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Expert consensus statement for telepsychiatry and attention-deficit hyperactivity disorder

Published online by Cambridge University Press:  20 May 2024

Jennifer Hong Open the ORCID record for Jennifer Hong [Opens in a new window] ,
Gregory W. Mattingly Open the ORCID record for Gregory W. Mattingly [Opens in a new window] ,
Julie A. Carbray ,
Takesha V. Cooper ,
Robert L. Findling ,
Martin Gignac ,
Paul E. Glaser ,
Frank A. Lopez ,
Vladamir Maletic  and
Roger S. McIntyre Open the ORCID record for Roger S. McIntyre [Opens in a new window]
...Show all authors
Jennifer Hong*
Affiliation:
Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA
Gregory W. Mattingly
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA Midwest Research Group, St Louis, MO, USA
Julie A. Carbray
Affiliation:
Department of Psychiatry and Nursing, University of Illinois at Chicago, Chicago, IL, USA
Takesha V. Cooper
Affiliation:
Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA
Robert L. Findling
Affiliation:
Department of Psychiatry, Virginia Commonwealth University, Richmond, VA, USA
Martin Gignac
Affiliation:
Department of Psychiatry, McGill University, Montréal, QC, Canada
Paul E. Glaser
Affiliation:
Department of Psychiatry, Washington University School of Medicine, St Louis, MO, USA
Frank A. Lopez
Affiliation:
Department of Pediatric Neurology and Epilepsy Research Center, Winter Park, FL, USA
Vladamir Maletic
Affiliation:
Department of Psychiatry, University of South Carolina, Greenville, SC, USA
Roger S. McIntyre
Affiliation:
Department of Psychiatry, University of Toronto, Toronto, ON, Canada
Adelaide S. Robb
Affiliation:
Department of Psychiatry and Behavioral Science Children’s National Hospital, Washington, DC, USA
Manpreet K. Singh
Affiliation:
Department of Psychiatry, Stanford University, Palo Alto, CA, USA
Mark A. Stein
Affiliation:
Department of Psychiatry and Pediatrics, University of Washington, Seattle, WA, USA
Stephen M. Stahl
Affiliation:
Department of Psychiatry and Neuroscience, University of California Riverside, Riverside, CA, USA Department of Psychiatry, University of California San Diego, San Diego, CA, USA
*
Corresponding author: Jennifer Hong; Email: jenniferhong95@gmail.com
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Abstract

Changing practice patterns caused by the pandemic have created an urgent need for guidance in prescribing stimulants using telepsychiatry for attention-deficit hyperactivity disorder (ADHD). A notable spike in the prescribing of stimulants accompanied the suspension of the Ryan Haight Act, allowing the prescribing of stimulants without a face-to-face meeting. Competing forces both for and against prescribing ADHD stimulants by telepsychiatry have emerged, requiring guidelines to balance these factors. On the one hand, factors weighing in favor of increasing the availability of treatment for ADHD via telepsychiatry include enhanced access to care, reduction in the large number of untreated cases, and prevention of the known adverse outcomes of untreated ADHD. On the other hand, factors in favor of limiting telepsychiatry for ADHD include mitigating the possibility of exploiting telepsychiatry for profit or for misuse, abuse, and diversion of stimulants. This Expert Consensus Group has developed numerous specific guidelines and advocates for some flexibility in allowing telepsychiatry evaluations and treatment without an in-person evaluation to continue. These guidelines also recognize the need to give greater scrutiny to certain subpopulations, such as young adults without a prior diagnosis or treatment of ADHD who request immediate-release stimulants, which should increase the suspicion of possible medication diversion, misuse, or abuse. In such cases, nonstimulants, controlled-release stimulants, or psychosocial interventions should be prioritized. We encourage the use of outside informants to support the history, the use of rating scales, and having access to a hybrid model of both in-person and remote treatment.

