Adult ADHD and Your Questions Answered: A Conversation With Leading Adult ADHD Psychiatrist, Dr. Scott Shapiro

ADHD doesn’t disappear in adulthood. For many, it quietly impacts careers, relationships, and emotional well-being, often without a clear diagnosis or effective support. Today, that’s beginning to change. Advances in treatment are reshaping how adults with ADHD find focus, build structure, and thrive.

Dr. Scott Shapiro, is a nationally recognized expert in adult ADHD and voted one of New York’s top psychiatrists. He provides treatment for adult ADHD, medications and therapy, and treats anxiety, depression and insomnia in people with and without ADHD.

In this Q & A, we discuss what adult ADHD really looks like and how evidence-based treatments can make a difference.

Q & A With Dr. Scott Shapiro About Adult ADHD

Background and Expertise

What drew you to specialize in treating adults with ADHD?

Dr. Shapiro: First, I want to thank you for inviting me to discuss ADHD. It is a subject I am deeply passionate about, and I value the opportunity to share my experiences and perspectives. What drew me to specialize in adult ADHD is that I believe that having and

achieving goals gives people meaning and purpose. ADHD often interferes with a person's ability to achieve their potential and reach their goals. This can impact every domain of a person’s life, including academics, career, relationships and ultimately fulfillment. When I provide comprehensive assessments and treatments, helping people achieve their goals and purpose, it is gratifying. That’s what makes me passionate about specializing in adult ADHD.

What do you wish more people understood about adult ADHD?

Dr. Shapiro: I wish more people understood that adult ADHD is a real and well-documented condition based on neuroscience, research and genetic studies. However, it remains deeply misunderstood. Many question its legitimacy, and some clinicians worry about overdiagnosis or being seen as overprescribing stimulants. While misdiagnosis and misuse do occur, the greater issue is that ADHD in adults is often missed and untreated.

In my practice, I have seen many patients who spent decades believing something was wrong with them but never received an explanation. When they finally understand, their struggles are linked to ADHD, the relief is profound, though often accompanied by grief for missed opportunities. Accurate diagnosis and evidence-based treatment can make a life-changing difference.

Understanding Adult ADHD

What are some misconceptions about adult ADHD?

Dr. Shapiro: One of the biggest misconceptions is that ADHD is only about being hyperactive or distracted, and that it’s primarily a childhood disorder. It’s a lifelong condition that often looks different in adulthood. Adults may appear successful on the surface because they’ve developed elaborate compensations including working excessive hours, using caffeine or nicotine to stay focused, or relying heavily on reminders and external structure. But those strategies come at a cost: stress, burnout, and strain on relationships.

How can ADHD go unnoticed in childhood, even when symptoms are present, and why does it often surface more strongly in adulthood?

Dr. Shapiro: ADHD symptoms must begin before the age of 12, but they are not always

recognized. In childhood, strong parental involvement, structured school environments, or natural intelligence may mask the signs. Parents often compensate by organizing schedules and giving reminders, while some children can rely on last-minute work or succeed in areas that come easily. On the surface, they may appear successful, despite the underlying struggles being present.

These challenges often become clearer in high school, college, or the workplace. With greater independence and higher expectations, there is less structure, more ambiguity, and no parents to provide support. Coping skills that once worked may no longer be effective, and procrastination or disorganization begins to interfere with performance, relationships, and self-confidence.

Another reason ADHD is missed is that people may not remember or report symptoms from childhood. Clinicians may also overlook the diagnosis if the person performed well

academically. This is why a thorough assessment is so critical. Reviewing old report cards, paying attention to teacher comments, and speaking with parents, siblings, spouses, or partners often reveals earlier signs that help clarify the picture and lead to a more accurate diagnosis.

What are some signs that might indicate an adult should consider an evaluation?

Dr. Shapiro: Red flags for adult ADHD include repeated job loss, underperformance at work despite strong intelligence, or chronic disorganization. Adults may find themselves struggling to sustain focus, missing deadlines, or working excessively long hours just to keep up with responsibilities that others manage more easily. These challenges often create stress, burnout, and strained relationships.

An evaluation is worthwhile if these patterns are persistent. It is important to note that ADHD symptoms must begin before age 12, although they may be masked in childhood by strong family support, structured school environments, or tutoring. As demands increase during adolescence and adulthood, these difficulties often become more apparent, underscoring the need for a thorough and accurate assessment.

Important clues can be uncovered by reviewing old report cards or speaking with family

members, which may reveal forgotten or unrecognized signs. In other cases, clinicians may mistakenly rule out ADHD because a person functioned well in earlier stages of life, even though the underlying symptoms were present all along. Recognizing these patterns is crucial to prevent overlooking adults who may benefit from treatment.

