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

Adults commuting from Bryant Park, College Park, or downtown Lake Worth Beach reach RECO Integrated Psychiatry's Delray office in about twenty-two minutes outside of season. The intake pairs the DIVA-5 structured diagnostic interview with a developmental history and comorbid screening on the PHQ-9 and GAD-7 — not a two-question telehealth screen. Stimulant and non-stimulant prescribing is anchored to scheduled visits with blood pressure, heart rate, and sleep review at every contact rather than message-based dose changes.

Lake Worth Beach sits fourteen miles up A1A from RECO Integrated Psychiatry’s Delray Beach office — twenty-two minutes on a Tuesday morning, longer once the seasonal traffic thickens through Lantana. Adults living in Bryant Park, College Park, Mango Groves, Parrot Cove, and the downtown grid can reach specialist-level psychiatric evaluation without leaving Palm Beach County or restructuring a work week. RECO’s outpatient model is built for clients who need rigorous diagnostic work and careful prescribing rather than a two-question telehealth screen and a prescription in the mail.

The diagnostic protocol that actually confirms ADHD

DSM-5-TR criteria for adult ADHD require symptom onset before age twelve, symptoms present in two or more settings, documented functional impairment, and rule-out of alternative explanations — major depression, generalized anxiety, obstructive sleep apnea, substance use disorder, and thyroid dysfunction all produce attention and concentration deficits that can mimic ADHD. Meeting that standard requires more than a self-report questionnaire. RECO’s intake pairs the Adult ADHD Self-Report Scale (ASRS-v1.1) as an initial screen with the DIVA-5 or CAADID as a structured diagnostic interview, and a developmental history that pulls in childhood report cards, teacher comments, or a family informant when adult memory of the elementary-school years is not reliable enough to anchor onset.

Overdiagnosis is a documented risk in the current care environment, driven by direct-to-consumer telehealth prescribing and diagnostic shortcuts that skip the developmental history entirely. Underdiagnosis is equally real, particularly in women and in adults whose inattentive presentation was labeled as anxiety or depression in their twenties. A rigorous protocol protects against both errors. Comorbid screening — the PHQ-9 for depression, the GAD-7 for anxiety, and an AUDIT-C or DAST-10 for substance use — runs at intake because untreated comorbidity changes both the diagnostic picture and the prescribing pathway.

Stimulant options and how we choose

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 substantially and is not reliably predicted by history, family response, or genotyping — a client who fails methylphenidate can respond well to amphetamine, and the reverse is common. Long-acting formulations are preferred over immediate-release agents to minimize dose-timing gaps, reduce rebound irritability, and lower diversion risk.

Vyvanse (lisdexamfetamine) is a prodrug that requires enzymatic conversion in the bloodstream, which produces a slower onset and a reduced abuse liability compared with immediate-release amphetamine salts. It is a first choice for clients with any substance use history and often the default starting point when a stimulant is indicated. Jornay PM is dosed in the evening for morning-onset coverage, which suits clients whose functional impairment concentrates in the first hours of the day. Titration is anchored to scheduled follow-up visits — dose changes happen after a documented conversation about symptom response, sleep, appetite, and cardiovascular parameters, not through message-based back-and-forth.

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

Not every adult with ADHD is a candidate for a stimulant, and not every stimulant trial produces a workable response. Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with a four-to-six-week onset, a lower abuse profile, and evidence in adults with comorbid anxiety. Viloxazine (Qelbree) is a newer non-stimulant option with a similar mechanism and a faster onset in some clients. Alpha-2 agonists — guanfacine extended-release and clonidine extended-release — are effective adjuncts or monotherapy when hyperactivity, impulsivity, or sleep disruption dominate the presentation. Bupropion has a modest evidence base in adult ADHD and is particularly useful when comorbid depression is present.

The non-stimulant pathway is the standard of care for clients with active substance use disorder, cardiovascular contraindications, a history of stimulant intolerance, or a preference to avoid a Schedule II medication. Coordinating with a primary care physician or cardiologist is routine when the medical picture warrants it. Clients whose primary complaint is executive dysfunction with a strong sleep component often do best on a combination — a long-acting stimulant for daytime function and guanfacine XR at night for sleep onset and next-day carryover. Referral to adult-ADHD-specific cognitive behavioral therapy is standard when the functional profile shows persistent organizational, time-management, or emotional-regulation deficits after the medication is optimized.

Cardiovascular safety and the medications we monitor

Stimulant initiation requires a documented cardiovascular history — personal history of arrhythmia, structural heart disease, or unexplained syncope, and family history of sudden cardiac death or early cardiac events. Resting blood pressure and heart rate are obtained at every visit. An EKG is ordered before initiation for adults over forty, for clients with any cardiac history, or when a family history raises concern. Sustained hypertension above 140/90 on repeat measurement or resting tachycardia above 100 bpm prompts a dose reduction, a switch to a non-stimulant, or a cardiology referral.

Height and weight are tracked over the course of treatment. Appetite suppression is expected in the first weeks and usually attenuates; persistent weight loss is not acceptable and is addressed by dose adjustment, timing change, or protein-forward meal scheduling. Sleep is assessed at every visit because stimulant-induced insomnia both worsens attention and elevates cardiovascular risk. The framework is standard adult psychiatric practice — the specific value RECO adds is that the framework is actually run at every visit rather than assumed from a prior note.

What to expect on your first visit

The initial evaluation runs sixty to ninety minutes and covers presenting symptoms, developmental history, medical history, current medications, substance use history, and a functional review of work, relationships, and daily routines. Rating scales — ASRS, PHQ-9, GAD-7, and where relevant an AUDIT-C or DAST-10 — are completed before the appointment through the client portal. A DIVA-5 or CAADID structured interview is scheduled as part of the intake when the presentation warrants it.

Diagnosis is not always finalized at the first visit if collateral information is still pending — a childhood report card, a note from a partner or parent, or a review of prior treatment records can change the clinical picture. When a stimulant is indicated, the first prescription is written after baseline vitals and a documented cardiovascular history. Clients seeking ADHD treatment that begins with a real diagnosis rather than a checkbox generally find the pace of the first two visits deliberate and the follow-up rhythm predictable.

Insurance and admissions from Lake Worth Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS plans. The admissions team verifies benefits before the first appointment and provides a written estimate of the client’s responsibility, including any deductible, copay, or coinsurance that applies to psychiatric evaluation and medication management. Out-of-network clients are offered a self-pay rate and a superbill for reimbursement submission.

The drive from downtown Lake Worth Beach — Lake Avenue, Lucerne, or the Bryant Park corridor — to RECO’s Delray office runs about twenty-two minutes outside of season and closer to thirty in February and March. Most clients on stable medication attend monthly for the first three months and quarterly thereafter, which fits comfortably around a Palm Beach County work schedule. Telepsychiatry follow-ups are available for established clients whose vitals and cardiovascular picture are stable.

Serving residents of: Bryant Park, College Park, Mango Groves, Parrot Cove, downtown Lake Worth.