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

RECO Integrated Psychiatry's Delray Beach office is 18 miles and 28 minutes south of downtown West Palm Beach on I-95. Adult ADHD is evaluated with the DIVA-5 structured interview, the ASRS, and a documented developmental history — not a two-question telehealth screen — and prescribing is anchored to office visits with blood pressure and heart rate checks at every follow-up rather than portal messages. Non-stimulant regimens (atomoxetine, viloxazine, guanfacine extended-release) are used where a controlled substance is contraindicated. In-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and BCBS.

West Palm Beach sits 18 miles north of RECO Integrated Psychiatry’s Delray Beach office — a 28-minute drive down I-95 or Federal Highway outside rush hour. For adults living in El Cid, Flamingo Park, Northwood Hills, SoSo, or Downtown WPB who suspect ADHD, were dismissed by a primary-care provider, or were started on a stimulant off a two-question telehealth screen, the Delray campus offers a structured diagnostic protocol and specialist-level prescribing built for a controlled-substance context.

The diagnostic protocol that actually confirms ADHD

DSM-5-TR requires that ADHD symptoms be present before age 12, cause impairment in two or more settings — work, school, home, relationships — and cannot be better explained by another disorder. That last clause carries most of the diagnostic weight. Untreated depression, generalized anxiety, obstructive sleep apnea, alcohol or cannabis use, thyroid dysfunction, and iron deficiency all produce attentional symptoms that look indistinguishable from ADHD on a five-minute checklist. A responsible evaluation rules them out before it labels them.

RECO’s intake pairs the Adult ADHD Self-Report Scale (ASRS) as an initial screen with the DIVA-5 or CAADID as a structured diagnostic interview covering both childhood and current symptom domains. Where adult memory of childhood function is thin, we look for corroborating evidence — old report cards, standardized-testing records, or a family informant — rather than relying on retrospective self-report alone. When comorbidity is likely, we add the PHQ-9 and GAD-7 and a documented substance-use history.

Overdiagnosis is a real risk in the current care environment; the two-question tele-ADHD workflow that dominated the pandemic-era market is not a diagnostic protocol, and DEA prescribing data has documented the pattern it produced. RECO’s process is deliberately slower because the medications on the other side of it are Schedule II.

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 by current evidence, and individual response cannot reliably be predicted in advance. The choice on visit one is made from history: prior personal response, family response, cardiovascular risk, sleep pattern, and substance-use profile.

Long-acting formulations are strongly preferred over immediate-release. They minimize the mid-afternoon dose-timing crash that drives redosing, produce a smoother clinical response across the workday, and carry lower diversion risk. For any adult with a personal or family history of substance use, Vyvanse (lisdexamfetamine) is the default first stimulant — it is a prodrug that requires hepatic conversion to become active, which flattens the euphoric peak and reduces abuse liability relative to racemic amphetamine.

Titration is anchored to office visits rather than portal messages. Dose adjustments happen when a clinician has taken a blood pressure, watched the patient describe response and side effects, and reviewed sleep and appetite in person — not from a two-line inbox request.

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

Not every adult ADHD case belongs on a stimulant. Atomoxetine (Strattera) is a norepinephrine reuptake inhibitor with a 4-6 week onset and a lower abuse profile; it is a reasonable first choice where controlled-substance prescribing is contraindicated or where the patient prefers a non-scheduled medication. Viloxazine (Qelbree) is a newer non-stimulant with a faster onset than atomoxetine and a separate side-effect profile worth trialing when Strattera fails on tolerability.

Alpha-2 agonists — guanfacine extended-release and clonidine extended-release — are effective adjuncts, particularly for hyperactivity, impulsivity, evening rebound, and sleep-onset insomnia. They can be layered onto a stimulant or used as monotherapy in mild-to-moderate presentations. Bupropion has meaningful evidence in adult ADHD when comorbid depression is present and stimulants aggravate anxiety.

For patients with a substance-use history, cardiovascular contraindications, prior stimulant intolerance, or a strong preference against controlled medications, the non-stimulant pathway is well-mapped and clinically legitimate. It is not a consolation prize; it is a distinct treatment lane with its own evidence base.

Cardiovascular safety and the monitoring stimulants require

Stimulant initiation is not a paperwork exercise. A responsible intake includes a personal and family cardiovascular history — sudden cardiac death, unexplained syncope, structural heart disease, arrhythmia — a resting blood pressure and heart rate, and an ECG in adults over 40, in anyone with cardiac history, or where the screen raises concern. AHA and APA guidance are consistent on this and are commonly skipped in high-volume prescribing settings.

At every follow-up, blood pressure and heart rate are recorded before any dose change is considered. Sustained hypertension or resting tachycardia prompts dose reduction, formulation change, or a switch to non-stimulant management — not a wait-and-see. Height and weight are tracked because appetite suppression is a real long-term side effect, and BMI drift needs to be caught before it becomes a problem.

Nothing in that framework is unusual. It is standard psychiatric practice for stimulant management. The distinguishing feature of RECO’s model is that the framework is actually run at each visit rather than documented as run.

What to expect on your first visit

The initial evaluation is a 60-90 minute psychiatric intake with an MD or psychiatric mental health nurse practitioner. It covers the DIVA-5 or CAADID diagnostic interview, the ASRS, PHQ-9 and GAD-7 screens for common comorbidities, a full cardiovascular and medication history, substance-use screening, and a functional impairment inventory across work, driving, finances, and relationships.

Where the diagnostic picture is straightforward, a treatment plan and — if indicated — a starting prescription are established at the end of the first visit. Where it is not, we schedule a second appointment to review collateral records, prior treatment notes, sleep-study or lab results, or to complete rule-outs before starting a controlled substance. Follow-up visits are typically every 2-4 weeks during titration and every 1-3 months once a maintenance dose is established. Full program details are on the ADHD treatment service page.

Insurance and admissions from West Palm Beach

RECO Integrated Psychiatry is in-network with Florida Blue, Aetna, Cigna, UnitedHealthcare, Humana, and Blue Cross Blue Shield commercial plans, and processes out-of-network benefits for other carriers. A benefits check is completed before the first visit so any copay, coinsurance, or deductible balance is known in advance rather than after the fact.

The Delray office is 18 miles south of downtown West Palm Beach — 28 minutes on I-95 in typical daytime traffic, slightly longer on Federal Highway or during the 4-6 PM southbound peak. After the initial in-person intake, established patients have the option of secure telepsychiatry follow-up, which Florida law permits for controlled-substance continuation under specified conditions.

Serving residents of: El Cid, Flamingo Park, Northwood Hills, SoSo, Downtown WPB.