Editorial Perspective: COVID‐19, ADHD management and telehealth: uncertain path

Stein, Mark A.

doi:10.1111/jcpp.13584

Cited by 3 publications

(4 citation statements)

References 11 publications

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“…All ADHD management was recommended to continue via telephone or a virtual platform when the pandemic began in accordance with American Psychiatric Association telepsychiatry guidelines, and this change brought about an unprecedented demand in telehealth [15]. A pediatric center in Washington, D.C. had 1,654 telehealth encounters between January 2016 and March 2020, but between March and June 2020, that number increased to 45,236 [16]. England experienced 2.6 million more phone appointments for patients under 25 years of age between March 2020 and February 2021 than the previous three years [14].…”

Section: Introductionmentioning

confidence: 99%

“…On one hand, patients experienced worsening ADHD symptoms during lockdown after the pandemic began, and fewer total in-person appointments were available [8,[11][12][13][14]. Conversely, telehealth appointments rapidly grew in number and had historically been underutilized but successful at managing ADHD [15][16][17][18][19][20]. Furthermore, while several studies examined ADHD symptoms and medication use during lockdown, few continued to follow these variables during the subsequent school years, during which students experienced changes between remote, in-person, and hybrid learning depending on local guidelines and infection rates.…”

Section: Introductionmentioning

confidence: 99%

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ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

Cunniff,

Ahsan,

McCrary

et al. 2024

BMC Psychiatry

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Background COVID-19 impacted all students, especially those with attention deficit hyperactivity disorder (ADHD), putting them at risk for disruption to their medication regimen and school performance. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refills and if telehealth management demonstrated a higher rate of adherence. Methods A total of 396 patients from the General Academic Pediatrics (GAP) clinic at Children’s Hospital of The King’s Daughters (CHKD) were included in the study. Patients were between the ages of 8–18 with a history of ADHD for three or more years that was medically managed with four or more prescription refills between January 2019 and May 2022. A retrospective chart review collected age, sex, race, refill schedule, appointment schedule, and number of telehealth appointments. Data analysis compared the variables and defined “pre-pandemic months” as January 2019 through March 2020 and “pandemic months” as April 2020 through June 2022. Results The total percentage of patients who had their ADHD medications during pre-pandemic months ranged from 40 to 66% versus 31–44% during pandemic months. Additionally, the total percentage of patients who had quarterly ADHD management appointments during pre-pandemic months ranged between 59 and 70% versus 33–50% during pandemic months. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Regarding race, Black patients had a lower number of medication refills compared to White patients when controlled for appointment type. They also had a lower number of total appointments, but there was not a significant difference in the number of virtual appointments. Conclusions Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence. However, racial inequities found in this study need to be addressed.

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Section: Introductionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

Cunniff,

Ahsan,

McCrary

et al. 2024

BMC Psychiatry

View full text Add to dashboard Cite

show abstract

“…All ADHD management was recommended to continue via telephone or a virtual platform in accordance with American Psychiatric Association telepsychiatry guidelines when the pandemic began, and this change brought about an unprecedented demand in telehealth (11). A pediatric center in Washington DC had 1,654 telehealth encounters between January 2016 and March 2020, but between March and June 2020, that number increased to 45,236 (12). England experienced 2.6 million additional phone appointments for patients under 25 years of age between March 2020 and February 2021 than the previous three years (10).…”

