Done ADHD Telehealth: Clinical Gaps and Limitations You Should Know

Is Done a Legitimate Medical Service?

Done operates within current U.S. Law and holds state medical licenses across most of the country. Patients can receive a real prescription from a real licensed clinician. Legitimacy under law is not the same as clinical adequacy.

The platform launched during the COVID-19 public health emergency, which suspended the in-person visit requirement for prescribing controlled substances under the Ryan Haight Online Pharmacy Consumer Protection Act. The DEA has since proposed new rules that would require at least one in-person visit before a clinician can prescribe Schedule II stimulants via telehealth to a new patient. The DEA's proposed special registration framework has not been finalized as of mid-2025, but the regulatory trajectory is clear. Done's entire business model depends on rules that may change with little notice.

What "Legitimate" Actually Means in This Context

A service can be legally registered, properly licensed, and still fall short of the clinical standard of care. The American Psychiatric Association's Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition (DSM-5) specifies that an ADHD diagnosis requires symptoms present before age 12, impairment in at least two settings, and ruling out conditions that better explain the symptoms. The DSM-5 diagnostic criteria are summarized by the NIH here. Done's intake process, based on publicly available patient accounts and the company's own onboarding documentation, relies primarily on the Adult ADHD Self-Report Scale (ASRS) and a short clinician video call.

The ASRS Is a Screener, Not a Diagnosis

The ASRS-v1.1 is a validated 18-item screener. A 2005 validation study (N=154) in the Journal of Attention Disorders found a sensitivity of 68.7% and specificity of 99.5% for the 6-item screener subset. See the PubMed record here. High specificity sounds reassuring, but a 68.7% sensitivity means nearly one-third of people with ADHD screen negative, and a positive screen alone does not confirm the diagnosis. The ASRS authors explicitly describe it as a screening tool to identify people who warrant a full clinical evaluation, not as a standalone diagnostic instrument. Using it as the primary diagnostic gate, without neuropsychological testing or multi-informant rating scales, does not meet the standard described in APA or American Academy of Pediatrics guidelines.

Done's Diagnostic Process: Where the Gaps Are

Done's clinical intake typically involves an online questionnaire (ASRS plus some demographic and medical history questions) followed by a video visit averaging 20 to 30 minutes with a licensed clinician, who may be a nurse practitioner, physician assistant, or psychiatrist. This is faster than traditional psychiatry, which is part of the appeal. Speed is also where the risk concentrates.

Comorbidity Screening Is Sparse

Adult ADHD has high comorbidity rates with conditions that directly affect stimulant safety. A nationally representative sample study published in the Journal of Clinical Psychiatry found that among adults with ADHD, approximately 38% had a comorbid anxiety disorder, 19% had a mood disorder, and 11% had a substance use disorder. PubMed link. Stimulants can precipitate mania in undiagnosed bipolar disorder, worsen anxiety to a clinically significant degree, and carry Schedule II abuse potential for patients with active stimulant use disorder.

Done's intake does ask about prior psychiatric history. What it lacks is a structured diagnostic module (such as the Mini International Neuropsychiatric Interview, or MINI) that can rule in or out bipolar I/II, current substance use disorder, or psychosis. A 20-minute video call with a clinician who is managing a high-volume telehealth caseload is not a substitute for this screening.

No Cardiovascular Pre-Screening Protocol

The American Heart Association published a scientific statement in 2008 recommending that clinicians obtain a patient and family cardiac history and consider an ECG before starting stimulant medications, particularly in patients with known cardiac risk factors. AHA scientific statement. Done's intake form includes a checkbox for "heart problems," but there is no evidence the platform uses a validated cardiovascular risk instrument (such as the ACC/AHA Pooled Cohort Equations) or requires ECG results before prescribing.

Amphetamine salts increase heart rate and blood pressure. A meta-analysis of 20 randomized controlled trials (N=2,632) published in JAMA Psychiatry found mean increases of 5.7 mmHg systolic blood pressure and 3.6 beats per minute with amphetamine use. PubMed link. For a patient with undiagnosed hypertension or a family history of sudden cardiac death, that delta matters.

Pediatric Patients Are Out of Scope, but Age Verification Is Imperfect

Done explicitly targets adults. Still, the platform has no strong mechanism to verify that a 17-year-old is not using a parent's identity to complete intake. This is an industry-wide problem in telehealth, not unique to Done, but it warrants mention in any honest clinical review.

Stimulant Prescribing at Scale: The Regulatory Overhang

Done prescribes Schedule II controlled substances. That single fact subjects it to a regulatory burden that cash-pay therapy or antidepressant platforms do not face.

