ADHD in Primary Care: How We Evaluate and Treat Adult ADHD

Many adults spend years wondering whether they have ADHD. Maybe you were the kid who couldn’t sit still, or maybe nobody noticed because you were quiet, smart, and falling behind in ways that didn’t show. Now you’re an adult juggling work, family, bills, and deadlines, and the same struggles with focus, organization, and follow-through are getting harder to work around.

Here’s something many people don’t realize: ADHD evaluation and treatment is within the scope of primary care. For the right patients, it’s something we’re glad to do at Aristos Internal Medicine, without months on a specialist waitlist.

What adult ADHD actually looks like

ADHD in adults often looks different than it does in children. Hyperactivity tends to fade into restlessness, and the main problems are usually inattention and executive function:

• Trouble starting or finishing tasks, especially boring ones
• Chronic lateness, missed deadlines, and forgotten appointments
• Losing things constantly
• Difficulty following long conversations or reading without drifting
• Impulsive decisions with money, words, or commitments
• Feeling like you’re working twice as hard as everyone else to keep up

By definition, ADHD is a developmental condition. The symptoms don’t appear for the first time in adulthood. Some of them were present in childhood (before age 12), even if nobody labeled them.

How we evaluate ADHD

Everyone has trouble focusing sometimes, and many other conditions can look like ADHD. A careful evaluation is the most important part of the process. At Aristos, it includes:

1. A detailed history of your symptoms now and in childhood, and how they affect work, school, relationships, and daily life.
2. Validated screening tools, such as the Adult ADHD Self-Report Scale (ASRS).
3. Information from other sources when possible, such as old report cards or input from a parent, partner, or close friend.
4. A search for conditions that mimic or accompany ADHD. Depression, anxiety, bipolar disorder, sleep apnea and poor sleep, thyroid disease, substance use, and some medications can all affect attention. Many people have ADHD and one of these, and treating only one piece rarely works.
5. A medical review, including blood pressure, heart rate, and any history of heart problems, before any medication is considered.

Sometimes the answer is clearly ADHD. Sometimes it’s something else, or the picture is complicated enough that formal neuropsychological testing or a psychiatrist’s input is the right next step. I’ll tell you plainly which situation you’re in.

Treatment options

Treatment is individualized and often combines several approaches.

Stimulant medications (methylphenidate- and amphetamine-based medications) are the most effective treatment for ADHD and have decades of evidence behind them. Long-acting versions provide smoother, all-day coverage.

Non-stimulant medications are good options for some people, including those who can’t tolerate stimulants, have certain medical conditions, or prefer to avoid controlled substances. Options include atomoxetine, viloxazine, and in some cases bupropion or guanfacine.

Skills and structure. Medication helps the brain focus; it doesn’t automatically build systems. Organization strategies, coaching, and cognitive behavioral therapy for ADHD can make a big difference.

Addressing everything else. Better sleep, treating depression or anxiety, and cutting back on alcohol and cannabis often improve focus on their own.

Our policy on stimulant prescribing

Stimulants are controlled substances, and we prescribe them responsibly.

• An in-person visit is required before we prescribe a stimulant. Although federal temporary telehealth rules currently allow some controlled substances to be prescribed without an in-person exam, our practice policy is to see you in person first. It lets us do a proper exam and build the kind of relationship this treatment deserves.
• A controlled substance agreement outlines expectations on both sides.
• Regular monitoring, which may include checks of Washington’s Prescription Monitoring Program and periodic drug testing, as with all controlled medications in our practice.
• At least one in-person visit per year for patients on ongoing controlled medications.

Many follow-up visits for stable patients can be done by virtual visit, which is convenient for busy adults.

When ADHD care is better handled by a specialist

Primary care is a good fit for straightforward adult ADHD. We may recommend psychiatry or specialized testing if there’s:

• Bipolar disorder, psychosis, or a significant eating disorder
• An active substance use disorder
• Significant diagnostic uncertainty
• Symptoms that haven’t responded to standard treatment

This isn’t us turning you away. It’s making sure you get the right care.

Getting started

If you think you might have ADHD, the first step is an honest conversation. Come to your first visit ready to talk about your childhood, your daily challenges, and what you’ve already tried. If you have old school records or a previous evaluation, bring them.

Learn more about our approach to behavioral health in primary care, read our FAQs, or schedule an appointment online. You can also call us at (509) 426-5425. We see adults at our Spokane office and offer virtual follow-up care across Washington.