Enhancing ADHD Management With Psychoeducation and Digital Therapeutics

In this video, Psych Congress NP Institute Co-Chair Julie Carbray, PhD, PMHNP-BC, FAAN, provides clinicians with practical psychoeducation strategies to strengthen attention-deficit/hyperactivity disorder (ADHD) management. Carbray highlights how thoroughly discussing patients’ daily challenges may clarify the functional impact of ADHD, allowing clinicians to better individualize treatment discussions and decisions to patient needs. She also explores how emerging digital therapeutics may offer additional support for bolstering treatment adherence and managing illness between appointments.

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• Psychoeducation should connect patients' everyday challenges—including work, relationships, driving, mood regulation, substance use, irritability, anger, and suicidal thoughts—to the functional impact of ADHD and guide individualized treatment discussions.
• Clinicians should regularly assess how current treatments affect daily functioning and tailor therapy to provide symptom control across the patient's day using a holistic approach.
• Emerging tools, including virtual reality, reminder systems, and executive functioning supports, may help bridge care between visits and provide additional data to inform treatment decisions.

Julie Carbray, PhD, PMHNP-BC, FAAN: Hi, I'm Julie Carbray. I am a clinical professor of nursing and psychiatry at the University of Illinois Chicago's Institute for Juvenile Research Department of Psychiatry, and I'm also a psychiatric mental health nurse practitioner.

Psych Congress NP Institute: What psychoeducation strategies can clinicians employ to address poor treatment adherence in patients with ADHD?

Carbray: The best psychoeducation in helping our patients understand the impact of their illness on their day-to-day life is really hearing about their lives and talking together about some of the challenges they're having, whether it's with driving or with relationships or with their job, and then really teaching them about how ADHD can commonly impair all of those domains.

I didn't even mention things like substance use or mood regulation, and how that might show up in relationships. 

We want to talk about what some of the challenges they're having across their overall functioning are and then bring to them some good information about what we know about ADHD. 

We know that ADHD can commonly impair work, relationships, driving, even suicidal thoughts and things like irritability and anger. We want to ask about those things, see where they may be showing up, and see how their current treatment is helping or aggravating any of those areas. 

Then taking it on from a holistic standpoint and talking with them about how different agents may help, to what extent, for how long across the day, and assuring that they have the right treatment that spans whatever those areas are, so that we're assuring good symptom control. 

PCNPI: What role may digital therapeutics play in the management of ADHD?

Carbray: In my opinion, digital therapeutics are very exciting for helping patients to manage their illness, outside of our offices especially. I think from a clinician standpoint, we're going to have some great data points to be able to talk with our patients around their non-digital treatments, psychopharmacology or their psychotherapy, and to determine where we need to fill in some more.

Digital therapies can actually bridge the gap between clinicians and our patients and help us to understand how to better target the treatment and what we are trying to address. 

In some cases, psychoeducation can be a huge component. There are some great new movements, things like virtual reality, reminder systems working on executive functioning, in which digital therapeutics show some great promise, especially with ADHD.

So, we're all staying very attuned to data that's coming out to help us as clinicians help our patients to have a more robust toolkit for us to be able to address symptoms across patients’ day.

Julie Carbray, PhD, PMHNP-BC, PMHCNS-BC, FAAN, holds her PhD (93) and Master of Science (88) degrees from Rush University, Chicago and her Bachelor of Science (87) degree from Purdue University in West Lafayette, Indiana. A Clinical Professor of Psychiatry and Nursing at the University of Illinois Chicago, she has been practicing as a Psychiatric Nurse Practitioner over 35 years.

As UIC faculty, Dr. Carbray teaches course content in psychopharmacology, mood disorders, and development and therapeutic interventions with children and adolescents for students across various multidisciplinary programs. As the Director of the Pediatric Mood Disorder Clinic, Dr. Carbray leads the clinical program and multidisciplinary training and is a nationally recognized clinical expert in children and adolescents with mood disorders. Dr. Carbray holds a national reputation of excellence in serving families of children with mood disorders, and was recognized with the UIC Preceptor of the year award, the Karen Gousman Excellence in Nursing Award, the American Psychiatric Nurses Association Best Practices in an Outpatient Program for Bipolar Disorder Award, the UIC Inspire Award, the APNA Distinguished Service Award and the Susan McCabe psychopharmacology lectureship from the International Society of Psychiatric Nurses.

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