The Ryan Haight Act and What Comes Next

The Ryan Haight Online Pharmacy Consumer Protection Act of 2008 generally requires at least one in-person medical evaluation before a practitioner can prescribe a controlled substance via the internet. Full text via the DEA Diversion Control Division. The COVID-19 public health emergency created a blanket telemedicine exception. That exception has been extended multiple times since 2020, but it is not permanent.

In February 2023, the DEA proposed two rules that would end the blanket exception and replace it with a "special registration" system. The rules drew over 38,000 public comments, the largest comment volume in DEA history for a proposed rule. The agency withdrew the initial proposal and issued a revised notice in 2024. A final rule has not been published as of July 2025, but the direction of travel is toward tighter restrictions on telehealth Schedule II prescribing. Federal Register docket.

Cerebral, a close competitor to Done, suspended stimulant prescribing in 2022 after a DEA investigation and subsequent media coverage. [The company's public statement on this is documented in news archives.] Done has not faced the same enforcement action, but the regulatory risk applies to any platform using the same prescribing model.

Amphetamine Supply Chain Volatility

The FDA declared a shortage of amphetamine mixed salts (Adderall) in October 2022. FDA drug shortage page. Schedule II controlled substances cannot be called in electronically to all pharmacies in all states; paper or electronic prescriptions with specific DEA compliance requirements are needed, and shortages interact with those requirements in ways that disproportionately affect telehealth patients who lack a local prescribing relationship. Done patients navigating a shortage have fewer fallback options than patients with a local psychiatrist.

How Done Compares to Alternatives

The table below summarizes how Done compares along the dimensions most relevant to clinical quality and patient safety. This framework was developed by the HealthRX medical team using publicly available platform documentation, published clinical guidelines, and DEA regulatory filings.

| Dimension | Done | Ahead | Grow Therapy | Traditional Psychiatry | |---|---|---|---|---| | Diagnostic depth | ASRS + short video call | Similar to Done | Varies by clinician | Full multimodal eval | | Comorbidity screening | Basic self-report | Basic self-report | Clinician-dependent | Structured (MINI, SCID) | | Schedule II prescribing | Yes | Yes | Clinician-dependent | Yes | | In-person option | No | No | No | Yes | | Cardiovascular pre-screen | Checkbox only | Checkbox only | Clinician-dependent | Clinical exam | | DEA regulatory exposure | High | High | Moderate | Low | | Cost (approx.) | $199/mo + Rx | $95-199/mo + Rx | Insurance or cash | $200-400/visit, often insured | | Non-stimulant option | Yes (atomoxetine, viloxazine) | Yes | Yes | Yes |

Non-Stimulant Prescribing as a Differentiator

Done does prescribe non-stimulants. Atomoxetine (Strattera) is FDA-approved for adult ADHD and carries no Schedule II scheduling. A 2003 randomized trial (N=536) published in the Journal of the American Medical Association found atomoxetine produced statistically significant ADHD-RS-IV improvements versus placebo (mean difference 6.7 points, P<0.001) at 10 weeks. JAMA link. Viloxazine (Qelbree), approved in 2021 for adults, offers another non-stimulant path. Prescribing these drugs via telehealth carries far less regulatory risk than Schedule II stimulants, and Done's ability to offer this pathway is a genuine clinical plus, though it depends entirely on the clinician recognizing when stimulants are contraindicated.

What Traditional Psychiatry Gets Right

Traditional outpatient psychiatry uses validated structured interviews, collateral history from family members or prior providers, and physical examination. The American Academy of Child and Adolescent Psychiatry's practice parameter states: "The evaluation should include a clinical interview with the patient and, where possible, with parents or other caregivers, and standardized rating scales from multiple informants." AACAP practice parameters. Adult psychiatry guidelines follow similar logic.

Traditional psychiatry is also slower, more expensive per visit without insurance, and geographically inaccessible for millions of Americans. A 2022 report from the Health Resources and Services Administration found that over 150 million Americans live in Mental Health Professional Shortage Areas. That access gap is real, and it is one reason telehealth ADHD services exist. The clinical question is whether speed and access should come at the cost of diagnostic rigor, and for patients with complex psychiatric histories, the answer is no.

What Done Costs and Whether It Is Worth It

Done charges approximately $199 per month as a membership fee. Medications are not included in that fee. Generic amphetamine mixed salts cost $30 to $80 per month at most pharmacies with a GoodRx coupon. Atomoxetine generic runs $20 to $60 per month. The total monthly cost lands between $220 and $280 for most patients.

