Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions

Abstract

Background Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study’s aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing. Methods In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients’ evaluation of the session, their treatment satisfaction, and patients’ and therapists’ ratings of therapeutic alliance. We also collected qualitative comments on both sides’ experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses. Results No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements. Conclusions Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.

Implementation, Adoption, and Perceptions of Telemental Health During the COVID-19 Pandemic: Systematic Review

“…However, it is important to note that clinical outcomes for telemental health were not comparable for all service users; for example, Dores et al [ 60 ] found that a quarter of psychiatrists reported poorer clinical outcomes after switching to remote care. Another study also indicated that only one-third of clinicians felt as though telemental health consultations were comparable to prepandemic sessions [ 114 ]. A full presentation of the clinical outcomes reported in included studies is shown in Table 6 .…”

The reliability of symptom assessment by telepsychiatry compared with face to face psychiatric interviews

“…In summary, these latest studies suggest that clinical outcome by telepsychiatry is as effective as face-to-face care though limitation on small sample size were noted. ( Cheli, Cavalletti, & Petrocchi, 2020 ; Dores, Geraldo, Carvalho, & Barbosa, 2020 ; Erekson, Bailey, Cattani, Fox, & Goates-Jones, 2020 ; Lynch, Medalia, & Saperstein, 2020 ; Sequeira, 2020; Wyler et al, 2021 )…”

Communicating and reading emotion with masked faces in the Covid era: A short review of the literature

“…When communication cannot be “healthy”, teleconsultation could be, otherwise, a great tool/strategy to overcome the negative influence of mask wearing, and could particularly be beneficial for bidirectional communication (from practitioner to patient and from patient to practitioner) and evaluation of mental states ( Thirthalli, 2020 ). Although telepsychiatric sessions have been experienced as being more superficial by participants so far, no difference was observed in post-session positivity in patients with attention deficit/hyperactivity disorder ( Wyler et al , 2021 ).…”