2 Jul 2020

Cortese S et al. Lancet Child Adolesc Health 2020; 4: e15

The European ADHD Guidelines Group have provided treatment recommendations to supplement their previously published guidance (Cortese et al, 2020a) on managing ADHD during the COVID-19 pandemic. These recommendations provide direction on starting ADHD medications (specifically psychostimulants and atomoxetine) for individuals who did not have a baseline face-to-face cardiovascular assessment prior to the pandemic.

To start a pharmacological treatment remotely, it is advised that three criteria should be met, which are summarised as follows:

  1. No personal history of cardiovascular risk factors, including shortness of breath, fainting, excessive palpitations/syncope, chest pain, hypertension, cardiac surgery, congenital heart abnormality or any underlying condition that increases the risk of a structural cardiac disorder*
  2. No family history of early (<40 years) sudden death in a first-degree relative
  3. Three separate baseline measures of heart rate and blood pressure, performed by a family member or another person remotely (for example, via telephone).

If criteria 1 and 2 are not met (i.e. cardiovascular risk factors are present), there should be referral to a cardiologist before starting treatment. For individuals without these risks, a cardiac auscultation is not mandatory in the present circumstances. If there is no baseline monitoring (criterion 3), the prescriber will need to evaluate the risks and benefits of a face-to-face assessment, taking into account the severity of the ADHD symptoms and their impact on the individual and their family.

In summary, the European ADHD Guidelines Group have recommended three criteria to assist with the remote initiation of treatment for ADHD – an addendum to their earlier publication on ADHD management during the COVID-19 pandemic.

Read more about starting ADHD medications during the COVID-19 pandemic here


*In line with NICE guidance for the diagnosis and management of ADHD (NICE 2018)

Cortese S, Asherson P, Sonuga-Barke E, et al. ADHD management during the COVID-19 pandemic: guidance from the European ADHD Guidelines Group. Lancet Child Adolesc Health 2020a; 4: 412-414.

Cortese S, Coghill D, Santosh P, et al. Starting ADHD medications during the COVID-19 pandemic: recommendations from the European ADHD Guidelines Group. Lancet Child Adolesc Health 2020b; 4: e15.

NICE guideline 2018. Attention deficit hyperactivity disorder: diagnosis and management. Available at: https://www.nice.org.uk/guidance/ng87. Accessed June 2020.

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