ADHD Therapies

Teletherapy for ADHD is Simplifying Pandemic Life (and Treatment)

The benefits of teletherapy for ADHD are numerous; it increases access to specialists and simplifies logistics to support clearer communication between patients and health-care providers. Read below to learn how adults, teens, and kids are getting evaluated, treated, and coached during the pandemic.

Vector illustration in flat  simple style - online psychological help and support service - psychologist and her patient having video call using modern technology app. Counseling therapy, depression and stress management
Vector illustration in flat simple style - online psychological help and support service - psychologist and her patient having video call using modern technology app. Counseling therapy, depression and stress management

Good health care relies on effective communication. Communication improves medical outcomes, raises patient satisfaction, and reduces provider burnout. In treating ADHD, telemedicine can increase access to specialists and shepherd clearer communication between patients and health-care providers.

Telehealth advantages may be even stronger for mental health treatment, perhaps due to better continuity and the comfort and convenience of being seen at home. According to Stephanie Sarkis, Ph.D., a clinical specialist in child and adolescent counseling, teletherapy benefits her patients. “There is evidence that cognitive-behavioral (CBT) teletherapy is just as effective as in-person therapy. For the treatment of depression, studies showed that CBT teletherapy was more effective than in-person therapy.”

In any situation, a patient should have the opportunity to communicate with a provider who listens well and asks appropriate follow-up questions. In the fields of child development and psychology, clinical care depends largely on observation and discussion, not physical examination. Effective supports rely not on a single office visit but on trusting your provider and feeling he or she understands your daily life.

Teletherapy for ADHD Evaluation

For the treatment and evaluation of ADHD, telemedicine can simplify the process through the follow-up stage. For both adult and childhood ADHD, your intention should be to share openly with someone who takes time to understand. When preparing for an ADHD evaluation, make notes about your concerns and collect information from teachers or therapists who might have something useful to add.

There is still no single test for ADHD, and symptoms are not always observed during an office visit. Diagnosis relies on clinical observation, discussion, and outside materials — like report cards and educational testing, and rating scales. Most patients do not require a full medical or neuropsychological evaluation. Evidence-based diagnosis comes from multiple reporters confirming symptoms, which is manageable online in most situations.

Of course, not everything that can be observed in person is observable online, and an initial evaluation should rule out medical conditions that mimic ADHD. Once again, however, that evaluation is largely based on medical history. Monitoring ADHD medication is also recommended, yet medical risk to ADHD patients is low. Periodic in-person sessions are ideal, but they can be temporarily deferred in most situations. Well care with your general physician is likely adequate, but you should discuss with your provider what’s most appropriate for you or your family.

[Download This ADHD Medication Tracking Log]

Teletherapy for ADHD: Pediatric Sessions

Parents may have concerns that their children will not engage fully online, or that a provider will miss details over the Internet. But as Ari Tuckman, Psy.D., MBA, an ADHD specialist and author of More Attention, Less Deficit (#CommissionsEarned), says, “It’s been helpful to see some kids at home — they are more themselves than when in some new guy’s office. It gives me a more accurate sense of who they really are.” A child’s behavior may be much worse or much better than usual during an office visit, and while some children have a hard time connecting online, many find it easier.

Diagnostic observations must always be put into the context of real life at home, school, and elsewhere. In-person sessions allow for direct interactions, but online sessions allow a child to engage in their own environment. Each has advantages. Children tend not to see their own ADHD in full, so ADHD diagnosis does not rely on a child giving her own history. A clinician seeks a full understanding of a child’s developmental history and life at home, at school, and with peers largely through parents, teachers, and therapists.

Teletherapy for Monitoring ADHD

Sorting out how ADHD affects life requires conversation and questioning. Monitoring medication requires descriptive feedback, too. Because comprehensive care relies on this kind consistency and talk, follow-up visits are typically effective and easier through telemedicine.

[ADHD in a Pandemic: ADDitude Surveys Its Readers About WFH, Distance Learning, Stress & More]

It can be difficult to get to appointments on time; when someone has ADHD, that logistic gets even harder. As Tuckman adds, with telemedicine “fewer clients are late or miss appointments. There has been more flexibility about scheduling, which has been helpful.” Many parents report that not having to get to the office greatly reduces their stress, too.

