Introduction
The need for guidance for prescribing stimulants by telepsychiatry/telemental health for attention-deficit hyperactivity disorder (ADHD) has suddenly come to the forefront. On the one hand, expanded telepsychiatry services (audio or video conferencing) during the pandemic led to enhanced availability of evaluations and treatment for ADHD accompanied by a spike in the number of prescribed stimulants.Reference Winkler1–Reference Danielson, Bohm and Newsome3 This development has been widely celebrated by those who champion better access to treatment for ADHD, where it is estimated that less than 1 in 5 childrenReference Olfson, Wall, Wang, Laje and Blanco4 and only 10.9% of symptomatic adultsReference Kessler, Adler and Barkley5 with ADHD receive treatment. On the other hand, as telepsychiatry for ADHD came online, there was also a depletion of stimulant supplies at some pharmacies,6, Reference Califf and Milgram9 causing others, especially in law enforcement, to become alarmed that a new opioid-like epidemic was being ignited, possibly by those gaming the system to obtain stimulants for diversion and misuse.Reference Winkler1, Reference Sibley, Faraone, Nigg and Surman7, Reference Brumbaugh, Tuan, Scott, Latronica and Bone8 As pandemic-related restrictions have lifted, federal policies for reimbursement, technology, and requirements for in-person visits are being debated, revised, and challenged with competing factions arguing either for or against continued easy access to telepsychiatry services for ADHD.Reference Califf and Milgram9 In that there are currently no published clinical guidelines to help inform policies on how to balance these opposing points of view, we have assembled a panel of 14 experts from diverse areas within the ADHD treatment ecosystems, including specialists with backgrounds in psychiatry, psychology, developmental pediatrics, and advanced practice mental health nursing. The assembled panel was chosen to represent diversity in clinical, cultural, and geographic backgrounds, with members drawn from academic institutions, psychiatric research, medical administration, and independent practice. All members of this expert consensus panel have extensive use of telepsychiatry with expertise in clinical care, medical education, teaching, medical administration, coordination of care, or consultation for companies providing telehealth services. Independent comprehensive literature reviews utilizing PubMed and Google Scholar were conducted by 3 members of the panel (GWM, JH, and SMS) to review prior research, published guidelines, and published commentary regarding ADHD and telepsychiatry care. Distinct questions regarding telepsychiatry and ADHD care were then posed to all 14 members to determine areas of consensus. These expert consensus statements are being developed to lend guidance regarding the role of telepsychiatry in ADHD care.
Current guidelines for mental health delivery and ADHD
Numerous guidelines have been developed and published by both US and international groups for the diagnosis and treatment of ADHD in children with face-to-face appointments.Reference Wolraich, Hagan and Allan10–Reference Cortese, Asherson and Sonuga-Barke19 Only international groups have published such guidelines for ADHD in adults, although the American Professional Society for ADHD and Related Disorders has recently announced its intent to develop them as well.Reference McAlister20 So far, only one international group has published guidelines for the use of telepsychiatry for ADHD during the pandemic but without comment on guidelines to follow the pandemic.Reference Cortese, Asherson and Sonuga-Barke19 No group has yet developed guidelines for the diagnosis and treatment of ADHD by telehealth post pandemic. Published guidelines for treating ADHD in face-to-face settings are shown in Table 1.Reference Wolraich, Hagan and Allan10–Reference Cortese, Asherson and Sonuga-Barke19
Table 1. Current Guidelines for ADHD
