Understanding ADHD across the lifespan

Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neurodevelopmental conditions we see, in keiki (children) and in adults who were never identified as kids. It is real, it is well-studied, and it is very treatable. This page explains what ADHD is, how we evaluate it at OhanaPsych, and how we approach care — including what we can and can’t do by telehealth.

What ADHD actually is

ADHD is a difference in how the brain regulates attention, activity, and impulse — not a matter of laziness, low intelligence, or poor parenting. The American Psychiatric Association’s DSM-5-TR groups its features into two clusters: inattention (trouble sustaining focus, following through, organizing, and managing distraction) and hyperactivity-impulsivity (restlessness, difficulty waiting, acting before thinking). People can lean mostly toward one cluster or show both.

What separates ADHD from ordinary distractibility or a busy mind is that the pattern is persistent, shows up in more than one setting (home, school or work, relationships), and genuinely gets in the way of daily life. Everyone loses focus sometimes; ADHD is a consistent, impairing pattern — and diagnosis is something we work through together, not a checklist you score on yourself.

Signs and symptoms

In children, ADHD can look like difficulty staying with schoolwork, frequent careless mistakes, losing things, not seeming to listen, fidgeting or leaving their seat, talking over others, and trouble waiting their turn. In adults, the same wiring often shows up as chronic procrastination, missed deadlines, difficulty with organization and time, forgetfulness, inner restlessness, and impulsive decisions — sometimes alongside long-standing anxiety, low mood, or substance use that developed as a way to cope.

A picture of what this can look like

Consider someone who did fine in school by working twice as hard as everyone else, then hit a wall in their twenties when life got more complex — bills, a job with no structure, a household to run. They’re bright and capable, but they describe feeling like they’re “always behind,” starting projects they can’t finish, and feeling ashamed about it. (This is a fictitious, illustrative composite, not a real patient.) For many adults, an ADHD evaluation is the first time someone explains why things have felt this way — and that reframing is part of the relief.

How we understand and evaluate ADHD

A careful ADHD evaluation is more than a quick questionnaire. We take a full history, look at how symptoms show up across settings and over time, use validated rating scales, and rule out other things that can mimic or accompany ADHD — anxiety, depression, trauma, sleep problems, and thyroid or other medical issues. Where it adds clarity, we may use objective neurocognitive testing to measure attention, processing speed, and other domains directly. The goal is an accurate, whole-person picture, not a label.

How ADHD is treated — and our approach

The evidence base supports a combination of approaches. For most people that means some mix of education about ADHD, practical skills and behavioral strategies (and, for children, parent and school support), and — when appropriate — medication. Both stimulant and non-stimulant medications are well-established options; which one fits depends on the individual, their health history, and their preferences.

We start from lōkahi — balance across the connected parts of your life — and treat ADHD in the context of your ‘ohana (family) rather than as an isolated symptom to be medicated away. Care is collaborative: we talk through the tradeoffs of each option with you (and, for keiki, with parents) and build a plan you actually agree with.

On controlled substances: stimulant medications are an appropriate, effective treatment for many people, and we do prescribe them — but responsibly. We do not start controlled substances in a one-off or crisis visit; appropriate use requires an established, ongoing relationship with your provider so we can monitor benefit, side effects, and safety over time. Decisions are made case by case, at provider discretion. If you are prescribed a controlled medication, you’ll complete our Controlled Substance Agreement; and if we later need to reduce or stop a controlled medication, we use our Controlled Substance Taper Agreement. For patients whose history includes substance use, we draw on addiction-medicine guidance (including ASAM/AAAP recommendations) to treat ADHD effectively while keeping risk in view — the two are not mutually exclusive.

Why we don’t combine stimulants with benzodiazepines

One position we hold firmly and want to be upfront about: we do not provide long-term treatment that combines a stimulant with a benzodiazepine. This isn’t red tape — it’s pharmacology and neuroscience. The two drug classes work directly against each other in the brain. Stimulants increase activity in the dopamine and norepinephrine systems to raise arousal and sharpen attention; benzodiazepines do the opposite, boosting the inhibitory neurotransmitter GABA to slow the brain down. Taking both long-term is like pressing the accelerator and the brake at the same time: each masks the other’s effects, which tends to push doses higher, worsen rebound and tolerance, and increase the risk of serious harm. Research on adults prescribed stimulants shows this opposing-mechanism combination is both common and risky.

