at all of these studies that have been done, there is some increase in blood pressure, but it's to the tune of 10 millimeters of mercury or less in most patients. And there is some increase in heart rate, but it's around the same, about 10 beats per minute or less. There's that occasional patient who never had blood pressure issues, they're young and healthy, you put them on stimulant medication, and their blood pressure may increase. And then you need to work with a family doctor to figure out why. Was it coincidental? Is it actually this is one of the cases where it's from the stimulant medication. If it is, let's look at the risk-benefit risk-risk assessment and decide how bad is the ADHD because there's also a risk of not treating ADHD.

There was another big study by this same group, and they found that the overall risk of cardiovascular disease in patients with ADHD, if you have ADHD, your risk of cardiovascular disease is significantly increased compared to people who don't have ADHD. So, it's difficult to tease that out then within these studies. And it's specifically higher for cardiac arrest, hemorrhagic stroke, peripheral vascular disease, and arteriosclerosis. So just by having ADHD, and nobody knows why, your risk for those things is already increased, independent of family history or medications that you may be taking.

And there are also other risks for having untreated ADHD. The risk for death from all causes is much higher in patients with ADHD. These folks abuse drugs more frequently. They get into accidents more frequently. They end up in prison more frequently. If you take a child or adolescent who has ADHD and don't treat them, their risk for substance abuse becomes much higher as they get into late adolescence and early adulthood.

Glen Stevens, DO, PhD: Cindy, you are a wealth of information.

Cynthia Seng, MD: I'm just really passionate about this, and I feel like it's been misunderstood for so long.

Glen Stevens, DO, PhD: No, it's fantastic.

Cynthia Seng, MD: It's been so stigmatized.

Glen Stevens, DO, PhD: So, I'm going to give you another old wives' tale, and I'm not sure how it applies to adults. But the story that I used to hear was that the kids would take their stimulant medication during the week when they're at school and then off on the weekend. Good idea, bad idea? Should stay on it? Where do you sit on that? I

Cynthia Seng, MD: I don't know the literature for kids. So let me say that right off hand, especially any new literature that may be out recently regarding children, because I've been focusing so much on adults. One of the nice thing about stimulant medication is how ultimately tailorable it is to a patient's needs. And with children, they are not always very reliable narrators. They can't always report things very well. So we're depending on parents and what they're seeing. And frequently for children, I think the idea has been that consistency is incredibly important for so many reasons. And that's true in many adults too.

But there are some good reasons why adults may want to take some time off of stimulant medication. One of them is sexual side effects. It doesn't happen frequently with stimulant medication, but it does happen. And since stimulant medication is very short acting, that's great because then you can take off Saturday and Sunday. That can be date night. And then you can be back on it during the work week.

There are people who during the work week may find that they need to use a long-acting stimulant medication during the day, and then use a little bit of a short acting in the evening in order to get through, not just work, but in order to be a good parent and spouse and do the things necessary at home in the evening. But on the weekend they may feel like they can not take that extra dose in the afternoon and have a chance to sort of rest their brain from taking the medication.

There are no good studies that tell us what that has to do with long-term efficacy of the medication. It doesn't seem to make a huge difference as long as it's being taken relatively consistently. I do have patients who use it much less consistently than that. Executives, for instance, who may only use it when they're getting ready to give a big presentation, or when there's a time of high sales and they need to be on the road more or things like that. When there are more things affecting their attention, and because of those added difficulties, they may need the medication more often, but may function pretty well without those things. So, it's really nice how tailorable a stimulant medication is. That's one of its advantages.

Glen Stevens, DO, PhD: Outside of stimulant medication, treatment options?

Cynthia Seng, MD: Yes, so we have a handful of non-stimulant options. Let me just say though, stimulants are highly, highly effective. They work about 80% of the time, which is pretty good. If you look at medications that are used in medicine in general, and what are the most efficient medications at treating the illness that they're made for, the number one most efficient medication? Do you want to take a guess?

Glen Stevens, DO, PhD: I'm going to say a stimulant.

Cynthia Seng, MD: No. Insulin.