The European ADHD Working Group is the only body of experts to have published practical guidelines at the start of the COVID pandemic on how to utilize telehealth services safely and consistently to deliver ADHD care throughout the COVID pandemic.Reference Cortese, Asherson and Sonuga-Barke19 These guidelines support the role of telemental health for new patient evaluations and for ongoing ADHD treatment and management; they also emphasize the need for a thorough initial evaluation to screen for both mental and physical comorbid conditions. The European ADHD group further discusses strategies to incorporate at-home or online tools for measuring blood pressure and heart rate when initiating ADHD treatment or modifying doses.Reference Cortese, Asherson and Sonuga-Barke19 They also highlight the lack of guidelines for the treatment of adults with ADHD in the United States or for the treatment of ADHD in adults or children utilizing telepsychiatry.Reference Cortese, Asherson and Sonuga-Barke19
Balancing the risks and benefits of telepsychiatry for ADHD: risks (Figure 1)
A significant perceived risk of telepsychiatry is the enablement of such easy access to stimulants that individuals, mostly adults, who do not have ADHD, might exploit telepsychiatry to get stimulants, especially immediate-release formulations for illegal use. Although this has not been documented in any study to date, the risk of diagnosing ADHD inaccurately by telepsychiatry may be greater than in face-to-face encounters. Such telepsychiatry evaluations may be inadequate due to reduced clinician–patient rapport, technologic limitations, and individuals who may be malingering with knowledge of ADHD symptoms seeking stimulant prescriptions for misuse, abuse, or diversion. Nonmedical use of stimulants by crushing, chewing, or consuming with alcohol is a huge challenge and is highly prevalent, ranging from 2.1% to 58.7%, and the prevalence of diversion is estimated to range from 0.7% to 80.0%.Reference Faraone, Rostain, Montano, Mason, Antshel and Newcorn21 Past-year prevalence among college students of nonmedical use was 5.9%.Reference Faraone, Hess and Wilens22, Reference McCabe, West, Teter and Boyd23 Among college students, the past-year medical use of prescription stimulants for ADHD has had similar increases in the past-year diversion and nonmedical use of prescription stimulants.Reference McCabe, West, Teter and Boyd23 It is exceptionally challenging to accurately detect malingering.Reference Sollman, Ranseen and Berry24 In one study, routine clinical evaluations proved neither useful nor sensitive for detecting malingering in ADHD. Furthermore, motivated college students who malingered readily produced ADHD-consistent profiles.Reference Musso and Gouvier25
Figure 1. Weighing the risks and the benefits of telepsychiatry for ADHD16.
Studies have found that college students misuse dextroamphetamine-amphetamine (immediate-release Adderall) more than other prescription stimulants.Reference McCabe, West, Teter and Boyd23 According to the 2012 National Survey on Drug Use and Health, nonmedical use of dextroamphetamine-amphetamine rose sharply among both college-aged adults and adults ages 26 and older (Figure 2). These findings plus the fact that much of the research into the misuse of prescribed stimulants focuses on college students suggest that guidelines for telepsychiatry should pay particular attention to this age group as studies have also found that up to 20% of college students have used a prescription stimulant without having a legitimate prescription in the prior year, and even those with legitimate prescriptions commonly either sell or give away their stimulants.Reference Faraone, Rostain, Montano, Mason, Antshel and Newcorn21, Reference McCabe, West, Teter and Boyd23, Reference Wilens, Adler and Adams26–Reference McCabe, Schulenberg, Wilens, Schepis, McCabe and Veliz28 In one case, 55% of fraternity members at a large public university in the Southeast had used prescription stimulants without a prescription.Reference McCabe, West, Teter and Boyd23, Reference Desantis, Noar and Webb29 In addition to obtaining stimulants from classmates or fraternity brothers, there is the very real possibility that prospective new patients in this age group presenting to telepsychiatry may be at higher risk for attempting to obtain prescription stimulants without having a diagnosis of ADHD.
