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

Wellington sits 28 miles and about 38 minutes west of RECO Integrated Psychiatry's Delray Beach office — close enough for a structured in-person evaluation, far enough that clients from Olympia, Versailles, and Palm Beach Polo typically pair the initial visit with a telepsychiatry follow-up cadence. Adult ADHD workups here use the DIVA-5 structured diagnostic interview and a documented developmental history rather than the two-question telehealth screening that produces overdiagnosis. Stimulant and non-stimulant options are titrated in visit-anchored increments with blood pressure and heart rate recorded at every contact.

Wellington’s equestrian neighborhoods sit 28 miles and roughly 38 minutes west of RECO Integrated Psychiatry’s Delray Beach office — inland enough that adults commuting from Olympia, Versailles, Aero Club, Palm Beach Polo, and Wellington View typically pair an in-person diagnostic evaluation with a telepsychiatry follow-up cadence rather than driving east for every visit. For adult ADHD in particular, that hybrid model works: the initial workup requires an in-person encounter and a structured clinical interview, but stimulant and non-stimulant titration can be handled by video once the treatment plan is set. What follows is the diagnostic protocol, medication pathway, and monitoring framework Wellington clients can expect.

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 (work, home, relationships, academics), demonstrable functional impairment, and — critically — the rule-out of alternative explanations including major depressive disorder, generalized anxiety, obstructive sleep apnea, active substance use, and thyroid dysfunction. Screening with the Adult ADHD Self-Report Scale (ASRS) is a starting point, not a diagnosis.

RECO’s intake pairs the ASRS with a structured diagnostic interview — the DIVA-5 (Diagnostic Interview for ADHD in Adults) or the CAADID — and a documented developmental history. Where adult recall doesn’t support the childhood-onset criterion, we request report cards, prior school evaluations, or interview a family informant. Concurrent PHQ-9 and GAD-7 quantify depressive and anxiety symptom burden so we can separate ADHD from mood-driven executive dysfunction, which has a different first-line treatment. Where sleep pathology is plausible, we screen with STOP-BANG and refer for polysomnography before initiating stimulants.

Overdiagnosis is a documented risk in the current care environment — the two-question telehealth screens common to direct-to-consumer platforms produce false positives and downstream controlled-substance concerns. The protocol above exists to prevent that.

Stimulant medication: methylphenidate, amphetamine, 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. Individual response varies and is not reliably predictable from demographics or comorbidity — trial-and-titration is the standard of care, with a switch to the opposite class if the first is ineffective or poorly tolerated.

Long-acting formulations are preferred over short-acting immediate-release for three reasons: smoother coverage across a working day, reduced dose-timing gaps, and lower diversion risk. Vyvanse (lisdexamfetamine) is a prodrug requiring gastrointestinal cleavage to yield active dextroamphetamine — that pharmacology reduces intranasal and intravenous abuse liability and makes it a preferred first choice for clients with any substance use history. Jornay PM is dosed at night to produce morning-onset coverage for clients whose functional impairment is worst on waking.

Dosing is titrated by response and side effects with visit-anchored feedback — not message-based adjustments or pharmacy-portal refill requests. That structure keeps the risk-benefit conversation clinically honest and the documentation defensible.

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

Atomoxetine (Strattera) is a selective norepinephrine reuptake inhibitor with slower onset — meaningful benefit is typically seen at four to six weeks — and no abuse liability. Viloxazine (Qelbree) is a newer serotonergic-noradrenergic modulator with a faster onset than atomoxetine. Alpha-2 agonists (guanfacine extended-release, clonidine extended-release) work as monotherapy for milder presentations and as adjuncts for hyperactivity, impulsivity, and stimulant-associated sleep disruption. Bupropion has evidence in adult ADHD, particularly when comorbid depressive symptoms are present, though it is used off-label for the ADHD indication.

The non-stimulant pathway is the clinically correct choice — not a consolation prize — for clients with active or recent substance use disorder, cardiovascular contraindications, stimulant-refractory presentations, or intolerable stimulant side effects. Because response takes weeks rather than hours, non-stimulant trials require clear expectations at the outset and adequate visit cadence to titrate through the therapeutic dose range without premature discontinuation.