Keywords

Attention-deficit hyperactivity disorderADHDtelehealthguidelinestimulantnonstimulantFDADEAmedicationpsychiatry

Information

Type
Guidelines
Information
CNS Spectrums , Volume 29 , Issue 5 , October 2024 , pp. 451 - 462
Copyright
© The Author(s), 2024. Published by Cambridge University Press

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References

Winkler, R. DEA pressed ADHD-drug makers about impact of telehealth firms on surging demand. Available at: https://www.wsj.com/articles/dea-pressed-adhd-drug-makers-about-impact-of-telehealth-firms-on-surging-demand-11672500036.Google Scholar
Galvin, E, Desselle, S, Gavin, B, et al. Patient and provider perspectives of the implementation of remote consultations for community-dwelling people with mental health conditions: a systematic mixed studies review. J Psychiatr Res. 2022;156:668–678. doi:10.1016/j.jpsychires.2022.10.051.CrossRefGoogle ScholarPubMed
Danielson, ML, Bohm, MK, Newsome, K, et al. Trends in stimulant prescription fills among commercially insured children and adults — United States, 2016–2021. MMWR Morb Mortal Wkly Rep. 2023;72:327–332. doi:10.15585/mmwr.mm7213a1.CrossRefGoogle ScholarPubMed
Olfson, M, Wall, MM, Wang, S, Laje, G, Blanco, C. Treatment of US children with attention-deficit/hyperactivity disorder in the adolescent brain cognitive development study. JAMA Network Open. 2023;6(4):e2310999. doi:10.1001/jamanetworkopen.2023.10999.CrossRefGoogle ScholarPubMed
Kessler, RC, Adler, L, Barkley, R, et al. The prevalence and correlates of adult ADHD in the United States: results from the National Comorbidity Survey Replication. Am J Psychiatry. 2006;163(4):716–723.CrossRefGoogle ScholarPubMed
FDA announces shortage of Adderall. United States Food and Drug Administration; 2022 October 12. Available at: https://www.fda.gov/drugs/drug-safety-and-availability/fda-announces-shortage-adderall.Google Scholar
Sibley, MH, Faraone, SV, Nigg, JT, Surman, CBH. Sudden increases in US Stimulant prescribing: alarming or not? J Attention Dis. 2023;27:571–574. doi:10.1177/10879547231164155.CrossRefGoogle ScholarPubMed
Brumbaugh, S, Tuan, WJ, Scott, A, Latronica, JR, Bone, C. Trends in characteristics of the recipients of new prescription stimulants between years 2010 and 2020 in the United States: an observational cohort study. EClin Med. 2022;50:101524. doi:10.1016/j.eclinm.2022.101524.Google ScholarPubMed
Califf, R, Milgram, A. Food and Drug Administration; 2023 August 1. Available at: https://www.fda.gov/media/170736/download?attachment.Google Scholar
Wolraich, ML, Hagan, JF, Allan, C, et al. Clinical practice guideline for the diagnosis, evaluation, and treatment of attention-deficit/hyperactivity disorder in children and adolescents. Pediatrics. 2019;144(4):e20192528.CrossRefGoogle ScholarPubMed
Australian evidence based clinical practice guideline for attention deficit hyperactivity disorder (ADHD). Available at: https://adhdguideline.aadpa.com.au/wp-content/uploads/2022/10/ADHD-Clinical-Practice-Guide-041022.pdf.Google Scholar
CADDRA-Canadian ADHD Resource Alliance. Canadian ADHD Practice Guidelines, Vol. 4, 1st edn. Toronto, ON: CADDRA; 2020.Google Scholar
Bond, DJ, Hadjipavlou, G, Lam, RW, McIntyre, RS, Beaulieu, S, Schaffer, A, Weiss, M; Canadian Network for Mood and Anxiety Treatments (CANMAT) Task Force . The Canadian Network for Mood and Anxiety Treatments (CANMAT) task force recommendations for the management of patients with mood disorders and comorbid attention-deficit/hyperactivity disorder. Ann Clin Psychiatry. 2012;24(1):23–37.Google Scholar