Figure 2. SAMHSA advisory on nonmedical use of Adderall.Reference Sollman, Ranseen and Berry24
Thus, there is concern that increasing access to telepsychiatry could potentially worsen “doctor shopping,” as desperate patients have been observed to drive hundreds of miles for prescriptions.Reference Kruse, Kindred, Brar, Gutierrez and Cormier30 There should always be a special concern for patients intentionally trying to obtain prescriptions with abuse potential, but extra caution should be taken for virtual or telehealth care delivery models as evaluation can be more limited than the traditional in-person evaluation.Reference Rolison and Bloch31 To prevent diversion and misuse, prescribers should check online databases for prescription drug monitoring programs.Reference Kruse, Kindred, Brar, Gutierrez and Cormier30 Short-acting stimulants should be avoided during initial telemedicine appointments and further minimized when treating young adults or adults with ADHD, as long-acting stimulants have lower rates of misuse or abuse with no significant differences in efficacy between short- and long-acting stimulant medications.Reference Faraone and Glatt32
The risks of inappropriate stimulant prescriptions are the known adverse medical outcomes with stimulants, especially if they are misused, including increased suicidality and death that occur in some individuals, particularly when administered by nonoral routes. Common side effects include insomnia, tics, anorexia, and weight loss that may lead to nonadherence or early discontinuation in young children due to fear of adversely stunting growth in kids. Other rare but serious side effects include increased blood pressure, stroke, myocardial infarction, sudden death, delusions, hallucinations, paranoia, and mania, and amphetamines may increase the risk of seizures.Reference Wigal33
Additionally, young adults who may be inappropriately seeking stimulants are quite impressionable, especially in the age of social media. A recent study evaluated the 100 most influential ADHD TikTok videos, a new social media platform popular among adolescents and young adults, and found that 52% of these videos were “misleading” or had incorrect information. Only 11% of these videos were found to be created by health care professionals, despite receiving millions of views, potentially contributing to high levels of misinformation.Reference Yeung, Ng and Abi-Jaoude34 Excessive social media marketing and social media exposure may increase the possibility that patients may increasingly seek evaluation for ADHD.
Consensus statements and guidelines should work to prevent financial incentives that encourage prescribers to employ shortcuts in assessing and treating ADHD at the expense of quality patient care and potentially dangerous consequences. One way to do this with the COVID-19 public health emergency ending is to reinstate the rule that patients must be seen in person prior to writing a prescription for a controlled substance.35 However, in practice, this is likely to create a large burden for certain underserved patients and providers, as some patients have only seen their providers virtually since the pandemic began, and there may not be an opportunity to be “grandfathered in.” Regulations for online prescribing of stimulants are likely to evolve with debate, professional society reactions, and even new legislation for the foreseeable future, trying to balance what has proven to be the great benefits of increased access to care with the risks of misuse, abuse, and diversion. Thus, this expert consensus guidelines for diagnosing and prescribing stimulants by telepsychiatry are important.
Balancing the risks and benefits of telepsychiatry for ADHD: benefits (Figure 1 )
The Centers for Disease Control and Prevention (CDC) has documented rising US adult stimulant prescriptions over the past 5 years, with a substantial spike from 2020 to 2021 following a temporary suspension of the Ryan Haight Act during the pandemic.Reference Danielson, Bohm and Newsome3, Reference Califf and Milgram9 The CDC, FDA, and Drug Enforcement Administration have all expressed concern about the significant increase in psychostimulant prescriptions that occurred in 2020 and 2021 with the dramatic increase in telepsychiatric prescribing.Reference Winkler1, Reference Danielson, Bohm and Newsome3, Reference Califf and Milgram9 Contributing factors to the spike in stimulant prescriptions could also be long-standing efforts to expand access to ADHD care by reducing disparities in rural areas and for those who cannot afford treatment, to increases in treatment-seeking due to the challenges of the pandemic, and to digital startups prescribing stimulants online. Reference Winkler1, Reference Sibley, Faraone, Nigg and Surman7 These gains risk being lost if overregulation of telepsychiatry in the postpandemic period unduly restricts access to diagnostic and treatment services for ADHD.
It is thus critical to know to what extent newly prescribed stimulants are medically appropriate and thus are reducing untreated ADHD, or instead represent stimulants being provided to those who do not need them. To optimize and shape future treatment guidelines for telepsychiatry and ADHD, research is necessary to assess those with new stimulant treatment received by telepsychiatry: are they young adults, older adults, or children, and are they receiving the most abusable immediate-release stimulants or other treatment options?