With a bit of dark humor: clinicians sometimes call this the “uppers-and-downers” mix — yes, the Elvis Presley combination — and it is simply not one we are willing to recreate.

So our position is straightforward, and we believe kinder in the long run: in general, you choose one path. When a benzodiazepine is truly warranted, it is for short-term, time-limited use; stimulant treatment for ADHD is long-term. We are glad to treat ADHD effectively with a stimulant and to manage anxiety with options that pair safely alongside it — therapy, SSRIs or SNRIs, and other non-controlled medications — but we will not maintain anyone on chronic stimulant-plus-benzodiazepine therapy. We say this with empathy, especially if you have been prescribed both in the past: our goal is your long-term safety and clear thinking, not to make your life harder.

Methamphetamine in our community — and stimulant stewardship

We cannot write honestly about prescription stimulants in Hawaiʻi without naming what our communities are living through. Methamphetamine — “ice” — is the leading substance involved in overdose deaths and addiction-treatment admissions in our state. The Hawaiʻi State Department of Health has reported that psychostimulants, primarily methamphetamine, are involved in roughly two-thirds of the state’s overdose deaths, and methamphetamine accounts for close to half of all substance-use treatment admissions. Nationally, methamphetamine overdose deaths have risen sharply over the past decade, with the steepest increases among Native and Indigenous communities. This is not an abstraction to us. It is a community-based crisis that destroys lives, families, and ‘ohana, and we refuse to contribute to it.

Prescription stimulants used to treat ADHD are effective and, used correctly, safe — but they are amphetamine-class controlled substances, and in a state carrying this much methamphetamine harm, responsible stewardship is not optional. That is why we evaluate carefully, prescribe only within an established relationship, monitor over time, and keep clear guardrails against misuse and diversion. We do this to protect you and to protect our community.

So we will say this plainly and firmly: if you are looking for a practice that will continue your drug of choice without an honest, evidence-based evaluation, appropriate care, and proper guardrails, we are not that practice. We offer real treatment — for ADHD, and, when it is present, for stimulant use disorder — with compassion and without judgment, grounded in addiction-medicine guidance. What we will not do is feed a problem that is already taking too much from the people of these islands. We say this with aloha, and we mean it as care.

Online “Adderall by subscription” is not what we do

About 85% of our care is delivered by telehealth, and we believe deeply in the access it provides — but how it is done matters enormously, especially for controlled stimulant medications. Under the federal Ryan Haight Act and DEA telemedicine rules, controlled-substance prescribing carries real legal and clinical obligations, and we follow them. We conduct a genuine evaluation, prescribe only within an ongoing provider relationship, and keep the guardrails — monitoring, reassessment, and limits against misuse and diversion — that responsible care requires.

We want to be blunt about a problem that has harmed patients and our profession’s credibility: a wave of direct-to-consumer “ADHD-medication-by-subscription” platforms sprang up offering quick stimulant prescriptions with little or no real evaluation. Some of them broke DEA rules, regulations, and the law. In one prominent case, federal prosecutors charged — and a jury convicted — the executives of a telehealth ADHD company for a scheme that funneled tens of millions of Adderall and other stimulant pills into circulation through subscription sign-ups. Frankly, shame on them. That is not telemedicine; it is a pill mill with a website, and it worsens the stimulant-diversion and methamphetamine problems our communities are already living with.

The evidence counsels care, too: research published in the American Journal of Psychiatry found that while telehealth prescribing of stimulants does not by itself raise the risk of a substance use disorder, patients whose stimulant treatment was initiated by telehealth showed a higher risk of later developing a stimulant use disorder — a reminder that the very first evaluation must be thorough and done right. So we will keep offering ADHD care by telehealth, with aloha and real convenience — but always the evidence-based way, with a true evaluation and proper guardrails. If that is not what you are looking for, we are not the practice for you.

Working with your primary care team — and why we do the right thing

You may have been referred to us by your primary care team, and we are grateful for that trust. We keep strong, ongoing relationships with primary care providers across our community for a simple reason: we do the right thing. We render honest clinical opinions, we practice evidence-based care, and we report our findings and recommendations back to your primary care team so everyone caring for you is working from the same page. Those referral relationships exist precisely because we have honest conversations — not because we tell people only what they want to hear.

