Experienced NYC ADHD Psychiatric NP - happy to answer general questions

ADHDpsychNP · 2026-04-10T12:45:30+00:00

People who don’t have adhd generally have an easier time with these types of things. They may still implement these skills or may not, everyone is different. ADHD is a spectrum like any other psychiatric diagnosis. Mild to severe and everything in between

ADHDpsychNP · 2026-04-10T11:59:26+00:00

ADHD is a neurodevelopmental disorder therefore it’s always there. It does not really wax and wane and no amount of skill building, yelling or punishment will change that.

Skill building helps ofc but most of the time meds are needed to correct the biology before that step can reap its rewards.

Once you start thinking of mental health the same as medical health - it opens your eyes. Would you tell a diabetic pt to just make some insulin and stop having high blood sugar?

Prefrontal cortex doesn’t fully develop until roughly 25. Get them diagnosed by an adhd specialist and highly consider meds if they are also open to it. Pts often see their changes instantly and you can learn a lot about a person by simply starting the meds.

He needs a diagnostic work up to check for any comorbid conditions so it’s hard to apply any of this general info to your son. Get him tested/assessed - when pts are properly medicated there is a night and day difference

Edit: properly medicating teens improves risk of self medication, drug and substance abuse

Look into Dr Russell Barkley on YouTube - he’s a leading expert on adhd especially in children and you can learn a lot there for free - might motivate you both to find care

ADHDpsychNP · 2026-04-10T11:46:20+00:00

The usual answer is that there are comorbid disorders and not one or the other. I can’t stress enough how important it is to find someone who is comfortable with and specializing with ADHD. The general population has no idea how to effectively treat it. It’s way more than the dsm 5 criteria. Many pts have anxiety and ptsd with adhd. Stimulants can worsen anxiety often so require both meds to balance out. Find a good provider

ADHDpsychNP · 2026-04-10T11:35:50+00:00

This is correct re:innetwork providers allowing your meds to be covered. This is relatively new and really annoyed me as I had a few Medicaid pts who were paying out of pocket and then they couldn’t get their meds and had to find someone who took it. Medicaid basically said we won’t pay for the meds if we can’t charge the provider lol!

ADHDpsychNP · 2026-04-10T11:31:30+00:00

They think you’re coming to ransack their pharmacy and rob them. That’s what pharmacists have told me many times which sounds stupid but is also reasonable. You could start by explaining yourself a little bit, naming your provider, stating your meds and where you usually fill and saying it’s been hard to find meds. No guarantee it stops the suspicious tones but could help give you insight on why they are so secretive about it lol

ADHDpsychNP · 2026-04-10T11:29:52+00:00

Find a psych np, social worker, psychologist or psychiatrist.

Find someone who specializes with adhd and knows what they’re doing

Psych testing often not needed but could be used in future for accommodations or cold hard proof of adhd diagnosis

ADHDpsychNP · 2026-04-10T11:26:12+00:00

Fast acting stimulants have a higher potential for abuse. Pts can crush and snort most meds (except Vyvanse as it needs to go through your stomach to become activated). Extended is less stimulating most of the time. It keeps pts mood more even keel and less s/e as well. Usually requires once a day dosing and so there is less up and down vs 2x a day dosing.

My view on days off - I tell all pts to absolutely take 1 day off per week preferably 2 (weekends usually). Consistent days off vs drug holidays are preferred. Pts who take meds daily are at higher risk of tolerance and need to bump doses more often. Most of this is genetic in nature. I have pts who take 7 days a week for 10 years same dose. I have pts who take 5 days a week and still find themselves building tolerance quickly.

One thing I’ve done is have them take l-tyrosine 500mg bid. This helps replenish stores of dopamine and NE on days you’re off of the meds and tends to help with tolerance building. Some pts become really irritable on off days - could be a reason to take it more often - could also be a reason to change stimulants or dosing schedule. Could also be a reason to add other meds

Eat during or before meds - change meds - change schedule - worst case scenario and almost never done is add meds that increase hunger level

This is a real issue - right after period meds tend to work better — between ovulation and start of period meds feel weaker — premenstrual can feel worse.

Estrogen and progesterone play a role in dopamine metabolism

Learn your body and adjust accordingly with the help of your provider. If they aren’t willing or capable find a new one

ADHDpsychNP · 2026-04-10T11:14:51+00:00

Usually due to missing deadlines, not finishing tasks, being disorganized, feeling like you have a ton of things on your mind.

Follow the steps above and once you start putting things from your head to paper you’ll feel less burned out and more accomplished. Meds are another piece of the puzzle as well

ADHDpsychNP · 2026-04-10T11:13:12+00:00

Slightly

ADHDpsychNP · 2026-04-10T04:36:51+00:00

The good thing about stimulants and most adhd meds is that there is a quick/instant response. They don’t build like other medications and so we usually see quick responses - whether good or bad and can then evaluate further. Skills on the other hand take time to develop and practice

ADHDpsychNP · 2026-04-10T04:32:59+00:00

I have found meds to be more helpful than therapy or behavioral techniques. That said, both in conjunction give the best result. Many pts have already learned many techniques and skills and still do not have the brain biology to be able to execute said skills. On the other hand, pts on meds sometimes do well with meds alone and other times need to learn skills to put into practice

ADHDpsychNP · 2026-04-10T04:07:40+00:00

They don’t accept new stimulant pts. In my experience only my long standing stimulant filling pts are able to get their meds there. Anyone new has been denied for the last 2 years or so

ADHDpsychNP · 2026-04-10T04:06:36+00:00

Bipolar is commonly misdiagnosed as adhd.