In addition to being perceived as enhancing access, surveys of ADHD advocates and support organizations have in general shown high favorability for ADHD telehealth and hybrid models, with decreased wait times and decreased amount of time required for traditional in-office care.Reference Vander Stoep, McCarty, Zhou, Rockhill, Schoenfelder and Myers36–Reference Myers, Vander Stoep, Zhou, McCarty and Katon38 An open trial was conducted to test the feasibility of video-conferenced psychotherapy for adolescents and their families, as adolescents with ADHD can be challenging to engage in treatment. All 20 families participated, incorporating dyadic therapy and motivational interviewing. There was high satisfaction with the families, perceived enhanced treatment, and reductions in ADHD symptoms.Reference Sibley, Comer and Gonzalez39 In the Children’s ADHD Telemental Health Treatment Study, methods were used to include underserved children. The study intervention group received 6 virtual sessions, each followed by a session of in-person caregiver training and compared it to the control, which received primary care treatment augmented with a single telepsychiatric consultation. As noted by both parents and teachers, children in the intervention group did significantly better than control on combined ADHD symptoms, oppositional defiant disorder, and parent-caregiver role performance.Reference Vander Stoep, McCarty, Zhou, Rockhill, Schoenfelder and Myers36–Reference Myers, Vander Stoep, Zhou, McCarty and Katon38 Caregiver stress and burden were also significantly improved in the group receiving online telehealth pharmacologic management.Reference Vander Stoep, McCarty, Zhou, Rockhill, Schoenfelder and Myers36 In addition to seeing patients virtually, digital augmentation for enhancing ADHD outcomes has shown promising results. Two studies utilizing digital coaching text reminders significantly improved medication adherence in both children and adults with ADHD.Reference Biederman, Fried and DiSalvo40, Reference Fried, DiSalvo and Kelberman41 Another meta-analysis included 12 studies that aimed to review telemedicine intervention for the management of children and adolescents with ADHD, looking at its effect size on symptoms. The pooled results of the 12 studies showed a small but significant effect of telemedicine on attention/cognitive function, hyperactivity–impulsivity, and oppositional behavior subscales.Reference Bemanalizadeh, Yazdi, Yaghini and Kelishadi42 Preliminary data for the use of telemedicine and digital augmentation in the treatment of ADHD are limited but are promising, and more research needs to be done.
The impact of enhanced access to evaluations and treatment for ADHD is, of course, a reduction in the known risks of untreated ADHD, including a variety of negative physical and emotional consequences with a potentially significant impact on social and emotional well-being. Beyond academic difficulties, children have been shown to struggle with learning disabilities and peer relationships, as well as have increased difficulty with emotional dysregulation.Reference Shaw, Stringaris, Nigg and Leibenluft43, Reference Antshel, Zhang-James and Faraone44 They also have an increased risk of several comorbid psychiatric illnesses including autism spectrum disorder, depression, generalized anxiety disorder, conduct disorder, and intermittent explosive disorder.Reference Antshel, Zhang-James and Faraone44, Reference Bélanger, Andrews, Gray and Korczak45 Adolescents are at increased risk for having unwanted teenage pregnancies, legal difficulties, and abusing substances.Reference Owens and Hinshaw46–Reference Sundquist, Ohlsson, Sundquist and Kendler48 Adults have increased rates of anxiety, mood disorders, and challenges with impulse control such as substance use disorders and binge eating disorder, increasing their chances of developing associated medical conditions such as obesity and type 2 diabetes.Reference Kessler, Adler and Barkley5 Adults with ADHD alone have almost twice the mortality rate compared with the overall all-cause mortality rate of the general population.Reference Dalsgaard, Østergaard and Leckman49 As the number of conditions comorbid with ADHD increases, all-cause mortality rates dramatically increase compared to the general population. If a patient with ADHD has one comorbid condition, the all-cause mortality rate is 4 times the general population and the mortality rate is 25 times the general population when they have more than 4 comorbidities.Reference Sun, Kuja-Halkola, Faraone, D’Onofrio, Dalsgaard, Chang and Larsson50
