ADHD Across the Lifespan: Managing a Common and Often Misunderstood Disorder (Podcast)

Attention deficit hyperactivity disorder (ADHD) is widely recognized as a childhood condition characterized by challenges with attention, organization and impulse control, but research shows the disorder frequently persists into adulthood, often going undiagnosed for decades.

ADHD, a neurodevelopmental condition that affects an estimated 6% of adults in the United States, often comes to light through life transitions or family experiences, explains Cleveland Clinic psychiatrist Cynthia Seng, MD.

“Some patients were diagnosed as children and seek treatment again later when academic or professional demands increase,” she says. “Others recognize their own symptoms only after a child receives an ADHD diagnosis. They’ll say, ‘My son has ADHD, and I’m exactly like him — maybe I have it, too.’ Fortunately, a growing awareness is revealing just how common the adult ADHD truly is.”

Adults with the disorder may struggle to focus, complete tasks or manage time effectively; common complaints include being easily distracted, frequently losing items or procrastinating. Dr. Seng notes that hyperactive or impulsive symptoms like fidgeting or interrupting others may also occur, but these issues often become less visible with age as individuals learn to manage their behaviors.

In the latest episode of Cleveland Clinic’s Neuro Pathways podcast, Dr. Seng shares practical insights for diagnosing ADHD, managing symptoms with medications and behavioral interventions and combating stigma. She also addresses the complexities of differentiating between ADHD and other conditions that can challenge attention, including sleep disorders, polypharmacy, endocrine disorders and neurological disease.

Click the podcast player above to listen to the 20-minute episode now, or read on for a short, edited excerpt. Check out more Neuro Pathways episodes at clevelandclinic.org/neuropodcast or wherever you get your podcasts.

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Podcast excerpt

Podcast host Glen Stevens, DO, PhD: How is the [ADHD] workup for an older patient different than the workup for a younger patient?

Seng: We do a basic screening for everyone – for all the potential things that might be adding to the Venn diagram of causes for attentional disorders. But in older folks – once they crest 35 and then again once they crest 55 – we tend to look for different kinds of problems. Sleep disorders, for example, can cause attention issues all by themselves. People with ADHD often have sleep disorders, usually phase disorders. They tend to be “vampires”…they go to sleep later. They may still get their eight hours, but sleep is phase-shifted.

Polypharmacy, especially in older adults, is something we see all the time. There are so many medications that can affect attention: pain medications, sleep medications, anxiety medications. And if you put a bunch of them together, it can absolutely [lead to attention issues]. Sometimes that's all we find.

Sometimes a patient will come in, looking to be treated for ADHD because their grandchild was diagnosed with it. The first thing we need to do is talk to their other physicians and try to pare down their medications to make sure they’re not the cause [of the complaint]. Mild cognitive impairment and dementia syndromes are frequently on the minds of people who come in.

Frequently, perimenopausal women will tell us, "I'm afraid I'm either losing my mind or I'm getting dementia, and here's why." So we evaluate that…and if we're really, really concerned, we will refer them for a brain health consultation or neuropsychiatric testing to make sure that's not part of the issue. There are a couple of wonderful studies. In 2021, Mendonca found that performance on neuropsychiatric testing is comparable for age-matched, perimenopausal women with ADHD and MCI [mild cognitive impairment]. It’s an interesting finding.

There are a lot of other kinds of neurological disorders…Parkinson's disease, for instance…that can present early with attention problems. Endocrine diseases…thyroid disorder…immune disorders… connective tissue disorders…lupus…mast cell activation syndrome. Hyperparathyroidism is a big one that’s missed quite often. If the calcium [level] is high-normal or just barely high in a post-menopausal woman – an age at which calcium should be starting to go down – it's time to look at the parathyroid hormone. There's a reasonable chance of hyperparathyroidism, which can cause significant brain fog and memory issues.

Recently, we've seen a number of people with long COVID. There's not a lot of good data about it yet, but we're just starting to see some [new] literature. Other post-infectious syndromes like Lyme disorder, chronic fatigue syndrome and myalgic encephalomyelitis can [cause attention problems] as well.

Because not everything is ADHD. If you listen to TikTok and 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. That's what we try to do a really robust [assessment]…to take a hard look at all the potential causes and come up with a rational approach to evaluation and treatment.