Teletherapy and Medication Management of Attention-Deficit/Hyperactivity Disorder with Co-occurring Internalizing Symptoms and Suicidality During the Pandemic.
Heather Potts, Deepika Shaligram, Rose Ashraf and 2 others
PMID 39514707WHAT IT FOUND
A young person with ADHD, anxiety, depression and suicidality improved after teletherapy engagement changes and a switch from atomoxetine and fluoxetine to guanfacine and escitalopram during hospitalization.
Key findings
01To support Sam's engagement in teletherapy, the team created a less distracting private space, sent printed materials, used snacks, a video-game reward, labeled praise, motivational interviewing, and frequent check-ins; in-person sessions replaced virtual therapy when quarantine lifted.
02After atomoxetine and fluoxetine changes during virtual school stress, Sam's anxiety escalated; during hospitalization, atomoxetine and fluoxetine were stopped, guanfacine extended release 1 mg at bedtime and escitalopram 5 mg in the morning were started, and he gradually improved with resolution of suicidal ideation and decreased cleaning compulsions.
03Over 3 years, escitalopram was increased to 20 mg/day and guanfacine extended release to 3 mg/day, then guanfacine was lowered to 2 mg/day while escitalopram remained 20 mg/day.
STILL TO COME
How it was doneWhat they foundWhat it means for OTs
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What it does not show
This is a single case report, so it shows what happened to a single person, not whether the treatments work. Sam received many treatments at the same time, including therapy changes, safety monitoring, hospitalization, and medication changes, so the contribution of a single component cannot be separated. The medication changes happened during virtual school stress, so it is unclear whether symptoms changed because of medication, stress, or both. Sam's family had motivation, education, technology access, insurance, and local mental health resources, which may not match many families. There was no comparison group in this single-person report.
The easy way to misread this
Do not conclude that switching to guanfacine and escitalopram caused improvement. This was a single-person report, and therapy changes, safety monitoring, hospitalization, and multiple medication adjustments happened together, so no single component can be separated.