The excess mortality in ADHD was mostly driven by deaths from unnatural causes, especially accidents, even when adjusted for conditions such as oppositional defiant disorder and substance use disorder.Reference Sun, Kuja-Halkola, Faraone, D’Onofrio, Dalsgaard, Chang and Larsson50–Reference Fitzgerald, Dalsgaard, Nordentoft and Erlangsen52 In addition to a rise in overall mortality rates, a cohort study of 2.9 million subjects with ADHD alarmingly found a fourfold higher rate of suicide attempts and deaths in patients with ADHD. This risk was increased 10-fold if the patient had another comorbid psychiatric diagnosis.Reference Fitzgerald, Dalsgaard, Nordentoft and Erlangsen52 Patients with untreated ADHD can struggle with lower lifetime occupational and economic performance, educational underachievement, and increased difficulty with financial management.Reference Faraone, Banaschewski and Coghill14, Reference Barkley, Murphy and Fischer53 Untreated individuals have an increased risk for all-cause mortality rates and psychiatric comorbidities including increased suicidality, underlying the potentially lifesaving importance of appropriately diagnosing and treating ADHD.Reference Faraone, Banaschewski and Coghill14, Reference Fitzgerald, Dalsgaard, Nordentoft and Erlangsen52, Reference Barkley, Murphy and Fischer53
Treatment for ADHD thus has many benefits and has been shown to improve measures of overall quality of life while simultaneously decreasing many negative outcomes associated with this disease. Specifically, treatment with ADHD medications reduces accidental injuries, traumatic brain injury, educational underachievement, bone fractures, sexually transmitted infections, criminal activity, and teenage pregnancy.Reference Faraone, Banaschewski and Coghill14, Reference Dalsgaard51, Reference Bihlar, Jokinen and Bolte54 Relative to the general population, those with untreated ADHD had increased all-cause mortality rates.Reference Dalsgaard, Østergaard and Leckman49 Treatment for ADHD was associated with an overall decrease in accidental injury and medical utilization due to accidents and trauma, with motor vehicle accidents decreased by up to 42%.Reference Chang55 Children with treated ADHD have shown significantly lower symptoms of aggression and reduced emergency room visits by 45% compared to their untreated peers.Reference Dalsgaard51 ADHD treatment has also been shown to decrease the development of secondary comorbidities including depression, anxiety, substance abuse, and cigarette smoking.Reference Faraone, Banaschewski and Coghill14, Reference Dalsgaard51, Reference Barkley, Murphy and Fischer53 Individuals treated for ADHD have better response rates to antidepressants resulting in better patient outcomes when treating for major depressive disorder.Reference Chen, Pan and Hsu56 Individuals with comorbid substance use disorders are also more likely to remain abstinent from substances, reducing the risks of continued substance use.Reference Bihlar, Jokinen and Bolte54 Additionally, the criminality rates of adolescents and adults go down by 31–41% when treated for ADHD.Reference Lichtenstein, Halldner and Zetterqvist57 Thus, treatment of ADHD can dramatically improve functionality and life outcomes. Having increased access to diagnosis and treatment via telepsychiatry will potentially bring the benefits of ADHD treatment to a new population of hitherto untreated patients with ADHD.
ADHD expert consensus statements
After initial discussions of various associated aspects of telepsychiatric care for ADHD, these experts were asked to respond to a poll on 8 specific statements, with the results shown in Figures 3–10. All experts here have personally used telehealth or supervised others in the use of telehealth to manage individuals with ADHD, and all experts felt that models incorporating ADHD telehealth were “as important” or “more important” than telehealth for other areas of mental health delivery. Our diverse panel of experts arrived at 8 ADHD Expert Consensus (EC) statements with high internal agreement.
Guidance 1. Optimal models for ADHD care incorporate hybrid treatment utilizing combinations of both in-person and online telehealth evaluation and management (Figure 3).
Figure 3. Guidance 1: Optimal models for ADHD care.
Guidance 2. Expanded health care through telemedicine for individuals with ADHD was rated as very important or extremely important by all experts (Figure 4).
Figure 4. Guidance 2: Expanded mental health care through telemedicine.
