The Impact of the COVID-19 Pandemic on Diagnosing and Treating Attention Deficit Hyperactivity Disorder: New Challenges on Initializing and Optimizing Pharmacological Treatment

Abstract

IntroductionCOVID-19 has been causing huge disruptions in mental healthcare services worldwide, including those related to ADHD. Some consequences of the pandemic, such as virtual schooling and remote work, as well as increased telemedicine, have posed new challenges for ADHD diagnosis and treatment. In this narrative review, we summarize existing COVID-19 and ADHD literature especially focusing on ADHD diagnostic during the pandemic and treatment adherence.MethodsThe databases searched were: PubMed, PsycINFO, EMBASE, Google Scholar and medRxiv. We included all English language articles and preprints that reported on medication/pharmacological treatment among the terms “ADHD” and “COVID-19” resulting in a total of 546 articles. The final search was done on Dec-23 2021. We selected fifteen articles focusing on the challenges of ADHD diagnostic during COVID-19 pandemic.ResultsOf the fifteen studies included, most were cross-sectional and perspective pieces. Most of them discussed that individuals with ADHD present risk factors that may make them more vulnerable to health negative consequences of the pandemic, which in turn may have an impact on treatment efficacy and adherence. Telemedicine is also addressed as a potential powerful instrument on monitoring ADHD treatment.ConclusionDespite the challenges posed by the pandemic on monitoring ADHD treatment, the available literature stressed that the current scenario also may offer new opportunities that could lead to the development of individualized treatment interventions, such as the remote monitoring of symptoms.

Remote mental health care interventions during the COVID-19 pandemic: An umbrella review

“…Difficulties with prescription medications for psychiatric out-or inpatients due to e.g. remote follow-up (Lignou, Greenwood, Sheehan, & Wolfe, 2022;Segenreich, 2022) and an increased risk for worse outcomes due to barriers in accessing health services timely was often highlighted, particularly for people with pre-existing mental health conditions and people from marginalized populations (i.e., black, indigenous and people of colour (BIPOC), refugees, migrants and prisoners) (Cabrera, Karamsetty, & Simpson, 2020;Fornaro et al, 2021;Lemieux et al, 2020;Murphy et al, 2021). Concerning inpatient mental health care, reduced access to emergency departments and (voluntary) admissions in psychiatric hospitals or self-harm/suicide were mentioned by multiple reviews (k = 9).…”

“…Practioners: beliefs, perceptions, knowledge, and self-efficacy in terms of TMH TMH/VMH: lack of technological literacy and experience in providers (Bertuzzi et al, 2021;Cabrera et al, 2020;Narvaez, 2022;Siegel et al, 2021) TMH increases access for young people with mental health problems (destigmatizing) (Keyes et al, 2022) TMH/VMH: concerns about therapeutic relationship/impersonal (Appleton et al, 2021;Kane et al, 2022;Li et al, 2021;Meloni et al, 2020;Selick et al, 2021;Siegel et al, 2021;Thenral & Annamalai, 2020;Tuczyńska et al, 2021) Limitations of TMH/VMH less important in medication consultations compared to psychotherapy (Segenreich, 2022) TMH: reluctance to use because desire for face-to-face or lack of confidence (Ardekani et al, 2021;Baumgart et al, 2021;Narvaez, 2022) TMH: more control over timeschedule (Keyes et al, 2022;Narvaez, 2022) TMH: requires more concentration; screen fatigue (Appleton et al, 2021;Keyes et al, 2022;Siegel et al, 2021) TMH: missing essential psychological cues (Drissi et al, 2021;Siegel et al, 2021) TMH: intercultural communication and language (Keyes et al, 2022) TMH: ethical concerns (Kane et al, 2022) TMH: inadequate information to support diagnosis (Li et al, 2021) TMH/VMH: increases pre-existing health inequalities (Keyes et al, 2022) TMH/VMH: perceived inefficacy (Abraham, Jithesh, et al, 2021) (Devoe et al, 2022) (continued on next page) Baumgart et al, 2021;Murphy et al, 2021;…”

“…Lack of organizational support for technological implementation/no support person to manage technology (Murphy et al, 2021;Selick et al, 2021;Tuczyńska et al, 2021) Organizational (technical) support (second person to assist) (Ardekani et al, 2021;Li et al, 2021) Time constraints to use TMH and VMH due to competing tasks COVID-19 (Narvaez, 2022;Siegel et al, 2021) Guidelines available from (international) professional bodies (Appleton et al, 2021;Segenreich, 2022) TMH or VMH not made available in organizations (Murphy et al, 2021) Decrease of waiting lists (Bertuzzi et al, 2021) Lack of equipment for TMH virtual platforms Inadequate IT infrastructure (Keyes et al, 2022;Mohammadzadeh et al, 2022;Selick et al, 2021;Siegel et al, 2021) Good quality of internet Computer in private area ( Selick et al, 2021) Outer setting: Patient needs accurately known and prioritized by the organization (e.g. payment and funding; privacy and ethics; regulations).…”

The impact of the COVID-19 pandemic on ADHD medicine consumption in 47 countries and regions

“…Additionally, a decline of healthcare workers due to quarantine regulations and terminations caused a shortage of skilled professionals ( Gohar et al, 2020 ), as well as supply chain problems, impeding the access to ADHD prescriptions. Secondly, the consumption drops in 2020 might also be explained by parental decision to reduce ADHD medication dosages during school closures, analogous to drug holidays ( Segenreich, 2022 ). This idea is supported by the strong correlation of school closures and consumption losses in 2020.…”

ADHD in children and adolescents: Review of current practice of non-pharmacological and behavioural management

“…We have assessed and summarise here the non-pharmacological interventions for ADHD which could be used as first line treatment for patients with ADHD. The implementation of non-pharmacological strategies has become particularly crucial during the COVID-19 pandemic crisis and thereafter, with restricted contact with healthcare professionals [4] . This article also explores the principles and published evidence of different non-pharmacological psychosocial interventions, providing a summary of most up-to-date evidence for their effectiveness.…”