We will be candid: if you are hoping to continue a treatment that the evidence does not support, we have real empathy for how hard that can be — but this practice will not provide non-evidence-based care. And with a wink to the occasional keyboard warrior who promises us a one-star review across every platform after not hearing what they wanted: we have come to wear that as a badge of honor. Our providers are encouraged to have the difficult, honest conversations. We will not make everyone in our community happy, but we will do the right thing — 100% of the time — and we will do it with aloha.

One more honest point, offered with respect. Many people arrive already carrying a psychiatric diagnosis made in primary care. That is no knock on primary care: because of a real and worsening shortage of mental health specialists, primary care now delivers most of the mental health treatment in this country — in our experience, well over half of it here at home — and those clinicians work hard under enormous constraints. But you are now being seen by a specialist. A brief primary-care visit is not the same as a full psychiatric evaluation, and conditions such as bipolar disorder are frequently misdiagnosed as ordinary depression when they are not assessed by someone who does this every day. So we do not automatically inherit a diagnosis made elsewhere; we conduct our own evaluation and reach our own conclusions — which is exactly what a specialist consultation is for, and exactly why your primary care team sent you to us.

At the same time, we want to be honest about who we are. The clinicians in this practice group practice alike and hold to the same evidence-based standards, so moving from one of our providers to another simply because you didn’t like what you heard is not how we work. We have firm, caring conversations and keep proper boundaries because that is part of good, safe care — always offered with aloha. If you are looking for a practice that won’t have those conversations, we may not be the right fit, and we say that with respect and genuine goodwill.

Brief screening (96127)

As part of getting started — and to track your progress over time — we use brief, validated questionnaires that are administered, auto-scored, and documented on the CNS Vital Signs platform and billed under code 96127 (brief emotional/behavioral assessment). For ADHD, that includes the Adult ADHD Self-Report Scale (ASRS-v1.1) for adults, and the Vanderbilt ADHD diagnostic and follow-up parent and teacher rating scales for children and teens (CNS Vital Signs, n.d.). Each takes only a few minutes and gives your provider objective information to guide care.

Getting care by telehealth

About 85% of our care is delivered by telehealth, and ADHD treatment generally works well remotely — evaluation, therapy, skills coaching, and ongoing medication management can all happen by secure video. There is one caveat worth naming: prescribing controlled stimulant medications by telehealth is governed by federal DEA/Ryan Haight rules. As of this writing, the DEA and HHS have extended the telemedicine prescribing flexibilities through December 31, 2026, which allows much of this care to continue remotely; depending on your situation, an in-person visit may still be needed at some point. We provide care to patients located in Hawaiʻi, and language-assistance is available so cost and language aren’t barriers to getting help.

One more note on access: as we complete the final stages of becoming a Rural Health Clinic (RHC), telehealth for mental-health care is here to stay with us. Under Medicare’s rural-health rules, RHCs are permanently authorized to provide behavioral and mental-health care by telehealth — including into your home, anywhere in Hawaiʻi — not under the temporary flexibilities that expire and must be renewed. (Prescribing of controlled medications still follows the separate Ryan Haight Act and DEA rules.) For our patients, that means dependable, lasting telehealth access to the care you need.

Wherever you live, OhanaPsych is your statewide practice. We provide care across the entire state of Hawaiʻi by telehealth, reaching every island — Hawaiʻi Island, Maui, Oʻahu, Kauaʻi, Molokaʻi, Lānaʻi, and Niʻihau. If you would rather be seen in person, you have that option at our offices in Hilo and Honolulu.

When to reach out — and when it’s an emergency

If attention, restlessness, or impulsivity are getting in the way of your work, school, relationships, or your child’s development, that’s a good reason to reach out — you don’t have to be in crisis to deserve help.

If you or someone you love is thinking about suicide or self-harm, please get help right away: call or text the 988 Suicide & Crisis Lifeline (call or text 988, or chat at 988lifeline.org). In Hawaiʻi, Hawaiʻi CARES is available by calling or texting 988, or at 808-832-3100 / 800-753-6879. In a life-threatening emergency, call 911.

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Medically reviewed by George Mackel, MSN, APRN, NP-C, PMHNP-BC, CARN-AP — President & Owner, OhanaPsych / Ohana Care Clinic.
Last reviewed: June 28, 2026. Citations verified: June 28, 2026.

