ADHD Is One of the Most Misdiagnosed Conditions I See: A Thoughtful Approach to Diagnosis and Treatment

One of My Strongest Clinical Beliefs

After many years as a Psychologist—and now as a Prescribing Psychologist—one belief has only become stronger:

ADHD is one of the most frequently misdiagnosed conditions I encounter in clinical practice.

That statement may surprise people.

ADHD is certainly real. It is a well-established neurodevelopmental disorder that affects millions of children and adults, and when accurately diagnosed, treatment can be life-changing.

However, I have also evaluated countless individuals who arrived convinced they had ADHD after seeing videos on social media, completing an online questionnaire, or struggling with concentration later in life. Or that high school or college student that happened to get access to their friend’s Adderall prescription and all of a sudden, they “can now focus” so that means they must have ADHD. Or many had already been prescribed stimulant medications before anyone had taken the time to ask a more important question:

"Why is your attention impaired?"

Difficulty focusing is a symptom—not a diagnosis.

Just as a fever can result from dozens of different illnesses, problems with attention and concentration can arise from many different medical, psychological, and environmental causes. The challenge—and responsibility—of a clinician is to determine which one is affecting you.

Not Everything That Looks Like ADHD Is ADHD

One of the most rewarding aspects of my work is helping patients understand that attention difficulties often have an explanation beyond ADHD.

Over the years, I have found that symptoms commonly attributed to ADHD are sometimes actually caused by:

• Chronic anxiety

• Depression

• Trauma or PTSD

• Obsessive-Compulsive Disorder (OCD)

• Chronic stress and burnout

• Obstructive sleep apnea or poor sleep

• Thyroid disorders or other medical conditions

• Medication side effects

• Substance use

• Nutritional deficiencies

• Hormonal changes

• Head injury or Traumatic Brain Injury

Each of these conditions can impair concentration, memory, motivation, and executive functioning.

Treating ADHD when the underlying issue is untreated trauma, anxiety, or sleep deprivation may provide only temporary improvement—or make symptoms worse.

A Comprehensive Evaluation Matters

One of the biggest mistakes in mental health is reducing ADHD to a checklist.

A thorough evaluation should answer questions such as:

• Were symptoms present in childhood?

• Do symptoms occur across multiple settings?

• Do the symptoms impact the person’s ability to function across various life domains?

• Is there evidence of lifelong executive functioning difficulties?

• Could anxiety or depression better explain the symptoms?

• Is sleep restorative?

• Are medical conditions contributing?

• What does the person's developmental, educational, and family history suggest?

Sometimes the answer is clearly ADHD.

Sometimes it isn't.

Sometimes it is ADHD and another condition that also deserves treatment.

The goal is diagnostic clarity—not simply assigning a label.

Medication Can Be Life-Changing—When It's the Right Medication

When ADHD is accurately diagnosed, stimulant medications remain among the most effective treatments in all of medicine. They work by increasing chemical messengers called neurotransmitters—specifically dopamine and norepinephrine—in the spaces between your brain cells. This creates more energy, better focus, and a sense of reward and motivation.

These medications help improve:

• Sustained attention

• Working memory

• Task initiation

• Organization

• Impulse control

• Executive functioning

For many patients, the right medication can feel like "putting on glasses for the brain."

But choosing the right medication is far more nuanced than many people realize.

There Is No "Best" ADHD Medication

Patients often ask:

"Which medication is the strongest?"

"Is Vyvanse better than Adderall?"

"Should I switch to Concerta?"

The truth is:

There is no universally best ADHD medication.

There is only the medication that works best for your brain.

Most stimulant medications fall into one of two families:

1)    Methylphenidate-Based Medications

Examples include:

• Concerta

• Ritalin

• Focalin

• Metadate

These medications often provide a smoother experience for some individuals and may be especially helpful for patients who are more sensitive to stimulant side effects.

2)    Amphetamine-Based Medications

Examples include:

• Vyvanse

• Adderall

• Mydayis

• Dexedrine

These medications tend to be highly effective for many patients, particularly those with significant executive functioning challenges, although they may also produce greater appetite suppression, insomnia, or anxiety in some individuals.

Neither category is inherently better.

The best medication is the one that provides meaningful improvement while minimizing side effects.

We also have non-stimulant medications that can also be helpful for the right patient—such as Wellbutrin/buproprion, Strattera/atomoxetine, Qelbree/viloxazine to name a few.

Just a few weeks ago, the FDA-approved Simtriyo/centanafadine is the first-in-class norepinephrine, dopamine, and serotonin reuptake inhibitor (NDSRI) for ADHD in adults and children ages 6 and older weighing at least 44 pounds.

More Medication Doesn't Mean Better Results

One of the biggest misconceptions I encounter is the belief that increasing the dose will automatically improve focus.

In reality, every stimulant has what clinicians call a therapeutic window.

Too little medication may leave symptoms uncontrolled.

Too much medication can produce:

• Anxiety

• Irritability

• Emotional flattening

• Appetite loss

• Poor sleep

• Increased heart rate

• Feeling "not like yourself"

The goal is not to prescribe the highest dose.

The goal is to find the lowest effective dose that allows you to function at your best.

Why Patients Sometimes Need to Switch Medications

Medication changes are a normal part of ADHD treatment.

Patients may switch medications because:

• The medication wears off too early.

• Side effects become problematic.

• Insurance coverage changes.

• National shortages affect availability.

• Life circumstances change.

• Another medication may simply be a better fit.

One of the most common questions I hear is:

"What's the equivalent dose?"

Although clinicians use approximate dose relationships as starting points, there is no exact conversion between stimulant medications.

Each medication differs in:

• How it is absorbed

• How it is metabolized

• How long it lasts

• How it is released into the bloodstream

• How each individual's body responds

Changing medications is therefore much more than matching milligrams. It requires careful clinical judgment, thoughtful monitoring, and collaboration with the patient.

Medication Is Only One Part of Treatment

Perhaps the most important lesson I've learned is this:

Medication helps create the opportunity for success—but it does not create success by itself.

Medication cannot teach:

• Time management

• Organization

• Planning

• Emotional regulation

• Study skills

• Healthy routines

• Self-compassion

The best outcomes occur when medication is combined with:

• Behavioral strategies

• Executive functioning skills

• Psychotherapy

• Healthy sleep

• Exercise

• Good nutrition

• Stress management

As both a Psychologist and prescriber, I believe these pieces work together—not separately.

My Philosophy as a Prescribing Psychologist

One of the unique advantages of working with a Prescribing Psychologist is that medication decisions are never made in isolation.

Rather than asking only,

"Which medication should we prescribe?"

I also ask:

• Is this truly ADHD?

• What else could be contributing?

• How is your sleep?

• How is your anxiety?

• Is trauma playing a role?

• Are there medical conditions we should consider?

• What strengths can we build alongside medication?

Medication is not the destination.

It is one tool that can help patients engage more fully in the meaningful work of learning new skills, improving relationships, achieving goals, and creating lasting change.

ADHD can be life-altering—but so can an inaccurate diagnosis. Taking the time to understand the whole picture allows us to provide care that is more thoughtful, more personalized, and ultimately more effective. Because the best treatment doesn't begin with a prescription—it begins with the right diagnosis.