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

For adults driving 50 minutes up I-95 from Hollywood for a specialist psychiatric evaluation, the value of the trip is that the diagnostic protocol at the other end actually holds up. RECO Integrated Psychiatry uses the DIVA-5 or CAADID with a documented developmental history rather than the two-question screen that has produced the current overdiagnosis and controlled-substance misuse concerns. Stimulant and non-stimulant options are prescribed with cardiovascular monitoring at every visit, and most maintenance care moves to telepsychiatry once the in-person baseline is documented.

Hollywood sits 35 miles south of RECO Integrated Psychiatry’s Delray Beach office — a 50-minute run up I-95 outside of rush hour, longer when the Sheridan Street interchange slows. For adults from Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, and Oakwood who want a structured ADHD workup rather than a two-question telehealth screening, the drive is the shortest part of the process. What follows is how the practice evaluates and treats adult ADHD, and where the diagnostic and prescribing decisions are actually made.

The diagnostic protocol that actually confirms adult ADHD

DSM-5-TR does not permit an ADHD diagnosis on the basis of adult inattention alone. Symptom onset must be documented before age 12, symptoms must appear in two or more settings — work and home, or work and school — functional impairment must be present, and other explanations must be ruled out. Depression and anxiety mimic inattentive-type ADHD closely; unrecognized obstructive sleep apnea produces the same executive-function complaints; stimulant, cannabis, and alcohol use interfere with concentration in ways that resolve when use stops; hypo- and hyperthyroidism produce fatigue, distractibility, and irritability that respond to endocrine treatment rather than psychostimulants.

Intake at RECO Integrated Psychiatry uses the ASRS as a screening instrument and either the DIVA-5 or the CAADID as a structured diagnostic interview. A developmental history is taken; where adult recall alone doesn’t establish onset before 12, the practice asks for childhood report cards, standardized testing records, or a family informant. PHQ-9 and GAD-7 are administered to quantify depression and anxiety, since either — if elevated in a range that could account for the presenting complaint — is treated first and ADHD is reassessed once mood and anxiety are stable. TSH and basic labs are obtained when clinically indicated.

Overdiagnosis is a real risk in the current care environment. The protocol described here is built to catch it. Clients whose symptom picture does not meet DSM-5-TR criteria are told so, and treatment is redirected — most often toward the mood, anxiety, sleep, or substance use disorder that is actually driving the impairment.

Stimulant options and how the starting agent is chosen

Methylphenidate-class agents (Concerta, Focalin XR, Ritalin LA, Jornay PM) and amphetamine-class agents (Adderall XR, Vyvanse, Mydayis) are equally first-line for adult ADHD. Individual response varies, often cannot be predicted from patient factors alone, and a client who fails one class may respond well to the other. That reality shapes the prescribing plan: the first agent is chosen on the basis of comorbidity, substance use history, side-effect profile, and duration-of-action needs — not on a claim that one molecule is universally superior.

Long-acting formulations are preferred over immediate-release for two reasons. They minimize the dose-timing gaps that produce afternoon rebound and end-of-day irritability, and they reduce diversion risk. Vyvanse (lisdexamfetamine) is a prodrug — inactive until enzymatically cleaved to dextroamphetamine — and carries a lower abuse liability than other amphetamine salts; it is the first choice for clients with any substance use history who are otherwise stimulant-appropriate. Jornay PM is a delayed-release methylphenidate dosed at bedtime for clients whose morning symptoms are disabling before a conventional morning dose could take effect.

Titration is anchored to office visits rather than message-based dose changes. Dose is adjusted by response, side effects, cardiovascular parameters, and functional outcome — not by request volume.

Non-stimulant options when stimulants aren’t the fit

Stimulants are not the right answer for every adult with ADHD. Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with a slower onset — meaningful response is usually seen at four to six weeks rather than the same-day effect of stimulants — and a considerably lower abuse profile. Viloxazine (Qelbree) is a newer non-stimulant with a similar mechanism and, in some patients, a faster onset. Both are uncontrolled and appropriate for clients whose work, licensure, or custody situation makes a controlled substance untenable.

Alpha-2 agonists — guanfacine extended-release and clonidine extended-release — are effective adjuncts, particularly for the hyperactivity, impulsivity, and sleep disruption that stimulants can worsen. Bupropion has reasonable evidence in adult ADHD, especially where comorbid depression is present, and is a useful pathway when a single agent can address both diagnoses. For clients with active or recent substance use disorder, significant cardiovascular contraindication to stimulants, or documented stimulant intolerance, the non-stimulant pathway is well-mapped and can be started at the initial visit.

Cardiovascular safety and the monitoring that keeps stimulant treatment safe

Stimulant initiation in adults requires a personal and family cardiovascular history, a resting blood pressure and heart rate, and an EKG in adults over 40 or with any personal or family history of cardiac disease, syncope, or sudden death. A screening question set alone is not adequate; the vitals are taken, documented, and used.

Follow-up visits include blood pressure and heart rate at every contact. Sustained hypertension — systolic above 140 or diastolic above 90 on repeat measurement — or resting tachycardia above 100 prompts a dose reduction, a switch to non-stimulant, or a cardiology referral, in that order of preference. Weight is tracked; unexpected loss is addressed rather than absorbed as a side effect. This framework is standard adult-psychiatry practice. The difference at RECO Integrated Psychiatry is that the framework is actually run at every visit rather than checked at intake and forgotten.

What to expect on the first visit

A first evaluation for ADHD treatment runs 60 to 90 minutes. It includes the diagnostic interview described above, PHQ-9 and GAD-7, a substance use history, a sleep history, cardiovascular history, current medication review, and a discussion of prior stimulant or non-stimulant trials. Clients are asked to bring pharmacy records from the past year, prior EKGs if available, and any childhood documentation they have.

Where the diagnosis is clear and no medical workup is outstanding, medication is initiated at the first visit. Where cardiovascular workup, thyroid labs, or a sleep evaluation is needed first, that is arranged and the medication decision follows. Same-day controlled-substance prescriptions are dispensed on the basis of a completed workup, not on request.

Insurance and logistics for Hollywood clients

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans commonly carried by Hollywood residents. The admissions team verifies benefits and quotes an expected specialist copay and deductible impact before the first visit rather than at the front desk on arrival. Self-pay rates for the initial evaluation and follow-up visits are published on request.

The drive from Hollywood is I-95 north to Atlantic Avenue in Delray Beach — 35 miles, roughly 50 minutes off-peak and closer to 75 minutes in evening traffic. Most ADHD follow-up visits are 20 to 30 minutes and can be scheduled by telepsychiatry once the initial evaluation and cardiovascular baseline are documented in person, which keeps ongoing care compatible with a Hollywood work schedule while preserving the periodic in-person vitals check that responsible stimulant prescribing requires.

Serving residents of: Hollywood Beach, Emerald Hills, Hollywood Lakes, Hollywood Hills, Oakwood.