Advice for health and social care professionals on the support and management of people with ADHD during the COVID-19 crisis.

While we are all having to make very significant adjustments to follow the everchanging rules and restrictions necessary to reduce the spread of the COVID-19 virus, those with ADHD – particularly those with severe symptoms – may find this particularly challenging. We believe that the following guidance applies when treating and supporting people with ADHD during this difficult period. Please contact us if you have and comments or additions to the below.

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Guidance from AAPDA

1

Stay up to date

Clinicians should keep up to date with and follow all national and local guidance.
2

Conduct online ADHD assessments

Assessments for ADHD should continue to be conducted using online video technology. During this period, it may be helpful to consider using a more structured approach to history taking. This can be helpful when adjusting to the new environment and context both for the clinician and the patient. It is helpful to structure the assessment around existing clinical practice guidelines such as those from NICE NG87 (2018)1 or the AAP (2019)2. It is essential to check that both the patient/family and the clinician feel that they have a private space to take the video call (for more details see Medical Board of Australia3 and RANZCP4 guidelines on telehealth).
3

Continue with medication as usual

Those with ADHD should continue to take their medications as usual. A failure to continue with an effective medication regime is likely to increase the health risks to the patient, their families and the general public. If ADHD symptoms and associated behaviours become less well-controlled, it will be more difficult to comply with the requirements for physical distancing. Increased impulsivity and overactivity are also likely to increase tensions within households who are already managing a complex and often challenging situation.
4

Avoid increasing or adding additional doses

Parents of children with ADHD and adults with ADHD should avoid increasing doses or adding additional doses (beyond those prescribed) to manage crisis/stress related to confinement. Parents should continue implementing behavioural strategies recommended for disruptive/challenging behaviours in children with ADHD (5).
5

Conduct routine clinical assessments via telehealth

Routine clinical assessments should continue using appropriate video or telephone technologies and following appropriate local and national guidance and best practice advice. As with assessments, many clinicians find the use of structured approaches to monitoring helpful when conducting telehealth. An example of a structured approach to monitoring ADHD has been described by Coghill and Seth (6) with sample protocols also available online (http://bit.ly/1Jme79g).
6

Postpone face-to-face C/V assessments

Routine face-to-face height and weight and cardiovascular (CV) assessments and monitoring for people with ADHD without any pre-existing difficulties or cardiovascular risk factors should be postponed until face-to-face clinical appointments are resumed. Currently, the risks of measuring face-to-face C/V assessments with these patients outweigh the benefits. We do however recommend home monitoring of blood pressure, pulse and weight whenever possible using home Blood Pressure machines (see below).
7

Support working from home

Those with ADHD may find working from home particularly challenging and anxiety-provoking. There are now several helpful web pages giving advice (e.g. https://www.additudemag.com/working-from-home-adhd) and ADHD coaching and ADHD support organizations and user groups and communities will be particularly important in this respect.
8

Continue ADHD medication if COVID-19 develops

If a person with ADHD does test positive for the COVID-19 virus or develops COVID-19 they do not need to stop taking their ADHD medication and there are likely to be advantages associated with the continued reduction in impulsivity and hyperactivity. However, they may need to consider reducing or stopping ADHD medications if they experience severe symptoms such as increased blood pressure, pulse or breathing difficulties. Clinicians should be prepared to discuss the risk-benefit balance with treating physicians.

The Raising Children Network

The advice about how best to manage our lives during this difficult times is evolving rapidly and this is reflected in the changes in the rules and restrictions placed on our movement and behaviour. The Raising Children Network has prepared helpful advice for parents about how we can support the children of Australia through the crisis and it may be helpful to refer parents to their website which also contains helpful more general information about managing ADHD in children and teens.

Advice On Home Monitoring

Patients could be encouraged to purchase a home Blood Pressure machine and be guided through using it including:

  • Taking the BP a few days after starting a new drug / dose
  • Taking the BP at least 2 hours after taking a dose
  • Sitting down for 10-15 minutes before taking the reading
  • Taking the reading on the left arm
  • Taking the lowest of 3 readings
  • At the same time capturing the pulse

Readings can then be communicated to the clinic, and advice on next steps can then be provided by the clinician.

Resources

  1. NICE. Attention deficit hyperactivity disorder: diagnosis and management; NICE guideline [NG87]. 2018.
  2. Wolraich ML, Hagan JF, Jr., 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).
  3. MBA. Technology-based patient consultations. Medical Board of Australia. Published 2012. Accessed 30/03/2020.
  4. RANZCP. Professional Practice Standards and Guides for Telepsychiatry. Royal Australian New Zealand College of Psychiatrists. Published 2013. Accessed 30/03/2020.
  5. Daley D, Van Der Oord S, Ferrin M, et al. Practitioner Review: Current best practice in the use of parent training and other behavioural interventions in the treatment of children and adolescents with attention deficit hyperactivity disorder. Journal of child psychology and psychiatry, and allied disciplines. 2017.
  6. Coghill D, Seth S. Effective management of attention-deficit/hyperactivity disorder (ADHD) through structured re-assessment: the Dundee ADHD Clinical Care Pathway. Child and adolescent psychiatry and mental health. 2015;9:52.
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