As Time Stands Still, ADHD Treatment Is in Almost Constant Flux
Trapped at home with a laptop and a lot of worry, ADHD symptoms have come into sharp focus for many ADDitude readers over the last five months. New circumstances have necessitated new coping mechanisms and unlocked new treatment options and opportunities. As a result, almost half of you have made changes to your own and/or your child’s delicate balance of medication, exercise, therapy, diet, and meditation. And still the landscape shifts.
August 14, 2020
ADHD Treatment in a Pandemic: Finding a New Balance
Fully 73% of us are feeling anxious and worried right now. In fact, two-thirds of ADDitude readers have been formally diagnosed with an anxiety disorder — the most prevalent ADHD comorbidity, followed by depression, which impacts 56% of you. Then there is the PTSD (4%), the learning disabilities (9%), OCD (6%), bipolar disorder (5%), sensory processing disorder (5%), and autism spectrum disorder (almost 4%).
The above findings from ADDitude’s recent survey of 1,252 readers — the ninth in a series of pandemic check-ins — confirm a long-standing but often discounted truth: ADHD is not a singular condition. It is, for the vast majority of people, a boiling, bubbling morass of symptoms that span multiple diagnoses. These comorbid conditions do not exist in isolation; they feed off of and blend into one another. And that complex, messy relationship makes treatment feel a bit like a living embodiment of the Cat in the Hat balancing on a beach ball while juggling a fish atop an umbrella, a birthday cake on his hat, a full jug of milk on a tray, and some books. While also on fire.
When coronavirus shut down workplaces and schools in March, it punctured a hole in that beach ball under our feet. Our already precarious foundations became unsteady and unpredictable, throwing off the delicate treatment balance for many. Meanwhile, the weight of the anxiety and depression we were holding was doubled by the pandemic, straining even the strongest backs. We came tumbling down — slowly.
A Changed Reality Requires a Changed Treatment Plan
“I am growing more and more incapacitated with depression and a sense that this world will never again be a place I can successfully navigate because it requires extremely high executive functioning,” wrote one mother with ADHD and depression who lives in Maryland with two teenagers who also have ADHD. “There is no use in changing anything. The future is an unending road of the impossible.”
This view, it turns out, is an extreme one. In fact, 44% of the adults who answered our survey during the first two weeks of August said they have made changes to their treatment plan since the pandemic began. Of those who have made changes during this time…
- 36% have increased at least one medication dosage
- 32% have added natural/non-medication treatments
- 19% have started medication for the first time
- 11% have switched medications
- 15% have stopped taking medication or reduced dosage
- 20% made other changes such as exercising more frequently or eating an ADHD diet
You’ll notice that the above adds up to far more than 100%. This is because, just as ADHD does not exist in isolation, neither does ADHD treatment. As pandemic worry spiked, many readers added a new or increased the dosage of an existing anxiety medication. Many also began taking melatonin or a stronger sleeping medication due persistent and stress-related sleep problems.
“My doctor recommended increasing my antidepressant due to ongoing struggles with concentration and focus,” wrote one woman in Seattle who also takes an ADHD medication and lost her job due to the pandemic. “She said the continuous low-grade anxiety from life just being different now can effect focus and concentration. Increasing the antidepressant is supposed to help with that.”
For many, increasing the dosage of an antidepressant or anxiety medication meant adjusting the dosage of an ADHD medication as well. Some reduced their dosages to off-set new side effects or because healthier exercise routines diminished their medication needs. Others increased their dosages to meet life’s new demands — like working from home, overseeing distance learning, or doing both while balancing on a deflating ball.
“I was so depressed and not knowing how to handle not working,” wrote one mother of two in Colorado with ADHD, anxiety, and depression who lost her job. “I was lying around all day, sad, and even crying. I started drinking more than usual and knew I had to make the change back to full strength on all of my medications.”
“Lack of structure had me depressed and floundering for months,” wrote another woman in California with ADHD, anxiety, and depression. “After I switched meds, I was able to get ideas on creating a weekly schedule and sticker charts for myself. Having structure is like night and day and I’m doing better and feeling empowered being able to provide that for myself.”
