Next Steps for Adult ADHD Diagnosis and Treatment
You need a comprehensive clinical evaluation to confirm the diagnosis using DSM-5 criteria, followed by FDA-approved stimulant medication as first-line treatment if ADHD is confirmed. 1
Immediate Diagnostic Steps
The diagnostic evaluation must document three critical elements before treatment begins: 1, 2
- Symptom onset before age 12 years - You need documented or reliably reported evidence of ADHD symptoms from childhood, either through school records, parent interviews, or credible recall 1, 3
- Current functional impairment in at least 2 settings - Work, home, and social relationships must show documented dysfunction from inattention, hyperactivity, or impulsivity 1, 2
- Meeting DSM-5 symptom criteria - At least 5 symptoms of inattention and/or hyperactivity-impulsivity persisting for ≥6 months in adults 4
Structured Assessment Tools to Request
Your provider should use standardized rating scales to systematically evaluate symptoms: 2, 5
- Wender Utah Rating Scale - Retrospectively assesses childhood ADHD symptoms 2, 5
- Conners Adult ADHD Rating Scale (CAARS) or Brown Attention-Deficit Disorder Scale for Adults - Quantifies current adult symptoms 2, 5
- Adult Self Report Scale (ASRS) - Self-report screening that takes 3-5 minutes 6, 5
Critical Comorbidity Screening Required
Before starting ADHD treatment, your provider must screen for and address these conditions: 1, 4
- Substance use disorders - Obtain detailed drug and alcohol history; consider urine drug screen if substance abuse suspected, as addiction treatment must precede or run concurrent with ADHD treatment 2, 1
- Depression and anxiety disorders - Present in approximately 10% of adults with ADHD and often require concurrent treatment for optimal response 4, 2
- Bipolar disorder - Must be ruled out, as mood stabilization is required first before treating ADHD 1
- Sleep disorders - Can exacerbate inattentive symptoms and must be addressed 4
First-Line Treatment Protocol
If ADHD is confirmed and comorbidities are addressed, FDA-approved stimulant medications are first-line therapy: 1, 4
Medication Options (in order of evidence strength)
- Methylphenidate or amphetamine formulations - Start with long-acting preparations for better adherence and lower rebound risk 4, 1
- Initial dosing approach - Titrate to maximum benefit with tolerable side effects rather than using strict weight-based dosing 7, 1
- Alternative if stimulants contraindicated - Atomoxetine (start 40 mg daily, increase after minimum 3 days to target 80 mg), viloxazine, or bupropion for patients with concurrent anxiety/depression or stimulant intolerance 1, 8
Monitoring Schedule
Your provider should establish this follow-up pattern: 7
- Weekly during initial dose titration - Assess response and side effects 7
- Monthly for first 3-6 months - Monitor for medication misuse, diversion, and treatment response 7, 1
- Every 3-6 months once stable - Ongoing chronic disease management 7
When to Request Subspecialist Referral
Ask for referral to a psychiatrist or ADHD specialist if: 1
- Diagnostic uncertainty exists due to complex psychiatric comorbidities 1
- Initial stimulant treatment fails or produces intolerable side effects 1
- Active substance use disorder requires specialized addiction treatment before ADHD management 1
- Severe mood instability suggests bipolar disorder requiring mood stabilization first 1
Common Pitfalls to Avoid
Do not delay pharmacological treatment while pursuing behavioral interventions alone if you have significant functional impairment - stimulants provide rapid symptom relief in adults, unlike the pediatric approach where behavioral therapy is often first-line 4
Do not assume your inattentive symptoms are less severe than hyperactive presentation - inattentive ADHD causes substantial functional impairment requiring aggressive treatment 4
Ensure your provider rules out alternative causes - mood disorders, anxiety, sleep disorders, and substance use can mimic ADHD symptoms 4, 2