Concerns grow over online ADHD diagnoses

About 10 million adults have attention-deficit/hyperactivity disorder (ADHD), according to CHADD, a respected ADHD organization founded in 1987.

Now some telemedicine services advertising an easy path to being evaluated for a possible ADHD diagnosis and getting a prescription, completely virtual, have entered the landscape and some experts and authorities are taking a closer look.

When not used as prescribed, stimulants can also be abused — as they can be addictive, according to a report conducted by the Drug Enforcement Agency (DEA). Chronic abuse of amphetamines, a category of stimulants commonly prescribed for ADHD, whose effects are similar to cocaine, can cause psychosis, which is “characterized by paranoia, skin picking, preoccupation with one’s own thoughts, and auditory and visual hallucinations,” according to DEA.

Health experts, such as dr. Judith Joseph, a board-certified psychiatrist, says telemedicine can be used safely in many medical contexts, but patients should be careful.

“Telemedicine is very important. It’s a game changer,” Joseph said. “However, when it comes to prescribing medications that are potentially harmful to your health, you really want to be careful.”

PHOTO: A teenager on a phone in an undated stock photo.

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To obtain a diagnosis and prescription through telemedicine

To understand how the online diagnosis and treatment of ADHD can work in some cases, Joseph and “GMA” worked with two patients, initially one with ADHD and one without. They used the platform Done, which describes itself as “a digital health company that makes high-quality psychiatric chronic care management more accessible and affordable for patients.”

Emily has been diagnosed with ADHD and on medication for years, while Madeline has never been diagnosed with ADHD and said she does not have the condition.

Both begin the process by taking a quick two and a half minute questionnaire, which is answered honestly, before setting up their telemedicine evaluation.

PHOTO: Methylphenidate 10-mg pills.  Methylphenidate also known as Ritalin is a central nervous system stimulant used in the treatment of attention deficit hyperactivity disorder (ADHD).

STOCK PHOTO/Getty Images

Methylphenidate 10-mg pills. Methylphenidate also known as Ritalin is a central nervous system stimulant used in the treatment of attention deficit hyperactivity disorder (ADHD).

With the guidance of Dr. Joseph, Emily is the first to meet online with the nurse practitioner, who accesses Emily’s prescription history in the state’s online prescription monitoring program, and offers to renew her same medication.

Madeline is referred to the same practitioner and mentions that she has recent stressors that have occasionally affected her concentration, but Joseph said that this does not constitute ADHD. After a series of questions, the practitioner offered Madeline a choice of eight medications, including five stimulants and three non-stimulants.

“It felt like I was at a candy store and could just pick which one I wanted,” Madeline said.

Joseph said she had never seen anything like it in her career.

“What’s interesting is that the actual questionnaire listed all the criteria, and [Madeline] still did not meet criteria based on the questionnaire. So it’s really quite upsetting,” Joseph said.

As a follow-up, Joseph observes a third patient testing the online diagnosis process. Jamie has also never been diagnosed with ADHD and said she doesn’t have a problem concentrating. She makes an online appointment and is connected to a different nurse than the first two patients.

Joseph said she watched the nurse prescribe medication to Jamie “based on her desire to get a prescription.”

“The prescriber literally told the patient that she didn’t meet the criteria for any diagnosis,” Joseph said. “And that he would prescribe her medication if she wanted it and then asked her, ‘Do you want me to diagnose you so you can get a medication or a prescription?’

ABC News reached out to both nurses but did not hear back from one and the other declined to comment.

Done Global Inc. (Done.) provided a statement to ABC News saying the company “…is not a healthcare provider.”

“Finished. is an online membership-based platform that allows individuals to connect with qualified clinicians to treat ADHD patients… [Clinicians] evaluate patients and make their own clinical judgment about treatment. Clinicians are not employees or contractors at Done,” reads part of the statement.

Done also tells ABC News they are committed to increasing access to ADHD care to help more patients.

When it comes to a proper evaluation according to CHADD, which does the evaluation business – look for a health care provider who is an expert in the evaluation and treatment of ADHD. A proper evaluation takes time and is important to ensure a correct diagnosis before stimulant prescription, especially given the risks of stimulant abuse.

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