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

For adults in Brickell, Coral Gables, Coconut Grove, Aventura, and Pinecrest, RECO Integrated Psychiatry is 65 minutes up I-95 in Delray Beach — close enough to reach for the initial in-person evaluation, far enough that most follow-up medication visits happen by telepsychiatry. The adult ADHD intake uses the DIVA-5 structured diagnostic interview with childhood collateral rather than a two-question telehealth screen, and controlled-substance prescribing follows the DEA and Florida Department of Health cadence. In network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS.

The drive from Brickell or Coral Gables to RECO Integrated Psychiatry’s Delray Beach office runs roughly 65 minutes up I-95 — long enough that most Miami adults batch a full diagnostic intake with two or three follow-up medication visits rather than commuting weekly. For adult ADHD care, that cadence is appropriate anyway: controlled-substance prescribing is anchored in careful evaluation and quarterly review, not message-based dose changes. After the initial in-person visit, telepsychiatry covers most follow-up work.

The diagnostic protocol that actually confirms adult 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 exclusion of alternative explanations. Major depression, generalized anxiety, obstructive sleep apnea, active substance use, hypothyroidism, and iron deficiency all mimic inattention and must be ruled out before a stimulant is written. The intake at RECO Integrated Psychiatry uses the Adult ADHD Self-Report Scale (ASRS-v1.1) as a screener, then moves to the DIVA-5 or CAADID as a structured diagnostic interview that walks through each criterion in adult and childhood terms.

Where adult recall is thin, the clinician requests collateral — old report cards, a parent or sibling interview, or prior school records — because the childhood-onset requirement is the criterion most often missed in rushed telehealth evaluations. The PHQ-9 and GAD-7 are run at intake to characterize comorbid mood and anxiety, and a sleep history plus substance use screen round out the differential. Overdiagnosis and controlled-substance diversion are real regulatory and clinical concerns in the current care environment; the protocol is built to be defensible in the chart and in the pharmacy.

Stimulant medication options and how we choose

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, and head-to-head response varies by individual in ways that cannot be predicted before a trial. Long-acting formulations are preferred over immediate-release preparations to reduce dose-timing gaps, minimize euphoric peaks, and lower diversion risk. Jornay PM is dosed the night before to cover morning executive function — useful for adults who struggle to get out of bed and start work.

Lisdexamfetamine (Vyvanse) is a prodrug requiring intestinal enzymatic conversion, which reduces abuse liability compared with immediate-release amphetamine salts; it is the preferred amphetamine for any client with a substance use history. Dosing is titrated by response and side effects across visit-anchored feedback rather than message-based dose changes between appointments — a pattern that keeps the prescriber accountable and matches how the DEA expects controlled-substance care to be documented. The full formulary is discussed in more detail on the ADHD treatment service page.

Non-stimulant options when stimulants are not the fit

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with a 4-6 week onset and no controlled-substance status; it is a reasonable first choice for clients with substance use history, cardiovascular concerns, or a documented preference to avoid stimulants entirely. Viloxazine (Qelbree) is a newer non-stimulant with a somewhat faster onset and a similar mechanism. Neither produces the immediate subjective effect of a stimulant, so patient education about the delay is essential to retention through the titration window.

Alpha-2 agonists — extended-release guanfacine and clonidine — are effective adjuncts for hyperactivity, impulsivity, and sleep disruption, and can be layered with a stimulant when a client needs coverage into the evening. Bupropion has moderate evidence in adult ADHD and is particularly useful when comorbid depression is present or when a client cannot tolerate stimulants but needs activating pharmacology. For adults with cardiovascular contraindications or active substance use, the non-stimulant pathway is well-mapped and does not represent inferior care.

Cardiovascular safety and medication monitoring

Stimulant initiation requires a documented cardiovascular history (personal and family), a resting blood pressure and heart rate at baseline, and an EKG in adults over 40 or with any personal or family cardiac history. Every follow-up visit includes vitals; sustained resting hypertension above 140/90 or tachycardia above 100 bpm prompts a dose reduction, a switch of stimulant class, or transition to a non-stimulant agent such as atomoxetine or guanfacine XR.

Height, weight, and appetite are tracked at each visit because stimulant-associated appetite suppression is common and clinically meaningful, especially in adults with a history of restrictive eating. Sleep quality is asked about at every contact — evening dosing errors are the most common cause of stimulant-induced insomnia and are usually correctable without changing the medication. The safety framework is standard psychiatric practice; the difference is that it is actually run rather than skipped.

Comorbidity — what usually shows up alongside adult ADHD

Roughly two-thirds of adults presenting for ADHD evaluation meet criteria for at least one comorbid condition. Generalized anxiety and major depression are the most common; the GAD-7 and PHQ-9 at intake screen for both, and treatment sequence matters. Untreated moderate-to-severe major depression will look like inattention on any ADHD rating scale, so a PHQ-9 score above 15 typically prompts an SSRI trial — sertraline or escitalopram — before or alongside stimulant initiation.

Substance use disorders, particularly alcohol and cannabis, co-occur at meaningfully elevated rates. When active use is present, the treatment sequence starts with the substance use — stabilization, sometimes naltrexone for alcohol use disorder — and stimulant prescribing is deferred until sobriety is established. Autism spectrum, obsessive-compulsive, and bipolar spectrum conditions all shift the medication algorithm; the intake is built to catch them at baseline rather than at the third dose change.

First visit and follow-up cadence for Miami clients

The initial evaluation is 60-90 minutes and covers the structured diagnostic interview, comorbidity screening, medical history, cardiovascular review, and prior treatment response. If ADHD is confirmed and stimulant treatment is appropriate, a starting medication and dose are chosen at that visit and a follow-up is scheduled within 2-4 weeks to assess response and titrate. Florida controlled-substance rules require prescriber contact at defined intervals; the practice follows the DEA and Florida Department of Health cadence rather than the looser telehealth schedules that drew federal attention in recent years.

Once a stable dose is established, follow-up moves to every one to three months depending on stability and comorbidities. Most Miami clients transition to telepsychiatry after the initial in-person visit, which keeps the drive-time burden low without compromising controlled-substance safeguards. Adjunctive adult-ADHD-specific cognitive behavioral therapy is referred out to Miami-based providers where the functional profile warrants it.

Insurance and admissions from Miami

RECO Integrated Psychiatry is in network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield plans, and admissions runs a benefits check before the first appointment so the copay and deductible are known in advance. Out-of-network superbills are provided for reimbursement when needed. For clients driving up from Brickell, Coral Gables, Coconut Grove, Aventura, or Pinecrest, morning appointments avoid the worst I-95 southbound congestion on the return trip.

Serving residents of: Brickell, Coral Gables, Coconut Grove, Aventura, Pinecrest.