ADHD Treatment with Natural Therapies on the Rise
Decades of research shows that exercise is the most effective natural treatment for symptoms of ADHD — in children and in adults. “With regular physical activity, we can raise the baseline levels of dopamine and norepinephrine by spurring the growth of new receptors in certain brain areas,” says Dr. John Ratey, author of SPARK: The Revolutionary New Science of Exercise and the Brain (#CommissionsEarned). The end result? Better focus, emotional regulation, and impulse control.
The benefits of exercise are not lost on ADDitude readers, especially during this strange and isolating time. According to the survey results, only about 57% of you are using ADHD medication but nearly as many are using exercise to manage symptoms.
- 53% exercise regularly to control ADHD symptoms
- 53% use vitamins and supplements like fish oil
- 50% practice mindful meditation
- 29% engage in cognitive behavioral therapy (CBT)
- 17% use coaching, talk therapy, or another natural treatment
“I’ve been exercising a lot more during the lockdown and I find that I don’t need the full dosage anymore,” wrote one woman who decreased her ADHD medication dosage. “I’ve also started experimenting (with the support of my doctor) with lowering/increasing my dosage based on my menstrual cycle because I find that that affects my focus levels.”
“I had no choice but to start practicing mindfulness; it was the only way to survive the overwhelming stress from working from home alongside my son, who also has ADHD,” wrote the single mother of a 7th grader in California. “We also started exercise and gratitude journaling to help us function and get through this thing.”
Treatment Goals for a Strange Fall with ADHD
More frequent exercise is the most common goal among ADDitude readers struggling to manage their symptoms as the pandemic surges through its sixth month in the United States. About one-third of adults with ADHD say they will continue to make treatment changes, including:
- 23% plan to increase medication dosage
- 21% plan to start a new medication
- 14% plan to switch to a new medication
- 3% plan to decrease a dosage
- 2% plan to stop taking a medication
“I’m still tweaking medications and dosages to find a combination that satisfies my insurance, shrink, pharmacy, and budget that is also an effective treatment for, you know, ME,” wrote one reader with ADHD, anxiety, depression, and sensory processing disorder.
ADHD Treatment with Therapy
Nearly half of ADDitude readers have attended at least one telehealth appointment — via a video or regular phone call — since March. For many, telehealth has meant virtual therapy. And among adults with ADHD and its comorbidities, the reviews are positive.
“I love my virtual therapy!” wrote the mother of two small children with autism spectrum disorder. “I actually kind of prefer it because it doesn’t involve executing a trip out of the house at a specific time, which is often difficult and stressful for me to coordinate.”
“It has been helpful and encouraging to me,” wrote an older reader. “It’s helped me to adjust my perspective and expectations for myself during this challenging time.”
Some adults have found virtual therapy difficult to execute with so many people home all of the time.
“As a parent working from home with two teenagers also at home, it is very difficult to schedule and/or find time to have privacy and meaningful discussion online with healthcare providers of any sort, and especially mental health practitioners,” wrote one parent with ADHD, anxiety, and depression. “So it’s like maybe 60% as effective as it was in person.”
For children with ADHD, 52% of whom have now used telehealth, the reviews are markedly worse. Only 18% of caregivers gave an ‘Excellent’ rating to the telehealth experience, which largely comprised therapy sessions. Half called it good or very good. And 9% said the experience was poor. The most common complaint: kids with ADHD are overdosing on screens right now, and one more ‘boring’ Zoom meeting is just more than their attention and focus can endure.
“When visiting in person, our child would talk to the psychiatrist while playing,” wrote the mother of a First grade student in Texas. “In our telehealth appointment, she was bouncing off the walls, hiding under the computer desk, putting her face in the webcam, etc. At one point, we actually had to remove her from the room because we thought she was going to knock the computer off the desk.”
For others, telehealth has helped to demolish barriers to treatment that previously stood in the way of positive momentum and symptom control.
“It used to be a struggle to physically get my son into see his behavioral therapist,” wrote the mother of a Ninth grader with ADHD in Chicago. “Since telehealth started at the end of March, he has talked to the behavioral therapist weekly — not monthly. He looks forward to it actually and is just more comfortable talking to her. Telehealth has been a blessing for us.”
