How Telepsychiatry Has Met The Need For ADHD Treatment

The attention-deficit/hyperactivity disorder (ADHD) diagnoses rate has been rising in the U.S. over the past decade. Social media platforms, most recently TikTok, have begun increasing public awareness of ADHD symptoms. But the impact of the COVID-19 pandemic encouraged providers and their patients to take a much closer look. 

Adults became more aware of their own attention span, motivation and organizational systems with the loss of certain external factors; in-person work, lectures and interactions. As children began to learn remotely, parents started to notice firsthand their child’s (or children’s) attention and educational struggles. This encouraged many to seek an ADHD evaluation. 

As COVID-19 precautions were implemented, in-person evaluations were limited. Telepsychiatry was already being used before the pandemic, but grew in popularity as the public was encouraged to quarantine and social distance. This growth in popularity allowed individuals and families to seek the help they needed but previously had limited access to. Now, due to the recent adderall shortage, patients and providers are turning toward more digital therapeutic (DTx) options.  

Note: Not all information on social media is factual or accurate. Check your sources to confirm reliability. 

Adderall shortage

On October 12, 2022, the U.S. Food and Drug Administration (FDA) announced a shortage of the immediate release formulation of amphetamine mixed salts, commonly referred to by the brand name Adderall or Adderall IR. Some manufacturers have stated that delays are due to demand increase or shortage of active ingredients while others have not disclosed a reason. 

Managing the Adderall shortage

The FDA and Drug Enforcement Agency (DEA) are surveying the shortage of the stimulant medication needed and communicating manufacturer supply updates with pharmaceutical companies to keep the public informed. Many of these companies are pushing to increase manufacturing, but this requires regulatory approval from agencies. This has been a very slow process and has affected the quality of patient care. 

The DEA sets the yearly quota for the amount of active ingredients pharmaceutical companies are allocated for Adderall. Additionally, the amounts distributed to each company are based on the previous year’s numbers. During the COVID-19 pandemic, prescriptions for stimulants like Adderall increased, causing the DEA’s quota to be below demand. 

Since amphetamine mixed salt, an active ingredient in Adderall, can be abused and used as a recreational drug, it’s necessary to control the supply. Controlling the supply of a medication with abuse liability must be done without compromising the treatment of patients. Unless the DEA raises the quota limit of Adderall’s active ingredient, the shortage cannot be quickly managed.

However, for the time being, there are alternative psychostimulants including the extended-release version of amphetamine mixed salts and behavioral therapies. 

Is it misdiagnosed or underdiagnosed?

In 2020, adult Adderall prescriptions rose by 15.1%, this was double the increase of the previous year (7.4%). 

With the surge in ADHD diagnosis and increased demand for stimulant medications, there has been much debate as to the cause. Some experts fear it is the result of abuse or misdiagnosis. On the other hand, some experts believe it is due to the previously unmet need for treatment. 

Misdiagnosis

Given changing diagnostic criteria in Diagnostic and Statistical Manual of Mental Disorders (DSM) and increased awareness, there is no surprise that it has become more prevalent. As the criteria develops, the chances of a misdiagnosis increases as discrepancies are worked out. DSM-IV divided the diagnosis into three subcategories: 

• predominantly inattentive

• predominantly hyperactive-impulsive 

• combined type

DSM-V was released in 2013, broadening the definition. One of the key changes is allowing autism spectrum disorder (ASD) to coexist with ADHD. This change added a previously excluded population group, which could be related to the increase in Adderall’s prescription increase. 

Underdiagnosed

ADHD commonly co-occurs with other mental health disorders including anxiety, depression and bipolar disorder to name a few. This makes it common for ADHD to be misdiagnosed as another mental illness. 

With the public becoming increasingly more aware of ADHD, people are more likely to bring up their concerns with a healthcare provider. Historically, the mental illness has been under-diagnosed in both children and adults. This is in part due to ADHD being considered solely a childhood disorder until the 1990’s. Many adults that had ADHD were not diagnosed or treated due to misinformation about the illness 

According to the Centers for Disease Control and Prevention (CDC), approximately 23% of children with ADHD did not receive medical or behavioral treatment. 

ADHD and Therapeutic Care

To combat the Adderall shortage, providers are increasingly turning to more therapeutic means of care for their patients. This idea isn’t new, however. There’s been a push within healthcare in the last few years to reduce the overprescribing of medications by turning to more non-medicated treatments. Telehealth has shown to be a helpful tool in servicing these modes of care, especially in mental health diagnosis like ADHD.

In the treatment of ADHD, psychostimulants undergo ongoing research on the potential of unintended effects of long-term use of stimulant medication on young children. ADHD treatment is a team effort, especially in the care of children. The use of telepsychiatry increases access to specialists and clearer communication between parents, patients and providers, thus decreasing the reliance of medical therapy. 

ADHD is not a mild diagnosis, but a severe neuropsychiatric disorder that inhibits an individual's ability to function in school, work, relationships and self-preservation. As one of the most common neurodevelopment disorders, it is often first diagnosed in childhood. However, some individuals' symptoms may not be apparent until adulthood. 

According to the CDC Vital Signs report, behavioral therapy has shown to be just as effective as medical therapy, without the risk of side effects. Other research has found that the diagnosis and treatment of ADHD through telemedicine is as effective as in-person services, American Psychiatric Association.

Telepsychiatry meets need in ADHD care

Telepsychiatry has eased the barriers to ADHD treatment for unrecognized and untreated cases. Specifically in females, People of Color (POC), rural and underserved areas; due to inaccessibility and it being most prevalent in males. 

Along with medical therapy, psychiatric therapy is just as important in the treatment and management of ADHD symptoms. There is psychotherapy and behavioral therapies that involve symptom management by teaching coping skills and strategies that suit the patient. The combination of medical and psychiatric therapy is often most effective, requiring efficient communication between care teams. 

The popularization of telepsychiatry has given mental health providers the platform to meet ADHD treatment needs while managing their own schedules and workflows. In fact, mental health care is among the fields with the largest adoption of virtual care services, just behind endocrinology and gastroenterology. Certain treatments like psychotherapy, cognitive behavioral therapy and meta-cognitive therapy can be used in telepsychiatry to treat ADHD.  

Psychotherapy

Psychotherapy, AKA talk therapy, involves a combination of exercises that help an individual identify and change emotions, thoughts and behaviors. Psychotherapy may help you:

• Improve time management and organizational skills

• Reduce impulsive behavior

• Develop problem-solving skills

• Cope with past failures

• Improve self-esteem

Cognitive Behavioral Therapy (CBT)

Cognitive behavioral therapy involves teaching skills and strategies to manage an individual's behavior and thoughts. This involves actively changing negative thinking patterns and behavior. By helping them address the issue this can help an individual work through challenges in day-to-day life.

The cognitive component teaches an individual to identify and then change ‘thought errors' or ‘thought distortions’ into positive and constructive thoughts. The behavioral component involves changing the environment for improved concentration, identifying what triggers problem behavior and what reinforces constructive behavior to improve a patient's functionality. 

Meta-Cognitive Therapy

Meta-cognitive therapy involves changing how people think rather than what they think about. The practice involves stepping back from the thought and taking a moment to understand why the thought occurred. Changing an individual's pattern/style of thinking can have a large impact on how they manage their life.  

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