Section: Introductionmentioning

confidence: 99%

ADHD Prescription Patterns and Medication Adherence during the COVID-19 pandemic

Cunniff,

Ahsan,

McCrary

et al. 2023

Preprint

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Background COVID-19 put students with attention deficit hyperactivity disorder (ADHD) at risk of disruptions to their medication regimen and school performance, and telehealth appointments became more common during the pandemic. Our study aimed to identify if ADHD medication regimens were disrupted through analyzing prescription refill schedules and if telehealth management demonstrated a higher rate of adherence. Methods Patients between the ages of 8–18 with a history of ADHD for three or more years medically managed with four or more prescription refills between January 2019 and May 2022 were reviewed. A retrospective chart review collected age, sex, race, refill schedule, and appointment schedule. Results The total percentage of patients who had their ADHD medications refilled between January 2019 and March 2020 ranged from 40–66% versus 31–44% between April 2020 and May 2022. Additionally, the total percentage of patients who had quarterly ADHD management appointments between January 2019 and March 2020 ranged between 59–70% versus 33–50% between April 2020 and June 2022. The number of months with ADHD prescription refills over the last three years was significantly higher among those who had both virtual and in-person visits than those who had just in-person visits, p < 0.001. Conclusions Since the start of the pandemic, ADHD patients have both refilled their prescriptions and returned to clinic less frequently. This data suggests a need to re-evaluate the ADHD symptoms of GAP patients periodically and return them to a more consistent medication regimen. Telehealth appointments are a potential solution to increase adherence.

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“…This may have limited the ability to confirm the presence of ADHD symptoms across settings and contributed to lower diagnostic certainty. Beyond observation, increased situational stressors impacting attention associated with the pandemic (e.g., extended hours on a computer screen during virtual schooling, onset/exacerbation of other mental health conditions, reduced sleep(Panchal et al, 2021), and confinement in general(Giménez-Dasí et al, 2020), versus pervasive attention symptoms reflective of ADHD was likely an added challenge for clinicians during the pandemic(Stein, 2022)). Taken together, there were likely both telehealth factors and pandemic factors contributing to lower diagnostic certainty in making ASD and ADHD diagnoses during the pandemic.…”

mentioning

confidence: 99%

Diagnostic certainty during in‐person and telehealth autism evaluations

Ludwig,

Holingue,

Hong

et al. 2023

JCPP Advances

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BackgroundMany diagnostic evaluations abruptly shifted to telehealth during the COVID‐19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic.MethodsThe sample included 2192 children, 1–17 years (M = 6.5 years; SD = 3.9), evaluated by a physician/psychologist at an ASD specialty center. A total of 649 children were evaluated in‐person September 1, 2019–March 13, 2020 (pre‐pandemic) and 1543 were evaluated via telehealth March 14, 2020–July 26, 2021 (during pandemic). Upon completion of each evaluation, clinicians provided a final diagnostic determination (i.e., “Yes,” “No,” “Possible,” or “Not Assessed”) for the following DSM‐5 conditions: ASD, attention‐deficit/hyperactivity disorder (ADHD), intellectual developmental disorder (IDD), anxiety (ANX), depression (DEP), and behavioral disorder (BD). “Possible” indicated lower certainty and the diagnosis was not provided. “Not Assessed” indicated the disorder was not evaluated.ResultsDiagnostic certainty for ASD and ADHD was lower and clinicians evaluated for and made diagnoses of IDD less often during evaluations that occurred via telehealth during the pandemic versus in person before the pandemic. DEP and BD were diagnosed more frequently, diagnostic certainty of DEP was lower, and no differences in the frequency of ANX diagnoses emerged during evaluations conducted via telehealth during the pandemic compared to those conducted in person before the pandemic.ConclusionsDifferences emerged in the frequency of diagnoses evaluated and made and diagnostic certainty for evaluations conducted via telehealth during the pandemic compared to in person before the pandemic, which likely impacted patients and reflect real‐word challenges. Future work should examine whether these patterns are generalizable and the mechanisms that contribute to these differences.

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Editorial Perspective: COVID‐19, ADHD management and telehealth: uncertain path

Cited by 3 publications

References 11 publications

ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

ADHD prescription patterns and medication adherence in children and adolescents during the COVID-19 pandemic in an urban academic setting

ADHD Prescription Patterns and Medication Adherence during the COVID-19 pandemic

Diagnostic certainty during in‐person and telehealth autism evaluations

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