Guidance 3. Initial assessments for ADHD evaluation can be done either online or in person, with the majority of experts feeling that “in-person” evaluation is preferential for an initial assessment. It is further recommended that short-acting stimulants be avoided during initial telemedicine appointments. The full reinstitution of the Ryan Haight Act will require patients to be seen in person before a stimulant can be prescribed, but the panel felt that exceptions to this should be possible for remote geography and other barriers to access to face-to-face interviews such as affordability, transportation, and disabilities in order to improve equitable access to care (Figure 5).
Figure 5. Guidance 3. Initial assessments for ADHD evaluation.
Guidance 4. Follow-up visits for ADHD assessment and management can be completed either in person or via telehealth depending on patient preference. However, in either case, careful follow-up for new patients in order to establish rapport, monitor compliance, and uncover malingering was agreed upon, especially for adults of college age who have no prior history of a diagnosis of ADHD in childhood and who request immediate-release stimulants explicitly (Figure 6).
Figure 6. Guidance 4. Follow-up visits for ADHD assessment.
Guidance 5. The vast majority of experts agreed that long-acting stimulants or nonstimulants are preferred during telemedicine, given the possibility of short-acting stimulant misuse or diversion. This guidance regarding minimizing the prescription of short-acting stimulants is especially important for adolescents, young adults, and adults who have been shown to have the greatest potential for misuse or abuse (Figure 7).
Figure 7. Guidance 5: Medication Options.
Guidance 6. A urine drug screen should be ordered in cases where substance abuse is suspected but is not mandatory when there is no suspicion of substance misuse, abuse, or diversion (Figure 8).
Figure 8. Guidance 8: Urine Drug Screens.
Guidance 7. Unanimous agreement that hybrid and telehealth can be utilized for both children/adolescents and adults with ADHD (Figure 9).
Figure 9. Guidance 7: Telehealth Utilization.
Guidance 8. There was unanimous agreement that telehealth ADHD treatment models should also offer in-person care when:
a patient is struggling with online treatment,
a patient decompensates and is in crisis,
a patient has a complicated differential diagnosis,
a patient asks for in-person psychotherapy (Figure 10).
In addition to these 8 statements, 85% of our experts felt that online initial ADHD evaluations would ideally have symptoms verified by an outside informant. When utilizing telehealth, 31% of our expert panel felt that rating scales were even “more important,” with 69% stating that they were similarly important as compared to in-person care. All felt that hybrid models had the potential to “enhance access to care” and 85% felt that it also had the potential to improve “follow-up and long-term management” and “standardize outcomes by increased utilization of rating scales.”
Discussion
These consensus statements to balance the competing forces of increasing the availability of telepsychiatry for ADHD to enhance access to care, reduce the large number of untreated cases, and prevent the treatable adverse outcomes of untreated ADHD, versus reducing the availability of telepsychiatry for ADHD in order to mitigate the possibility of exploiting telepsychiatry for misuse, abuse, and diversion of stimulants. This Expert Consensus Group felt that the benefits of telehealth ADHD care include increased access for patients and consumers, especially for individuals in geographically challenged communities. Telehealth and hybrid models may also help bridge the lack of affordable mental health care and help decrease disparities in care. In many communities, access to experts with ADHD expertise is not only limited but can prove cost-prohibitive. This is especially important, given the nationwide shortage of mental health professionals and the systemic limitations on training new psychiatric residents and fellows. Dropping the requirement for an in-person evaluation prior to prescribing a stimulant likely ignited a spike in the number of stimulants prescribed. Reinstituting this requirement permanently and in full will likely greatly reduce access to ADHD evaluations and treatment with stimulants once again. While these guidelines advocate for some flexibility in allowing telepsychiatry evaluations and treatment without an in-person evaluation, they also recognize the need to give greater scrutiny to certain subpopulations, such as young adults without a prior diagnosis or history of ADHD treatment who request immediate-release stimulants. In these cases, the guidance is to raise the index of suspicion for diversion, misuse, and abuse and to consider the prescription of nonstimulants or controlled-release stimulants for treatment. In cases of diagnostic uncertainty or perceived increased risk of misuse or diversion, psychosocial interventions or therapy should also be considered as an initial treatment option.
