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

RECO Integrated Psychiatry is a specialist outpatient practice 45 minutes south of Jupiter on I-95 that runs adult ADHD workups through the DIVA-5 diagnostic interview and documented developmental history — not a two-question telehealth screen. Prescribing covers stimulant and non-stimulant options with cardiovascular monitoring at every visit. For Abacoa, Tequesta, and Jupiter Inlet Colony patients, one in-person intake in Delray sets the diagnosis and treatment plan; medication management follow-ups can then move to telepsychiatry.

Jupiter sits 32 miles north of RECO Integrated Psychiatry’s Delray Beach office — about 45 minutes down I-95 outside of rush hour. For adults in Abacoa, Tequesta, or Jupiter Inlet Colony who suspect ADHD and want a workup that goes further than a two-question telehealth screen, that drive is short enough to fold into a workday and long enough to reach a specialist practice built around structured diagnosis and careful prescribing rather than volume dispensing.

The diagnostic protocol that actually confirms adult ADHD

DSM-5-TR requires four things before an ADHD diagnosis is defensible: symptom onset before age 12, symptoms present in two or more settings, functional impairment traceable to those symptoms, and rule-out of alternative explanations that mimic the presentation. The differential is long — untreated depression, generalized anxiety disorder, obstructive sleep apnea, active stimulant or cannabis use, subclinical hypothyroidism, iron deficiency, and post-concussive syndrome all produce the same subjective cluster of distractibility and executive dysfunction that an ASRS will flag positive.

RECO’s intake reflects that reality. The ASRS is used as a screen, not a diagnosis. The structured interview is the DIVA-5 or CAADID, which walks each DSM-5-TR criterion through both childhood and adult time frames. Where adult recall doesn’t clearly place symptoms before age 12, we ask for report cards, teacher comments, or a family informant. TSH, CBC, and ferritin are ordered when clinically indicated. PHQ-9 and GAD-7 run in parallel to characterize comorbid mood and anxiety load, because untreated major depression will masquerade as ADHD and a stimulant will not fix it.

Overdiagnosis is a real problem in the current care environment, driven largely by 15-minute telehealth encounters that skip developmental history entirely. Underdiagnosis is also real, particularly in adult women whose inattentive presentation was missed in childhood. A structured protocol is what distinguishes the two, and it takes time that a rushed intake doesn’t allow.

Stimulant options and how we select

Methylphenidate-class agents — Concerta, Focalin XR, Ritalin LA, Jornay PM — and amphetamine-class agents — Adderall XR, Vyvanse, Mydayis — are equally first-line under the current adult-ADHD literature. Individual response is idiosyncratic; roughly a third of patients respond preferentially to one class over the other, and this cannot be predicted from history alone. When a first-line agent produces partial response or intolerable side effects, a cross-class switch is the standard next step rather than open-ended dose escalation.

Long-acting formulations are preferred over immediate-release. Dose-timing gaps, afternoon rebound irritability, and diversion risk all rise with short-acting stimulants. Vyvanse (lisdexamfetamine) is a prodrug — pharmacologically inert until hepatic metabolism releases dextroamphetamine — which produces a smoother onset and a lower abuse liability profile. It is a first choice for any patient with prior substance use disorder or a family history of stimulant misuse. Jornay PM, dosed the previous evening for morning-onset coverage, is useful when morning executive dysfunction is the dominant complaint.

Titration is anchored to scheduled visits, not to inter-visit messages. Doses change with documented blood pressure, heart rate, sleep data, and functional outcomes. DEA registration and PDMP checks are standard practice, not friction.

Non-stimulant options for when stimulants aren’t the fit

Not every adult with ADHD is a candidate for stimulant therapy, and not every adult who tries a stimulant tolerates one. Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with an onset window of 4-6 weeks and no controlled-substance status. Viloxazine (Qelbree) is a newer non-stimulant with a similar mechanism and somewhat faster onset. Both are reasonable monotherapy when a stimulant is contraindicated or refused.

Alpha-2 agonists — extended-release guanfacine and clonidine XR — are effective as adjuncts, particularly for the hyperactivity, impulsivity, and sleep-onset disruption that stimulants alone don’t resolve. Bupropion has meaningful evidence in adult ADHD, especially when comorbid depression is present; the indication is off-label but the use is well-supported. For anxiety-dominant presentations, buspirone is sometimes added to address the anxiety without amplifying stimulant-driven activation.

The non-stimulant pathway is the correct pathway for patients with active or recent substance use disorder, uncontrolled hypertension, structural cardiac disease, personal history of psychosis, or clinically significant anxiety that stimulants would amplify. An evidence-based sequence exists for these patients, and it is walked in order rather than defaulting to stimulants and hoping for tolerability.

Cardiovascular safety and what we actually monitor

Stimulants raise heart rate and blood pressure. In healthy adults the increase is modest and clinically insignificant, but in patients with pre-existing hypertension, arrhythmia, or structural heart disease the calculus changes. RECO’s initiation protocol requires a cardiovascular history — personal and family — a resting BP and HR, and an EKG in adults over 40 or with any cardiac history, family history of sudden cardiac death, or exertional syncope.

Every follow-up visit includes vitals. Sustained systolic elevation above baseline, resting tachycardia, or new chest symptoms trigger dose reduction, a switch to a non-stimulant, or cardiology referral before continuing. Height and weight are tracked because appetite suppression matters, particularly in patients already on the lower end of BMI. Sleep is asked about at every visit — stimulant-induced insomnia often responds to earlier dosing or a small reduction rather than adding trazodone on top.

None of this is unusual; it is standard psychiatric prescribing practice. The distinction is that the framework is actually run at each visit rather than documented once at intake and forgotten.

What to expect on your first visit

The initial evaluation is 60 to 90 minutes with a psychiatrist or psychiatric mental health nurse practitioner. Intake paperwork — the ASRS, PHQ-9, GAD-7, a substance use inventory, and a medical history — is completed before the appointment. The clinical interview covers the DIVA-5 or CAADID diagnostic framework, developmental history, prior treatment response, and current functional impairment across work, relationships, and self-care.

If diagnosis is clear at the end of the initial visit, a treatment plan is discussed the same day. When history is incomplete, a second visit is scheduled to review collateral records — school reports, prior psychiatric documentation, primary care labs — before a controlled substance is prescribed. First stimulant prescriptions are typically written for a short duration to allow rapid titration; follow-up is scheduled at 2-4 weeks, then monthly until stable, then every 3 months. Referral for adult-ADHD-specific CBT is offered when executive function coaching, not medication, is the missing piece.

Insurance and getting to RECO from Jupiter

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans. Coverage for psychiatric evaluation and medication management is standard across these carriers; benefits verification is completed before the first visit so copay, deductible progress, and any prior authorization requirement are known in advance.

From Jupiter the route is I-95 south to Linton Boulevard — 32 miles, about 45 minutes off-peak, closer to 70 minutes at rush hour. For established patients, follow-up medication management is offered by telepsychiatry, which for most Jupiter families means one in-person visit for the diagnostic evaluation and cardiovascular baseline, then remote follow-ups thereafter. Detailed information about the adult ADHD treatment program is available on the service page.

Serving residents of: Abacoa, Jupiter Inlet Colony, Tequesta, Admirals Cove, Jonathan's Landing.