Attention Deficit Disorder Treatment for Adolescents and Adults
Careful diagnosis, an honest conversation about medication, and a plan that fits the life you actually lead. Dr. Smita Patel provides psychiatric evaluation and ongoing ADHD treatment in-office in Washington, DC, and by secure telemedicine for residents of the District of Columbia, Maryland and Florida.
The Three Presentations of ADHD
ADHD is one condition with three recognised presentations. Which one fits can change over a lifetime, which is part of why it is so often identified late.
Predominantly Inattentive
Difficulty sustaining attention, losing the thread of instructions or reading, appearing not to listen, disorganisation, avoiding tasks that need sustained mental effort, misplacing things, forgetfulness in daily routines. This is the presentation most often missed — particularly in girls, and in capable students who compensate successfully until the workload outgrows the strategy.
Predominantly Hyperactive-Impulsive
Restlessness, difficulty staying seated or settled, talking over others, answering before the question is finished, difficulty waiting, acting before thinking it through. In adolescents and adults this usually reads as internal restlessness and impatience rather than visible overactivity.
Combined
Enough symptoms of both to meet criteria for each. This is the presentation seen most often in clinical practice.
Diagnostic note: Diagnosis requires that several symptoms were present before age 12, that they appear in two or more settings — for example both school or work and home — and that they genuinely interfere with functioning. Difficulty concentrating on its own is not ADHD.
What Often Sits Alongside It
ADHD rarely arrives on its own, and treating it in isolation when something else is driving the difficulty tends not to work. A first evaluation looks deliberately wider than attention.
- Anxiety disorders — Commonly co-occurring, and easily mistaken for inattention when worry is what is consuming the attention.
- Depression and other mood disorders — Including the demoralisation that follows years of underperforming relative to effort.
- Bipolar disorder — The overlap matters clinically, because stimulant medication can destabilise a bipolar illness that has not been identified.
- Sleep disorders — Including delayed sleep phase and sleep apnoea, both of which produce daytime inattention that looks identical to ADHD.
- Substance use — Sometimes self-medication, sometimes a separate problem.
- Learning differences — Dyslexia, dysgraphia and dyscalculia frequently sit alongside attention difficulties, and are screened for during evaluation.
- Autism spectrum conditions — The two co-occur more often than was once recognised.
How Dr. Patel Approaches It
A full diagnostic evaluation, not a questionnaire
Developmental, academic and work history; validated rating scales; collateral information from a family member or partner where you want that included; and a deliberate review of medical causes that imitate ADHD — thyroid disease, sleep apnoea, iron deficiency, substance use, and the side effects of other medications.
Medication management, discussed openly
Stimulant medications (the methylphenidate and amphetamine classes) are the best-evidenced treatment for core symptoms. Non-stimulant options — atomoxetine, viloxazine, guanfacine and bupropion among them — matter when stimulants are not tolerated, not appropriate, or not wanted. Cardiovascular history and blood pressure are reviewed before any stimulant is started, and prescribing of controlled medication follows District of Columbia and federal requirements.
What works alongside medication
Organisational and behavioural strategies, sleep and exercise, ADHD coaching, and documentation for academic or workplace accommodation where that is useful. Medication makes strategies possible; it does not replace them.
Coordination with the rest of your care
With your therapist, your primary care physician, and your school or university where you want that contact made.
Frequently Asked Questions
Common questions about ADHD evaluation, medication, telemedicine, and what to expect.
Find out whether ADHD explains what you have been dealing with
Dr. Smita Patel is a board-certified psychiatrist with over 30 years in practice, seeing patients in-office at 1629 K St. NW, Suite 300, Washington, DC, and by secure telemedicine for residents of the District of Columbia, Maryland and Florida.