The Thrive Journal · Psychiatry
ADHD in adults: what a real evaluation looks like
By Jay Borrego, DNP, PMHNP-BC, CRNA · Written and clinically reviewed by the author · Published September 2026 · Last clinical review: September 3, 2026 · Coral Gables, FL
Adult ADHD is real, under-diagnosed in women, and — at the same time — over-diagnosed by ten-minute questionnaires. Both things are true. A good evaluation respects both.
What we rule out first
Sleep debt, untreated anxiety, depression, thyroid disease, perimenopause and substance effects all produce inattention, restlessness and poor follow-through. Treating those as ADHD leads to stimulants that don't work and a diagnosis that follows you. So the first part of the visit is the part most clinics skip.
What the evaluation includes
A structured diagnostic interview covering childhood and adult symptoms; validated rating scales (ASRS, and collateral where possible); screening for the conditions above; a review of any prior trials; and, when it changes the decision, labs or a pharmacogenomic test. You leave with a written answer — yes, no, or “not yet, here's what we test first.”
If it is ADHD
Stimulants remain first-line for most adults and work well when monitored. Non-stimulant options exist for people with anxiety, cardiac concerns, or a preference to avoid controlled medications. Either way you are enrolled in the Focus & Flow track — the structure between visits that makes medication actually translate into a working day.
Book an ADHD evaluation — in person in Coral Gables or by telehealth across Florida.
This article is educational and not a substitute for an evaluation. Individual results vary.
References
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Wolraich ML, et al. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of ADHD in Children and Adolescents. Pediatrics. 2019;144(4):e20192528.
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National Institute for Health and Care Excellence. Attention deficit hyperactivity disorder: diagnosis and management (NG87). 2018, updated 2019.
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Kessler RC, et al. The World Health Organization Adult ADHD Self-Report Scale (ASRS). Psychol Med. 2005;35(2):245-256.
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Faraone SV, et al. The World Federation of ADHD International Consensus Statement. Neurosci Biobehav Rev. 2021;128:789-818.