ADHD Psychiatrist Evaluation and Treatment

Attention Deficit and Hyperactivity Disorder, aka ADHD or ADD can affect self-esteem, learning habits, sleep, dating, friendships, family relationships, and much more. Early treatment can help children and teens develop better learning habits and self-esteem which may lead to improved outcomes later in life including less chance of problematic substance & alcohol use, decreased divorce rate, as well as a decreased rate of arrests and incarceration.

Attention Deficit and Hyperactivity Disorder is a common disorder which affects approximately 5-7% of the adult population. ADHD has demonstrated abnormalities in metabolic activity and dopamine prevalence in areas of the brain such as the dorsolateral prefrontal cortex.

ADHD has 3 primary subdomains: Inattention, Hyperactivity, and Impulsivity.

According to the DSM-5 the Diagnostic Criteria for the inattention subdomain involves the following:

Inattention: One must display at least six of the following symptoms consistently for a minimum of six months, to an extent that is not in line with their developmental stage and significantly hinders their social and academic or occupational functioning:

1. Frequently makes errors or overlooks details in schoolwork, work, or other activities due to a lack of attention to detail, resulting in inaccuracies.
2. Struggles to maintain focus during tasks or recreational activities, such as difficulty staying attentive during lectures, conversations, or lengthy reading sessions.
3. Often appears not to be listening when directly spoken to, with their mind seemingly elsewhere, even without any apparent distractions.
4. Frequently fails to complete tasks or assignments as instructed, frequently starting them but quickly losing focus and getting sidetracked.
5. Encounters difficulty in organizing tasks and activities, including managing sequential tasks, maintaining order in materials and belongings, producing messy and disorganized work, struggling with time management, and missing deadlines.
6. Avoids or dislikes tasks that require sustained mental effort, such as schoolwork, homework, or, for older individuals, tasks like preparing reports, completing forms, or reviewing lengthy documents.
7. Frequently loses essential items needed for tasks or activities, such as school materials, pencils, books, tools, wallets, keys, paperwork, eyeglasses, or mobile phones.
8. Easily gets distracted by unrelated stimuli, which can include unrelated thoughts for older adolescents and adults.
9. Often forgets to carry out daily activities, such as household chores, errands, or, for older individuals, returning calls, paying bills, and keeping appointments.

The Hyperactivity and Impulsivity domain involve the following criteria:

Six (or more) of the following symptoms have persisted for at least 6 months to a degree that is inconsistent with developmental level and that negatively impacts directly on social and academic/occupational activities:

For older adolescents and adults (age 17 and older), at least five symptoms are required.

1. Often fidgets with or taps hands or feet or squirms in seat.
2. Often leaves seat in situations when remaining seated is expected (e.g., leaves his or her place in the classroom, in the office or other workplace, or in other situations that require remaining in place).
3. Often runs about or climbs in situations where it is inappropriate.

(Note: In adolescents or adults, may be limited to feeling restless.)

1. Often unable to play or engage in leisure activities quietly.
2. Is often “on the go,” acting as if “driven by a motor” (e.g., is unable to be or uncomfortable being still for extended time, as in restaurants, meetings; may be experienced by others as being restless or difficult to keep up with).
3. Often talks excessively.
4. Often blurts out an answer before a question has been completed (e.g., completes people’s sentences; cannot wait for turn in conversation).
5. Often has difficulty waiting his or her turn (e.g., while waiting in line).
6. Often interrupts or intrudes on others (e.g., butts into conversations, games, or activities; may start using other people’s things without asking or receiving permission; for adolescents and adults, may intrude into or take over what others are doing).

Several of these symptoms need to be present before age 12 and present in multiple settings e.g., school/work and home.

ADHD affects children, teens, and adults. It is always present before adolescence but may not be diagnosed by a clinician that early particularly due to lack of psychiatric evaluations or compensating factors in the child such as a high IQ masking the difficulty they are having in school. Additionally, people with ADHD may excel in certain things that they find stimulating or enjoyable and have a harder time than most switching out of these activities. They may have a difficult time completing tasks which are required but are not as stimulating as their current focus.

It’s important to note that ADHD is a complex condition, and its symptoms can vary widely from person to person. It can also coexist with or be mistaken for other mental health conditions. A partial list of common symptoms, which does not begin to encompass all possibilities, that can be shared by other disorders and ADHD and need thorough diagnosis and assessment include: reduced focus caused by overthinking in depression and anxiety disorders. Decreased concentration due to malnutrition in anorexia or bulimia. Irritability or impulsivity due to hypomania or mania in bipolar disorder, or due to frantic attempts to avoid real or imagined abandonment in borderline personality disorder. Additionally, many psycho-social issues can affect concentration and mood which are too numerous to name. It is recommended that ADHD be diagnosed by a Board-Certified Psychiatrist with expertise in ADHD, and someone who will spend time to go through complex differential diagnosis and relevant psycho-social issues.

Treatment options for ADHD typically include supportive services such as school/work accommodations and counseling, behavioral therapy & cognitive therapy, medication such as Adderall, Concerta, Ritalin, Focalin, Vyvanse, Strattera, or Jornay depending on the individual’s needs and preferences. These treatments can help children, teenagers, and adults with ADHD manage their symptoms effectively and improve their overall quality of life.

Post reviewed and edited by Dr. Nicolas Sikaczowski, Board-Certified Psychiatrist. 

If you have any concerns about your mental health, please reach out today. With multiple locations and telehealth options we can provide the necessary guidance and support for ADHD evaluations and ADHD treatment in Coral Gables, Florida, Aventura, FL and Greater Portland, ME.