ADHD Clinical Accountability on LinkedIn

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 audience
• The 20-year clinical trajectory from psychiatric hospital floor to specialized adult ADHD practice
• A recent LinkedIn exchange about stimulant prescribing tension and what was missing from the original post
• The OCPD differential as the diagnostic move clinicians need to make when assessing adults presenting with executive function complaints
• Why ADHD criteria require chronic functional decline across multiple domains and across the lifespan, not acute decline tied to current circumstances
• The echo chamber pattern in peer clinical discourse and what gets lost when validation replaces clinical reasoning
• The cultural stigma around stimulants and what it does to prescriber decision-making
• Why clinicians must understand their own biases before they can understand their patients
• The undiagnosed adult ADHD reality and why "it was hard for me so it should be hard for you" thinking distorts clinical judgment
• The patently false claim that stimulants work for anyone regardless of diagnosis, and why clinical discernment refutes it
• The fundamental position of stimulants and dopaminergic medication as the oldest psychiatric medication class
• Why generalists who avoid ADHD treatment become weaker clinicians by leaving a major neurodevelopmental disorder off the table
• The 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 Jaded
• Why the provider who actually likes their job is the fifth category worth finding
• The vetting process from The Process for adults navigating the search for a real ADHD clinician

This 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/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.

What is Actually ADHD | Medication Strategies & Clinical Wisdom?

Adult ADHD from the board-certified PMHNP behind the YouTube channel Focus Path and the book The Process. Clinical perspective on medication, frameworks, and the conversations the internet hasn't been having.

This is Actually ADHD, sponsored
by the Focus Path YouTube channel.

Welcome back.

This is Jonathan Murphy,
psychiatric nurse practitioner.

And today, I have some things to talk
about, and I realized I can really

talk about whatever I want to, and
that was the intent for this podcast.

I've established my voice and become
familiar teaching various topics on

YouTube as well as writing on LinkedIn,
Substack, so on and so forth But this is

an opportunity for me to speak without
a filter, and that means I can speak

to whoever, especially the clinician.

Many people that are listening to this
are probably in the industry, psychiatry.

I've been in the psychiatry
industry for over 20 years

because I started at the bottom.

At 22 to 23 years old, I started working
at a for-profit adult psychiatric

hospital, working on a 27-bed
unit, 20-bed, floating in between.

There were several different units,
but, , they were all high acuity.

And then it went from there.

So when I finally became a psychiatric
nurse practitioner I started working

in ADHD, and I've come a long way from
complete ignorance to fairly strong

competence, and it just so happens
to be due to the fact that it's

what I've spent the most time doing.

But it never ceases to amaze me
the bias from other clinicians

when it comes to ADHD medication

For instance, yesterday on LinkedIn
I saw, I believe a psychiatric nurse

practitioner, and it started with
a good hook It said the safety data

about s-stimulant medication for ADHD
was reassuring, meaning it's safe.

And then she went on to discuss her bias.

But why does she still struggle?

Is it the patient that has a problem,
or are they just trying to fit

themselves in to a certain category?

Are they trying to adhere to a higher
standard of success than is reasonable?

In other words, are we humans
meant to live in such a manner?

" What's the difference between
someone struggling and

someone taking on too much?"

And I was happy to respond, because
this is a very simple answer.

The difference is in
the diagnostic criteria.

It's all right there.

The functioning, there's a decline in
functioning due to chronic symptoms

of inattention across the lifespan
since childhood adolescence, and

it's a pattern that you can follow
despite current circumstances.

Current circumstances would be
an acute decline in function.

Someone just can't hack it.

Or You're looking across the
lifespan, you should be able to

track the chronic deficits in
attention and executive function.

If you cannot, then that's not ADHD.

So you have your answer, and you need a
decline in function in more than one area.

So I responded, and I mentioned OCPD.

It's a personality disorder, obsessive
compulsive personality disorder.

And this is gonna account for unrealistic,
inflexible standards of success, what

is achievable, what is attainable.

This, a stimulant will not fix.

It will merely mask it because
the underlying pathology isn't

an issue with executive function.

It's an issue with perfectionism However
I didn't receive much by way of response.

And I look at the other comments
and responses and what do I see?

An echo chamber.

It's just validation without substance.

Are we having a conversation?

Are we actually learning from each other?

Yes or no And I've specialized in ADHD, so
I happen to have the experience that many

others don't, and I understand the biases.

I have the bias myself from a
very young age, having ADHD.

There can't be something wrong with me.

You know, the assumption is
that, especially from this

clinician, the assumption is

someone is cheating, someone's taking a
medication to enhance their performance.

It's the same old stigma repackaged,
and it's always gonna be there because

stimulants can p- enhance performance.

But if we're talking about
psychiatry, if you're a nurse

practitioner or a psychiatrist or
clinician, or if you're a patient

The stigma is real, and any clinician
that is gonna prescribe medication or

do therapy needs to explore themselves.

They need to understand themselves
before they can understand anyone else,

because when you understand yourself,
you'll understand your own bias.

Many, many adults with ADHD are
undiagnosed, and it's very, very hard

to become successful, and also life is
hard and people have their own issues.

So It's very common for people with
untreated ADHD to say, " It's hard for

me, so it needs to be hard for you, too.

