Welcome to ReachMD. This Spotlight on ADHD, addressing ADHD management strategies during the COVID 19pandemic, is sponsored by Tris Pharma Inc. Presenting is psychiatrist Dr. Suvrat Bhargave, president of the Center for Family Psychiatry Inc. in Tyrone, Georgia. He’s also a board-certified psychiatrist, educator, and speaker. Here’s Dr. Bhargave now.
In my experience, ADHD is a chronic condition, and it’s not typically one that you simply outgrow. When there’s an effective treatment plan in place for patients with ADHD, you’re helping them learn how to compensate, and how well a person compensates depends on the demands on that person at any given time. COVID-19 has really changed those demands, and a lot of the strategies that were being used pre-COVID-19 don’t seem to be working as well now. What I’m seeing with my patients is that in some homes, kids and adults are feeling more stressed, frustrated, or irritated. In other homes, people are looking more discouraged, even lonely, and are bored easily, and it’s caused them to act out. So COVID-19 really has changed the way people are experiencing their day-to-day lives.
Treating ADHD during the COVID-19 pandemic has required a lot of adjustments to be made to existing strategies that were part of a treatment plan, and in some cases, it means creating new strategies altogether. So now, an effective ADHD treatment plan will incorporate a lot of different techniques to address structure, routine, motivation, organization, and in many cases, adjustments will need to be made to medications as well. For example, structure now means creating a workspace or a school space within the home that minimizes distractions. Routine now means scheduling not only your office hours or your school hours, but also scheduling breaks, lunches, exercise, and sleep, since all those things impact ADHD symptoms. Motivation now means that the ways in which we used to talk ourselves into doing the things that needed to be done are no longer triggered by the cues that we were used to, and we have to find new ways to do that. For example, pre-COVID-19, simply walking into an office building or a school building would’ve started a dialogue in your head to get you to be engaged, and now, we need to talk and think differently in order to get ourselves into the right headspace.
In addition to rethinking our treatment plan in terms of structure, routine, and so forth, medications may also need to be adjusted as a result of the COVID-19 pandemic. Since the demands and the environments are constantly changing, it’s helpful to have medication formulations that can be adjusted to accommodate patients’ varying needs. For example, many of the children that I see right now are returning to school with a hybrid attendance model. So, two days a week they’re in class, and perhaps three days a week they’re getting virtual instruction. What their parents are telling me is that the demands are different based on the setting. So, certain formulations, such as liquid formulations, allow for dose adjustments to be made, based on the patient’s response to treatment and the treatment goals. And just to reiterate, when considering adjustments needing to be made for medications, formulations do make a difference.
Finally, I’d like to add that, logistically, even though telemedicine has certainly salvaged care by allowing me to communicate with my patients in a safe way, it surely isn’t the same thing as an in-person, face-to-face interaction. But by employing these strategies and by adapting our care approach to ADHD, we can help ensure continued care for our patients— even from afar.
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