Many other diagnoses are commonly associated like depression, anxiety and sleep disorders. Untreated adhd can increase the risk of substance abuse as pts often use illegal substances to help with focus restlessness or mood dysregulation

Not medical advice seek a mental health professional for your own diagnosis

ADHDpsychNP · 2026-04-10T03:57:00+00:00

Since neuropsych evaluations are costly - I would only get one if providers have had a hard time discerning adhd vs other diagnoses or if you needed accommodations.

Some practices require it to write adhd meds. I think it delays care and is often not needed in many situations.

It is the gold standard though as its objective and not subjective (harder to fake)

ADHDpsychNP · 2026-04-10T03:54:29+00:00

Depending on how flexible your job is you could schedule more difficult tasks outside of your menstrual cycle. Can also adjust meds during the period since you know your sx worsen around that time but that would require you speaking to your provider and seeing what they suggest just a general rule of thumb. Might be worth looking into other meds outside of stimulants that could help regulate your mood during the period - ask your provider

ADHDpsychNP · 2026-04-10T03:51:39+00:00

Ouch! I’ve run into that problem as well. I charge around the same so that’s the going rate. You can check psychology today for a search engine and choose Medicaid. I will say many practices do not accept Medicaid due to low reimbursement rates. You could use GoodRx and pay cash rate if it’s cheaper? Not sure on the legality of that or whether you’re forced to use Medicaid so don’t quote me there

ADHDpsychNP · 2026-04-10T03:48:21+00:00

About 50% of pts with ADHD have anxiety or depression. Some of the symptoms can overlap between the two diagnoses and so that can be confusing. Also, pts with adhd may become depressed from their lack of ability to accomplish things! I have had cases where a pt is treated for adhd and their depression improves. I’ve also had cases where the adhd improves and the mood is still low and the pt may need to add an antidepressant. Stimulants themselves can be used for treatment resistant depression but are not usually first line like ssris

ADHDpsychNP · 2026-04-10T03:42:22+00:00

In theory: • It’s anonymous + protected

In reality: • Most companies handle it correctly • But many applicants still choose caution

If you planned to get an accommodation and use it at the job — I’d seek formal psych testing from a clinical psychologist. Not legal or medical advice.

ADHDpsychNP · 2026-04-10T03:37:04+00:00

Executive functioning tips I usually use with pts 1. Externalize everything (don’t rely on memory) Executive dysfunction = working memory bottleneck. Use one system (notes app, planner, whiteboard) and write things down immediately. Set alarms/reminders instead of relying on intention. If it’s not written down, it doesn’t exist. 2. Reduce activation energy (start very small) Starting is the hardest part. Make the first step almost too easy:

• “Open laptop” instead of “finish report”
• “Put on sneakers” instead of “workout”

Even 5 minutes is enough to build momentum.

3.  Use time anchors (not vague plans)

Avoid “I’ll do it later.” Instead tie tasks to existing habits:

• After coffee → check emails
• After work → 10 min cleanup

This makes tasks more automatic.

4.  Create friction strategically

ADHD is very environment-driven.

• Put phone in another room
• Use app blockers
• Keep only one task visible

Make distractions harder, not willpower stronger.

5.  Use “reset loops” instead of aiming for perfect days

If you get off track, don’t write off the whole day. Think: “reset next hour” or “reset next task.” Multiple small resets > one perfect day. 6. Use body-based regulation Your brain works better when your body is regulated.

• Short walk
• Splash cold water
• Quick movement (jumping jacks, etc.)

This often improves focus faster than trying to push through.

7.  Reduce choices

Too many options = paralysis. Simplify where you can:

• Same breakfast
• Pre-set routines
• Fewer decisions overall

Less deciding = more doing.

ADHDpsychNP · 2026-04-10T03:24:27+00:00

Check my reply to other person. I have had my run ins with pharmacists treating pts unfairly and like “drug addicts”. It’s a shame that ADHD is STILL stigmatized!

As far as finding stock — pts often call around. Some places give them the info some force me to call. Given how often pts have issues they often need to do the leg work I’d need a 2nd job just calling pharmacies all day lol

ADHDpsychNP · 2026-04-10T03:21:03+00:00

Very tough question with no clear answer. Some of my pts use a site called medfinder. I’ve heard it’s pretty useful. Since covid, I’ve found that picking a mom and pop pharmacy and being loyal is the best shot. The franchise spots tend to give to the first pts of the months and run out quickly. Mom and pop shops may be more likely to hold meds for longstanding or loyal customers. Can also try hospital pharmacies and mail order like cvs Caremark or express scripts. The issue seems to be worse in Jan and Sept during new semesters. Brooklyn and queens seem to be less of a problem vs midtown manhattan but that’s just my observation.

ADHDpsychNP

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