Faraone, SV, Banaschewski, T, Coghill, D, et al. The World Federation of ADHD International Consensus Statement: 208 evidence-based conclusions about the disorder. Neurosci Biobehav Rev. 2021;128:789–818. doi:10.1016/j.neubiorev.2021.01.022.CrossRefGoogle ScholarPubMed
National Institute for Health Care Excellence (NICE). Attention deficit hyperactivity disorder: diagnosis and management (NG87). Available at: www.nice.org.uk/guidance/ng87.Google Scholar
SAMHSA advisory adults with attention deficit hyperactivity disorder and substance use disorders. Available at: https://store.samhsa.gov/sites/default/files/d7/priv/sma15-4925.pdf.Google Scholar
Barbaresi, WJ, Campbell, L, Diekroger, EA, et al. Society for developmental and behavioral pediatrics clinical practice guideline for the assessment and treatment of children and adolescents with complex attention-deficit/hyperactivity disorder. J Dev Behav Pediatr. 2020;41(Suppl 2S):S35–S57. doi:10.1097/DBP.0000000000000770.CrossRefGoogle ScholarPubMed
Sibley, M, Childress, A. Why we need U.S. guidelines for adults with ADHD. IBCCES learning community. Available at: https://ibcces.org/learning/why-we-need-u-s-guidelines-for-adults-with-adhd/.Google Scholar
Cortese, S, Asherson, P, Sonuga-Barke, E, et al. ADHD management during the COVID-19 pandemic: guidance from the European ADHD Guidelines Group. Lancet Child Adolesc Health. 2020;4(6):412–414. doi:10.1016/S2352-4642(20)30110-3.CrossRefGoogle ScholarPubMed
McAlister, B. American Professional Society of ADHD and Related Disorders (APSARD). The first U.S. guidelines for adult ADHD to be released by the American Professional Society of ADHD and Related Disorders (APSARD.org). 2022 August 23. Available at: https://apsard.org/us-guidelines-for-adults-with-adhd/.Google Scholar
Faraone, SV, Rostain, AL, Montano, CB, Mason, O, Antshel, KM, Newcorn, JH. Systematic review: nonmedical use of prescription stimulants: risk factors, outcomes, and risk reduction strategies. J Am Acad Child Adolesc Psychiatry. 2020;59(1):100–112. doi:10.1016/j.jaac.2019.06.012.CrossRefGoogle ScholarPubMed
Faraone, SV, Hess, J, Wilens, T. Prevalence and consequences of the nonmedical use of amphetamine among persons calling poison control centers. J Atten Disord. 2019;23(11):1219–1228. doi:10.1177/1087054719843182.CrossRefGoogle ScholarPubMed
McCabe, SE, West, BT, Teter, CJ, Boyd, CJ. Trends in medical use, diversion, and nonmedical use of prescription medications among college students from 2003 to 2013: connecting the dots. Addict Behav. 2014:39(7), 1176–1182. doi:10.1016/j.addbeh.2014.03.008.CrossRefGoogle ScholarPubMed
Sollman, MJ, Ranseen, JD, Berry, DT. Detection of feigned ADHD in college students. Psychol Assess. 2010;22(2):325. doi:10.1037/a0018857.CrossRefGoogle ScholarPubMed
Musso, MW, Gouvier, WD. “Why is this so hard?” A review of detection of malingered ADHD in college students. J Atten Disord. 2014;18(3):186–201. doi:10.1177/1087054712441970.CrossRefGoogle ScholarPubMed
Wilens, TE, Adler, LA, Adams, J, et al. Misuse and diversion of stimulants prescribed for ADHD: a systematic review of the literature. J Am Acad Child Adolesc Psychiatry. 2008;47(1):21–31.CrossRefGoogle ScholarPubMed
Massuti, R, Moreira-Maia, CR, Campani, F, Sônego, M, Amaro, J, Akutagava-Martins, GC, Tessari, L, Polanczyk, GV, Cortese, S, Rohde, LA. Assessing undertreatment and overtreatment/misuse of ADHD medications in children and adolescents across continents: a systematic review and meta-analysis. Neurosci Biobehav Rev. 2021;128:64–73. doi:10.1016/j.neubiorev.2021.06.001.CrossRefGoogle ScholarPubMed