When seen in the backdrop of a nationwide stimulant shortage, these expert consensus findings stress that long-acting stimulant and nonstimulant medications are preferred when utilizing telehealth. The ADHD expert consensus panel unanimously found that in-person initial evaluation is preferred but that telehealth assessments can be utilized when clinically warranted. ADHD telehealth has been shown to enhance or improve outcomes for children, adolescents, and adults similar to standard care models. Both pharmacologic and psychotherapeutic interventions have shown benefits with ADHD telehealth. In cases where substance use, abuse, or misuse is suspected, a urine drug screen is recommended but not mandated in cases without such concern. Organizations delivering online ADHD telehealth must also provide in-person services when there is a complicated differential diagnosis, a patient is struggling with online treatment, a patient asks for in-person psychotherapy, or when a patient decompensates or is in crisis.
The telehealth revolution has created a dramatic evolution within the mental health field for clinicians, our patients, and society. Harnessing the power of these rapidly evolving technological advances has the potential to improve access, promote education, enhance outcomes, and destigmatize the burden of seeking treatment for ADHD and associated mental health conditions.
Figure 10. Treatment Options.
Author contribution
Writing – original draft: R.S.M., M.K.S., J.H., S.M.S., M.S., R.L.F., T.V.C., A.S.R., F.A.L., J.A.C., M.G., P.E.G., V.M., G.W.M.; Writing – review & editing: R.S.M., M.K.S., J.H., S.M.S., M.S., R.L.F., T.V.C., A.S.R., F.A.L., J.A.C., M.G., P.E.G., V.M., G.W.M.; Conceptualization: J.H., G.W.M.; Investigation: J.H.; Project administration: J.H., G.W.M.
Disclosure
Mattingly GW has served as a consultant to AbbVie, Alfasigma, Alkermes, Axsome, Biogen, Boehringer Ingelheim, Cerevel, Corium, Eisai, Intracellular, Ironshore, Janssen, Lundbeck, Neurocrine Biosciences, Noven, Otsuka, Redax, Revibe, Roche, Rhodes, Sage Therapeutics, Skye Therapeutics, Sunovion, Supernus, Takeda, Teva, Trispharma. Speakers Bureau for AbbVie, Alkermes, Corium, Eisai, Intracellular, Ironshore, Janssen, Lundbeck, Neurocrine, Noven, Otsuka, Sunovion, Supernus, Takeda, and Trispharma. Research grant/support from AbbVie, Acadia, Alkermes, Akili, Axsome, Beohringer, Biogen, Eisai, Emalex, Idorsia, Intracellular, Janssen, Karuna, Lumos Labs, Medgenics, NLS-1 Pharma AG, Redax, Relmada, Roche, Sage, Sirtsei, Sunovion, Supernus, Takeda, and Teva.
Carbray JA has served on advisory boards for Supernus Pharmaceuticals and Karuna Therapeutics and as a consultant to Karuna Therapeutics.
Cooper TV. None to disclose.
Findling RL has received research support, acted as a consultant, and/or has received honoraria from AbbVie, Acadia, Adamas, Afecta, Ajna, Akili, Alkermes, Allergan, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Arbor, Axsome, Bioexcel, Idorsia, Intracellular Therapies, Iqvia, Lundbeck, Medavante Prophase, MJH Life Sciences, Neurim, NIH, Novartis, Otsuka, Oxford University Press, PaxMedica, PCORI, Pfizer, Physicians’ Postgraduate Press, Radius, Receptor Life Sciences, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Takeda, Tris, and Viatris.
Gignac M has served as a consultant/adviser: Biron, Elvium, Janssen, and Takeda.
Glaser PE. None to disclose.
Hong J. None to disclose.
Lopez FA has served as a consultant and or speakers bureau for Ironshore, Noven, Novartis, Rhodes, Tris, CellTech-Medeva, Corium, Eli Lily, Shire US, Canada, Global/UBC Europe and Korea, and Supernus. Research support from Ironshore, Celltech-Medeva, Eli Lily, Noven, Novartis, and Shire.
