How Online Therapy Helps Soothe the ADHD Mind and Soul During This Pandemic

Online therapy — a.k.a. teletherapy, telemental health, telepsychology, online counseling, and more — is not new. But it is newly ubiquitous, accessible, and helpful as whole states shutter and order social distancing measures to stem the tide of a pandemic. Today, mental health providers across the spectrum are providing their services online — exclusively and indefinitely.

The transition to digital technology is good news for existing patients stuck at home and for those new to therapy and eager to find help, especially as heightened anxiety, stress, and fear clash with existing conditions like attention deficit hyperactivity disorder (ADHD). Here’s what online therapy looks like, how it can help, and what factors to consider as the treatment landscape changes for adults and children with ADHD.

What is Online Therapy?

Online therapy refers to mental health services provided outside of a traditional office, usually over the Internet using video conferencing on a HIPAA-secure platform. But it doesn’t stop there. Therapists also work with patients on phone calls, e-mails, texts, and newly expanded websites and apps designed to connect users to mental health care providers.

Prior to the pandemic, some mental health professionals used teletherapy to supplement in-person visits, while some worked almost entirely online. Now, the latter is the temporary norm.

Therapy, whether in person or via teletherapy, can help treat neurological and psychological disorders like panic disorder, anxiety, and obsessive compulsive disorder (OCD). Therapists can help their patients better manage stress and cope with life’s many hurdles, including the unique challenges brought about by conditions like ADHD.

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Dr. Maria Zimmitti, president of Georgetown Psychology, a practice with offices in Washington D.C., Maryland, and Virginia, has spent more than 20 years evaluating and treating children, adolescents, and adults with ADHD.

“ADHD treatment is comprehensive,” she said, noting that treatment can and often does extend beyond medication. For many people with ADHD, symptoms like impulsivity, executive dysfunction, and poor focus trigger further problems ranging from low self-esteem, behavioral and interpersonal problems, and mood disorders. Therapy can effectively address many of these problems, making it an important component of ADHD treatment.

Many parents of children with ADHD also benefit from therapy designed to help them better manage their child’s behavior and symptoms. The American Academy of Pediatrics recommends combining medication treatment with behavior therapy for children with ADHD.¹

Teletherapy is a convenient and effective option for many patients — and providers. Zimmitti’s practice, which began offering online therapy years ago, shifted entirely online in a matter of days in response to the outbreak, and continues to provide support for patients who are sheltering in place.

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“Telehealth is now the primary mode that most therapists are working in, which is a drastic change from a couple of weeks ago,” Zimmitti said, noting a recent uptick in anxiety symptoms like stomach aches, worries, and fears about germs among many patients.

“Families are under unexpected, unplanned, and never-before-experienced stress because of this pandemic,” she said.

How Can Online Therapy Help Now?

Though face-to-face therapy is unsafe now, mental health professionals today are largely keeping their “doors” open online, not just to continue caring for existing patients, but to work with first-time patients and parents who need new and timely support.

“Teletherapy support for parents, including parents of children with ADHD, is helpful and can be offered in the form of virtual support groups and online resources,” she said. “Research has shown that training parents in interventions to deal with a child’s ADHD symptoms can be done effectively with teletherapy.”

For patients experiencing extreme stress over the outbreak, Zimmitti said she is focusing on teaching strategies that emphasize social connection and good health habits, and promote self-regulation.

“The first thing we want to do is normalize anxiety,” she said. “Anxiety in and of itself is not a bad thing, and they certainly are in good company; the world is feeling anxious right now.”

Helping children feel in control, especially under uncertain circumstances, is important. Having kids wash their hands frequently and stay at home to promote health is one way to help ease anxiousness. Devising and maintaining a reliable schedule — including adequate sleep, exercise, meal times, and recreation — helps as well.

The social distancing measures widely in effect should not be conflated with social isolation, which can increase the risk for mood disorder, poor sleep quality, and other adverse effects.² Some ideas include:

• Organizing virtual playdates
• Meeting up for coffee over Zoom
• Signing up for online classes in art, yoga, anything
• Video calls with grandparents and other family members

What Does Online Therapy Look Like?

Online therapy retains the structure and goals of in-person sessions. Sessions are conducted from home or another convenient location that is secure, quiet, and private — both for the therapist and the patient. Protecting a patient’s privacy means ensuring that no one else is in the room, and insisting that everyone wear headphones during the session, which may take place using any Internet-enabled device including desktop computer, laptop, tablet, or smartphone.

Most therapists use HIPAA-compliant platforms and technologies for services. Typically, penalties would exist for failing to do so, however enforcement has been temporarily relaxed in light of the public health emergency.³ Non-compliant technologies like FaceTime and Skype, therefore, can be used without risk of penalty with patient consent.

“The biggest issue, I think, is making sure the technology is working,” Zimmitti said. “If it’s not, then that certainly can be frustrating for patients, but typically, once you work out the kinks, it runs very smoothly.”

Online therapy is a convenient, easily accessible way to continue essential care. Some facets of in-person sessions, however, are lost online. “The sessions tend to be more waist-up in terms of how you’re seeing people,” she said. “You’re going to miss some of the non-verbal pieces that you might get otherwise.” That includes knowing when a patient might be looking at their phone during an online session or reading full body language.

Still, the benefits outweigh the minimal downsides. “People show up for appointments more consistently with teletherapy because they don’t have the hassle of all the things that can get in the way,” she said. “It opens up therapy for a lot of people who would struggle to get it otherwise.”

Is Online Therapy Right for You?

Online therapy is effective ⁴ for many patients and practitioners, but it’s not right for everyone. Meanwhile, the pandemic is driving up demand for online therapy and forcing mental health professionals into unchartered territory.

Online therapy is generally not appropriate for someone in crisis, who would benefit more from in-person sessions and other targeted resources. Still, if teletherapy is deemed appropriate for a patient, therapists will develop a crisis plan to use in the event that an emergency arises.

Therapists largely prefer to see new, potential patients in person first and conduct evaluations face-to-face, which is often not possible during the pandemic.

“In-person intakes are optimal,” Zimmitti said. “But given the current situation, initial sessions are being done via videoconferencing, which is why therapists must be especially detailed and include rating scales and structured interviews to assess a client’s symptoms.”

Those interested in teletherapy should reach out to their insurance company to see if the service is covered, or if co-pays have been waived in response to the pandemic; many health insurance providers have temporarily done this ⁵. Fees vary depending on the practice, but rates may be the same for in-person and teletherapy sessions.

Though some states have temporarily lifted their licensing restrictions, allowing out-of-state therapists and clinicians to treat residents, it is recommended that individuals new to therapy look for professionals licensed in their state to ensure continuity of care once the crisis settles.

To find a therapist who specialize in ADHD, these resources may help:

• The ADDitude Directory
• The CHADD Professional Directory
• Psychology Today Therapist Directory

“If you’re having trouble, reach out for help,” Zimmitti said. “Teletherapy is an effective and an appropriate treatment during COVID and beyond.”

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