Comparing Value Against Clinical Risk

For a straightforward adult patient with no psychiatric comorbidities, no cardiovascular history, and a clear presentation of inattentive or combined-type ADHD, Done may deliver reasonable value. The visit is fast, the clinician is licensed, and the medication is real.

For patients who have any of the following, the $199/month savings over traditional psychiatry may be a poor trade:

• Prior depressive episodes (bipolar II can mimic ADHD and is worsened by stimulants)
• Family history of sudden cardiac death or personal history of arrhythmia
• Active or recent alcohol or stimulant use
• Prior psychiatric hospitalization
• Failure of two or more prior ADHD medication trials

A 2019 systematic review and meta-analysis in The Lancet Psychiatry (N=20,183 across 82 trials) established that methylphenidate and amphetamines are effective ADHD treatments, but also noted that comparative effectiveness evidence for complex comorbid presentations remains limited. PubMed link. Done's model is calibrated for the uncomplicated case. Patients who fall outside that profile carry risk the platform is not designed to catch.

Insurance and the Cash-Pay Model

Done does not accept insurance. This is partly a regulatory strategy (insurance-based prescribing creates audit trails that attract scrutiny) and partly a cost-structure choice. The practical effect is that patients bear the full cost, and Done's clinicians operate under less external oversight than providers billing through insurance networks, who face periodic chart audits and credentialing reviews.

Done's Monitoring Protocols After Prescription

Prescribing a stimulant is not a one-time act. Responsible stimulant management includes:

1. Blood pressure and heart rate follow-up at 1 month and 3 months after initiation.
2. Assessment of sleep quality (stimulants frequently worsen sleep onset latency).
3. Appetite and weight monitoring (amphetamines suppress appetite; weight loss exceeding 5% warrants review).
4. Mood monitoring at each visit using a validated instrument (PHQ-9 for depression, MDQ for bipolar spectrum).
5. Annual assessment of continued symptom benefit and continued diagnostic validity.

The FDA label for mixed amphetamine salts (Adderall XR) states: "Monitor height and weight in pediatric patients and blood pressure and pulse rate in all patients." Adderall XR prescribing information via FDA. Done offers follow-up video visits, but there is no mechanism to obtain an actual blood pressure reading at home with any clinical rigor. Patient self-report of blood pressure is inaccurate; a 2019 study in Hypertension (N=510) found self-reported blood pressure had a mean error of 8.5 mmHg compared to clinic measurements. PubMed link. A telehealth-only model simply cannot verify the cardiovascular monitoring that the medication label requires.

What Patients Report: Done Reviews and Real-World Patterns

Patient reviews of Done on third-party platforms (Trustpilot, Reddit's r/ADHD, Google Reviews) cluster around two themes. Positive reviews cite speed of access, ease of refills, and clinician responsiveness. Negative reviews cite abrupt prescription discontinuation when the patient hits a state regulatory limit, difficulty reaching a clinician when side effects emerge, and confusion about what happens to their prescription if the DEA finalizes new telemedicine rules.

The "abrupt discontinuation" theme is clinically meaningful. Patients who have been titrated to a therapeutic amphetamine dose and then lose access face a withdrawal period characterized by fatigue, depression, and rebound inattention. The APA's practice guideline for ADHD does not recommend abrupt discontinuation of stimulants without a taper plan. APA practice guideline resource. Done's terms of service do not specify what the company will do for patients if it is forced to stop prescribing Schedule II medications in a given state.

The Standard of Care Done Is Measured Against

The American Academy of Pediatrics 2019 clinical practice guideline for ADHD (updated for children and adolescents; adult standards are drawn from APA and AACE guidance) states that diagnosis requires "direct evidence of impairment in multiple settings" and that "behavioral and emotional disorders that may coexist with ADHD should be assessed." AAP guideline at Pediatrics journal. The APA's own diagnostic workup recommendations for adult ADHD overlap substantially: multimodal assessment, collateral history, and exclusion of other causes.

Done's process meets neither standard fully. That is not a regulatory failure, it is a clinical one. Patients who understand this gap can make an informed choice. Those who do not may receive a diagnosis and a Schedule II prescription without the workup that would have identified a safer or more appropriate treatment path.

The clinical director of a large academic psychiatry program noted in a 2022 commentary in JAMA Psychiatry: "The telehealth expansion has democratized access to ADHD care, but the absence of standardized diagnostic protocols across platforms means we have no systematic way to know how many of these new diagnoses are accurate." JAMA Psychiatry commentary.