ADHD: Strategies for Developing a Further Dialogue - Episode 6
Key opinion leaders provide caregivers with practical advice on how to effectively manage pediatrics with ADHD (attention deficit hyperactivity disorder) during the COVID-19 pandemic, with special consideration to various educational difficulties.
Tim Wilens, MD: Thinking about the family in these settings, often, no surprise to anybody on this, this is a highly genetic disorder. And often there’s a parent who had ADHD [attention-deficit/hyperactivity disorder] who’s trying to care for kids at home with ADHD, and that can create a tremendous amount of stress. Ann, what kinds of things do you recommend to families in terms of resiliency and managing right now?
Ann Childress, MD: One of the things, if people have some financial stability, if they have some extra money, there are a lot of substitute teachers right now who are unemployed. Some of the families are getting together and creating these learning pods. They will have a teacher who was a substitute, a real teacher because they’re used to dealing with kids, and they’ve had background checks, so that makes them ideal, for $15 an hour. And 2 or 3 families will get together with maybe 4 or 5 kids, and they’ll go from house to house, or a couple of days at one house, a couple of days at another house. They’re in a room with their computers or their iPads, and basically they have a teacher who is making sure everybody is getting on the right website at the right time. That’s great if families have the money.
I have another family, the mom has 3 children, she’s a kindergarten teacher, so she’s working too during the day. She bought Echo Dots, and she programmed them with alarms for when the kids are supposed to go to the next class, and she’s got the websites up on the computer where her 7-year-old can just click to this, and click to that. Alexa has been helpful for some of our families in doing this.
It’s interesting because for the last 15 years when families would say, “I want to homeschool Johnny,” I would say, “Do you know what that involves? You are going to become a full-time teacher.” And I’d do everything I can to try to get them to not homeschool, and now we’ve just got to deal with it with everybody.
Tim Wilens, MD: That’s a great point, and the other thing I would add is, what we’re trying to do in our area is build kids’ resiliency right now, and their parents’. There are components of resiliency, and it helps these kids with ADHD because most of these kids have a lot of emotional anxiety, as well as mood dysregulation. We teach them components of mindfulness meditation mixed with coping skills. What do you do if you’re feeling anxious? What do you do if you’re feeling moody? How do you manage feeling lonely when you miss your friends? What are some techniques you can learn?
There are resiliency groups online, there are several apps that you can get, at least for the mindfulness meditation part, and some of them are free. I encourage people to recommend that or to advocate to have a resiliency group, a virtual group, started in your area because these can be very helpful for these kids, like I said, many with ADHD in particular, where they have other conditions, other things going on, that make them vulnerable.
Ann Childress, MD: I’m probably the only one in the group here who’s seeing people in the office now. I get lonely. I don’t want to do just telemedicine, and I do like to get vital signs; I get blood pressure and weight. We have Buddy, the therapy dog, and initially I was saying just the parent and the child who has the appointment come in, because we were all afraid of COVID-19 [coronavirus disease 2019], which I think we should be. But everybody’s got their mask on, and I’ve got my bleach bottles, and if brothers and sisters want to come in, fine. It’s their 1 outing for the month that they come and see Dr Childress, and even the snarky teenagers are happy to see me these days, which is great for my self-esteem. Of course, we have the therapy dog, Buddy. A lot of people come to see Buddy, I realize it’s not me. That’s OK.
-Dr. Findling receives or has received research support, acted as a consultant and/or has received honoraria from Acadia, Adamas, Aevi, Afecta, Akili, Alkermes, Allergan, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Arbor, Axsome, Daiichi-Sankyo, Emelex, Gedeon Richter, Genentech, Idorsia, Intra-Cellular Therapies, Kempharm, Luminopia, Lundbeck, MedAvante-ProPhase, Merck, MJH Life Sciences,NIH, Neurim, Otsuka, PaxMedica, PCORI, Pfizer, Physicians Postgraduate Press, Q BioMed, Receptor Life Sciences, Roche, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Syneurx, Takeda, Teva, Tris, and Validus.
-Dr Gephart is retired from the practice of medicine. He is on the faculty of the REACH Institute for a course entitled “Patient Centered Mental Health in Primary Care.” He receives a stipend for serving as a virtual consultant to Course graduates who call in and present difficult cases. He has no other financial contracts to report.
-Dr Childress reports receipt of research or writing support, participation on advisory boards, and service as a consultant or speaker for Adlon Therapeutics, Aevi Genomic Medicine, Akili Interactive, Allergan, Arbor Pharmaceuticals, Cingulate Therapeutics, Emalex Biosciences, Ironshore Pharmaceuticals, Jazz Pharmaceuticals, KemPharm, Lundbeck, Neos Therapeutics, Neurovance, NLS Pharma, Otsuka, Pearson, Pfizer, Purdue Pharma, Rhodes Pharmaceuticals, Sunovion, Supernus Pharmaceuticals, Takeda, and Tris Pharma.
-Dr Wolraich is professor emeritus from the University of Oklahoma Health Sciences Center. He is on the steering committee and a faculty member of the REACH Institute, a non-profit organization providing CME training on mental health to primary care physicians. He has no affiliations or investments where he receives any compensation, and he is no longer in any clinical practice.
-Dr Wilens is Chief, Division of Child and Adolescent Psychiatry and Co-Director of the Center for Addiction Medicine at Massachusetts General Hospital. He receives or has received grant support from NIH(NIDA). He is or has been a consultant for Arbor, Otsuka, Ironshore, KemPharm and Vallon. He is the author of Straight Talk About Psychiatric Medications for Kids (Guilford Press). He is co-editor of ADHD in Adults and Children (Cambridge University Press), Massachusetts General Hospital Comprehensive Clinical Psychiatry (Elsevier); and Massachusetts General Hospital Psychopharmacology and Neurotherapeutics (Elsevier). He is co-owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire) and has a licensing agreement with Ironshore (BSFQ Questionnaire). He serves as a clinical consultant to the US National Football League (ERM Associates), U.S. Minor/Major League Baseball; Gavin Foundation and Bay Cove Human Services.