Red flags & when to go in person for ADHD (Child) - Evaluation Pathway

Audience: pediatric

Attention-Deficit/Hyperactivity Disorder (ADHD) is a common condition in children characterized by symptoms like difficulty paying attention, hyperactivity, and impulsiveness. Telemedicine can help families start the evaluation process by discussing symptoms and concerns with a healthcare provider remotely. However, some signs mean your child should be seen in person for a full evaluation. These include sudden changes in behavior, severe mood problems, or safety concerns. This guide explains when to seek in-person care, what telemedicine can and cannot do for ADHD evaluation, and how to prepare for a tele-visit. Remember, telemedicine is a helpful first step but is not a substitute for thorough, in-person assessment when needed. Always seek emergency care if your child shows signs of danger or severe distress.

Red flags — go in person / ER

• Sudden mood changes or signs of depression or self-harm — seek immediate in-person mental health care.
• New or worsening speech, movement problems, or loss of previously gained skills — arrange urgent in-person neurological evaluation.
• Severe impulsivity or aggression putting child or others at risk — go to emergency services or urgent care.

What telemedicine can do

• Initial symptom discussion and history taking
• Providing education about ADHD
• Guidance on mild symptom management
• Referrals for in-person evaluation

What telemedicine cannot do

• Formal ADHD diagnostic testing
• Physical or neurological examination
• Prescribing medication without prior in-person assessment
• Emergency or crisis mental health situations

Understanding ADHD in Children

ADHD is a condition that affects how children pay attention, control impulses, and manage activity levels. It often shows up as trouble focusing, being overly active, or acting without thinking. These behaviors can affect school, home, and social life. Early evaluation helps get the right support.

When to Use Telemedicine for ADHD Evaluation

Telemedicine allows you to talk with a healthcare provider from home. It is useful for discussing your child's symptoms, learning about ADHD, and deciding if further evaluation is needed. Providers can guide you on next steps and offer resources remotely.

Red Flags That Need In-Person Evaluation

Certain signs mean your child should be seen in person promptly:

What Telemedicine Can and Cannot Do for ADHD

**Can handle:**

**Cannot handle:**

Preparing for Your Telemedicine Visit

To get the most from your tele-visit:

After Your Telemedicine Visit

After the visit, follow the provider's advice. This may include:

How to prepare for your tele-visit

• Observe and note your child's behaviors, including when and where they occur
• Collect any school or caregiver reports about your child's attention and behavior
• Prepare a list of questions or concerns to discuss
• Ensure a quiet, private space with reliable internet for the tele-visit
• Test your device's camera and microphone before the appointment

After your tele-visit

• Follow provider recommendations for further evaluation or care
• Implement suggested behavioral strategies at home
• Monitor your child's symptoms and note any changes
• Seek emergency care if any red flags develop
• Maintain communication with your healthcare provider for ongoing support

FAQs

Can ADHD be diagnosed through telemedicine?

Telemedicine can help start the conversation and gather information, but a formal ADHD diagnosis usually requires in-person evaluation, including observation and testing by a healthcare professional.

What should I do if my child shows sudden mood changes?

Sudden mood changes, especially signs of depression or self-harm, require prompt in-person evaluation or emergency care. Contact your healthcare provider or emergency services immediately.

How can I prepare my child for a telemedicine visit?

Explain the visit in simple terms, find a quiet space, and have your child's recent behavior notes or school reports ready. Make sure the device is working well with camera and microphone enabled.

Is medication prescribed during a telemedicine visit?

Medication for ADHD typically requires an in-person assessment before prescribing. Telemedicine providers may discuss medication options but usually will refer for an in-person visit first.

When should I seek emergency care for my child?

Seek emergency care if your child shows severe aggression, self-harm, suicidal thoughts, or sudden loss of abilities. These are urgent signs that need immediate attention.

Sources

1. Attention-Deficit / Hyperactivity Disorder (ADHD) — MedlinePlus, U.S. National Library of Medicine.
2. ADHD: What You Need to Know — Centers for Disease Control and Prevention (CDC).
3. Attention-Deficit/Hyperactivity Disorder (ADHD) in Children — Mayo Clinic.
4. Clinical Practice Guideline for the Diagnosis, Evaluation, and Treatment of Attention-Deficit/Hyperactivity Disorder in Children and Adolescents — American Academy of Pediatrics.

This telemedicine guidance is for educational purposes only and is not a substitute for professional in-person medical evaluation and care. If your child has urgent or severe symptoms, seek immediate in-person medical attention.