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

RECO Integrated Psychiatry is a 35-minute drive south of PGA National and BallenIsles, and adult ADHD is evaluated against a DSM-5-TR-aligned protocol — ASRS screen, DIVA-5 structured interview, and documented developmental history — rather than the two-question telehealth model that produced the current overdiagnosis pattern. Stimulant and non-stimulant medication management is titrated against blood pressure, heart rate, sleep, and symptom response at office visits, not through portal messages. For Palm Beach Gardens residents who want a defensible workup and a prescriber who owns the cardiovascular safety framework, the drive to Delray is short and the clinical standard is higher.

Palm Beach Gardens sits 25 miles north of RECO Integrated Psychiatry’s Delray Beach office — roughly a 35-minute drive down I-95 for residents of PGA National, Mirasol, BallenIsles, Frenchman’s Reserve, and Old Palm. Northern Palm Beach County has no shortage of primary care physicians and general psychiatric practices, but adult ADHD evaluation performed to a defensible diagnostic standard — DSM-5-TR criteria, structured interview, documented developmental history — is harder to locate than the current wait-list environment suggests. What follows describes how RECO evaluates and treats adult attention-deficit/hyperactivity disorder, and what a first appointment from Palm Beach Gardens actually involves.

The diagnostic protocol that actually confirms ADHD

DSM-5-TR requires four elements before an adult ADHD diagnosis is defensible: symptom onset before age 12, evidence of impairment in two or more settings (work, home, relationships, driving, finances), meaningful functional impact, and rule-out of conditions that mimic the presentation. Depression flattens attention. Generalized anxiety fractures it. Untreated sleep apnea, subclinical thyroid dysfunction, iron deficiency, chronic cannabis use, and long-standing benzodiazepine exposure all produce ADHD-like cognitive symptoms in adults who never had ADHD as children.

RECO’s intake reflects that reality. The Adult ADHD Self-Report Scale (ASRS v1.1) is used as an initial screen; the DIVA-5 (Diagnostic Interview for ADHD in Adults) or CAADID serves as the structured diagnostic interview. Developmental history is documented — childhood report cards, IEP or 504 records, teacher comments, family informants — because adult recall alone rarely establishes the pre-age-12 onset the DSM requires. Comorbid screening with the PHQ-9 and GAD-7 is standard; if depression or anxiety appears more explanatory than ADHD, the treatment plan changes accordingly.

Overdiagnosis of adult ADHD is a documented consequence of the telehealth prescribing environment of the last several years. RECO’s protocol is built to catch it. A negative or ambiguous evaluation results in an honest differential and a plan for the real problem — not a controlled-substance prescription written to close a visit.

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 is idiosyncratic — a patient who fails one class often responds well to the other — and there is no reliable predictor short of a supervised trial. Long-acting formulations are preferred over short-acting because they smooth the pharmacokinetic curve, reduce end-of-dose rebound, and lower diversion risk in adult populations.

Vyvanse (lisdexamfetamine) is a prodrug requiring enzymatic conversion in the bloodstream, which flattens the euphoric spike and reduces abuse liability. It is a preferred first choice for adults with any substance use history or a family history of stimulant misuse. Jornay PM is dosed in the evening for a morning-onset effect, which suits patients whose primary impairment is executive dysfunction on waking.

Titration is anchored to scheduled office visits — not to messages exchanged over a portal. Dose adjustments are made against blood pressure, heart rate, sleep, appetite, and symptom response documented in a visit note, which is both a safety practice and a Schedule II prescribing standard. Refills follow the same cadence.

Non-stimulant options when stimulants are not the fit

Not every adult with ADHD is a stimulant candidate. Cardiovascular history, prior substance use disorder, poor tolerance, or informed patient preference move treatment onto the non-stimulant pathway, which is evidence-based and well-mapped rather than a consolation option.

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with a 4-to-6-week onset and no controlled-substance status. Viloxazine (Qelbree) is a newer non-stimulant with a similar mechanism and a somewhat faster response window. Alpha-2 adrenergic agonists — guanfacine extended-release and clonidine extended-release — are effective, particularly for hyperactivity, emotional dysregulation, and sleep disruption, and are frequently combined with a stimulant rather than used alone. Bupropion has meaningful evidence in adults with comorbid depression and ADHD and is often a two-diagnosis solution.

Selection is driven by the comorbidity profile, cardiovascular status, and prior medication history rather than habit. For a patient with active benzodiazepine use, an alcohol use disorder in early remission, or borderline hypertension, non-stimulant treatment is often the safer starting point, with re-evaluation for a stimulant trial once other variables are stable.

Cardiovascular safety and the monitoring we run

Stimulant initiation is a cardiovascular event. Baseline evaluation includes a personal and family history of arrhythmia, structural heart disease, and sudden cardiac death, along with a resting blood pressure and heart rate. An EKG is obtained in adults over 40, in anyone with a cardiac history, or when the baseline exam is abnormal. Uncontrolled hypertension is corrected before initiation, not managed around it.

At each follow-up visit, blood pressure and heart rate are re-measured. Sustained increases of 10-15 mmHg systolic or 15 beats per minute prompt dose reduction, non-stimulant substitution, or coordination with primary care. Height and weight are tracked and unintended weight loss is investigated. Sleep is documented at every contact because stimulant-induced insomnia both worsens attention and increases cardiovascular strain.

This framework is not novel — it is the standard the American Heart Association and the American Academy of Child and Adolescent Psychiatry describe for stimulant prescribing. The differentiator is execution: RECO runs the framework at every visit rather than at intake alone.

What to expect on your first visit

The initial appointment is a full 60-to-90-minute psychiatric evaluation. Expect a symptom history that reaches into childhood, a review of prior treatment, PHQ-9 and GAD-7 administration, ASRS screening, and either a DIVA-5 interview at intake or scheduled to a second visit if the first runs long. Bring any childhood documentation available — old report cards, IEP or 504 records, teacher comments — and a list of prior medication trials including doses, duration, and response.

Sleep, caffeine, cannabis, alcohol, and prescription stimulant history are all part of the intake. Honesty here shortens the path to the right treatment. If the evaluation confirms ADHD, medication is discussed at the initial visit and initiated at the follow-up once labs, EKG (if indicated), and cardiovascular clearance are in hand. Adult-ADHD-specific CBT — a structured, skills-based protocol distinct from general talk therapy — is referred where the functional profile warrants it.

Insurance and admissions from Palm Beach Gardens

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield plans commonly held by Palm Beach Gardens residents. Benefits are verified before the first visit so cost is known, not estimated. For patients whose plan requires prior authorization on a stimulant prescription, the front office manages that workflow with the insurer and pharmacy directly.

The drive from Palm Beach Gardens is 25 miles and typically 35 minutes via I-95 south to Linton Boulevard. For most residents, that trade — a short drive for a defensible diagnostic workup and a medication plan managed in-office rather than by portal message — is the reason to make the appointment. More detail on the practice’s adult ADHD treatment program is available, or the front desk can schedule an initial evaluation directly.

Serving residents of: BallenIsles, Frenchman's Reserve, Mirasol, Old Palm, PGA National.