AIMSThe aims of this review were to summarize the scientific evidence about the risks of using methylphenidate for ADHD in pregnancy and lactation, to present a case in which interruption of treatment after delivery and during breastfeeding was harmful and to discuss the implications of treating or not treating ADHD in pregnancy and lactation. METHODSFor the systematic review, databases searched included Pubmed, Psychinfo, Web of Science, Embase, Biosis and Medline. RESULTSThree articles were found with a total sample of 41 children exposed to methylphenidate in pregnancy. Malformations reported included congenital heart defects (n = 2), finger abnormalities (syndactyly, adactyly and polydactyly n = 2) and limb malformations (n = 1). Other problems included premature birth, asphyxia and growth retardation. One case report (n = 1) and one case series (n = 3) were identified regarding exposure to methylphenidate through breast feeding. In all cases, children developed normally and no adverse effects were reported. In our case report we describe an infant exposed to methylphenidate during pregnancy and breast feeding, who developed normally having no detectable congenital abnormalities. CONCLUSIONSThe number and size of the studies found were small. Identified cases were not representative of the general adult ADHD population having methylphenidate as monotherapy during pregnancy as all the articles reported combinations of methylphenidate with either known teratogenic drugs or drugs of abuse. There is a paucity of data regarding the use of methylphenidate in pregnancy and further studies are required. Although the default medical position is to interrupt any non-essential pharmacological treatment during pregnancy and lactation, in ADHD this may present a significant risk. Doctors need to evaluate each case carefully before interrupting treatment.

Covid‐19 has led to a shift towards online therapy. This paper focuses on therapists’ experiences of translating systemic practice online with families. A range of UK services are represented, including community, inpatient, adult and children services. A social construction theory, coordinated management of meaning, is used to understand online family and systemic therapy. The new context of online therapy influenced all other levels of the therapeutic encounter including content and structure of sessions, therapeutic relationship, therapists’ identity and culture of therapy. The relationship between ‘doing’ online therapy and reflecting on practice has been central in co‐constructing new ways of interacting. There were many similarities across services, where there were differences these were client and context specific. As better ways of engaging emerged, therapists became more confident, creativity in therapy increased and attitudes about online therapy became more positive. Practitioner points Online systemic therapy is possible across adult and children services at different tiers within community and inpatient settings. CMM provides a framework to understand communication in online therapy. Online therapy requires reconsiderations at all levels of the therapeutic encounter. Increased confidence and competence correlates with positive attitudes about online therapy. Online therapy is impacting on the overall evolving culture of therapy.

This study shows that Monks and Nuns who are more advanced in practicing meditation show fewer signs of psychological distress than Monks and Nuns who are less advanced in the art of meditation. The practice of meditation may have therapeutic value in the management of psychological distress, and could be offered as a non-pharmacological treatment alternative in patients with anxiety and depression. This is a preliminary study with limitations. More robust evidence is needed before we can confidently establish a causal link between meditation and psychological wellbeing. Our findings should, however, encourage further research in this area to generate better evidence for the health benefits of what is a long established practice in Buddhist communities.