A responsible adult ADHD evaluation takes real time, usually 60 to 90 minutes, gathers your history back to childhood, and rules out the conditions that mimic ADHD, such as thyroid problems, poor sleep, iron deficiency, anxiety, and depression. Treatment can include a stimulant or non-stimulant medication when it fits, but it is managed with guardrails: a prescription-monitoring check, scheduled follow-ups, careful dose titration, and no automatic refills. Fishtown Medicine provides this kind of physician-led adult ADHD care in Philadelphia and by video across Pennsylvania, with one doctor who knows your whole story instead of a rotating queue. Patients moving from Done ADHD or another online service are welcome, and the first step is a real evaluation rather than an instant refill.
TL;DR: If Done ADHD or a similar online service managed your prescriptions and has closed, changed hands, or stopped prescribing, you are not stuck, and you did nothing wrong. The model that treated an ADHD prescription like a monthly subscription, with a rushed intake and an automatic refill, was never good medicine. Real adult ADHD care starts with a proper evaluation, rules out the conditions that look like ADHD, and manages medication with genuine guardrails and follow-up. This guide walks through what responsible care looks like, what to do if you are suddenly without a prescriber, and how Fishtown Medicine handles adult ADHD in Philadelphia and by video across Pennsylvania.
If you found your way here, there is a decent chance the app or website that used to send your prescription, Done ADHD or one of the services like it, went quiet, tightened its rules, or shut down. That is unsettling, especially when the medication was helping you hold your job and your life together. I want to start with the reassuring part: needing a real doctor now is not a step backward. It is the care you should have had from the beginning.
The harder truth is that a lot of online ADHD care was built to move fast and prescribe faster, and speed is exactly the wrong instinct for a diagnosis this easy to get wrong. Below is what careful care looks like instead, and how to move yours without losing the ground you have gained.
What went wrong with the subscription-for-prescription model?
The problem was never telehealth itself. Video visits are a fine way to deliver most ADHD care, and I use them every week. The problem was a business model that turned a medical decision into a monthly subscription.
When a company measures success by how many people it can sign up and keep paying, the incentives quietly bend the medicine. Intake visits get shortened until there is no time to ask a real question. Prescribers feel pressure to say yes on the first visit, because a "no" costs a customer. Refills get automated so nobody has to check in. And the follow-up that should catch a rising blood pressure, a sleep problem, or a medication that stopped fitting simply never happens.
None of that is care. It is a vending machine with a doctor's name on it, and when regulators and pharmacies started paying attention, several of these services contracted or closed. If yours was one of them, the closure is not a judgment on you. It is the model catching up with itself.
What does a responsible adult ADHD evaluation actually look like?
A real evaluation takes time, usually 60 to 90 minutes, because ADHD is one of the harder diagnoses in medicine to make well, not one of the easier ones.
Here is what that time is for. Adult ADHD is diagnosed from a pattern, not a moment: symptoms of inattention or hyperactivity and impulsivity that are persistent, that started in childhood, and that cause real trouble in more than one part of your life, at work and at home, not just on a bad week. A good evaluation walks through your history, often going back to report cards and childhood memories, and looks at how the pattern shows up now.
Just as important is what an evaluation rules out, because a long list of ordinary problems can look exactly like ADHD:
- Sleep. Chronic short sleep and untreated sleep apnea wreck attention and are easy to miss.
- Thyroid, iron, and other medical causes. An underactive thyroid or low iron can leave you foggy and flat, and a simple blood test finds them.
- Anxiety and depression. Both scatter concentration, and both are common. Treating them sometimes resolves the "ADHD" entirely, and sometimes they sit alongside it and all of it needs a plan.
- Substances and medications. Alcohol, cannabis, and even some prescriptions blunt focus.
When it helps, a proper workup includes a physical exam, targeted labs, and standardized rating scales, and sometimes a word with a partner or family member who has watched the pattern for years. The goal is not to talk you out of a diagnosis. It is to make sure that if you get one, it is the right one, because the right diagnosis is what makes the treatment work.
How is ADHD medication supposed to be managed?
Stimulants and non-stimulants can be life-changing for the right person, and they are controlled substances that deserve respect. Responsible prescribing runs on guardrails, and none of them are meant to make your life harder:
- A prescription-monitoring check. Before prescribing a controlled medication, your physician reviews the state Prescription Drug Monitoring Program, a database that keeps everyone safe.
- Start low, adjust with you. The right dose is found by titration, starting low and adjusting based on how you actually respond, not by handing over a standard dose and disappearing.
- Real follow-up. Blood pressure, heart rate, sleep, appetite, and mood get checked, especially early on, because that is where a problem shows up first.
- No automatic refills. A refill is a small clinical decision, a moment to ask how it is going, not a background transaction.
You can read exactly how Fishtown Medicine handles this on our controlled substances safety and policy page. The short version: the guardrails exist to protect you, and they are the difference between a doctor and a dispenser.
