All Episodes

Psychiatric nurse practitioner Jonathan Murphy, PMHNP-BC, returns to the Lindsay Clancy case for a deeper clinical perspective. In this episode of Actually ADHD, we move past the media circus and into the clinical reality — what psychosis actually looks like, why personality disorders are the more logical differential diagnosis, and why the mob's narrative keeps stretching further from the facts. After twenty years in psychiatry starting from one-to-ones with psychotic patients on a 27-bed acute unit to prescribing medication in private practice, this case is not about the system failing a patient. The question is straightforward — did she knowingly kill her children or was she out of her mind? The benzodiazepine prescriptions, the timing around her return to work, the fact that she said she wanted to start therapy but never did — these are the details the media skips past while framing her as a victim. Narcissistic personality disorder and narcissistic injury are discussed as the most clinically logical explanation for what happened. Narcissistic injury can and does kill. The concept of mentalization — the ability to understand that other people have their own thoughts and emotions — is central to understanding the pathology underneath. Not everyone operates with the same concept of self and others. If you are a golden rule person, not everybody is. A parent kills a child every three days. Brown University FBI arrest data, 32-year longitudinal study. The rate has been stable for decades.This episode also raises the question of whether the mob's influence on this case could affect the legal outcome, and what it means when media narrative overrides the rule of law. Next episode: Reddit — more tea to spill. Actually ADHD is sponsored by the Focus Path YouTube channel — practical ADHD strategies from a nurse practitioner with 20,000+ hours of clinical experience. Subscribe at @FocusPathSystems The Process: An Adult's Guide to ADHD Medication — available now on Amazon

Psychiatric nurse practitioner and Duxbury native Jonathan Murphy, PMHNP-BC, breaks down the Lindsay Clancy trial from a clinical and local perspective. In this episode of Actually ADHD, we discuss how misinformation spreads through echo chambers, the difference between postpartum depression and personality disorders, why the mob mentality around this case is dangerous, and what it's actually like to live in Duxbury, Massachusetts — the Pine Barrens, not the South Shore. Includes discussion of group psychology, media literacy, and how to filter information during high-profile criminal cases. This is not a true crime breakdown. This is a mental health professional's perspective on a case that hits close to home. A mother kills a child every 3 days in the US. The rate has been stable for 32 years. (Brown University, FBI arrest data)Postpartum psychosis affects 1-2 in every 1,000 women. (MGH Center for Women's Mental Health)Actually ADHD is sponsored by the Focus Path YouTube channel — practical ADHD strategies from a nurse practitioner with 20,000+ hours of clinical experience. Subscribe at @FocusPathSystems The Process: An Adult's Guide to ADHD Medication — available now on Amazon

How to actually navigate the current ADHD medication shortage and the generic manufacturing variability underneath it. Jonathan Murphy, PMHNP-BC, walks through what the Reddit narrative gets wrong, why Adderall XR generics have the least reliable quality control, and how to work the pharmacy system to find your medication. This episode covers:The August 2026 ADHD medication shortage compared to the 2020-2021 shortage and why this one is harder to work aroundWhy the "I can't function" Reddit echo chamber distorts the actual choices patients haveWhy medication optimization matters more than any specific generic manufacturer and what optimization would do to shortages overallThe Adderall XR generic manufacturing problem: many manufacturers, low quality control, high variabilityWhy patients should never lock into "I have to have brand X" thinking when generic manufacturers shift constantlyThe medications with better quality control: brand-only, Dexedrine Spansules, Vyvanse, Mydayis, Focalin, and the various methylphenidate extended-release optionsWhy Concerta's spherical versus oblong tablet distinction matters for absorptionThe pharmacy hierarchy: pharmacy-first stores versus grocery-store pharmacies (Safeway, Fred Meyer, Hannaford) versus big-box (Costco, Sam's Club) versus mail order (Express Scripts)The polite pharmacy-transfer script that gets a prescription moved without provider interventionWhy one pharmacist saying "we'll never have it" is not a reliable signal about the wider supplyThe middleman supplier reality: one pharmacy on a block is out while the one across the street has stockWhen to switch medications entirely: Mydayis, Vyvanse, Dexedrine, or the methylphenidate family as alternatives to Adderall XRWhy the controlled substance barriers happen before pickup and picking up your medication is not a suspect actWhy consistency matters more than the "best" medication, and how daily consistency compounds into new habits and new neural pathwaysThis is the fifteenth episode of Actually ADHD. Previous episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, ADHD and identity, the ADHD Matrix, the peer clinician perspective, the DRT origin story, the Focus Path YouTube channel reflection, the Friction and Flow talk, the guanfacine controversy, the Vyvanse deep dive, and the Ride Out or Bail side effects framework.The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.

