The COVID-19 Pandemic is Flipping the Script on ADHD

AKA: TikTok may be the reason you can’t get your Adderall right now

PHOTO CREDIT: CEREBRAL

Taking advantage of many attributes of the COVID-19 pandemic, telehealth startups — namely Cerebral, Done, and Hims/Hers — began to diagnose Attention Deficit Hyperactive Disorder in ways that blurred the line between treatment and profit. Emerging from a telehealth-reliant world, the consequences are starkly apparent.

—

Through the repeal of the Ryan Height Act, telehealth diagnostic companies seized the opportunity to capitalize on the now-allowed online prescription of Schedule-II medication, including stimulants for ADHD. Machine-automated medication suppliers, such as Truepill, further assisted telehealth expansion by allowing prescriptions to be bottled, sealed, and sent to one’s local CVS faster (and cheaper) than ever.
Appealing to a time in which patients required reliance on their own symptomatic knowledge due to lack of in-person care, social media-based telehealth ads provided direct-to-consumer language encouraging the viewer to analyze possible signs of ADHD within themselves:

7 SIGNS YOU MAY HAVE ADHD
WHAT IT’S LIKE HAVING ADHD
I THINK I HAVE ADHD…

In response to these factors combined, mental health-related telehealth startups experienced a major financial boom. Cerebral specifically stated to have currently treated over half a million patients during its almost three years of operation, alongside a 2022 evaluation of $300 million. Such success, however, is paired against the suspected public backlash: ADHD telehealth advertisements were “broad” and “predatory”, big-pharma fears of the evil businessman who wants to sell your children Adderall and Xanax were all too real to the viewer outside of Cerebral’s expected social media audience.

Insider voices, however, reflected similar panics. Nurses who had associated with mental health telehealth companies complained that they did not feel as though they had adequate time to work with patients before being required to give a prescription. Lawsuits appeared regarding CEOs demanding every evaluation ends with a diagnosis. Former employees discuss ending their time with companies out of uneasiness towards the brand’s approach to medication, such as through label aesthetics. Federal investigations aimed to conclude whether prescriptions were being handed out accordingly.

“Seven former nurses for the company say they worried that Cerebral wasn’t merely meeting a demand but was also, by making access so easy, effectively creating it”

—

Through new observations encouraged by the unusual circumstances of the pandemic, telehealth’s praises and problems contributed to further muddying the waters of ADHD. Outcries over plain statics (ADHD has risen in diagnosis over 10%! More than 500,000 new children have been prescribed stimulants!) paired with sketchy business models and unrecognizable medical technology created a black-and-white diagnostic scenario of ADHD diagnosis.

As Tricia Hersey insists in her manifesto “Rest is Resistance”, people are best to “survive, not thrive”, as capitalism requires the direct opposite. Leaning into the pandemic, this notion became muddled: the requirements to survive were now much higher, but the internal need to thrive in “productive” areas of life was impossible to meet or see (think leaving the office vs. closing your laptop while working from home).

With almost the entire population being forced into new, more stagnant pandemic life routines, feelings of unproductiveness, fatigue, and self-consciousness flourished within ADHD and non-ADHD civilians alike — our ingrained capitalistic desire for productivity was far from adequately met while staying at home, enhancing the shame of “not doing enough”, allowing defiant guilt which resonated with ADHD patients prior to the pandemic to now be adopted by non-ADHD citizens.

The language used by telehealth advertisements took quick advantage of these overlapping symptoms: ADHD, pandemic burnout, general anxiety, trauma, etc. are generalized through quick and funny video format. Companies like Cerebral’s swift APIs allow anyone to have instant access to medical professionals — many of whom have admitted to not being qualified to assess and diagnose conditions like ADHD, yet were hired to do so regardless. Our constant negative state of pandemic and ADHD lifestyle alike is aggressively reminded through telehealth advertisements:

FATIGUED
CAN’T FOCUS
OVEREATING
BAD MEMORY

Forever living in a world of stigmatized stimulants, it is striking to see advertisements of young adults shaking bottles of Adderall while dancing with a smile on their faces. Symptoms of the disorder have similarly 180-ed, aiming to include many participants rather than connect with the niche situations worrying those who may have ADHD or a similar disorder. All-encompassing videos from telehealth advertisements have been seen throughout other social media realms, with a study from the Canadian Journal of Psychiatry finding more than half of ADHD TikToks researched to be considered misleading.

