Adult ADHD evaluation and treatment for Delray Beach — structured diagnosis, careful prescribing.

RECO Integrated Psychiatry's Delray Beach office sits inside the city itself — a five to ten minute drive from Pineapple Grove, Lake Ida, Osceola Park, and Tropic Isle, and a short walk from Atlantic Avenue. Adult ADHD is evaluated with the DIVA-5 or CAADID rather than a two-question telehealth screen, and prescribing is anchored to visit-based cardiovascular monitoring rather than message-based dose adjustments. For Delray Beach residents, that means specialist psychiatric care without a drive to Boca Raton or West Palm Beach.

Delray Beach’s downtown — Atlantic Avenue, Pineapple Grove, the Beach District — is a neighborhood most residents already move through daily. Psychiatric care that fits inside that geography, rather than requiring a drive to Boca Raton or West Palm Beach, is the premise of RECO Integrated Psychiatry’s Delray Beach practice. For adults seeking evaluation or treatment for ADHD, the appointment sits within the same few blocks as home, work, and the neighborhoods — Osceola Park, Lake Ida, Tropic Isle — where daily life actually happens.

The diagnostic protocol that actually confirms ADHD

DSM-5-TR criteria for adult ADHD require symptom onset before age 12, symptoms present in two or more settings, documented functional impairment, and rule-out of alternative explanations. Major depressive disorder, generalized anxiety, obstructive sleep apnea, active substance use, thyroid dysfunction, and iron deficiency all produce attention complaints that mimic ADHD, and a two-question telehealth screen cannot distinguish among them. RECO Integrated Psychiatry’s adult ADHD treatment intake uses the ASRS as an initial screen, followed by the DIVA-5 or CAADID as a structured diagnostic interview.

Developmental history is treated as clinical data rather than a formality. Where adult recall alone does not support symptom onset before age 12, clinicians request childhood report cards, prior psychoeducational evaluations, or a collateral interview with a parent or long-tenured family member. Comorbidity screening — PHQ-9 for depression, GAD-7 for anxiety, structured sleep and substance history — is completed at the same visit. Overdiagnosis of adult ADHD, driven by expedited telehealth prescribing, is a documented problem in Florida and nationally; the protocol is built to catch cases that do not meet criteria as much as it is to confirm the ones that do.

Stimulant selection and titration

Methylphenidate-class agents (Concerta, Focalin XR, Ritalin LA, Jornay PM) and amphetamine-class agents (Adderall XR, Vyvanse, Mydayis) are both first-line for adult ADHD. Head-to-head evidence does not favor one class over the other at the population level, but individual response varies substantially and is not reliably predicted by baseline features. Titration begins with a low dose of a long-acting formulation and adjusts by response and tolerability at scheduled follow-up visits rather than between-visit messages.

Long-acting formulations are preferred over immediate-release for three reasons: smoother symptom coverage across the workday, lower reinforcement value, and reduced diversion risk. Vyvanse (lisdexamfetamine), a prodrug requiring enzymatic conversion, has the lowest abuse liability among stimulants and is the default first choice for clients with any history of substance use disorder. Jornay PM, a delayed-release methylphenidate dosed the evening before, is considered where the primary functional problem is morning executive dysfunction. Dose changes are anchored to standardized outcome measures — ASRS scores, target-symptom checklists, and objective occupational functioning — rather than global impression alone.

Non-stimulant pathways when stimulants are not the fit

Stimulants are not appropriate for every adult meeting ADHD criteria. Cardiovascular disease, active substance use, severe stimulant-driven anxiety amplification, prior intolerance, or a considered patient preference against controlled prescribing all point toward the non-stimulant pathway. That pathway is well-mapped and is not a second-tier compromise.

Atomoxetine (Strattera), a selective norepinephrine reuptake inhibitor, has a slower onset — meaningful response typically emerges at four to six weeks — but produces sustained coverage without diurnal drop-off. Viloxazine (Qelbree) is a newer non-stimulant with a similar mechanism and comparable onset. Alpha-2 agonists (guanfacine XR, clonidine XR) are effective adjuncts for hyperactivity, impulsivity, and sleep-onset difficulty, and are frequently combined with a stimulant or with atomoxetine. Bupropion has adult ADHD evidence where depression is comorbid; it is not first-line for isolated ADHD but is a reasonable single-agent option in the right clinical context.

Cardiovascular safety and stimulant monitoring

Stimulant initiation requires a documented cardiovascular history — personal and family — a baseline resting blood pressure and heart rate, and an EKG in adults over 40 or with any cardiac history, exertional syncope, or a family history of sudden cardiac death under 50. Follow-up visits include BP and HR at every contact. Sustained hypertension (readings consistently above 140/90 on treatment) or resting tachycardia prompts dose reduction, cardiology referral, or transition to a non-stimulant regimen.

Height, weight, and appetite are tracked visit-over-visit because stimulant-associated weight loss is dose-dependent and often reversible with dose adjustment or a scheduled dosing holiday. Sleep is reviewed at every visit because both untreated ADHD and stimulant treatment can degrade it. Comorbid conditions — anxiety exacerbation, mood cycling in undiagnosed bipolar spectrum, tic emergence — are monitored explicitly rather than left to the client to raise. This is standard psychiatric practice; the practical difference is that the framework is executed at every visit rather than checked at intake and abandoned.

Comorbidity, therapy referral, and coordination with primary care

Adult ADHD rarely presents alone. Depression, generalized anxiety, alcohol and cannabis use, insomnia, and executive-function-related occupational stress are common comorbidities and often benefit more from combined treatment than from stimulants alone. Where the functional profile warrants it, referrals are made to adult-ADHD-specific cognitive behavioral therapy (Safren protocol) rather than generic CBT, and to behavioral coaching when the deficit is primarily organizational rather than affective.

Comorbid depression may be treated with sertraline or bupropion; comorbid anxiety with an SSRI paired with targeted skills work; alcohol use disorder with naltrexone alongside the stimulant decision, and CIWA-anchored medical detox where indicated before outpatient prescribing begins. Records are shared with the client’s primary care physician under written consent, which matters for cardiovascular monitoring, contraception counseling on stimulants, and any concurrent prescriptions with interaction risk. For Delray Beach residents already established with a PCP at Delray Medical Center or a local group practice, that coordination is straightforward.

What to expect on the first visit

The initial evaluation is 60 to 90 minutes and covers the ASRS, a structured DIVA-5 or CAADID interview, developmental history, comorbidity screening, medical and cardiovascular history, and a review of prior treatment. Where the diagnosis is clear, treatment planning — medication selection, monitoring cadence, and therapy referral — is completed at the same visit. Where it is not, additional data collection (collateral interview, records request, sleep or thyroid workup) is scheduled before any prescribing decision.

Follow-up is typically at two to four weeks during titration, then monthly during stabilization, then every one to three months during maintenance. Controlled-substance prescriptions require synchronous in-person or telehealth contact under current federal and Florida rules; refills are not issued outside a scheduled visit.

Serving residents of: Pineapple Grove, Lake Ida, Tropic Isle, Beach District, Osceola Park.