McCabe, SE, Schulenberg, JE, Wilens, TE, Schepis, TS, McCabe, VV, Veliz, PT. Prescription stimulant medical and nonmedical use among US secondary school students, 2005 to 2020. JAMA Network Open. 2023;6(4):e238707. doi:10.1001/jamanetworkopen.2023.8707.CrossRefGoogle ScholarPubMed
Desantis, A, Noar, SM, Webb, EM. Nonmedical ADHD stimulant use in fraternities. J Stud Alcohol Drugs. 2009;70(6):952–954. doi:10.15288/jsad.2009.70.952.CrossRefGoogle ScholarPubMed
Kruse, CS, Kindred, B, Brar, S, Gutierrez, G, Cormier, K. Health information technology and doctor shopping: a systematic review. Healthcare (Basel). 2020;8(3):306. doi:10.3390/healthcare8030306.CrossRefGoogle ScholarPubMed
Rolison, MJ, Bloch, MH. Revisiting best practices: a reflection on the online evaluation and treatment of ADHD and implications for future practice. Child Adolesc Psychiatry Ment Health. 2023;17(1):43. doi:10.1186/s13034-023-00593-z.CrossRefGoogle ScholarPubMed
Faraone, SV, Glatt, SJ. A comparison of the efficacy of medications for adult attention-deficit/hyperactivity disorder using meta-analysis of effect sizes. J Clin Psychiatry. 2010;71(6):754–763.CrossRefGoogle ScholarPubMed
Wigal, SB. Efficacy and safety limitations of attention-deficit hyperactivity disorder pharmacotherapy in children and adults. CNS Drugs. 2009;23(Suppl 1):21–31.CrossRefGoogle ScholarPubMed
Yeung, A, Ng, E, Abi-Jaoude, E. TikTok and attention-deficit/hyperactivity disorder: a cross-sectional study of social media content quality. Can J Psychiatry. 2022;67(12):899–906.CrossRefGoogle ScholarPubMed
Second temporary extension of COVID-19 telemedicine flexibilities for prescription of controlled medications. Federal Register: The Daily Journal of the United States Government, 2023. Available at: https://www.federalregister.gov/documents/2023/10/10/2023-22406/second-temporary-extension-of-covid-19-telemedicine-flexibilities-for-prescription-of-controlled.Google Scholar
Vander Stoep, A, McCarty, CA, Zhou, C, Rockhill, CM, Schoenfelder, EN, Myers, K. The children’s attention-deficit hyperactivity disorder telemental health treatment study: caregiver outcomes. J Abnorm Child Psychol. 2017;45(1):27–43. doi:10.1007/s10802-016-0155-7.CrossRefGoogle ScholarPubMed
Vander Stoep, A, Myers, K. Methodology for conducting the children’s attention-deficit hyperactivity disorder telemental health treatment study in multiple underserved communities. Clin Trials. 2013;10(6):949–958. doi:10.1177/1740774513494880.CrossRefGoogle ScholarPubMed
Myers, K, Vander Stoep, A, Zhou, C, McCarty, CA, Katon, W. Effectiveness of a telehealth service delivery model for treating attention-deficit/hyperactivity disorder: a community-based randomized controlled trial. J Am Acad Child Adolesc Psychiatry. 2015;54(4):263–274. doi:10.1016/j.jaac.2015.01.009.CrossRefGoogle ScholarPubMed
Sibley, MH, Comer, JS, Gonzalez, J. Delivering parent-teen therapy for ADHD through videoconferencing: a preliminary investigation. J Psychopathol Behav Assess. 2017;39(3):467–485. doi:10.1007/s10862-017-9598-6da.CrossRefGoogle ScholarPubMed
Biederman, J, Fried, R, DiSalvo, M, et al. A novel digital health intervention to improve patient engagement to stimulants in adult ADHD in the primary care setting: preliminary findings from an open label study. Psychiatry Res. 2020;291:113158. doi:10.1016/j.psychres.2020.113158.CrossRefGoogle ScholarPubMed
Fried, R, DiSalvo, M, Kelberman, C, et al. An innovative SMS intervention to improve adherence to stimulants in children with ADHD: preliminary findings. J Psychopharmacol. 2020;34(8):883–890. doi:10.1177/0269881120908014.CrossRefGoogle ScholarPubMed