Treatment and Support

Dr. Shapiro: The most effective treatments are multimodal. Evidence-based therapy,

particularly cognitive behavioral therapy (CBT), combined with medication, structured coaching, and accountability, tends to work best. Therapy is a comprehensive and structured approach that focuses on building new skills, setting goals, and developing tailored strategies for each individual. CBT goes further by also addressing the underlying thoughts, feelings, behaviors, and core beliefs that can limit progress. This allows patients not only to manage symptoms but also to thrive and reach their potential.

I work closely with patients to define specific and measurable goals, establish clear priorities, and create systems that support follow-through between sessions. Accountability is essential, because treatment is not only about gaining insight but also about taking consistent action that leads to meaningful and lasting progress.

How do you help clients balance medication, therapy, and lifestyle changes?

Dr. Shapiro: Balance starts with education. Medication can be helpful for some people, but it is not the only path to improvement. I have worked with many patients who make significant progress without medication through cognitive behavioral therapy (CBT) that is highly structured and focused. Research has shown CBT to be effective both with and without medication, and in my experience many patients do very well without medications.

There are many reasons someone may not use medication. Some prefer not to, while others may be unable to tolerate the side effects. In some instances, medical or psychiatric conditions may make medication less appropriate. At times, further assessments are necessary, such as when a patient has a cardiac condition that requires clearance by cardiology before treatment can be safely initiated. In such situations, therapy can be initiated immediately to establish momentum and achieve results.

What is so rewarding about treating ADHD is that it is one of the conditions most responsive to medication, with studies showing that 80 to 90 percent of people respond positively. At the same time, in my opinion, therapy is often the core of treatment. It provides the skills, strategies, and accountability that support long-term success and is essential even when medication is part of the plan. For many people, the most effective approach is a combination of therapy and medication, tailored to the individual’s needs and circumstances.

AI and ADHD

How do you see AI tools supporting adults with ADHD in a healthy, ethical way?

Dr. Shapiro: AI has real potential to act as a scaffolding tool for executive functioning. It can support adults with ADHD by helping them stay organized, breaking tasks into manageable steps, and maintaining accountability. But ethical use is essential. AI should be a tool for empowerment, not a crutch that replaces human connection or fosters unhealthy dependence.

What are some practical examples of how AI can help with focus, organization, or

executive functioning?

Dr. Shapiro: AI can be beneficial for adults with ADHD. It can generate structured task lists and calendar prompts to reduce the effort of organizing daily responsibilities. It can also provide real-time reminders that make it easier to stay on track and break large projects into smaller, more manageable steps. These tools create external structure and accountability, helping people focus on what matters most.

It is essential, however, to use AI in an ethical and productive way. AI should support thinking and learning, not replace them. In school, this means using it to enhance organization and comprehension while still engaging in the actual studying and problem-solving. At work, AI can be useful for scheduling, workflow, and accountability, but people must still take responsibility for critical thinking and decision-making. Ethical use also means being mindful of privacy, accuracy, and avoiding overreliance so that AI becomes a tool for growth rather than a distraction.

Final Insights

What small, actionable steps can adults take today to make life with ADHD more

manageable?

Dr. Shapiro: One simple but powerful step is handwriting. Research shows that handwriting improves memory and focus more than typing. I often recommend keeping a notebook such as a Moleskine to jot down daily tasks. Pairing this with a weekly planner or a calendar that displays the entire week with time slots provides a strong foundation for organization. For those who want more comprehensive systems, I share detailed strategies for time management and organization on my website. Working with a trained ADHD psychiatrist or coach can further amplify these benefits and help turn simple tools into lasting habits.

What resources, books, or communities do you recommend to your patients?

Dr. Shapiro: Three books I often suggest are Dr. Edward Hallowell’s Driven to Distraction, James Clear’s Atomic Habits, and Jeffrey Young’s Reinventing Your Life. That last book isn’t specifically about ADHD, but it addresses core beliefs and schemas, which are especially relevant for adults who struggle with shame.

I also encourage joining supportive communities. In my own workshops, I’ve seen how activity partners can transform outcomes. Research shows that accountability with a peer greatly increases follow-through. One participant told me she used the skills we practiced for a year and landed her dream job. Those moments highlight the power of connection.

For those supporting a loved one with ADHD, what’s the best way to be helpful without

being overbearing?

Dr. Shapiro: Support works best when it is collaborative rather than controlling. The most

effective approach is to validate your partner’s experience and acknowledge their challenges without judgment. Offering structure and reminders in a supportive and noncritical way can also make a meaningful difference. Above all, it is important to approach ADHD management as a shared journey rather than an individual burden. The goal is always to help your loved one thrive while preserving respect and autonomy.

Looking for Support?

If you are struggling with ADHD or think you might be, you do not have to navigate it alone. Dr. Scott Shapiro is one of the country’s leading experts in adult ADHD and a top New York psychiatrist who also treats anxiety, depression, and insomnia.

Visit his website to learn more about adult ADHD and practical strategies that work. Based in NYC, he provides comprehensive care that integrates medication and therapy. To learn more or schedule a consultation, click here to visit Dr. Shapiro’s website or call 212-631-8010.