This page is general health education from OhanaPsych. It is not a substitute for a personal evaluation by a qualified clinician who knows your situation, and reading it does not create a provider–patient relationship. If you think you may have ADHD or another condition, reach out to us or another licensed provider. In an emergency, call 911.

References

CNS Vital Signs. (n.d.). CNS Vital Signs computerized rating instruments. https://www.cnsvs.com/WhitePapers/CNSVS-RatingInstruments.pdf

American Psychiatric Association. (2022). Diagnostic and statistical manual of mental disorders (5th ed., text rev.). https://doi.org/10.1176/appi.books.9780890425787

American Society of Addiction Medicine & American Academy of Addiction Psychiatry. (2024). Clinical practice guideline on the management of stimulant use disorder. Journal of Addiction Medicine, 18(1S), S1–S56. https://doi.org/10.1097/ADM.0000000000001299

Brunner, E., Chen, C.-Y. A., Klein, T., Andrews, C. M., Ashworth, H., Crystal, S., Dziura, J., Fiellin, D. A., Galuska, M., Heyward, J., Kraemer, K. L., Larkin, K., Olfson, M., Rana, A., Smith, K. D., & Tilstra, S. A. (2025). Joint clinical practice guideline on benzodiazepine tapering: Considerations when risks outweigh benefits. Journal of General Internal Medicine, 40, 2814–2859. https://doi.org/10.1007/s11606-025-09499-2

Culpepper, L. (2014). Misdiagnosis of bipolar depression in primary care practices. The Journal of Clinical Psychiatry, 75(3), e05. https://www.psychiatrist.com/jcp/misdiagnosis-bipolar-depression-primary-care-practices/

Han, B., Cotto, J., Etz, K., Einstein, E. B., Compton, W. M., & Volkow, N. D. (2021). Methamphetamine overdose deaths in the US by sex and race and ethnicity. JAMA Psychiatry, 78(5), 564–567. https://doi.org/10.1001/jamapsychiatry.2020.4321

Hawai’i State Department of Health, Alcohol and Drug Abuse Division. (n.d.). Substance use statistics. Retrieved June 28, 2026, from https://bh808.hawaii.gov/substance-use/

Hughes, P. M., Annis, I. E., McGrath, R. E., & Thomas, K. C. (2024). Psychotropic medication prescribing across medical providers, 2016–2019. Psychiatric Services, 75(5), 477–480. https://doi.org/10.1176/appi.ps.20230156

Moore, T. J., Wirtz, P. W., Curran, J. N., & Alexander, G. C. (2023). Medical use and combination drug therapy among US adult users of central nervous system stimulants: A cross-sectional analysis. BMJ Open, 13(4), e069668. https://doi.org/10.1136/bmjopen-2022-069668

National Institute on Drug Abuse. (2024). Drug overdose death rates. https://nida.nih.gov/research-topics/trends-statistics/overdose-death-rates

Rao, V., Lanni, S., Yule, A. M., McCabe, S. E., Veliz, P. T., Schepis, T. S., & Wilens, T. E. (2025). Telehealth prescribing of stimulants for ADHD and associated risk for later stimulant and substance use disorders. American Journal of Psychiatry, 182(8), 779–788. https://doi.org/10.1176/appi.ajp.20240346

U.S. Department of Health and Human Services. (2026). Telehealth policy updates. Telehealth.HHS.gov. https://telehealth.hhs.gov/providers/telehealth-policy/telehealth-policy-updates

U.S. Department of Health and Human Services & Drug Enforcement Administration. (2025). Third temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications.

U.S. Department of Justice. (2024). Founder/CEO and clinical president of digital health company arrested for $100M Adderall distribution and health care fraud scheme [Press release]. https://www.justice.gov/opa/pr/founderceo-and-clinical-president-digital-health-company-arrested-100m-adderall-distribution

Wolraich, M. L., Hagan, J. F., Allan, C., Chan, E., Davison, D., Earls, M., Evans, S. W., Flinn, S. K., Froehlich, T., Frost, J., Holbrook, J. R., Lehmann, C. U., Lessin, H. R., Okechukwu, K., Pierce, K. L., Winner, J. D., & Zurhellen, W. (2019). Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics, 144(4), e20192528. https://doi.org/10.1542/peds.2019-2528