Adult ADHD Diagnosis & Treatment in Salem,NH & Boston, MA
Six States ADHD is solely dedicated to diagnosing and treating adult ADHD with evidence‑based care.
We perform comprehensive diagnostic evaluations, individualized medication management, and skills-based executive function coaching grounded in mindfulness and informed by cognitive behavioral therapy.
What We do
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diagnose, treat, and empower adults across New England with adhd
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collaborative care: Patients are partners.
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holistic care: We integrate pharmacotherapy, skills‑based coaching, nutrition, and sleep optimization to improve outcomes
our team
CASEY BRACHVOGEL, CRNA, PMHNP-BC
Licensed in New Hampshire and Massachusetts
I’m a Psychiatric Nurse Practitioner and Certified Nurse Anesthetist dedicated to helping adults manage ADHD and live their best lives. Before founding Six States ADHD, I spent eight rewarding years as an anesthetist at Massachusetts Eye and Ear Infirmary. In 2019, I opened New England Ketamine to support patients facing refractory chronic pain and tough-to-treat mental health conditions.
My practice combines professional expertise with a down-to-earth approach, creating a welcoming space for anyone navigating the challenges of ADHD.
My goal is simple: to partner with you in a way that respects your unique experiences, simplifies your treatment journey, and empowers you to thrive.
Check out My Other Specialty Practices
New England Ketamine: Treating Medication-Resistant Depression, PTSD, and Chronic Pain
OUR CDO
CHIEF DISTRACTION OFFICER
mia wallace
Patient RoadMap
What to expect at every step with Six States ADHD
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We confirm: adult care, your location (NH/MA), your goals, and any safety red flags.
We outline next steps, costs, and what records help us help you faster.
What you do: Pick a time, bring questions.
What we do: Confirm eligibility, explain process, send intake if you’re moving forward. -
Step 2 — Intake & Records (online)
Intake forms: health history, ADHD screens, sleep/substance/heart history.
Upload records (if you have them): prior ADHD testing, med list, past notes, labs/ECG.
Logistics: policy acknowledgment, consent, ID, payment method.
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A comprehensive visit (typically 60–90 minutes) covering:
Clinical interview: childhood onset, persistence into adulthood, functional impact (work/home/school).
Screeners & rating scales: standardized tools to support the diagnosis.
Rule-outs & safety: anxiety, depression, sleep, substance use, medical contributors.
Vitals: blood pressure/heart rate; medication safety review.
Outcome:
Clear explanation of findings (ADHD, “ADHD likely,” or alternative/adjacent concerns).
If ADHD is diagnosed: a personalized treatment plan
Treatment options: stimulants, non-stimulants, sleep optimization, skills training/coaching, workplace/academic strategies.
Risks/benefits & monitoring: what to expect, how we follow up, how to reach us.
Your goals: 2–3 measurable targets (e.g., “finish weekly reports on time,” “reduce task switching by 50%,” “sleep 7+ hours”).
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If We Start Medication
We dose low and slow, prioritizing safety and function.
Weeks 0–2: Initiation
Start at a low dose. Track focus, distractibility, appetite, sleep, heart rate/BP, and any side effects.
Short check-in (message/telehealth) to see how you’re tolerating it.
Weeks 2–4: Adjustment
Fine-tune dose and timing (e.g., morning XR with small afternoon IR “booster,” or non-stimulant daily).
We watch for sleep issues, anxiety, and rebound.
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Medication Optimization & stability check. We lock in the simplest regimen that meets your goals with the fewest side effects.
Add coaching/skills if helpful.
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Maintenance care (telehealth, periodic check-ins) every 3 months.
Refill policy reviewed (we cannot refill without appropriate follow-up).
Ongoing tracking of vitals, side effects, and progress toward goals.
Not a medication person? No problem—many adults do well with coaching, structure, and targeted behavioral strategies. We’ll design a non-med plan if that’s your preference or best fit.
Six States ADHD Patient FAQ
Who we treat: Adults (18+) with ADHD and related concerns
Where: In-person evaluation in Salem, NH and Boston, MA; telehealth follow-ups in NH & MA
How to start: Optional 10–15-minute fit call → online intake → in-person diagnostic evaluation
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Q: How do I become a patient?
A: Book a brief fit call (optional), complete online intake, then schedule your in-person diagnostic evaluation in Salem, NH or Boston, MA. Most follow-ups are telehealth (NH & MA).Q: Do I need a referral?
