Can you imagine an attending psychiatrist making it through medical school, board exams, and psychiatry residency without knowing how to treat ADHD? Fucking hell, even a competent internist, family physician, or pediatrician could at least competently initiate treatment for ADHD. Imagine going to a dealership and buying a car, only to be told that there was no engine in the car. As evidenced by the above post from "Shelly Lee", a.k.a. PMHNP Michelle Lee Kling of Valley Health Outpatient Behavioral Health in Winchester, Virginia, this is the sorry state of midlevel nurse practitioner education today, folks. Indeed, let it fully sink in: a psychiatric-mental health nurse practitioner has "zero experience" treating one of the most common psychiatric disorders, affecting around 10% of children.  These are the kinds of highly qualified "providers" that some of society's most underserved and vulnerable patients can expect to see. Truly, it's amazing how people like this even get hired.

One can deduce that Ms. Kling has "zero experience with ADHD" just by the way this "silly question" is worded. As the table above shows, a virtual cornucopia of medications for ADHD exists, ranging from amphetamines to methylphenidates to nonstimulants, further subclassed into long-acting and short-acting formulations, marketed under a variety of brand names as well as generics. To ask for an "alternative" is essentially meaningless without the appropriate clinical context, of which none is provided other than "insurance won't cover it". What's to say insurance would cover anything else from a laundry list of ADHD medications? Indeed, PMHNP Kling later admits that her previous experience is in addiction medicine, which, needless to say, is not very relevant to the treatment of ADHD, especially if one of the goals of that specialty is to "steer clear of stimulants", which are often indicated as the first-line treatment for ADHD in adults.

As one would expect from a Facebook group bursting at the seams with undertrained midlevel nurse practitioners, the comments section and random "suggestions" provided therein are even more of a hot flaming mess, and we're not even psychiatrists.

"It's pretty much the same as Vyvanse but in the methylphenidate family" - What in the actual hyperactive fuck? How can Metadate be "pretty much the same" when it (being a methylphenidate) isn't even in the same medication class as Vyvanse (a dextroamphetamine prodrug)?

And now the conversation has devolved into personal experiences with stimulant ADHD medications. Imagine a consulting physician writing in their note that they recommend one medication over another based on their personal experience with the drug instead of evidence-based medicine - such behavior would be medically and ethically unacceptable.

Boy, what an absolute trainwreck that was! Moral of the story: If you have ADHD or any other psychiatric condition, run far, far away from PMHNPs or other midlevel providers and head straight to the nearest MD/DO psychiatrist. Now, if you'll excuse us, we're going to need some cognitive-behavioral therapy to process the trauma incurred from writing this post.