Treatment Changes for Children with ADHD
Adding telehealth is just one of many treatment changes made during this pandemic by caregivers eager to balance symptom management with overall health — mental, physical, and psychological. Half of the caregivers who responded to ADDitude’s latest survey said they have made treatment changes in the last five months. Of those,
- 33% said their child stopped taking medication
- 24% said their child began taking natural treatments
- 19% increased their dosage of ADHD medication
- 17% decreased their dosage of ADHD medication
- 17% switched ADHD medications
- 15% started taking an ADHD medication for the first time
Among the families that reported ceasing ADHD medication, one primary reason rose to the top: With lighter academic demands and a more flexible learning environment at home, many caregivers felt their children no longer needed medication to help them sustain focus and attention during the day. By taking a medication vacation, they said they hoped to address a common side effect: diminished appetite and weight loss.
“When our son stopped going to public school in March, a lot of the behavior related to his ADHD went away or I was able help him focus by finding the best times to get his work done,” wrote one mother who plans to home school for the first time this Fall. “The anxiety, anger, and frustration caused by his lack of social skills and feeling ‘not as smart’ went away.”
“He needs to be more focused during school, so a higher dose is necessary to help with that,” wrote one Florida mother who decreased her child’s ADHD medication dosage. “At home, it is one-on-one and I can redirect and repeat repeat, which cannot be done at school.”
Other caregivers reported that new spikes in anxiety caused by the coronavirus prompted them to make several medication adjustments.
“We increased my daughter’s anxiety meds because she was experiencing major disappointments and upsets re: missing her senior year, but we decreased her ADHD meds because her school day was shorter,” wrote one parent of a teen with ADHD.
Among those who increased their child’s ADHD medication dosage or introduced meds for the first time, at-home behavior — namely emotional dysregulation, anger, and outbursts — was commonly cited as a motivating factor.
“Behaviors always prompt us to change their treatments, especially as it pertains to meds,” wrote the parent of First and Third grade students with ADHD. “We saw an increase in quick emotional tantrums, the ones that made us seek medication as a portion of their treatment plans.”
More Changes for Back-to-School Season
As of early August, the treatment landscape for children of ADDitude readers looked like this:
- 65% of children were taking medication
- 49% were managing symptoms with exercise
- 47% were engaging in behavioral therapy
- 41% were taking vitamins and/or supplements
- 19% were engaging in regular mindful meditation
In the coming weeks, that mix will change, as 43% of survey respondents said they plan to make further adjustments to their child’s treatment plan before school starts — in person or otherwise. Of those making treatment changes, two-thirds will be boosting meds — 38% said their child will begin taking medication and 28% said they will increase their child’s medication dosage. Another 13% said their child will be changing medications, but less than 1% said their child would be ceasing ADHD medication anytime soon.
“The med helps him focus — period — so he is better able to comprehend work, complete it, and not become overwhelmed,” wrote one mother of a high school student in Kentucky. “He will also be exercising and/or meditating every day, as that helps his mood, cooperation, and energy level, too.”
“Without medication, my child won’t be able to control his impulses to follow the strict social distancing rules at school,” wrote the parent of a Second grade student with ADHD.
Many other parents said they will delay any decisions until they can observe their child learning at home or in a hybrid model for a few weeks. Treatment is just one of many moving parts for families this academic year.
“I’m hoping to not need to restart meds, but unfortunately I do not feel my son will be able to learn half in school and half online without meds, based on his behaviors,” wrote the parent of a high school student with ADHD in New York. “I will certainly try first before restarting meds.”
“Once school resumes (distance learning for now) and we have a few weeks under our belt, I hope to reach out to my daughter’s psychiatrist to see what may need to be done,” wrote the parent of a Fifth grade student with ADHD in California. “My daughter has had a growth spurt and her meds may need to be adjusted. I also need to work with her school to put her 504 Plan officially into place, with accounting for distance learning concerns, if any. We still don’t know what the expectations are and how the schedule will look.”
As with all things these days, flexibility is both essential and exhausting.
ADHD Telehealth and Medication Changes: Next Steps
- Read: Can You Stock Up on ADHD Medication During a Crisis?
- Read: How Online Therapy Helps Soothe the ADHD Mind and Soul During This Pandemic
- Download: Distance Learning Strategies for Children with ADHD
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