When possible, removing tech barriers also facilitates communication. Place lighting behind the computer, not your head. Set the camera at eye level. Use an Internet landline if possible, or stay close to your WiFi source. Shut down any extra programs on your device during the visit.

ADHD care relies on communication and trust. Continuity of care, emotional connection, and sharing details of your life may be simpler through telehealth. Amid our ongoing crisis, health care visits from home may be one small change that makes life easier.

Teletherapy: ADHD Medication Tips

Social distancing has meant cancelled appointments and delays in new diagnoses. At the beginning of the pandemic, those just beginning to explore the diagnosis of ADHD were in a precarious situation. Why? The Haight Act of 2008 restricts the prescription of controlled substances on the Internet if someone hasn’t been previously seen in person by the prescriber.

Studies have found that the diagnosis and treatment of ADHD through telemedicine is as effective as in-person services. Telemedicine is especially helpful for rural and disadvantaged patients. Even before the pandemic, telemedicine had been the fastest-growing means of health-care delivery for mental health patients. Outcomes and patient satisfaction ratings of telemedicine were the same as for in-person care.

When COVID became a national emergency in March 2020, the federal government made changes to telemedicine restrictions and services. It eased the restrictions of needing an initial in-person appointment. It has allowed people to get the support and services they need without an office visit.

What This Means for Prescribing ADHD Medication

Physicians can now prescribe controlled substances, like stimulant medication, without an in-person medical evaluation first. However, medical practitioners must adhere to the standards of the professional guidelines in the state in which they practice.

The Health Insurance Portability and Accountability Act (HIPAA) has been waived. This change allows the use of any video-conferencing modality, including audio only, if that is all that is available, to deliver services.

Some states now require reimbursement for all telemedicine services from in-network physicians at the same rates as for in-person visits. This includes waiving co-pays, deductibles, and co-insurance for medically necessary treatment delivered through telemedicine. To find out if your state has made this change, check with your state’s board of medicine.

Who knows how long all these changes will stay in place. Physicians and patients should stay up-to-date.

Laurie Dupar, PMHNP, RN, PCC

Teletherapy for Teens with ADHD

Telehealth is surprisingly effective for teens. Thanks to texting, gaming, and social media, digital communication feels like a natural way for adolescents to connect with friends and family. This ease with media extends to teletherapy.

There are several benefits of online sessions for teens with ADHD. Electronic appointment reminders cue them to show up on time. They can see you in the comfort of their home. With no pressure to make direct eye contact or to show emotions in an office setting, many kids can be more willing to explore deeper issues.

Online therapy helps them with executive functioning skills and self-esteem issues in real time. There’s a unique digital window into their daily lives that I don’t see in my office. I helped a 13-year-old girl organize her closet as we discussed the best way for her to keep things orderly. I assisted a 16-year-old boy with making a schedule for school via screen-sharing. In addition, we explored options to reduce his anxiety in real time.

Of course, there are also limitations. It’s hard to comfort someone who is crying or is agitated through a screen. Sometimes I have to ask for eye contact, or remind a teen not to multi-task or leave the room to get food.

Online therapy relies on verbal skills: It’s tougher to connect with kids who aren’t talkers. This takes more creativity and planning for the therapist. Sensitivities to sounds and distractions are more pronounced. One tween yelled repeatedly downstairs to her older siblings to be quiet when I couldn’t hear anything. While these interruptions were jarring, we looked at the underlying issues of helplessness and rejection she often feels in her family.

Teletherapy with adolescents offers a unique opportunity to work through behavioral patterns, address emotional issues, and find potent interventions. When you recognize the challenges of being online, and work through them, the end results are usually productive.

Sharon Saline, Psy.D.

Teletherapy for ADHD: Next Steps

Mark Bertin, M.D., is a developmental pediatrician based in Pleasantville, New York. He is the author of How Children Thrive (#CommissionsEarned) and Mindful Parenting for ADHD (#CommissionsEarned) and an assistant professor at New York Medical College.

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