A: No. Self-referrals are welcome. If you have prior testing or records, bring them—they help.Q: How soon can I be seen?
A: We aim to schedule new-patient evaluations within 1–2 weeks, depending on availability. -
Q: Do you see children or teens?
A: No—our practice is dedicated to adults (18+).Q: I live in Massachusetts. Can I do everything by telehealth?
A: The initial diagnostic evaluation is in person in Boston, MA or Salem, NH. After that, most visits can be telehealth if you’re in NH or MA.Q: Do you offer fully remote new-patient evaluations?
A: Not at this time. The first visit must be in person for accuracy and safety. -
Q: What happens at the diagnostic evaluation?
A: We review your history (including childhood symptoms), use validated screeners, check vitals, rule out look-alikes (sleep, anxiety, depression, substance use), and discuss next steps.Q: Do I need neuropsychological testing or QbCheck?
A: Not always. Many adults can be diagnosed based on clinical assessment plus rating scales. Additional testing is considered case-by-case.Q: Can you diagnose other conditions too?
A: We screen for common overlaps (anxiety, depression, sleep issues) and coordinate care as needed. -
Q: Do you prescribe stimulant medications?
A: Yes, when appropriate and safe. We also offer non-stimulants and non-medication strategies (sleep optimization, coaching, skills training).Q: What if I prefer not to take medication?
A: That’s fine—many adults improve with structured behavioral strategies and coaching. We’ll build a non-med plan with you.Q: How long until I notice improvements?
A: Some feel changes in days to weeks. Expect 4–12 weeks to fine-tune dose, timing, and routines. -
Q: Why do you require an in-person visit first?
A: It improves diagnostic accuracy and safety (e.g., vitals, cardiac risk review).Q: Will you check the PDMP?
A: Yes. We check the state Prescription Drug Monitoring Program when prescribing controlled medications.Q: Do you require urine drug screens?
A: We may request baseline and/or random toxicology screens when clinically indicated to ensure safe prescribing.Q: How do refills work?
A: Refills are provided at or after required follow-ups. Please request refills 3–5 business days in advance; we can’t back-date or rush controlled-substance refills.Q: What if I miss an appointment?
A: We’ll help you reschedule quickly. Note that missed visits can delay refills for safety and compliance reasons. -
Q: How often are follow-ups?
A: During dose-finding, every 4 weeks; once stable, typically every 3 months.The first one month follow up is free
An annual in-person recheck is required.
Q: What platform do you use for telehealth?
A: A HIPAA-compliant video platform. Please join from a private, quiet space with good internet.Q: Do you offer evening or weekend hours?
A: Limited slots may be available—check the scheduling link for current openings. -
Q: Do you take my insurance?
A: No. we can provide a superbill for reimbursement.Q: Can I use HSA/FSA funds?
A: Yes—HSA/FSA cards are typically accepted for qualified services.Q: Will I see pricing upfront?
A: Yes—you’ll receive a transparent estimate before your visit. No surprise billing. -
Q: Can you complete workplace or school forms?
A: Often, yes. We complete reasonable documentation related to ADHD care; some forms may require a recent evaluation or additional visit.Q: Do you write letters for accommodations?
A: Case-by-case, aligned with clinical findings and objective data when available. Fees may apply.Q: Can you coordinate with my therapist or PCP?
A: Absolutely—with your permission, we share summaries to keep your care team aligned. -
Q: What’s the best way to reach you?
A: Use secure portal messaging for non-urgent questions and medication updates. Call or text during business hours for scheduling or time-sensitive issues.Q: How fast do you respond?
A: We aim to reply within 3 business day. For urgent issues, call us; for emergencies, see below. -
Q: What is your cancellation policy?
A: Please give 48 hours’ notice to avoid fees. This helps us keep access open for all patients.Q: I’m running late—what should I do?
A: Call the office. We’ll try to accommodate; we may need to reschedule if there isn’t enough time to provide safe care. -
Q: Are my visits private?
A: Yes. We use HIPAA-compliant systems. We release records only with your written consent or when required by law.Q: How do I request my records?
A: Send a portal message or call the office; we’ll provide a simple authorization form and timeline. -
Q: Do you provide emergency services?
A: No. If you are in crisis or at risk of harm, call 988, go to the nearest ER, or dial 911.