Screening for ADHD via Telehealth

In this video, Craig Chepke, MD, DFAPA, co-chair of Psych Congress Elevate 2023, shares his thoughts on screening for, diagnosing, and treating attention-deficit/hyperactivity disorder (ADHD) via telehealth.

While a virtual platform presents it’s own unique challenges, Dr Chepke emphasizes the importance of offering patients care in whatever format works best for them. While recognizing potential difficulties in diagnosing milder cases, he emphasizes balancing the risk of underdiagnosis and over-diagnosis and stresses the clinical imperative to pursue ADHD diagnoses diligently, even in telemedicine.

For more expert insights on applying telehealth to psychiatry practice, visit our Teleheath Excellence Forum.

To register for Psych Congress Elevate 2023, held in Las Vegas from May 30 to June 2, visit the meeting website.

Read the Transcript

Psych Congress Network: Can clinicians evaluate ADHD on a telehealth platform? What are the best practices for doing so?

Craig Chepke, MD, DFAPA: We're well over 3 years into the COVID-19 pandemic and still many of us--I'd say most of us—are still doing a lot of telemedicine. It's something that's not going to go away, we're going to have hybrid practices. So the question is, what about ADHD? Can we evaluate for ADHD over a telehealth platform?

I would say the answer is, "Yes." Number one, we can't not evaluate our patients through telehealth. As I said, "It's not going away." And for reasons of equitable access, it really shouldn't go away. There are people who live in areas where there may not be a mental health provider for hours and hundreds of miles. So, they would have actual no access to care if they didn't have telehealth. So we have to figure out ways of making all diagnoses over telehealth.

With a telepsych connection, sometimes it might make it a little bit easier because when people are in our office, especially if they have maybe what might be considered more mild forms of ADHD, then there's not as many distractions for them that they would normally consider... Especially if you've got a boring office, maybe I do, that they're not going to be tempted as much to be distracted. But when they're at home, number one, they're on the computer, they could be clicking through other stuff, there could be other noises going on, which we often control for, in our clinical settings. There could be other people around, where you might see some of that come out more than you would if it were in your office. And then if it's someone with more severe ADHD that we would've caught in person, well it might make it even easier to see there because they might not even stay at the computer, if they've got severe ADHD.

Where I think sometimes for me it's harder, is in the middle, where it's kind of questionable, that is this ADHD or is this the consequence of a mood or anxiety disorder? Because, while I mentioned, that maybe it might be ADHD that causes people to multitask on the computer, it's not only ADHD, it's just such a difficult temptation I think, for everybody. So it could get muddy with many cases, but we need to continue to assess and make those diagnoses and not deny treatment and diagnosis to people who need it, because ADHD is a very serious condition. It's not just something mild, not something that kids just always grow out of. There are very profound consequences to ADHD, especially in adulthood. Think about driving. Driving is all about impulse control. ADHD is not just about the ability to sustain attention—impulse control dysregulation is a huge critical factor of it. If you're trying to decide if you're going to make a left turn across traffic to beat the yellow light, then before it turns red, you've got a split second to decide, "Do I go, or do I just wait for the next one?" That could be the difference between a car accident and not. In fact, there are some pretty famous studies that have shown that using the same people as their controls, that once that they... These are with adults, once these adults took their ADAH medication, they were statistically significantly less likely to have motor vehicle accidents, than when they did not take their ADHD medication. So this is something that could be profoundly impairing to their lives, to their health, their relationships, their employment, their educational attainment, so we do need to take ADHD and adults seriously and make the correct diagnosis.

We don't want to underdiagnose and we don't want to over-diagnose, but if we suspect it, whether in person or through telemedicine, it is our duty to pursue it and do what it takes to make that diagnosis. One thing that could maybe even help with telemedicine is getting a collateral informant. Because while often our adult patients might come to the office by themselves, at home, maybe one of their parents is around, their spouse, a sibling, someone else you can ask and get a second opinion, because that is almost always one of the best ways to really be clear about that diagnosis, because the people around the person with ADHD often can give us a much clearer picture of what that person is actually experiencing on a day-to-day basis.

Craig Chepke, MD, DFAPA, is a Board-Certified psychiatrist and a Distinguished Fellow of the American Psychiatric Association. Dr Chepke is the medical director of Excel Psychiatric Associates in Huntersville, NC as well as an Adjunct Associate Professor of Psychiatry for Atrium Health. As part of an interdisciplinary treatment team, he employs a person-centered care model to tailor treatments to each individual's needs, integrating traditional pharmacotherapy with psychotherapeutic and physical health and wellness interventions.