Glen Stevens, DO, PhD: Yeah, I guess-

Cynthia Seng, MD: Insulin for type-

Glen Stevens, DO, PhD: ... it makes sense.

Cynthia Seng, MD: ... one diabetes.

Glen Stevens, DO, PhD: Yeah, makes sense.

Cynthia Seng, MD: Right. That makes sense. Stimulants are number two. So, they are highly, highly effective. The non-stimulant medications are less effective. So why use a non-stimulant when you can use the gold standard? And there are a few reasons that we can talk about if you would like to.

The most common non-stimulant medication used is atomoxetine and there is another one like that. And those are SNRIs, they're norepinephrine inhibitors. In Europe, they're used as antidepressants as well as ADHD medications. In the US, they're labeled specifically for ADHD. They do help 60 to 70% of the time. And in some patients, they're the right choice. A patient for instance with active substance use disorder, someone who is actively recovering, someone who has no desire to recover, someone who may be even drinking or using legal cannabis products in a way that you as a physician don't feel is consistent with treating the ADHD with the stimulant, you can use those medications and they will be helpful.

Some people just don't tolerate the stimulant medications. Stimulant medications do have some side effects. They decrease your appetite. So, some people lose weight and find it difficult to eat. Most adults don't have a problem with that. If they lose a few pounds, it's okay. But that's not always true. They can cause insomnia. Even the short acting ones in the right person can cause insomnia. Sexual dysfunction, like I just mentioned, and a few other things. They cause your pupils to get big, and for some people that can cause eye problems and some other things like that. So, if you can't tolerate stimulants, if you've tried them all. They can make you jittery too. Some people they make jittery or may increase anxiety. That's a good reason.

Bupropion is a medication that can be used. Again, it only works about 50 to 60% of the time, but it can help concentration. So again, in the right patient. For instance, a patient who has depression and ADHD and a substance use issue, and you don't want them on a stimulant medication, that may be a good place to start where it can at least help take the edges off of the problem.

And then we have alpha-2 blockers, guanfacine and others, clonidine. This one. They affect blood pressure, so you have to be careful. They can lower blood pressure and pulse. But they are good for the impulsive and hyperactive symptoms. They're used more in children. But for adults who, for instance, have a lot of difficulty with blurting things out and interrupting and doing impulsive kinds of behaviors, the 40 year old who loves to ski but in an instant may impulsively decide he's going to try that jump he could do when he was 17 and really should not do that. Things like that. Those medications are helpful for those kinds of symptoms and do help the attention symptoms a bit. So, they are also medications that can be used. And those can be added to stimulant medications as well in more treatment-resistant situations where you may need both.

Glen Stevens, DO, PhD: Well, it's hard to believe, Cindy, but we're up against the clock. But I'll ask you one last question. Behavioral therapy.

Cynthia Seng, MD: Behavioral therapy is the least effective thing alone, but in combination with medication, it's golden. There's a lot of good research about cognitive behavioral approaches. So, ADHD-informed therapy can be very, very important. There are maneuvers and strategies that as adults people may not have learned that may sound very reasonable to you and I, but people just need to be taught. So cognitive behavioral strategies and coaching can be very, very important. And something called rhythm therapy, that's important in mental health in general, where people learn just about how important consistency is. Getting to sleep at the same time every night so that you get a good night's sleep to help your attention, for instance, things like that.

Glen Stevens, DO, PhD: All right, final takeaways.

Cynthia Seng, MD: ADHD exists. It's fairly easy to diagnose, it's very easy to treat, and it can make a huge difference in people's lives.

Glen Stevens, DO, PhD: Well, Cindy, I know that I'm going to call you the next time I can't finish a book, and you're going to get me on the right path. But I appreciate all your information today. It's fantastic. And thanks for what you do.

Cynthia Seng, MD: Thank you very much.

Closing: This concludes this episode of Neuro Pathways. You can find additional podcast episodes on our website, clevelandclinic.org/neuropodcast, or subscribe to the podcast on iTunes, Google Play, Spotify, or wherever you get your podcasts. And don't forget, you can access real-time updates from experts in Cleveland Clinic's Neurological Institute on our Consult QD website. That's @CleClinicMD, all one word. And thank you for listening.