I did it, so you can do it, too."

But that doesn't account
for the individual, the

individual, the actual person.

It's easy to talk about ADHD on LinkedIn
and talk about performance enhancement

and over-diagnosis, and people are
talking about this too much, and this

is a problem But When you're actually
confronted with the human, then you

see beyond whatever you're imagining.

You see the person that shows
up that doesn't wanna be there.

They don't wanna take medication.

Maybe they've tried, maybe their family
told them for years, and they've crashed

out again, and they don't wanna do it.

So the assumption that people just
wanna do it, wanna take stimulants

, That's just rude, quite frankly.

You have to really look at the individual.

We have distinct personalities.

These personalities are , individual
differences and what we define

as important, what drives us.

We have only ourselves to self-assess,
and we only have that basis for

which to judge other people.

And psychiatry and psychology gives
us a way to look past your bias

and actually just look at the page.

What does the page say?

Doesn't make sense this ADHD isn't a
real thing or I don't believe in ADHD

and stimulants and so on and so forth.

You cannot give stimulants to everyone.

And then I saw the same person commented,
"Oh, well, , stimulant doesn't confirm

diagnosis, like if it's effective
because it will be effective for anyone."

That is patently false.

Patently false.

And anyone that's spent enough time
developing the discernment, prescribing

the medication because at the end
of the day, you signed up for this.

You have the job to prescribe medication,
and what you're doing is you're leaving

a medication off the table, and you're
becoming, if you're a clinician, you're

becoming a weaker clinician because you're
not looking at things comprehensively.

There's only so many medications you
can prescribe at the end of the day.

Stimulants and dopaminergic medication
is the oldest psychiatric medication

on the market, so it's very much a
fundamental part of the toolkit, but you

can't reach for it when it's not ADHD.

That's the rub.

That's the thing.

That's why the criteria is unique,
and that's why there's really only one

medication for it 'cause it's a really
good way of identifying people that are

gonna respond best to this medication.

But these biases, they persist despite the
fact that people will overprescribe every

mood stabilizer, every antidepressant,
every antipsychotic, benzodiazepines,

the list goes on and on and on.

And then they come to me, and
they're like, "I've never been able

to get it together," and then we
prescribe the stimulant, and then

it all improves quite quickly.

And that's the rewarding part is like
ADHD when it's treated just like anything,

any person that has all the issues
that they're faced with treated and

they move in the direction they want to
and they go on to win, that's awesome.

You can't have someone move
forward with undiagnosed ADHD

without treating that ADHD.

And at the end of the day, people
need to be real about their biases

and ask themselves the question from
a clinical lens, ethical lens, make

the decision, make the call, refine
your specialty, and it's not for

me to say what your conclusion is.

But the generalists out there that are
just gonna do a little bit of everything

It's not doing anyone any good
because you're just gonna become a

jack of all trades, a master of none.

So if you don't agree with ADHD, look
at your credentials, look at your scope

of practice, and niche down, and be
confident in your clinical assessment.

Think things through.

It's not, there's not one or another.

You don't have to do the job because
you're getting paid to and you're

just a product of the system.

That is a really toxic way to think.

You wanna feel good about what you're
doing, so you need to put on the glasses

or the-- look through the lens that you've
been given to decide if ADHD treatment

is something that you wanna treat.

Because if you can be real about it,
then the patients can just move it along.

So that's why I always encourage patients
when they're looking for a provider,

when they think they might have ADHD,
or they're continuing ADHD treatment, or

they just want to see a provider that is
actually gonna consider everything instead

of leaving a major neurodevelopmental
disorder off the table, be upfront

about it and see how they respond.

And If you find my book on amazon.com,

The Process: An Adult's Guide to
ADHD Medication, I have a whole

vetting process how to figure
out and bridge the gap between

. Between knowing what you need and
actually going and getting it.

It's being real.

You gotta understand that
providers are not all angels.

They're people, they're humans, they're
just like me and you, and you're

not looking for the perfect person.

It's a starting point.

But just to be realistic, there's probably
four types of providers out there.

You got your burnt out.

The burnt out types are
usually older and surly.

There's not gonna be a lot of
warm and fuzzies, but for a

certain sensibility, the burnt
out clinician might be a good fit.

You have the green as
grass, fresh out of school.

They're very attentive, very nice,
trying to get everything right,

a little nervous, by the book.

There's a lot of benefits to
this that doesn't suit everyone,

but maybe a green as, as grass
provider is what you're looking for.

Then you have means
well, but out to lunch.

These are the people that are gonna
smile, put on the happy face, listen to

everything you say, validate the heck
out of you, not leave you with much else.

If you're good with that, this might
be the right clinician for you.

But if you want something deeper,
you're gonna wanna move it along,

because the other type of provider
I see is means well, but jaded.

The profession has broken them down
a little bit, and they've become a

little bit grumpy, but they care,
or at least they're someone that got

into it with the right intentions.

Of course, there is another type of
provider, the type that likes their job.

But I want you to think about those
other categories because it would allow

you to put the majority of, providers
into a bucket for you to figure out So

anyway, that's a bit of a rant for you.

The first of its kind on
the Actually ADHD podcast.

That's gonna do it for today.

So tune in next time for more
practical strategies from a nurse

practitioner that won't sell you short