Is medication the whole answer?
No, and any honest clinician will tell you so. Medication is a powerful tool, and it is not the entire plan.
Let me be fair to the medication first, because there is a lot of noise out there. For adults with genuine ADHD, stimulants are among the most effective and best-studied treatments in all of psychiatry, and used well they are associated with real-world benefits, including fewer car accidents and, in large population studies, lower rates of serious harm. Fear-based headlines that call these medicines poison do a disservice to the many people they help.
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A 90-minute conversation with Dr. Ash. A written plan you can actually follow.
And medication alone rarely gets anyone all the way there. The pieces that compound the benefit are the unglamorous ones: protected sleep, regular movement, external structure like lists and calendars and body-doubling, and treatment for the anxiety or depression that so often rides along. Some of the biggest gains I see come not from a dose change but from a person landing in work that finally fits how their brain runs. A stimulant can make a boring, ill-fitting environment tolerable, but building a life that fits your brain is the part that lasts. The most durable results come from combining the two, which is the whole idea behind our detailed guide to whole-system ADHD care.
What should I do if my ADHD provider or service shut down?
First, do not panic, and do not white-knuckle it in silence. Here is a calm order of operations:
- Do not treat it as an emergency taper, but do not ignore it either. Stimulants are not medications you must slowly taper for physical safety, so a short gap will not harm you. What a gap does do is bring your symptoms roaring back and leave you foggy and flat, which is disruptive at work and behind the wheel. Treat continuity as the goal.
- Gather your records. Ask your old service, whether that was Done ADHD or another company, for your evaluation notes and prescription history, or pull them from the pharmacy. Walking into a new visit with that history saves everyone time and helps a new physician continue your care sooner.
- Find a physician who will actually evaluate you. The right next step is a real doctor who can review your history, confirm the diagnosis, and take over prescribing, ideally one who will still be there in 6 months. If a medication has clearly been working, a careful physician can often continue it after a proper review rather than starting you from zero.
- Plan around the shortage. Stimulant supply has been tight for a while, and specific formulations come and go at pharmacies. A doctor who knows you can help by choosing an available formulation, sending the prescription promptly, and having a backup plan.
If the wall you are hitting is a refill you cannot get rather than a diagnosis you need, our guide on bridging a medication refill gap in Philadelphia walks through how to close it safely. Note that some controlled-substance prescriptions carry extra telemedicine requirements, sometimes including an in-person visit, which a good practice plans in advance rather than springing on you.
How does Fishtown Medicine handle adult ADHD?
Fishtown Medicine is a physician-led direct primary care practice, which means the opposite of the vending-machine model: one doctor, real time, and a relationship that continues.
A first visit runs 60 to 90 minutes, long enough to take the history seriously and rule out the mimics. When medication fits, it is prescribed and monitored with the guardrails above, and paired with the sleep, structure, and co-occurring-condition work that makes it hold. Care happens in Philadelphia and by secure video across Pennsylvania, so distance is not a barrier, and the person you talk to at your first visit is the person you message three months later. Dr. Ash treats adult ADHD as part of whole-person care, not as a prescription to rubber-stamp.
If that is what you were missing, the first step is a free call with no pressure on it, so we can both tell whether this is the right fit.
Key Takeaways
- A discontinued online service is not your failure. The subscription-for-prescription model was built for speed, and speed is the wrong instinct for a diagnosis this easy to get wrong.
- A real evaluation takes 60 to 90 minutes. It gathers your history and rules out the mimics, sleep, thyroid, iron, anxiety, and depression, so that a diagnosis is the right one.
- Medication deserves guardrails. A prescription-monitoring check, careful titration, scheduled follow-ups, and no automatic refills are what make it safe and effective.
- Medication is a tool, not the whole plan. Used well it helps a great deal, and it works best combined with sleep, structure, movement, and treatment of co-occurring conditions.
- Continuity is the point. One physician who knows your story, available in Philadelphia and by video across Pennsylvania, is the difference between care and a vending machine.
Scientific References
- American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders, 5th ed, Text Revision (DSM-5-TR). 2022.
- The MTA Cooperative Group. "A 14-Month Randomized Clinical Trial of Treatment Strategies for Attention-Deficit/Hyperactivity Disorder." Archives of General Psychiatry. 1999;56(12):1073-1086.
- Li L, Zhu N, Zhang L, et al. "ADHD Pharmacotherapy and Mortality in Individuals With ADHD." JAMA. 2024;331(10):850-860.
Related at Fishtown Medicine
- ADHD: A Detailed Guide to Diagnosis & Care - the whole-system approach, from evaluation to the work beyond medication
- Controlled Substances: Safety & Policy - the exact guardrails behind responsible stimulant prescribing
- Doctor Won't Refill Your Medication? How to Bridge the Gap in Philadelphia - what to do when the wall is a refill you cannot get
- Virtual Primary Care Across Pennsylvania - how continuous physician-led care works by video, wherever you are in the state
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