The Ride Out or Bail framework for the first month on an extended-release ADHD stimulant. Jonathan Murphy, PMHNP-BC, reads from The Process and walks through the eight most common side effects, week by week, so patients and prescribers know when to hold the course and when to switch. This episode covers: Why the first four weeks are the assessment window and how to think about tolerable side effects inside "all good, no bad" Dry mouth: ride out weeks one and two, bail at week four, and why prolonged dry mouth signals overstimulation Why caffeine, cannabis, and nicotine muddy the read on any side effect and have to be pulled out to assess the medication alone Low appetite versus appetite suppression, and why the ADHD-food-dopamine relationship changes on medication Protein and calorie strategies for the first weeks and when persistent low appetite becomes a real problem Mild insomnia and the first-place-to-look rule: take the medication as soon as you wake up, consistently When mild insomnia after four weeks signals the wrong extended-release capsule or the wrong dose Jitteriness as a mild overstimulation signal, and the caffeine-elimination step before considering a medication change Euphoria in week one as honeymoon period versus euphoria at week four as a mania signal Hypersexuality as a possible mood-irregularity signal versus a baseline personality feature Headache: hydrate first, and why headaches are usually not caused by the medication itself Irritability as a new-skill side effect versus true agitation The automatic bailouts: persistent agitation, anxiety, and complete zombification, most commonly on methylphenidate This is the fourteenth episode of Actually ADHD.  The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Focus Path | PMHNP-BC for the Ride Out or Bail video and the full clinical education catalog. https://www.youtube.com/@focuspathsystems For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Why Vyvanse became the internet's favorite ADHD medication and what patients and prescribers should actually understand about it.  Jonathan Murphy, PMHNP-BC, walks through the pharmacology, the Reddit hype cycle, and how Vyvanse fits into the real optimization pathway. This episode covers: Why extended-release stimulants became first-line and how insurance approval finally caught up to clinical reality The two stimulant chemicals: amphetamine and methylphenidate, and why roughly half of adults respond best to one over the other What "zombification" on methylphenidate signals and what "tweaking out" on amphetamine signals Why Adderall XR gets prescribed first most of the time and what that pathway leads to The Vyvanse pharmacology: lisdexamfetamine as a prodrug that converts in the bloodstream to dextroamphetamine The dextro versus levo amphetamine distinction: dextro for the brain, levo for the peripheral nervous system Why Vyvanse feels like a smoother ride for patients who don't tolerate the levoamphetamine in Adderall XR The Reddit dynamic that keeps positioning Vyvanse as the best ADHD medication and why that framing distorts optimization The Dexedrine Spansule as the older, cheaper alternative that does essentially the same thing pharmacologically Why "all good, no bad" is the standard, not "good enough" The big four extended-release stimulants: Adderall XR, Vyvanse, extended-release methylphenidate (Ritalin LA or Concerta), and Focalin Why there is no best ADHD medication, only the right medication for your brain This is the thirteenth episode of Actually ADHD.  The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Why guanfacine keeps getting mistaken for a first-line ADHD medication. Jonathan Murphy, PMHNP-BC, walks through the clinical reality of guanfacine, the Reddit dynamics that promoted it, and the groupthink pattern that keeps patients on medications that don't actually treat their condition.This episode covers:What guanfacine actually is: an antihypertensive with pediatric ADHD approval, not adult approval, not first-lineWhy guanfacine gets prescribed to adults with ADHD anyway, and what that says about prescriber bias against stimulantsDr. William Dodson's rejection sensitivity dysphoria article, its amplification through How to ADHD, and how it entered the Reddit ADHD tribal vocabularyThe Gustave Le Bon group psychology framework, sentiment, ideas, and custom, applied to online ADHD communitiesWhy tribal identity on Reddit doesn't map to individual psychiatric diagnosis, and how that distortion produces bad treatmentThe 95/5 clinical reality: stimulants work for adults with ADHD roughly 95% of the time; non-stimulants roughly 5%The "medicine show" metaphor for online misinformation and where the licensed prescriber fits in the wildernessWhy guanfacine feeling helpful for a specific patient doesn't make it an ADHD medicationThe book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

