A parent asked me recently whether her nine-year-old's report card was an attention problem or an attitude problem. She had been told both, by different people, in the same month.
That question is the actual work. Trouble focusing is a symptom, not a diagnosis, and plenty of things produce it: poor sleep, anxiety, a learning disability nobody has tested for, depression, a chaotic stretch at home, or ADHD. Treating the wrong one wastes months.
What an evaluation actually covers
I ask when the difficulty started and whether it shows up everywhere or only in specific settings. ADHD does not politely confine itself to math class. I ask about sleep, because a child who sleeps badly looks inattentive by mid-morning and a teenager on four hours looks like almost anything. I ask what has already been tried. I ask about anxiety and mood, because both impair concentration and both are frequently mistaken for ADHD in bright kids who have been compensating for years.
For adults, the question is usually different. Many were never evaluated as children, succeeded by working harder than the people around them, and hit a point where effort stopped covering it. A promotion, a second child, or a job with less external structure will do it.
Two things I want to say plainly
If your child has significant tics, I will raise that before medication is ever on the table. Stimulants can make tics worse. That does not automatically rule them out, but it changes the conversation and the monitoring, and it is not something to discover after starting.
I also do not perform psychological or neuropsychological testing, which includes IQ testing, learning disability batteries, and autism diagnostic assessment. That is a licensed psychologist's work, not a psychiatric nurse practitioner's, regardless of who you see. If autism is the real question, particularly for school accommodations or an IEP, you need that testing, and I would rather tell you directly than spend your money circling it. I can still help with focus, sleep, mood, or irritability alongside a psychologist, and I will coordinate if you are already working with one.
About medication
Medication is one option among several, and it is not the first move for everyone. When it fits, I explain what to expect and what to watch for, including appetite and sleep changes, and we check in rather than setting it and forgetting it. If several medications have already been tried without benefit, genetic testing can sometimes narrow which are more likely to suit your body instead of continuing trial and error.
Behavioral strategies, school or workplace accommodations, and structural changes matter, and for some patients they carry most of the weight.
What treatment is aiming at
Not a perfect week. Fewer dropped balls, less friction at home, and enough working memory left by evening to have a life. In New Mexico, psychiatric nurse practitioners have full practice authority, so I can evaluate, diagnose, and prescribe independently, and I see patients age 6 and older by telehealth.
Kevin Lazar, MSN, APRN, PMHNP-BC · WellnessRx · View the source
If you are in crisis, call or text 988 (Suicide & Crisis Lifeline). Medications prescribed only when clinically appropriate. Individual results vary. Telehealth services available to New Mexico residents.