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

For adults in Bel Lido, Toscana, or Ocean Cove, RECO Integrated Psychiatry sits twelve minutes north on A1A — close enough to sustain the in-person visit cadence a defensible ADHD workup requires. The intake runs the DIVA-5, not a two-question screener, and stimulant prescribing is anchored to documented cardiovascular monitoring at every visit. Non-stimulant pathways — atomoxetine, viloxazine, guanfacine XR — are used routinely when the clinical picture warrants it, and controlled-substance decisions are made in-office by the prescriber, not through a portal message.

Highland Beach occupies a narrow strip of A1A between Delray and Boca Raton, and residents of Bel Lido Isle, Toscana, Ocean Cove, Boca Cove, and Penthouse are closer to specialist psychiatric care than the drive to a Boca multispecialty group implies. RECO Integrated Psychiatry’s Delray Beach campus sits seven miles north up A1A — twelve minutes in ordinary traffic — and for adults who suspect ADHD, that proximity matters. A defensible workup takes more than a video screener; it takes the kind of structured intake the drive supports.

The diagnostic protocol that actually confirms adult ADHD

The DSM-5-TR criteria for adult ADHD require documented symptom onset before age 12, evidence of symptoms across two or more settings — work, home, social — and clinically significant functional impairment. Equally important is the differential: major depressive disorder, generalized anxiety, obstructive sleep apnea, cannabis or stimulant misuse, thyroid dysfunction, and iron deficiency each produce attentional complaints that can mimic ADHD and that respond poorly, or dangerously, to a stimulant prescription.

RECO’s intake for suspected ADHD treatment uses the Adult ADHD Self-Report Scale (ASRS) as a first-pass screen, the DIVA-5 or CAADID as the structured diagnostic interview, and a developmental history that reaches back to childhood — report cards, teacher comments, or a family informant when adult memory alone cannot support the age-of-onset requirement. The PHQ-9 and GAD-7 are administered concurrently to characterize comorbid depression and anxiety, which are present in the majority of adult ADHD presentations and often shape the medication sequence.

Overdiagnosis in the current telehealth environment is a documented problem. A protocol that catches it — before a controlled substance is prescribed — is not a formality. It is the standard of care.

Stimulant options and how we choose between them

Methylphenidate-class agents (Concerta, Focalin XR, Ritalin LA, Jornay PM) and amphetamine-class agents (Adderall XR, Vyvanse, Mydayis) are equally first-line under current guidance. Individual response varies and cannot be reliably predicted from history alone; roughly one in three adults responds preferentially to one class over the other, which is why a considered trial-and-titration sequence matters more than an opinionated first choice.

Long-acting formulations are preferred over immediate-release: they minimize the mid-afternoon dose-timing gap, reduce rebound irritability, and lower diversion risk. Jornay PM, dosed the night before, is useful for adults who cannot function during the first hour of the workday. Vyvanse (lisdexamfetamine) is a prodrug requiring enzymatic conversion, which lowers its abuse liability relative to other amphetamines — for this reason it is a first-choice stimulant for any client with substance use history, alongside consideration of naltrexone or buprenorphine coverage where a concurrent addiction diagnosis is active.

Titration is anchored to scheduled visits with objective side-effect and response tracking, not to between-visit portal messages. Doses are adjusted with a clinician who has a rating scale, a blood pressure cuff, and the chart open in front of them.

Non-stimulant options when stimulants aren’t the fit

Stimulants are not appropriate for every adult with confirmed ADHD. Contraindications include structural cardiac disease, uncontrolled hypertension, active stimulant use disorder, and severe insomnia unresponsive to sleep-hygiene correction. In those situations the non-stimulant pathway is well-mapped.

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with a four-to-six-week onset — slower than a stimulant, but with no scheduled-substance status and a lower abuse profile. Viloxazine (Qelbree) is a newer non-stimulant with a similar mechanism and a faster titration schedule. Alpha-2 agonists — guanfacine extended-release and clonidine extended-release — are effective as monotherapy for adults with prominent hyperactivity, impulsivity, or sleep-onset disruption, and pair usefully with a stimulant when residual symptoms persist at the ceiling dose.

Bupropion carries evidence for adult ADHD when comorbid depression is present and is a reasonable off-label choice in that context. Sertraline, escitalopram, or another SSRI may be layered when anxiety or depression outweighs the attentional presentation — but SSRIs alone do not treat ADHD, and sequencing matters.

Cardiovascular safety and the monitoring we actually run

Stimulant initiation is not clinically neutral. RECO’s protocol requires a personal and family cardiac history, a baseline resting blood pressure and heart rate, and a baseline EKG in adults over 40 or in any adult with a history of syncope, palpitations, structural heart disease, or a first-degree relative with sudden cardiac death before 50.

Follow-up visits include blood pressure and heart rate at every contact. Sustained elevations — a resting BP above 140/90 or a heart rate above 100 that does not resolve with dose reduction — prompt a switch to a non-stimulant. Height and weight are tracked because appetite suppression is common and clinically consequential in adults with lower baseline BMI. Thyroid function and a metabolic panel are drawn when the intake history suggests an endocrine or metabolic concern.

None of this is exotic. It is the safety framework every ADHD prescriber is expected to run; the difference at RECO is that it is actually documented and reviewed.

What to expect on your first visit

The initial evaluation is scheduled for 60 to 90 minutes with a board-certified psychiatric prescriber. Intake paperwork — ASRS, PHQ-9, GAD-7, and a developmental history questionnaire — is completed before the visit, which preserves clinical time for the DIVA-5 interview and the differential discussion. Prior records, when available, shorten the workup meaningfully.

A same-day stimulant prescription is not the default. When the diagnostic picture is clean and the cardiovascular history is unremarkable, a starting-dose stimulant may be initiated at the intake visit. When the picture is mixed — significant anxiety, active substance use, unaddressed sleep pathology, or an unclear developmental timeline — the first visit ends with a working differential and a plan to close it before a controlled-substance prescription is written. Follow-up cadence is typically every two to four weeks during titration, then every one to three months once stable.

Insurance and admissions from Highland Beach

RECO Integrated Psychiatry accepts Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield plans. Verification of benefits is completed before the first visit so the copay and any deductible obligation is documented in advance. For Highland Beach residents whose plans include out-of-network psychiatric coverage, a superbill is issued for reimbursement.

The drive from Highland Beach to the Delray campus is seven miles north up A1A — twelve minutes in ordinary traffic and rarely more than twenty at the height of season. In-person visits are preferred for the diagnostic intake and the early titration visits; established clients may transition to telepsychiatry once the regimen is stable, subject to DEA in-person-visit rules for controlled-substance prescribing.

Serving residents of: Bel Lido Isle, Boca Cove, Ocean Cove, Toscana, Penthouse.