 Jonathan Murphy, PMHNP-BC, returns to the Focus Path YouTube channel with the 101st video and processes the launch of the Friction video — the underlying formula for building capacity, the medium-is-the-message principle for video creation, the Gatekeeper commenter archetype, and why accessible teaching serves the audience the academic monolith alienated.This episode covers:The return to weekly uploads and the new Shows format on the Focus Path YouTube channelThe Road to 100 playlist as a narrative thread through 25 videos on the creative and educational journeyThe Friction video walkthrough: how bureaucratic busy work drains the energy battery so nothing recharges itDirecting energy toward what you do naturally without thinking as the mechanism for recharging capacityPassion versus natural fluency and why passion is a feeling that changes over time while natural fluency is durableThe problem-solving of friction at work versus the natural work that made you employable in the first placeThe paycheck as an exchange of energy and the question of what the paycheck actually costsDocumentation and bureaucracy as the friction that had to be delegated for the actual clinical work to expandThe medium is the massage as the working principle for creating on YouTubeVideo as entertainment medium and why clinical content has to be delivered in the register the medium requiresThe comment section as a public FAQ and the classical rhetoric register for engagementThe Gatekeeper archetype: viewers who claim to want factual knowledge but complain about presentation styleLearning versus acquiring knowledge for application and why real learners take information from any containerThe academic educational monolith and its alienating effect on people who could have been reached with accessible teachingThe clinical mission underneath the register: reaching people intimidated by academic culture who need to know there's an easier wayThis is the eleventh episode of Actually ADHD. Previous episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, ADHD and identity, the ADHD Matrix, the peer clinician perspective, the origin story of Developmental Reinforcement Theory, and the Focus Path YouTube channel reflection. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the Friction video and the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Creating the Focus Path YouTube Channel. Jonathan Murphy, PMHNP-BC, reflects on the first 100-video sprint of the Focus Path YouTube channel — the market gap that made the work necessary, the YMYL suppression that has capped distribution, the LegitScript certification process, the coiled spring of 100 videos awaiting verification, and the Healthy Gamer documentary that closed the first arc.This episode covers:The one-month production break after 100 videos in eight months and what it revealedThe catalog composition: 40-50 medication optimization videos, survival modality material, habit formation theory, and the journey from early videos to the book releaseThe Process: An Adult's Guide to ADHD Medication as the synthesis of approximately 40 transcripts from the channelThe market gap that made the channel worth building and the trial-and-error learning curve with the YouTube algorithmThe realization that came when a video with strong metrics still tanked despite everything looking correctYour Money or Your Life and why ADHD medication content sits in the highest-risk category alongside personal financeThe LegitScript certification fee, the health shelf application, the May 1 ghosting, and the eventual creator support conversation at 4,000 watch hoursWhy board certification, DEA licensing, state licensing, and all standard credentialing don't produce YouTube distributionThe imminent verification request and the coiled spring of 100 videos awaiting releaseThe Healthy Gamer documentary as the endpoint of the 100-video arcThe grifter grandfathered into the pre-2025 algorithm while verified credentialed voices face YMYL suppressionThe parasocial mechanism of internet therapy monetizationGroup psychology from 100 years ago as the predictive framework for internet group behaviorYouTube prioritizing the platform over the credentials that earn platform accessThis is the tenth episode of Actually ADHD. Previous episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, ADHD and identity, the ADHD Matrix, the peer clinician perspective, and the origin story of Developmental Reinforcement Theory. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

