Treatment provision for adults with ADHD during the COVID-19 pandemic: an exploratory study on patient and therapist experience with on-site sessions using face masks vs. telepsychiatric sessions
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Abstract
Background
Maintaining the therapeutic care of psychiatric patients during the first wave of the COVID-19 pandemic in Switzerland required changes to the way in which sessions were conducted, such as telepsychiatric interventions or using face masks during on-site sessions. While little is known about how face masks affect the therapeutic experience of patients and therapists, the effectiveness of telepsychiatry is well documented for several psychiatric disorders. However, research on the benefits of telepsychiatry in adult patients with attention-deficit/hyperactivity disorder (ADHD) remains scarce. This seems problematic since the symptoms typically associated with ADHD, such as attention problems and distractibility, may lessen the utility of telepsychiatry for this particular group. The present study’s aim was to explore how adult patients with ADHD and their therapists experienced therapy sessions during the COVID-19 pandemic in three different settings: face-to-face with the therapist wearing a face mask, via telephone, or via videoconferencing.
Methods
In this exploratory, quantitatively driven mixed-method study (quantitative questionnaire data and qualitative data from open-ended responses), we assessed patients’ evaluation of the session, their treatment satisfaction, and patients’ and therapists’ ratings of therapeutic alliance. We also collected qualitative comments on both sides’ experience of the session. Overall, 97 therapist and 66 patient questionnaires were completed. Results are reported for the N = 60 cases for which data from both parties were available. Sequential multiple regressions adjusted for therapist and number of sessions were used for the main quantitative analyses.
Results
No statistically significant differences regarding session flow, post-session positivity, satisfaction and therapeutic alliance were observed. The only exception was that telepsychiatric sessions were rated as significantly less deep than face-to-face sessions, an effect that may decline over time, especially in the videoconferencing group. Patients and therapists identified similar facilitating and complicating aspects, but differed in their emphasis of specific elements.
Conclusions
Both settings, on-site with the therapist wearing a face mask and telepsychiatric, seem to be valid options to continue treatment of adults with ADHD during a situation such as the COVID-19 pandemic. Aspects such as patient preference, session content, and therapeutic methods may be useful to identify the most suitable modality.
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SciScore for 10.1101/2020.12.11.20242511: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Participants provided informed consent by ticking boxes to indicate that they had understood the aims of the study and their rights.
IRB: The Cantonal Ethics Committee of Bern filed a letter of non-competence and stated no objection to the study (Req-2020-00421).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Sample and Recruitment: Participants in this study were adults with a diagnosis of ADHD according to the 10th revision of the International Classification of Diseases [57], who were receiving treatment (multi-modal therapy … SciScore for 10.1101/2020.12.11.20242511: (What is this?)
Please note, not all rigor criteria are appropriate for all manuscripts.
Table 1: Rigor
Institutional Review Board Statement Consent: Participants provided informed consent by ticking boxes to indicate that they had understood the aims of the study and their rights.
IRB: The Cantonal Ethics Committee of Bern filed a letter of non-competence and stated no objection to the study (Req-2020-00421).Randomization not detected. Blinding not detected. Power Analysis not detected. Sex as a biological variable not detected. Table 2: Resources
Software and Algorithms Sentences Resources Sample and Recruitment: Participants in this study were adults with a diagnosis of ADHD according to the 10th revision of the International Classification of Diseases [57], who were receiving treatment (multi-modal therapy combining pharmacological therapy and psychotherapy) at a specialised outpatient clinic. Diseasessuggested: NoneResults from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).
Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:Similar to the face-to-face group, the therapists were again much more concerned with the limitations of the telepsychiatric modalities, particularly the full or partial lack of visual cues, than were their patients. The responses to the open-ended questions on how the session was experienced also provided some insight into the circumstances under which a telepsychiatric session was considered more or less suitable. One aspect mentioned by both patients and therapists was session content. Telepsychiatric treatment was perceived to be more suitable if the session focused on discussing medication or other issues that were not too personal in nature. If more sensitive/intimate topics needed to be discussed, a face-to-face session was considered preferable. Therapists felt that telephone consultations were less appropriate for patients who were particularly unwell. Both patients and therapists also mentioned that, because of the limitations of telepsychiatry, some therapeutic methods could not be implemented (e.g. using white boards for to-do lists or plans), thereby highlighting another factor that may need to be considered when deciding on the modality of a session. Strengths, Limitations, and Future Research: Strengths of this study include that it sheds light on both the patients’ and the therapists’ experience with different treatment settings and provides us with qualitative information on these experiences. Moreover, to our knowledge it is the first study to investigate ho...
Results from TrialIdentifier: No clinical trial numbers were referenced.
Results from Barzooka: We did not find any issues relating to the usage of bar graphs.
Results from JetFighter: We did not find any issues relating to colormaps.
Results from rtransparent:- Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
- Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
- No protocol registration statement was detected.
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