Abstract
This issue of the journal is distinguished by several important articles on the demographics of attention deficit/hyperactivity disorder (ADHD) diagnosis and trends in medication treatment, as well as a timely article on telemental health (TMH) at a large academic medical center (Seattle Children's) during the coronavirus crisis. This range of topics illustrates a key fact that it is important to acknowledge: although the fabric of practice and environmental stresses is changing rapidly, chronic conditions and treatment challenges remain. I hope that as researchers and clinicians we can be attentive and adaptable to the great upheaval in children's mental health in 2020 while continuing to address the persistent needs of our most vulnerable young people.
“Implementation of Home-Based Telemental Health in a Large Child Psychiatry Department During the COVID-19 Crisis” from Sharma et al. is a must read. The authors describe the implementation of a TMH service in response to the rapid coronavirus shutdowns that hit the United States in March (and may still return). They describe effectiveness, cost considerations, technological and administrative challenges, and scheduling issues that confronted a program that not only provides care but also training.
For Sharma et al., something about the present moment indicates a sea change. “TMH has been ‘here to stay’ for several years in response to the convergence of technological advances and public mandates to increase access to psychiatric care,” they write. Of course, it has not been “here to stay” for real. The requirement that clinicians and programs adapt wholesale during the pandemic is the proof-of-concept necessary to enable a lasting transition, the authors continue. “Crises create opportunities and bring lasting societal change. Exactly what TMH will look like after the COVID-19 crisis is not clear; but our faculty's relatively rapid, but complicated, development of clinicwide TMH…may prelude to the opportunities to come.”
Elsewhere, Davis et al. describe a retrospective cohort study of children on Medicaid in Kentucky who received a diagnosis of ADHD. The authors add new and valuable insight into a phenomenon that has been well described in the literature: increased diagnosis and stimulant treatment in low-SES cohorts such as Medicaid beneficiaries. Davis et al. look at increases in the prescription of alpha agonists as an alternative to stimulants, a trend that seems to follow from Food and Drug Administration (FDA) approval of long-acting A2As for ADHD treatment in 2010. Whether children are prescribed stimulants or A2As, the authors write, “primary care physicians are the highest prescribers,” and the odds for receiving medication treatment decrease if the youth also receive psychosocial treatment or see a psychiatrist or neurologist.
Finally, Pearson et al. report on methylphenidate effects on cognitive performance in youth with autism spectrum disorder and ADHD, and Siffel et al. describe trends in the use of lisdexamfetamine dimesylate as a treatment for ADHD in European children, adolescents, and adults.