ADHD, Trauma, and Developmental Healing. Jonathan Murphy, PMHNP-BC, tells the origin story of Developmental Reinforcement Theory and the survival modalities, tracing the clinical, personal, and intellectual journey from failed behavioral instruction to the framework that now anchors the Focus Path YouTube channel.This episode covers:Ten years specializing in adult ADHD treatment and what the work turned out to be versus what was expectedThe behavioral instruction approach from the first book Cheat Codes and why teaching habit formation worked for the author but failed with many patientsThe personal habit formation story: athletic transformation from age 35, guitar, personal finances, writing, YouTube channelThe structural emptiness of the ADHD diagnostic criteria as transition, forgetfulness, losing things, sustaining attention, initiating tasks, without specifying contentWhy building a tribal identity around a structural pattern produces a loose, amorphous conglomeration of people that share the pattern but share nothing elseThe silent majority of adults with ADHD who are doing the individual treatment work without participating in the online identity spaceThe realization triggered when the author's daughter reached an age that activated memoriesThe encounter with complex PTSD as a framework that explained what behavioral instruction couldn't reachThe bio change that added trauma to the practice description and the immediate shift in clinical presentationsThe defense mechanisms emerging more visibly than attachment theory predictedThe intellectual lineage informing the framework: Skinner, CBT, attachment theory, Gustave Le Bon on group psychology, Edward Bernays and Walter Lippmann on media and propaganda, internal family systems, Body Keeps the ScoreThe flip phone decision and the underlying dopamine-loop researchThe 2024 burnout point and the delegation that opened up writing timeAI as analyzer rather than creator: talk-to-text brain dumps, ChatGPT then Claude, the mirroring back of accumulated materialThe development of the screener through four axes, refined to six, that identified specific pathologies and produced the eight survival modalitiesThe 70-75% comorbidity observation: most adult ADHD patients appear to have some form of complex PTSDThe universal applicability of Developmental Reinforcement Theory beyond ADHD because the framework is about survival adaptation patterns that everyone hasThis is the ninth episode of Actually ADHD. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full Survival Modality season one catalog and the Developmental Reinforcement Theory framework.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

A Practical ADHD Clinician's Perspective. Jonathan Murphy, PMHNP-BC, drops the filter and speaks directly to peer clinicians about bias, deskilling, the OCPD differential, the patently false claim that stimulant response doesn't confirm ADHD, and the four types of providers patients actually encounter.This episode covers:Why the podcast is now operating in the off-camera register and what that means for the audienceThe 20-year clinical trajectory from psychiatric hospital floor to specialized adult ADHD practiceA recent LinkedIn exchange about stimulant prescribing tension and what was missing from the original postThe OCPD differential as the diagnostic move clinicians need to make when assessing adults presenting with executive function complaintsWhy ADHD criteria require chronic functional decline across multiple domains and across the lifespan, not acute decline tied to current circumstancesThe echo chamber pattern in peer clinical discourse and what gets lost when validation replaces clinical reasoningThe cultural stigma around stimulants and what it does to prescriber decision-makingWhy clinicians must understand their own biases before they can understand their patientsThe undiagnosed adult ADHD reality and why "it was hard for me so it should be hard for you" thinking distorts clinical judgmentThe patently false claim that stimulants work for anyone regardless of diagnosis, and why clinical discernment refutes itThe fundamental position of stimulants and dopaminergic medication as the oldest psychiatric medication classWhy generalists who avoid ADHD treatment become weaker clinicians by leaving a major neurodevelopmental disorder off the tableThe four types of providers patients actually encounter: the Burnt Out, the Green as Grass, the Means Well But Out to Lunch, the Means Well But JadedWhy the provider who actually likes their job is the fifth category worth findingThe vetting process from The Process for adults navigating the search for a real ADHD clinicianThis is the eighth episode of Actually ADHD. Previous episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, ADHD and identity, the ADHD Matrix, and the cultural critique of online ADHD discourse. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

