What we treat
Diagnostic evaluation first, with medication management when the diagnosis supports it
Attention-deficit/hyperactivity disorder affects about 4.4% of US adults, according to the National Institute of Mental Health. It is a neurodevelopmental condition with a strong genetic basis, rooted in how the brain regulates attention, impulse control, and executive function: planning, organizing, prioritizing, managing time, and regulating emotion. It is not laziness or a lack of willpower.
Many adults go undiagnosed or misdiagnosed for years. This is especially true for women, who often compensate through high effort and hit a wall when life demands outgrow that effort. Adults who seek evaluation often describe a long history of underperformance, chronic disorganization, or relationship strain that finally prompted them to look for answers.
Trouble sustaining focus, losing things, missing deadlines, and disorganization despite real effort. At work, strong at ideas and weak on follow-through. Formerly called ADD, it is more common in women and easy to miss because there is no visible hyperactivity.
Restlessness, trouble sitting through meetings, interrupting, and acting before thinking through consequences, including impulsive spending or comments. Adults often internalize the hyperactivity and describe feeling "always on."
Significant symptoms of both. This is the most common presentation and tends to affect the widest range of work, relationships, and self-care. Over time, the accumulated frustration often leads to anxiety or depression as well.
Adult ADHD rarely looks like the hyperactivity seen in children. It shows up as executive function problems that affect work and relationships:
If this sounds familiar, an evaluation with Dr. Fredes can clarify what is going on.
An accurate diagnosis matters. ADHD medications, especially stimulants, are controlled substances, and prescribing them responsibly requires a full evaluation. ADHD also frequently overlaps with anxiety, depression, sleep disorders, and thyroid problems, and many adults spend years on medications that do not address the actual problem.
Dr. Fredes conducts ADHD evaluations during a 60-minute initial appointment: developmental and symptom history from childhood on, current impairment across work, relationships, and daily life, screening for co-occurring conditions, review of prior evaluations or school records if available, medical history and lab work when indicated, and standardized rating scales alongside the clinical interview. This depth matters because ADHD presentations vary widely, overlap with other conditions, and require ruling out medical causes (thyroid disease, sleep apnea, anemia) that can mimic ADHD. You will not receive a diagnosis after a five-minute conversation. It takes time, careful questions, and clinical judgment.
Stimulant medications (methylphenidate-based and amphetamine-based) increase the availability of dopamine and norepinephrine in brain regions involved in attention and impulse control. They are controlled substances, prescribed only after Dr. Fredes' own in-person evaluation, and they come in immediate-release and extended-release forms chosen to fit your day.
Non-stimulants are often preferred with cardiovascular concerns, significant anxiety, a history of substance use, or stimulant side effects. They work through different pathways and take 2–4 weeks to build effect. Options include atomoxetine (which increases norepinephrine), guanfacine and clonidine (often used for hyperactivity and impulsivity), viloxazine (a selective norepinephrine reuptake inhibitor), and bupropion (an antidepressant that can be useful when anxiety or depression co-occur).
Stimulants can reduce appetite, disturb sleep, raise heart rate, and cause jitteriness, especially at higher doses. Non-stimulants can cause headache, nausea, dizziness, or sedation, usually easing over the first weeks. Finding the right medication and dose is deliberate: follow-up visits every 1–2 weeks after each change, incremental adjustments based on your feedback, and a realistic timeline of 4–12 weeks. Some people settle on the first medication; others try two or three.
Women with ADHD are frequently underdiagnosed, often not until adulthood. Girls learn to mask restlessness, get through school on effort alone, and are more likely to have the quieter inattentive presentation. Hormonal changes across the menstrual cycle, pregnancy, and perimenopause can make symptoms noticeably worse, which can look like ADHD coming and going. Dr. Fredes' evaluation accounts for these patterns, and women's mental health across the reproductive years is a focus of her practice.
Undiagnosed ADHD often surfaces at a transition: the move from high school's built-in structure to college, an early-career step up in complexity, or parenting, where consistency and household logistics strain executive function. Many adults seek evaluation after their own child is diagnosed and they recognize themselves in the symptoms. At work, untreated ADHD tends to mean underperformance, frequent job changes, and chronic stress, and a clear diagnosis is the first step toward changing that pattern.
Adult ADHD is often tangled up with anxiety and depression, and it deserves more than a quick prescription. Dr. Fredes sees every patient herself, with no nurse practitioners or physician assistants, so you work with a board-certified psychiatrist from the first appointment on. She takes time to understand your history and life context before recommending treatment, adjusts medication carefully, and monitors your response closely. When medication alone is not enough, she connects you with therapists, coaches, and other specialists.
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ADHD does not begin in adulthood; it is a neurodevelopmental condition that starts in childhood. Many adults are not diagnosed until later, because symptoms were masked by compensating strategies, attributed to anxiety or depression, or never evaluated. Some adults only recognize it when new demands (college, a promotion, parenting) exceed what their coping strategies can handle.
Adult ADHD diagnosis requires a full evaluation: detailed developmental history, current symptoms across work, relationships, and organization, screening for co-occurring conditions, and standardized rating scales. Adults are assessed on how ADHD affects real-world functioning. Dr. Fredes conducts thorough in-person evaluations lasting 60 minutes to reach an accurate diagnosis and rule out conditions that can mimic ADHD.
Stimulant medications for ADHD are controlled substances because they carry a risk of misuse and dependence. Misuse most often happens when they are taken in higher doses than prescribed, by other routes, or without medical oversight. Dr. Fredes monitors every controlled-substance prescription closely and adjusts dosing only when clinically warranted.
Stimulants (methylphenidate-based and amphetamine-based medications) increase dopamine and norepinephrine in the brain. Non-stimulants such as atomoxetine, guanfacine, and viloxazine work through different mechanisms and are often preferred with cardiovascular concerns, a history of substance use, or stimulant side effects. Both have evidence behind them; Dr. Fredes chooses based on your medical history, preferences, and symptoms.
Yes. Adult ADHD is often misdiagnosed as anxiety or depression, because emotional dysregulation, racing thoughts, and trouble concentrating appear in all three. ADHD is rooted in executive function and impulse control, anxiety in worry and threat detection, depression in mood and motivation. Many people have more than one, which is why a careful evaluation matters: the treatments differ.
Controlled substances are prescribed only when a complete diagnostic evaluation supports the diagnosis. Dr. Fredes does not prescribe stimulants at a first visit and does not transfer or continue an existing stimulant prescription without her own full evaluation. Initial evaluations for stimulant medication are conducted in person. Dr. Fredes carefully monitors response, adjusts dosing, and watches for side effects.
Usually 4–12 weeks. After each new medication or dose, you will have a follow-up in 1–2 weeks to review effectiveness and side effects, and Dr. Fredes adjusts incrementally from there. Some people settle on the first medication; others try two or three options. Detailed feedback at follow-ups makes the process work.
Medication is one of the best-studied treatments for ADHD, but it is not the only approach. Structured routines, sleep, exercise, behavioral strategies, and ADHD coaching help many people, on their own or alongside medication. Dr. Fredes tailors the plan to your symptoms and preferences. The goal is sustainable improvement in day-to-day functioning.
Schedule a consultation with Dr. Fredes to discuss your care.