Closing the Gap on Adult ADHD in Primary Care

By Karina Cata and Rachel Quintana, DNP

Adult ADHD is common, yet primary care often misses it. Adults who come in for anxiety, poor sleep, or trouble at work rarely have an underlying attention problem considered. Even when they raise attention concerns, most clinics have no established way to screen for adult ADHD and no standard process for referring the patient to a specialist. For her DNP capstone at Ana G. Méndez University, Karina Cata set out to close that gap in South Florida.

Cata developed a policy titled “Evaluation of an Institutional Policy for Standardizing Adult ADHD Screening and Referral in South Florida Primary Care.” It gives primary care providers one method they can use repeatedly to screen for possible adult ADHD. The project site was L&C Professional Medical Center in Miami, where Liagnys Garcia, DNP, MSN, ARNP-FNP, served as her clinical preceptor. Rachel Quintana, DNP, served as faculty mentor. The project was literature-based, built entirely on published evidence rather than patient data.

The policy rests on more than a dozen peer-reviewed studies covering adult ADHD screening, referral pathways, and clinical decision support. Cata matched each source to the policy component it informed, so every element of the policy is supported by and derived from published evidence.

For screening, the policy uses the Adult ADHD Self-Report Scale (ASRS-6), a six-question tool for adults. It is short enough to fit into a busy primary care visit. Cata built the policy around the COM-B model, which asks whether clinicians have the capability, the opportunity, and the motivation to change their behavior. A screening tool only works if staff can use it, so that question shaped every design choice.

The policy adds two more components. The first is a clinical decision support tool that helps clinicians identify possible adult ADHD and decide on the next step. The second is a rapid referral pathway that sends patients with a positive screen to a specialist for further evaluation, so a screening result always leads to a defined action. Cata also operates her own small clinic, which gave her a point of contrast with high-volume centers like L&C, and she designed the policy to work in both.

The main benefit of a standardized process is consistency. When screening depends on whether one clinician thinks to consider ADHD during one visit, patients receive uneven care. Once a clinic adopts a standard process, that guesswork is removed and every patient gets the same starting point. The project also offers a template that other practices can adapt to build their own screening and referral policies.

The project’s central lesson is that good policy is specific. Vague guidance does not change what happens in an exam room, but clear and actionable steps create an approachable and meaningful path to long-term change. A clinician who knows exactly what to do next is far more likely to do it, and that is where lasting improvement starts. Cata hopes this work contributes to earlier recognition and better care for adults living with ADHD.