How Can ADHD Be Diagnosed Remotely During the COVID-19 Pandemic?

What you need to know

• Remote ADHD assessments became necessary during the COVID-19 pandemic to continue providing care while minimizing in-person contact
• With appropriate adaptations, the core components of ADHD assessment can be completed remotely in many cases
• Remote assessments have both advantages and limitations compared to in-person evaluations
• A hybrid model combining remote and in-person elements may be optimal for many patients going forward

How the COVID-19 pandemic impacted ADHD care

The COVID-19 pandemic disrupted many aspects of healthcare, including assessments and treatment for attention-deficit/hyperactivity disorder (ADHD). To reduce viral spread, many ADHD services quickly pivoted to remote care using phone and video appointments. This allowed care to continue but required significant changes to usual clinical practices.

For children and adolescents with ADHD, the pandemic brought unique challenges. School closures, lockdowns, and other restrictions disrupted routines and reduced typical social interactions. Some studies found increases in ADHD symptoms and behavioral problems during lockdowns, especially for younger children. However, the impacts varied, with some youth actually showing improvements in certain areas.

Core components of ADHD assessment

A comprehensive ADHD assessment typically includes several key elements:

1. Detailed history-taking from parents/caregivers about the child’s development, current symptoms, and medical/family history
2. Information from teachers or other observers about symptoms in different settings
3. Direct interview and observation of the child/adolescent
4. Consideration of other possible diagnoses or co-occurring conditions
5. Evaluation of how symptoms impact daily functioning and quality of life

The goal is not just to determine if ADHD criteria are met, but to develop a full understanding of the individual’s strengths, challenges, and needs.

Recommendations for remote ADHD assessment

The European ADHD Guidelines Group provides several recommendations for conducting ADHD assessments remotely:

Use video when possible

Video calls are preferable to phone calls, as they allow for some visual observation of the patient. Ensure good lighting and audio quality.

Gather information from multiple sources

As with in-person assessments, it’s important to obtain input from parents/caregivers, teachers, and the patient themselves. Online questionnaires can be helpful for collecting standardized rating scales.

Consider developmental level

Remember that ADHD symptoms should be evaluated relative to what’s typical for a child’s developmental stage, not just chronological age. The pandemic may have impacted developmental trajectories for some children.

Be flexible with teacher reports

With disruptions to in-person schooling, standard teacher reports may be incomplete. Parent observations of remote learning engagement can be used to supplement teacher input.

Assess co-occurring conditions

Other mental health concerns like anxiety or depression should still be evaluated, as these may have been exacerbated by the pandemic for some youth.

Use online cognitive testing cautiously

While some cognitive assessments can be administered remotely, results should be interpreted carefully, as the testing environment is less controlled than in-person.

Adapt physical exams

Basic physical measurements like height and weight can often be obtained at home. For other aspects like blood pressure, parents may need instructions on using home devices.

Maintain privacy and confidentiality

Ensure the patient has a private space for the appointment. Be aware of who else may be in the room off-camera.

Have a backup plan

Technical difficulties are common with remote care. Have a plan in place for what to do if video or audio cuts out.

Advantages of remote assessment

Remote ADHD evaluations offer several potential benefits:

• Increased accessibility, especially for families in rural areas
• Reduced travel time and costs for families
• Ability to observe the child in their home environment
• May be less stressful for some children compared to an unfamiliar clinic setting
• Allows care to continue during pandemics or other disruptions

Limitations of remote assessment

There are also some drawbacks to consider:

• More difficult to observe subtle behavioral and nonverbal cues
• Challenges in maintaining the child’s attention and engagement
• Cannot perform hands-on physical exams
• Potential for technical difficulties disrupting the assessment
• May be harder to establish rapport, especially with new patients
• Privacy concerns if the patient lacks a confidential space at home

Future directions

While remote assessments were initially adopted out of necessity during the pandemic, they are likely to remain an important part of ADHD care going forward. A hybrid model combining remote and in-person elements may be ideal for many patients.

More research is needed to:

• Compare the accuracy and reliability of remote vs. in-person ADHD assessments
• Identify which patients are best suited for remote evaluations
• Develop best practices for integrating remote and in-person care
• Evaluate the cost-effectiveness of different assessment models

Healthcare providers will need ongoing training in conducting effective remote assessments. And efforts should be made to ensure equitable access to remote care technologies.

Conclusions

• Remote ADHD assessments can be done effectively with appropriate adaptations to standard protocols
• A combination of remote and in-person care may offer the best of both approaches for many patients
• More research is needed on optimizing remote assessment practices
• Clinicians should consider both the advantages and limitations of remote evaluations for each individual patient

With careful implementation, remote assessments can be a valuable tool for improving access to ADHD care, both during public health crises and as part of routine practice. However, in-person evaluations will likely remain important, especially for complex cases or when hands-on exams are needed. The future of ADHD care will likely involve thoughtfully integrating remote and face-to-face approaches to best serve patients and families.