The Role of Telehealth in Rising ADHD Diagnosis Rates

With the COVID-19 pandemic, telehealth emerged as a crucial tool, allowing remote patient consultations for safety and accessibility. Some argue it also drove the increase in adult ADHD diagnosis.

Psych Congress Network sat down with Lenard A. Adler, MD, director of the Adult ADHD Program at NYU Langone Health, on site at the 2024 APA Annual Meeting in New York City, to hear his thoughts on the relationship between expanded telepsychiatry care and rising adult ADHD diagnosis rates. Dr Adler discusses the benefits and drawbacks of remote evaluation and the challenges surrounding virtual prescribing.

For more expert insights on virtual practice, visit our Telehealth Excellence Forum.

Psych Congress Network: The COVID-19 pandemic and the rise of telepsychiatry have brought both challenges and opportunities to ADHD diagnosis and treatment. Could you discuss how these factors have influenced diagnostic rates, especially in adults, and what strategies clinicians can employ to ensure accurate assessments in virtual settings?

Lenard A. Adler, MD: With the COVID-19 pandemic, telepsychiatry was a wonderful blessing. We were able to throw up a switch. We did it at our institution. It was incredible to be able to start to see patients remotely—it was for safety reasons and we didn't know if it would work, but it did. Having a remote option improves access. It allows someone to be seen who has maybe not been seen previously because they can't come in, because they can't travel a certain distance, for example.

It did create certain challenges though. There are differences in a tele-visit as compared to a regular visit in terms of, you only see what the camera sees and there's a distance that's created by the camera. There's also a blessing in some ways. When I evaluate an adult with ADHD, I'm able to ask them to turn the camera around and let me see their room, and I can actually see their stacks of papers right there, and I can't do that if they're in the office.

But it also does create certain legal issues in terms of requirements for stimulant monitoring. The DEA suspended certain requirements that are now going to be put back into place. This is going to be something to keep in mind for clinicians in terms of monitoring the rules coming out, like the requirement to to see someone face-to-face at least once prior to prescribing a stimulant. So, this is an evolving piece of information that clinicians really need to stay on top of. Those have been suspended for now, but are coming back.

Regarding diagnosis rates, what ended up happening during the pandemic in psychiatry and in general, but also particularly in ADHD, many more people came in for diagnosis. More people were getting treated. Data out of the CDC clearly showed that more people were getting diagnosed and more people were getting treated via telehealth. Whether the evaluations were as thorough as possible—because we tend to do evaluations with rating scales—some of these scales, especially some of the scales we've developed, are usable in the public domain for self-assessment for the patients. They will help you establish a symptom inventory, and we think that's critical.

But in a tele-assessment, you still have to do everything the same. You still have to go through those 4 cardinal areas and establish an accurate diagnosis whether the patient is in front of you or not. That doesn't change. One thing that came out—I think this was presented at the American Professional Society of ADHD and Related Disorders Meeting by the CDC but not published—was that even though diagnostic and treatment rates went up for adults with ADHD, that was not all due to telehealth. Some of that was just due to more adults with ADHD coming into treatment. So, this is an evolving area. There are more adults with ADHD coming in to be diagnosed and treated.

There are still issues with under-diagnosis, even with the increased number of people coming in for diagnosis but this has put pressure on the market and in part contributed to some of the shortage of medication that we've been seeing.

Lenard A. Adler MD, completed his residency and chief residency in Psychiatry at the NYU Grossman School of Medicine, where he has remained on staff since 1986. Dr Adler is a professor of psychiatry and child and adolescent psychiatry. His research and clinical interests center on attention-deficit/hyperactivity disorder (ADHD) in adults, mainly focusing on new assessments and treatments. He serves as vice chair for education in the Department of Psychiatry and director of the Adult ADHD program.  He has published over 150 peer reviewed manuscripts and served previously as the President of American Professional Society of ADHD and Related Disorders.