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Practice / ADHD
"Worked with Dr. Chacko for over a year on my ADD and completely changed how I was doing in life. He's patient and tailors each session to whatever is going on in your life at the moment. Was struggling post-college and over a year later things have completely turned around."
— Bob B. · Patient
"The fact that he's both a therapist and an MD adds another layer of trust, especially when navigating issues like ADHD and anxiety."
— Nathan J. · Patient
Psychiatrist & Therapist · San Francisco

Adult ADHD diagnosis and therapy in San Francisco — finally an explanation that fits.

Adult ADHD often goes unrecognized for years — especially in high-achieving people who learned early to work twice as hard to get the same results. Andrew offers comprehensive ADHD evaluation, diagnosis, and ongoing care in San Francisco. Not just a prescription — a real understanding of how ADHD shapes your work, relationships, and sense of self, and a treatment plan built around your specific life. An estimated 6% of U.S. adults have received an ADHD diagnosis, with about half receiving that diagnosis for the first time in adulthood (American Psychiatric Association, 2024). Many more remain undiagnosed — a national survey found that one in four adults now suspect they may have ADHD they've never had evaluated (Ohio State University Wexner Medical Center, 2024).

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What It Looks Like

How adult ADHD shows up
in daily life.

Difficulty sustaining attention on tasks that aren't immediately stimulating

Chronic disorganization despite real effort to get organized

Losing things regularly — keys, phone, wallet, documents

Starting many projects but struggling to finish them

Impulsivity in decisions, purchases, or conversations

Emotional dysregulation — frustration and overwhelm that feel out of proportion

Time blindness — difficulty estimating how long things take or getting started

Restlessness or difficulty sitting with inactivity

A pattern of underperforming relative to intelligence and actual effort

Why intelligence doesn't
protect you from ADHD.

ADHD is not a problem of intelligence, motivation, or character. It's a problem with the executive functions — the systems that regulate attention, initiation, and working memory. High intelligence doesn't fix this; it masks it. Smart people with ADHD often spend years being told they're lazy, careless, or not living up to their potential — when in fact they're working harder than most of their peers just to keep up. Up to 70% of children with ADHD continue to experience impairing symptoms into adulthood, even when they no longer meet full diagnostic criteria — a recognition that has fundamentally changed how the field understands ADHD as a lifespan condition (World Journal of Psychiatry, 2025).

Many of Andrew's ADHD patients describe a moment of profound relief at diagnosis — not because a label fixes anything, but because it finally explains a lifetime of effortful struggle that no one around them seemed to share.

Treatment beyond the prescription.

Medication is often the most immediate lever — stimulants and non-stimulant options can produce significant improvement in attention, impulse control, and executive function. But Andrew's approach to ADHD doesn't stop at prescribing. He works with patients on the behavioral structures, systems, and strategies that build sustained functioning: time management, task initiation, organization, emotional regulation, and the relational patterns that ADHD tends to create.

ADHD and co-occurring conditions.

ADHD rarely travels alone. Anxiety, depression, and sleep disorders co-occur at high rates — sometimes as secondary effects of untreated ADHD, sometimes as independent conditions that interact with it. Andrew evaluates and treats the full picture, adjusting the treatment plan as each piece comes into clearer focus. This comprehensive view is one of the key advantages of working with a psychiatrist rather than coordinating between separate providers.

Andrew sees patients for ADHD in person at his Pacific Heights office — conveniently located for those coming from Presidio Heights, Cow Hollow, the Marina, and Nob Hill — and via telehealth throughout California.

Understanding what's been
happening changes everything.

Andrew is accepting new patients in San Francisco. The first call is complimentary — no paperwork, no commitment.

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Questions

Common questions
about adult ADHD.

Anything else — the complimentary phone call is the right place to ask.

Adult ADHD presents differently than the hyperactive child running around the classroom. In adults, it more often looks like chronic difficulty sustaining attention on non-stimulating tasks, pervasive disorganization, emotional dysregulation, impulsivity in decisions or relationships, and a pattern of underperforming relative to intelligence and effort. Many adults with ADHD were never diagnosed in childhood — particularly those who were high-achieving enough to compensate.
Medication is often part of effective ADHD treatment, but it's not the whole picture. Stimulant medications (and non-stimulant alternatives) can reduce the core symptoms significantly — but they don't build the systems, habits, and strategies that sustain functioning over time. Andrew integrates medication management with the coaching and behavioral work that makes a real difference in daily life.
Evaluation involves a thorough clinical interview covering your history — childhood, school, work, relationships — along with standardized rating scales and a careful assessment of other conditions that can look like or co-occur with ADHD (anxiety, depression, sleep disorders, trauma). Andrew doesn't do neuropsychological testing himself, but can interpret it and coordinate care with neuropsychologists when a more comprehensive workup is indicated.
Frequently. The chronic experience of underperforming, forgetting, losing things, and being told you're not trying hard enough takes a significant psychological toll. Many adults with ADHD have developed anxiety from years of vigilance and self-monitoring, and depression from a sense of inadequacy that has nothing to do with their actual intelligence or character. Treating ADHD often improves anxiety and depression significantly.
Yes. Many high-achieving adults with ADHD compensated through intelligence, strong family structure, or highly stimulating environments — and only run into trouble when the demands of adult life (less structure, more self-direction, more sustained attention) exceed their coping strategies. Late diagnosis in high-functioning adults is very common, and often explains a long history of working harder than peers for the same results.
Clinically reviewed by Andrew Chacko, MD · April 2026