The ADHD Matrix. Jonathan Murphy, PMHNP-BC, names the false reality of ADHD as it exists on the internet and breaks down how smartphone technology is specifically designed to exploit the ADHD brain.This episode covers:The ADHD Matrix as the false reality constructed by online ADHD discourseWhy the ADHD brain's reliance on external stimulation makes the smartphone a unique problemThe slot machine mechanic at the core of smartphone design: variable reward schedules, multi-modal stimulation, anticipation as dopamine driverWhy reaching for the phone first thing in the morning makes everything else in the day harderThe 2019 flip phone decision and what cutting out the smartphone actually producedHabit stacking, stupid small steps, and behavioral modification through positive reinforcementFriction removal as a tool for behavioral change without device dependencyAlgorithmic pricing as the next layer of dystopia: prices changing based on individual impulsivity rather than demographicsWhy data surveillance matters even when you have nothing to hideThe "technology weaponizing ADHD brains" observationCreativity as the deepest stimulation source and what differentiates it from instant gratificationWhy the Reddit r/ADHD community has silenced ADDitude despite ADDitude being the credentialed industry standardThe two ADHDs: the individual clinical diagnosis that responds to medication and behavioral skills, versus the online tribal identity that focuses on societal changeWhy the individuals who have actually improved their ADHD symptoms aren't online setting the narrativeThe return to individual change: medication, behavioral tools, and the personal assessment of whether your fails are becoming winsThis is the seventh episode of Actually ADHD. Earlier episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, the broader cultural context of ADHD and identity, and now the technological architecture exploiting the ADHD brain. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Navigating ADHD, the internet, and identity. Jonathan Murphy, PMHNP-BC, steps back from the medication optimization material to address the broader context patients are navigating — the cultural moment where ADHD became an online identity, the attachment system dynamics underneath identity-driven engagement with mental health content, and what actually helps versus what makes things worse.This episode covers:Why the clinical experience of an adult ADHD specialist is rare and what that means for the public conversationThe early ADHD internet creators and the TED Talk that helped turn ADHD into an identity rather than a diagnosisThe difference between being diagnosed in childhood or adolescence and being diagnosed as a late-discovery adultWhy a psychiatric diagnosis cannot be an identity even when the internet treats it as oneThe structural problem with online tribes forming around psychiatric diagnosesWhy the goal of ADHD treatment is to not be defined by ADHDWhy the internet itself is structured around money and data, not patient wellbeingThe attachment system as a relic of childhood that shapes adult online behaviorParental congruence in early childhood and the long-term consequences of incongruent validationWhy children cannot self-regulate and what validation actually accomplishes developmentallyThe connection between unhealed childhood emotional dysregulation and adult online identity dependencyWhy connecting on the internet from a lonely place creates problems rather than solutionsThe reframe back to clinical optimization: predictable repeatable behaviors and patternsWhy advertising and marketing psychology demystify the myth of talentHow consistency and repetition produce results that look like talent from the outsideThis is the sixth episode of Actually ADHD. Earlier episodes covered the optimization blueprint, the medication walkthrough, the Goldilocks Zone framework, the seven reasons medication fails, and the prescriber-patient dynamic. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

Seven reasons your ADHD medication isn't working. Jonathan Murphy, PMHNP-BC, walks through the clinical patterns that show up when adult ADHD medication fails to deliver the expected response — and what each pattern actually points toward.This episode covers:Why daily consistency matters more than the cultural narrative around "as needed" stimulant useWhy ADHD is a disorder of inconsistency and how consistent medication produces a different person over timeThe diagnostic question hiding underneath medication non-response: do you actually have ADHDThe OCPD distinction — patients who don't fluctuate in attention but instead narrow their perception of what's possibleWhy patients with primary ADHD plus secondary anxiety often confuse the two and reach for the wrong primary treatmentThe honeymoon period of stimulant response and why a sudden three-day drop signals underlying depressionWhy immediate-release tablets can't deliver consistent symptom control and what the spike-and-crash actually represents pharmacokineticallyThe undertreatment pattern: 5-10 milligram Adderall starting doses from prescribers uncomfortable with adult ADHD medicationThe 50/50 split between adults who respond best to methylphenidate versus amphetamineWhy hunting down a specific generic manufacturer creates more problems than it solvesThe Reddit r/ADHD ideology breakdown: how tribal identity formation distorts clinical reasoning around ADHD treatmentThe three components of online ADHD tribal narrative: the idea (our brains are different), the sentiment (it's not fair nobody noticed), the custom (complaint without accountability)Why the podcast operates with less filter than the YouTube channel and what that medium difference enablesThis is the fifth episode of Actually ADHD. Earlier episodes covered the optimization blueprint, the medication walkthrough, and the Goldilocks Zone framework. The book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

How to know you're on the correct dose of ADHD medication. Jonathan Murphy, PMHNP-BC, breaks down the Goldilocks Zone — the framework for identifying the right dose of stimulant medication for an adult with ADHD. Not too little, not too much, just right.This episode covers:Why there is no universal "right dose" or "best medication" for ADHDThe Goldilocks Zone: too low means tired, too high means tweaking out, just right means calm and functionalDuration as part of the optimization equation and what a crash actually signalsWhy side effects and poor toleration are not necessary parts of ADHD treatmentThe pattern of overstimulation on amphetamines pointing toward methylphenidateThe pattern of zombification on methylphenidate pointing toward non-stimulants or dexmethylphenidateWhy extended-release technology is what makes optimization possible at allTonic versus phasic dopamine receptor activation and why consistency is the goalThe myth of toleration and the normal three-to-four-week adjustment from initial response to maintenance doseWhy the diagnostic criteria of ADHD are validated by medication response, not just by symptom checklistThe "prescriber as cop" framing: how the Controlled Substance Act has distorted clinical decision-makingWhy a patient who feels shame at the pharmacy can't ask the simple question "how do I know if I'm on the right dose?"The role of secondary symptom resolution — forgetfulness and organizational difficulty as downstream effects of consistent medicationWhy one month is the minimum trial period and what shooting at moving targets looks likeThe internet-filtered version of ADHD: how tribal identity formation distorts clinical reasoningWhy guanfacine monotherapy in adults is sometimes a signal to reconsider the diagnosis, not to celebrate the medicationThis is the fourth episode in the sequence covering the optimization process from the book The Process: An Adult's Guide to ADHD Medication, available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