Maletic V. Consultant—AbbVie/Allergan, Acadia Pharmaceuticals Inc., Alfasigma, USA, Inc., Alkermes Inc., Biogen, Boehringer Ingelheim, Cerevel Therapeutics, LLC, Corium, Intra-Cellular Therapies, Ironshore, Janssen, Lundbeck A/S, Jazz Pharmaceuticals, Neurelis, Neumora, Noven Pharmaceuticals Inc., Otsuka America Pharmaceutical Inc., Pax Medica, Relmada Therapeutics, Sage Pharmaceuticals, Sunovion Pharmaceuticals Inc., Supernus Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited. Speakers Bureau—AbbVie, Acadia, Alfasigma, Alkermes Inc., Axsome, Eisai, Ironshore, Intra-Cellular, Corium, Janssen, H. Lundbeck A/S, Otsuka America Pharmaceutical Inc., Sunovion, Supernus Pharmaceuticals Inc., Takeda Pharmaceutical Company Limited.
McIntyre RS. Grant support from CIHR/GACD/National Natural Science Foundation of China (NSFC) and the Milken Institute; Speaker/consultation fees from AbbVie, Alkermes, Atai, Axsome, Bausch Health, Biogen, Boehringer Ingelheim, Eisai, Intracellular, Janssen, Kris, Lundbeck, Mitsubishi, Neumora, Neurawell, Neurocrine, NewBridge Pharmaceuticals, Novo Nordisk, Otsuka, Pfizer, Purdue, Sage, Sanofi, Sunovion, Takeda. Dr. Roger McIntyre is the CEO of Braxia Scientific Corp.
Robb AS reports: AACAP honoraria, AbbVie grant support, Alkermes grant support, Eli Lilly stock in IRA, Glaxo Smith Kline stock in IRA, Johnson & Johnson stock in IRA, Lundbeck grant support and advisory board, MapLight grant support, Neuren other data safety monitoring board, NIMH grant support and other (data safety monitoring board), NCATS grant support, NICHD advisory board, Neuroscience Education Institute honoraria and travel support, Otsuka other data safety monitoring board, Pfizer stock in IRA, Syneos Health/Tetra Therapeutics Data Safety Monitoring Board.
Singh MK has received research support from Stanford’s Maternal Child Health Research Institute and Stanford’s Department of Psychiatry and Behavioral Sciences, National Institute of Mental Health, National Institute of Aging, Patient Centered Outcomes Research Institute, Johnson & Johnson, and the Brain and Behavior Research Foundation. She is on the advisory board for Sunovion and Skyland Trail and is a consultant for Johnson & Johnson, Alkermes, Neumora, AbbVie, Karuna Therapeutics Inc., and Boehringer Ingelheim. She receives honoraria from the American Academy of Child and Adolescent Psychiatry, and royalties from American Psychiatric Association Publishing and Thrive Global. She has previously consulted for X, moonshot factory, Alphabet Inc., and Limbix Health.
Stein MA. Consultant/Adviser Genomind, Maxis Health, Medici, Periapt Health, Supernus, and Tiefenbacher Pharmaceuticals.
Stahl SM. Consultant to Acadia, Alkermes, Allergan, AbbVie, Axsome, Clearview, Done, Eisai Pharmaceuticals, Gedeon Richter, Intra-Cellular Therapies, Karuna Therapeutics, Levo Therapeutics, Lundbeck, Neurocrine Biosciences, Neurawell, Otsuka, Relmada Therapeutics, Sage Therapeutics, Sunovion, Supernus, Taliaz, Teva, Tris Pharma, and VistaGen; options in Genomind, Lipidio, Neurawell, and Delix; Speakers bureaus for Acadia, Lundbeck, Neurocrine, Otsuka, Servier, Sunovion, and Teva. Grant support from Acadia, Allergan/AbbVie, Avanir, Boehringer Ingelheim, Braeburn Pharmaceuticals, Daiichi Sankyo-Brazil Eisai, Eli Lilly, Harmony Biosciences, Indivior, Intra-Cellular Therapies, Ironshore, Neurocrine, Otsuka, Pear Therapeutics, Sage, Shire Sunovion, Supernus, and Torrent.