Bemanalizadeh, M, Yazdi, M, Yaghini, O, Kelishadi, R. A meta-analysis on the effect of telemedicine on the management of attention deficit and hyperactivity disorder in children and adolescents. J Telemed Telecare. 2021;11:1357633X211045186. doi:10.1177/1357633X211045186.Google Scholar
Shaw, P, Stringaris, A, Nigg, J, Leibenluft, E. Emotion dysregulation in attention deficit hyperactivity disorder. Am J Psychiatry. 2014;171(3):276–293. doi:10.1176/appi.ajp.2013.13070966.CrossRefGoogle ScholarPubMed
Antshel, KM, Zhang-James, Y, Faraone, SV. The comorbidity of ADHD and autism spectrum disorder. Expert Rev Neurother. 2013;13(10):1117–1128.CrossRefGoogle ScholarPubMed
Bélanger, SA, Andrews, D, Gray, C, Korczak, D. ADHD in children and youth: part 1—Etiology, diagnosis, and comorbidity. Paediatr Child Health. 2018;23(7):447–453. doi:10.1093/pch/pxy109.CrossRefGoogle ScholarPubMed
Owens, EB, Hinshaw, SP. Adolescent mediators of unplanned pregnancy among women with and without childhood ADHD. J Clin Child Adolesc Psychol. 2020;49(2):229–238. doi:10.1080/15374416.2018.1547970.CrossRefGoogle ScholarPubMed
Chang, Z, Ghirardi, L, Quinn, PD, Asherson, P, D’Onofrio, BM, Larsson, H. Risks and benefits of attention-deficit/hyperactivity disorder medication on behavioral and neuropsychiatric outcomes: a qualitative review of pharmacoepidemiology studies using linked prescription databases. Biol Psychiatry. 2019;86(5):335–343. doi:10.1016/j.biopsych.2019.04.009.CrossRefGoogle ScholarPubMed
Sundquist, J, Ohlsson, H, Sundquist, K, Kendler, KS. Attention-deficit/hyperactivity disorder and risk for drug use disorder: a population-based follow-up and co-relative study. Psychol Med. 2015;45(5):977–983. doi:10.1017/S0033291714001986.CrossRefGoogle ScholarPubMed
Dalsgaard, S, Østergaard, SD, Leckman, JF, et al. Mortality in children, adolescents, and adults with attention deficit hyperactivity disorder: a nationwide cohort study. Lancet. 2015;385(9983):2190–2196.CrossRefGoogle ScholarPubMed
Sun, S, Kuja-Halkola, R, Faraone, SV, D’Onofrio, BM, Dalsgaard, S, Chang, Z, Larsson, H. Association of psychiatric comorbidity with the risk of premature death among children and adults with attention-deficit/hyperactivity disorder. JAMA Psychiatry. 2019;76(11):1141–1149. doi:10.1001/jamapsychiatry.2019.1944.CrossRefGoogle ScholarPubMed
Dalsgaard, S, et al. Effect of drugs on the risk of injuries in children with attention deficit hyperactivity disorder: a prospective cohort study. Lancet Psychiatry. 2015;2(8):702–709.CrossRefGoogle ScholarPubMed
Fitzgerald, C, Dalsgaard, S, Nordentoft, M, Erlangsen, A. Suicidal behaviour among persons with attention-deficit hyperactivity disorder. Br J Psychiatry. 2019;215(4):615–620.CrossRefGoogle Scholar
Barkley, RA, Murphy, KR, Fischer, M. ADHD in Adults: What the Science Says. New York: Guilford Press; 2010.Google Scholar
Bihlar, MB, Jokinen, J, Bolte, S, et al. Long-term outcomes of pharmacologically treated versus non-treated adults with ADHD and substance use disorder: a naturalistic study. J Subst Abuse Treat. 2015;51:82–90.CrossRefGoogle Scholar
Chang, Z, et al. Association between medications use for attention-deficit/hyperactivity disorder and risk of motor vehicle accidents. JAMA Psychiatry. 2019;74(6):597–603.CrossRefGoogle Scholar
Chen, MH, Pan, TL, Hsu, JW, et al. Attention-deficit hyperactivity disorder comorbidity and antidepressant resistance among patients with major depression: a nationwide longitudinal study. Eur Neuropsychopharmacol. 2023 May 1. doi:10.1016/j.euroneuro.2016.09.369.Google Scholar
Lichtenstein, P, Halldner, L, Zetterqvist, J, et al. Medication for attention deficit-hyperactivity disorder and criminality. N Engl J Med. 2012;367(21):2006–2014.CrossRefGoogle ScholarPubMed