A deep dive into the extended-release ADHD stimulant medications. Jonathan Murphy, PMHNP-BC, walks through every major option in the methylphenidate and amphetamine categories, the clinical reasoning behind choosing one over another, and the specific patient presentations that point toward each medication.This episode covers:The two stimulant categories: methylphenidate and amphetamineOROS technology in Concerta versus micro-bead technology in newer extended-release formulationsWhy Concerta's absorption can be spotty and when to move to Ritalin LAThe methylphenidate bead ratios: 50/50, 60/40, 70/30 and what each one does clinicallyAptensio, Metadate, and Jornay PM as alternatives within the methylphenidate familyFocalin (dexmethylphenidate) as the second-line methylphenidate when standard formulations don't deliverThe amphetamine side: Adderall XR, Vyvanse, Dexedrine, and MydayisWhy dextroamphetamine-only options (Vyvanse) work better for some patients than mixed amphetamine salts (Adderall)The 25-30% of adult patients who do best on a pure dextroamphetamineWhy "all good, no bad" is the optimization standard, not "good enough"The diagnostic value of medication response: if any properly trialed medication works, the diagnosis is confirmed and other options remain availableWhy FDA-recommended dosing limits are appropriate guardrails, not arbitrary restrictionsThis episode references the Top 10 ADHD Stimulants video on the Focus Path YouTube channel: https://youtu.be/xJQLSCGY9VcThis is the third episode in the sequence covering the optimization process from the book The Process: An Adult's Guide to ADHD Medication, available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

The Optimization Blueprint — the algorithm Jonathan Murphy, PMHNP-BC, uses to find the right medication and the right dose for adults with ADHD. This episode is for two audiences simultaneously: clinicians refining their adult ADHD prescribing practice and patients trying to understand whether their current treatment is optimized. This episode covers:The three medication categories: methylphenidate, amphetamine, and non-stimulantWhy extended-release stimulants are first-line and why the "controlled substance" framing misleads prescribersThe standard adult starting doses for the major medicationsThe response and toleration framework for assessing the first prescriptionWhen to start with amphetamine versus methylphenidate based on presentationWhy methylphenidate is often the better starting point despite being less culturally familiarWhat "optimized" actually means: all good, no bad, no side effects, works like a vitaminThe risk of dysfunctional medication relationships and how they formWhy providers who haven't developed comfort with adult ADHD prescribing should consider referring out rather than under-treatingThis is the second episode in the sequence covering the optimization process from the book The Process: An Adult's Guide to ADHD Medication, available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4T Find the YouTube channel Focus Path | PMHNP-BC for the full clinical education catalog. For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.

The first episode of Actually ADHD.Jonathan Murphy, PMHNP-BC, board-certified psychiatric nurse practitioner with 20,000+ clinical hours specializing in adult ADHD, opens the show with the conversation the internet hasn't been having.This episode covers:Why the book The Process: An Adult's Guide to ADHD Medication exists and why the field needed itThe clinical history of ADHD from 18th-century behavioral observations to the modern DSMCharles Bradley's 1937 discovery at the Emma Pendleton Bradley Home that changed the fieldThe pharmacology evolution from immediate-release amphetamine to modern extended-release formulationsWhy adult ADHD treatment is in some ways newer than the patients in itThe personal story of becoming the ADHD clinicianWhy most prescribers in primary care and general psychiatry struggle with optimizationWhat "Actually ADHD" actually meansThe book The Process: An Adult's Guide to ADHD Medication is available on Amazon: https://www.amazon.com/dp/B0H2Z6PM4TFind the YouTube channel Focus Path | PMHNP-BC for full clinical education content.For educational purposes only. Not medical advice. Consult your own provider for clinical decisions.