ADHD

Dr. Pham specializes in the diagnosis, evaluation, and treatment of ADHD to get you back to focus

Updated: 10/2026
Written by Julie Pham, MD

What is ADHD

ADHD is a neurodevelopmental condition. The brain systems that handle attention, planning, getting started, and keeping impulses in check work differently, and they have since childhood, whether or not anyone noticed. It runs strongly in families, and it is common: in a national survey of US adults, about 4.4% met criteria for ADHD in the past year (Kessler et al., 2006).

An international consensus statement that gathered the strongest research on ADHD begins by pointing out that misconceptions about the disorder stigmatize people and delay treatment (Faraone et al., 2021). I see the cost of that often. Many of the adults I meet have spent years calling themselves lazy or disorganized when the problem was never effort.

How it shows up in adults

Childhood hyperactivity often turns inward. Adults describe a motor that never fully shuts off, trouble relaxing, or a steady sense that they should be doing something else. Other things I hear again and again:

  • Starting is the hard part. You know exactly what needs doing and cannot begin until the deadline is close enough to be frightening.

  • Time slips away. You underestimate how long things take and run late to things you care about.

  • Attention follows interest and urgency, not importance. A dull task can feel physically impossible, while an absorbing one swallows six hours.

  • Small things pile up: unopened mail, an inbox in the thousands, lost keys, missed refills.

  • Emotions hit fast and hard. Frustration, irritability, and sensitivity to criticism are common, and they rarely make it onto the checklist version of ADHD.

Many of the people I treat are high-performing professionals: physicians, attorneys, engineers, founders. They got through school on intelligence, deadlines, and last-minute intensity. That works until the job gets bigger, a baby arrives, or the structure of school or residency disappears. Then the workarounds stop holding.

Women are diagnosed later, on average, and more often have the inattentive presentation, which is quieter and easy to mistake for anxiety or depression (Quinn & Madhoo, 2014). Hormonal transitions such as the postpartum period and perimenopause can make symptoms suddenly harder to manage.

How we evaluate ADHD

There is no blood test or brain scan for ADHD, so the diagnosis rests on a comprehensive clinical history.

We go through your childhood and school years (old report cards and teacher comments help if anyone kept them), your work history, and what daily life looks like now. The diagnostic criteria require that symptoms began in childhood and cause problems in more than one setting. I use standardized rating scales, and with your permission I am glad to hear from a parent, partner, or friend who knows you well.

Then I look for everything else that could be causing the same symptoms or riding along with them. Adults with ADHD have much higher rates of mood and anxiety disorders than other adults (Kessler et al., 2006), and the reverse is also true: depression, anxiety, bipolar disorder, trauma, poor sleep, and sleep apnea can all wreck concentration. So can thyroid problems, low iron, heavy cannabis use, and some prescription medications.

Getting this wrong in either direction costs people years. Treating depression in someone whose root problem is ADHD often goes nowhere. Giving a stimulant to someone with untreated bipolar disorder or severe anxiety can make things worse.

Treatment

Medication. Stimulants are the best-studied and most effective treatment. A network meta-analysis of 133 randomized trials found that every medication studied, except modafinil in adults, beat placebo. When benefit and tolerability were weighed together, amphetamine-based medications came out as the preferred first choice for adults. Effects were smaller and side effects more common in adults than in children (Cortese et al., 2018). Non-stimulants such as atomoxetine, viloxazine, and guanfacine are good options when stimulants do not suit you because of anxiety, sleep, blood pressure, or preference.

I start low and increase slowly. I check blood pressure and pulse, and I ask about sleep, appetite, and anxiety at every visit. Controlled substances are monitored through California’s CURES database, as the law requires. I do not start a stimulant without a comprehensive ADHD Evaluation first.

Beyond the prescription. Medication helps with focus and drive but it does not build systems. Most people do best with practical supports as well: ADHD-informed coaching or therapy, external structure like calendars, alarms, and body doubling, regular sleep, and exercise. We also do a holistic and lifestyle assessment in addition to medication management.

References

  1. Faraone SV, Banaschewski T, Coghill D, et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789-818. PubMed

  2. Cortese S, Adamo N, Del Giovane C, et al. Comparative efficacy and tolerability of medications for attention-deficit hyperactivity disorder in children, adolescents, and adults: a systematic review and network meta-analysis. Lancet Psychiatry. 2018;5(9):727-738. DOI

  3. Kessler RC, Adler L, Barkley R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716-723. PubMed

  4. Quinn PO, Madhoo M. A review of attention-deficit/hyperactivity disorder in women and girls: uncovering this hidden diagnosis. Prim Care Companion CNS Disord. 2014;16(3):PCC.13r01596.

Frequently asked questions

  • Yes. ADHD is a neurodevelopmental condition that can often persist into adulthood. Many adults are not diagnosed until their late 20s, 30s, or even later, particularly women and other high functioning adults utilize compensatory “masking” earlier in life. A thorough diagnostic evaluation can determine an ADHD diagnosis regardless of age

  • Yes, routinely. Typically ages 5+

  • Yes, when a thorough evaluation is done and if it is determined to be clinically appropriate. In addition, we also offer holistic interventions, such as sleep, therapy, and diet, as well as non-stimulant options like atomoxetine and wellbutrin. We take into account the whole person and how it fits your specific needs.

  • Yes, and the reverse can also be true. If under-treated, ADHD frequently can cause secondary depression and anxiety. Conversely, anxiety and depression can also mimic similar concentration issues found in ADHD. Therefore, we conduct a thorough diagnostic evaluation first in order to rule these conditions out.

  • It should not. If you feel flat, wired, or not like yourself, the drug or the dose is wrong and we adjust it.

Get started on your ADHD evaluation

Questions before you book? Call 909-257-7268 or send Dr. Pham an email at Drpham@jpconciergepsych.com



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