The introduction of profitable telehealth to ADHD treatment, however, makes the word “misleading” difficult to dissect, the same way it was previously difficult to label telehealth advertisements as strictly “predatory”, even though the public is able to witness the rising numbers in ADHD diagnoses and stimulant prescriptions. Considering the effects of such social changes and their impacts on the individual, we are encouraged to view post-telehealth statics regarding ADHD through the lens of the sixth principle of data feminism: considering context.

The bottom line for numbers is that they cannot speak for themselves. In fact, those of us who work with data must actively prevent numbers from speaking for themselves because when those numbers derive from a data setting influenced by differentials of power, or by misaligned collection incentives (read: pretty much all data settings), and especially when the numbers have to do with human beings or their behavior, then they run the risk not only of being arrogantly grandiose and empirically wrong, but also of doing real harm in their reinforcement of an unjust status quo.

If considering the context of new diagnostic statistics, paired alongside background knowledge of profitable telehealth companies, the conversation of ADHD within the scope of the pandemic should heavily consider medicalization’s reliance upon social factors. It is, in fact, only recently that we have had the capability to expand and understand ADHD in terms of adult functionality, rather than seeing it as child-only. The same can be said for the introduction of stimulant medication: ADHD is a great example of changing genealogy among diagnostic criteria.

Before the popularity telehealh, Peter Conrad describes within “The Changing Social Reality of ADHD” that the evolution of technology is bound to impact how we learn about, diagnosis, and treat ADHD. Telehealth plays into this prediction all too well, reflecting other discussions of Conrad’s as well, such as that ADHD treatment for older patients requiring a more adaptable approach than that with children due to factors like employment or higher education. This “adaptable approach” usually finds itself in the form of stimulant medication, while children are more likely to receive benefits such as cognitive behavioral therapy.

Information as such continues to confuse companies like Cerebral’s messaging, lacking answers to questions similar to: How is telehealth bringing new “adaptable approaches” to the table when treating ADHD? How are telehealth visits keeping in mind the pandemic affecting necessary activities such as employment and education? Is telehealth prepared for the new challenges patients will face within the pandemic/virtual work or learning?

In attempted answer, previous CEO and creator of Cerebral Kyle Robertson responds in his Medium article as to why he started the company that “we believe in the power of comprehensive care”. However, Roberston continues

“our care managers and prescribing providers alike know that medication alone may not be enough for many of our clients… First, we seek to provide easy access to the highest quality medication management for anxiety and depression using telemedicine. If we can do this successfully at scale, we will expand to provide a broad array of options for anxiety and depression, such as cognitive behavioral therapy and mindfulness”

Such reflects Conrad’s predictions of the expansion of ADHD: Cerebral’s idea of telehealth lies more within telemedicine than online, qualified conversational care and personal patient attention. While this may provide a decent bandaid while restricted within the pandemic, Robertson’s approach to ADHD treatment strives to uphold the factors negatively affecting ADHD and non-ADHD patients alike through a strong capitalistic drive in treatment, advertisement, etc.

—

Beginning 2023 with a well-known Adderall shortage, many peak-pandemic repercussions of telehealth approaches to ADHD are present in everyday media. A lack of comprehension on a day-to-day level presented an extremely difficult struggle to many, ADHD or not. With telehealth startups having the ability to provide the public an easy-grabs stimulant prescription and unqualified diagnosis, they fail to
discredit stereotypes and moral panics regarding ADHD that have complicated the medicalization and accessibility of the disorder/diagnosis for decades.

Telehealth’s practices throughout COVID-19 create further difficulty in analyzing statistics regarding ADHD and its corresponding practices, allowing for biased or extreme-scaled public discourses of the disorder. Using the information available about the overlap of ADHD and telehealth, observations of diagnostic criteria should be closely read into to understand the effects America’s society will witness in the upcoming months or years.