ADHD
Although a new diagnosis of ADHD and initiation of medication regimen require important components from an in-person visit, the follow up of existing ADHD and medication titration can occur via telehealth.
Treatment is based on 4 primary modalities:
- Behavioral therapy (counseling)
- Educational program
- Lifestyle (diet, sleep, screen time)
- Medication
Suggested format for follow up visit:
- Date of initial ADHD diagnosis and type (inattentive, hyperactive/impulsive, combined)
- Current medications
- ADHD medications used previously
- Date of starting medication or last medication change
- Medication side effects, concerns
- Progress since last visit (consider use of follow up Vanderbilt scales)
- Nutrition/activity
- Focus on concerns around weight or reduced appetite (if on stimulant medications)
- Caffeine intake
- Physical activity
- Screen Time
- School information
- Did patient have an individualized educational plan (IEP) in place?
- Obstacles to obtaining services through school during COVID-19 and hybrid learning modules?
- Review histories
- Past medical history and comorbid conditions
- Family history, including ADHD, psychiatric illnesses, substance abuse, and cardiac conditions
- Sleep concerns
- Conduct virtual exam
- Determine follow up plan, prescribe refills/titrate medication and consider referrals
Resources:
- Healthy Children.org ADHD. https://www.healthychildren.org/English/health-issues/conditions/adhd/Pages/default.aspx
- Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHADD). https://chadd.org/for-parents/overview/
- National Alliance on Mental Illness, with ADHD subpage. https://www.nami.org/About-Mental-Illness/Mental-Health-Conditions/ADHD/Support
References:
- AAP Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents (2019).
- Overview of the ADHD Care Process: https://www.aap.org/en-us/pubserv/adhd2/Pages/kit/data/papers/ADHD_algorithm.pdf
- AAP Caring for Children with ADHD: A Resource Toolkit for Clinicians, 2ndEdition. https://www.aap.org/en-us/pubserv/adhd2/Pages/default.aspx
By: Pooja Kakar MD
Last updated: January 2021