Guidance for the assessment and management of ADHD during the COVID-19 pandemic from the European ADHD Guidelines Group
Dr Maite Ferrin is a leading Consultant Psychiatrist at Re:Cognition Health, with a special interest in ADHD and a member of the European ADHD Guidelines Group (EAGG).
EAGG has recently published guidance for the assessment and management of ADHD during the COVID-19 pandemic. Below, Mr Ferrin shares a summary of the paper:
The increased hygiene measures which have been put in place, social distancing restrictions, lockdown and the uncertainty we are currently experiencing are creating huge difficulties for everybody, however these difficulties and restrictions are exacerbated for individuals with ADHD and for their families.
Indeed, behaviour related to ADHD may become more disorganised and poorly controlled at this time, impacting adversely on requirements for physical distancing and on family dynamics, already severely challenged by the consequences of the COVID-19 virus pandemic.
Diagnosis and follow-up assessments:
Respecting the need for physical distancing, all relevant service provisions should continue via telephone or appropriate online video technology such as Skype or Zoom, in line with current recommendations for the use of telepsychiatry.
Medication management:
It is hoped that regulatory authorities will allow for some flexibility around these measures during the COVID-19 virus crisis to make sure patients receive their medication in a timely manner.
Individuals with ADHD should, if clinically indicated and as recommended in standard national guidelines, be offered the opportunity to start on a pharmacological treatment after completion of the initial assessment or, if already on medication, continue with this as usual.
Increasing dosage of medication or adding additional doses should be avoided. Similarly, the EAGG sees no strong rationale to introduce weekend drug holidays during the current crisis.
Routine cardiovascular clinical examination and face-to-face monitoring of individuals with ADHD who do not have cardiovascular risk factors could be postponed until routine face-to-face visits are restarted.
Pharmacies can experience a delay in sourcing medication during this time. This does not mean that patients and parents should ask for extra prescriptions “just in case”, but this should be planned well in advance before medications are running low, in order to request a new prescription and to get the medication delivered on time.
The importance of behavioural management strategies:
The EAGG recommend the use of behavioural parenting strategies as these are beneficial effects in helping to reduce oppositional, defiant and disruptive behaviour which is common in children and adolescents with ADHD. Parent training can help teach parents strategies on breaking coercive cycles. Self-help versions of parent training are available online whilst face-to-face learning is unavailable.
For adolescents with ADHD, the loss of a daily structure with school, homework, hobbies and friends combine with the stress and anxiety related to the COVID-19 virus and being in constant close proximity to parents and siblings, lockdown can be very difficult to cope with. This can cause disruptions with the day-night rhythm and sleep problems known to be associated with ADHD may occur or worsen. As a result, individuals may experience an increase in depressive and anxiety symptoms and it may lead to severe levels of family conflict.
For parents it is important to understand how difficult these times are for adolescents with ADHD and to be stay connected, be mindful of their feelings and help give structure and support to their daily schedule.
Schools and teachers should try to monitor all their students but especially adolescents with ADHD due to their noted disorganisation and the risks described above.
To read the full article:
ADHD management during the COVID-19 pandemic: guidance from the European ADHD Guidelines Group is available to read: http://dx.doi.org/10.1016/S2352-4642(20)30110-3.
Re:Cognition Health is providing a video consultation service to support individuals with ADHD and their families throughout the COVID-19 pandemic. For further information on this service please visit: https://recognitionhealth.com/videoconsultations/