Cardiovascular monitoring at every visit

Stimulant initiation requires a personal and family cardiovascular history, baseline resting blood pressure and heart rate, and an EKG in adults over 40 or in anyone with prior cardiac history, arrhythmia, unexplained chest pain, or significant family history of sudden cardiac death. Structural heart disease is a contraindication to stimulant therapy — the non-stimulant pathway is the answer.

At every follow-up visit, blood pressure and heart rate are recorded. Sustained hypertension (systolic above 140 or diastolic above 90 across two visits) or resting tachycardia prompts a dose reduction, a switch to a lower-cardiovascular-impact stimulant, or transition to a non-stimulant regimen. Weight is tracked because chronic stimulant exposure can suppress appetite in adults as well as adolescents. The framework itself is standard psychiatric practice — the operational difference is that RECO runs it at every contact rather than treating it as a one-time intake exercise.

Comorbid mood, anxiety, and substance use — the diagnoses ADHD often hides behind

Adult ADHD rarely presents alone. Roughly half of adult ADHD clients meet criteria for at least one comorbid mood or anxiety disorder, and a substantial minority carry a substance use history. Treating ADHD in isolation while ignoring co-occurring major depressive disorder or generalized anxiety disorder produces partial response and preventable functional relapse.

Sertraline, escitalopram, or bupropion are common first-line agents when comorbid depression is present; sertraline, escitalopram, or buspirone address anxiety. Where mood instability suggests bipolar-spectrum illness, stimulant initiation is deferred until mood stabilization with lithium, lamotrigine, or an atypical antipsychotic (quetiapine, aripiprazole) is achieved — stimulants can precipitate hypomania in undiagnosed bipolar disorder.

For clients with alcohol or opioid use history, we coordinate medication-assisted treatment where indicated — naltrexone for alcohol use disorder, buprenorphine for opioid use disorder — and default to the non-stimulant pathway or lisdexamfetamine for ADHD pharmacotherapy. CBT tailored to adult ADHD, or ACT for emotional-regulation-heavy presentations, is a useful adjunct where the functional profile warrants skills training rather than medication alone.

What to expect on your first visit from Wellington

The initial appointment runs 60 to 90 minutes and is conducted in person at the Delray Beach office — 28 miles and about 38 minutes from most Wellington addresses via Southern Boulevard to I-95, or via Forest Hill Boulevard and the Florida Turnpike depending on time of day. The visit covers current symptom review, ASRS and DIVA-5 completion, developmental and academic history, medical and psychiatric history, family history, medication reconciliation, and PHQ-9 and GAD-7 screening. Baseline blood pressure, heart rate, height, and weight are obtained.

If ADHD is confirmed and stimulant therapy is appropriate, a starting dose is prescribed and a two-to-four-week follow-up is scheduled. Follow-up visits run 25 to 30 minutes and can be conducted by telepsychiatry once the initial in-person encounter is complete. Florida law requires controlled-substance prescribers to see the patient in person at least annually for ongoing stimulant therapy — that visit is scheduled proactively rather than left for pharmacy refusal to force. Full details on our ADHD treatment workflow are available on the service page.

Insurance and telepsychiatry logistics for Wellington clients

RECO Integrated Psychiatry is in network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS. Coverage for adult ADHD evaluation, stimulant and non-stimulant medication management, and follow-up telepsychiatry visits is standard across these plans. Prior authorization is occasionally required for brand-name stimulants when a generic equivalent exists — the billing team handles the paperwork rather than pushing it to the client.

For Wellington clients, the practical model is an in-person initial evaluation, an in-person visit at least annually to satisfy Florida controlled-substance prescribing requirements, and telepsychiatry follow-up in between. Prescriptions are sent electronically to a pharmacy of the client’s choosing anywhere in Palm Beach County.

Serving residents of: Olympia, Versailles, Aero Club, Palm Beach Polo, Wellington View.