ADHD Diagnosis Accessibility with Dr. Barry Herman
In this episode, I talk with Dr. Barry Herman, Chief Medical Officer of Mentavi Health, about the clinical validation of the ADHD Smart Assessment, the rise of telehealth, and how these advances are improving access to ADHD diagnosis and treatment.
We cover key insights and practical takeaways, including:
The process and significance of clinically validating the ADHD Smart Assessment
How telehealth is expanding access to mental health care, especially for ADHD
The challenges and solutions in diagnosing ADHD in adults
To try the assessment and to save $40, visit https://adhdonline.com/adultingwithadhd/ and use promo code ADULTINGADHD40.
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Summary
Dr. Barry Herman, Chief Medical Officer of Mentavi Health, discusses his background in psychiatry and his current work in digital health. The conversation covers the evolution of Mentavi Health (formerly ADHD Online) and its clinically validated Smart Assessment for ADHD. Dr. Herman explains how the online platform is designed to improve access to care amid a shortage of psychiatrists. The discussion also touches on the challenges of diagnosing ADHD, particularly in women, and how Mentavi's assessment model aims to reduce bias and provide timely evaluations.
The evolution of Mentavi Health from ADHD Online into a telehealth provider.
The use of the Mentavi Smart Assessment, a clinically validated tool for diagnosing ADHD.
Addressing the national shortage of psychiatrists to improve access to care.
The challenges of diagnosing ADHD, particularly the underdiagnosis of women.
How the company's model aims to reduce bias in mental health evaluations.
Transcript
00:00 - Speaker 1
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00:52 - Sarah (None)
Learn more at attcom slash 5G network. The Adulting with ADHD podcast is not a substitute for medical advice. Please see a medical professional if you think you have ADHD or have ADHD and need additional assistance. For podcast archives, please visit patreoncom slash adulting with ADHD. A quick word before getting started. Today's guest is from Mentavi Health, the parent company of ADHD online, which is one of our sponsors. This is the adulting with ADHD podcast self-empowerment for people with ADHD. Today I sit down with Dr Barry Herman, chief Medical Officer of Mentabi Health and home of the ADHD assessment we will discuss today. Welcome to the show.
01:40 - Dr. Herman (None)
Thank you, Sarah. It's a pleasure to be here. Thank you.
01:43 - Sarah (None)
You played a key role in validating the accuracy of this ADHD assessment. Could you share a bit about your background and what led you to focus on this area?
01:52 - Dr. Herman (None)
Sure, I'm a psychiatrist by training. I'm board certified in adult and child and adolescent psychiatry. I did my training in child psychiatry at Stanford, began my career in clinical practice as a practicing child and adolescent psychiatrist and, as you can imagine, adhd and other neurodevelopmental disorders were really the bread and butter of my clinical practice. You see quite a bit of it, and so I would say that just my training background and my initial clinical experience really exposed me to ADHD and my interest in it. After about a dozen years of practice, I actually embarked on what I refer to as my encore career, which was a career in industry.
02:46
I went back to school, I got a business degree, then I worked for a couple of years in the insurance industry and spent about three or four years there before taking on my first job in the pharmaceutical industry, and that was in 2001 with Pfizer. Worked for a number of different companies over that period of time, always focused on psychiatry and related disorders, both what we call medical affairs and clinical development, meaning bringing new medicines to the market. And my last job in industry, in the pharma industry, was at Tris Pharma, where I was the chief medical officer, and Tris had a portfolio of branded ADHD medicines. I would say that the last seven or eight years in pharma were spent focused almost exclusively on ADHD or related disorders, and so I had a lot of exposure to ADHD, and so it was a natural interest and a good fit for me in my career.
03:56
The last five years of my career have been spent in digital health, and that's what brought me to Mentavi about two years ago, and the history of Mentavi is that the company began in 2018, was called ADHD Online. It focused almost exclusively on assessing for ADHD, and since the company has come under the umbrella of the Mentavi brand, if you will, we're now Mentavi Health, and, along with ADHD, we've now expanded to assess and treat a wide array of mental health conditions, especially those that are commonly associated with ADHD. So we've expanded from an ADHD assessment company to a broad national behavioral telehealth company, treating a wide variety of mental health conditions, but still having our legacy embedded in that ADHD brand.
05:03 - Sarah (None)
Yeah, that makes sense. That touches so many areas. The Mentavi Smart Assessment it was recently clinically validated, the first in the industry. What does that mean to be clinically validated, and why is that so critical?
05:18 - Dr. Herman (None)
Yeah, this has been a very exciting year for us. As you may know, telehealth has become increasingly popular and there's a lot of reasons for that. Certainly, covid really accelerated the use of telehealth services and provided a tailwind for its growth. But there are a lot of advantages of telehealth. It provides access to people who would otherwise have difficulty being able to get treatment and, frankly, providers and patients love it because of the convenience of telehealth. And, as I said, it's particularly well suited for folks who are somewhat disenfranchised from the health system Either they're geographically remote or they have their other factors contributing to being somewhat estranged from the health care system and telehealth really makes it much easier.
06:22
We have a big workforce shortage right now in psychiatry. Approximately 60% of counties in the United States don't have a single psychiatrist, so for many people you've Pardon me 60%, 60% and somewhere upwards of 80% don't have a child psychiatrist. There's a tremendous workforce shortage. It's not going to change anytime soon and we have to rely more and more on other ways to be able to reach patients who would otherwise not have access to treatment. Technology is one way to try to help that. Telehealth is an obvious way to do it and so it's popular.
07:08
People do, like its convenience and what we actually the Center for Disease Control and Prevention recently issued a report on ADHD and found that adults with ADHD utilize telehealth services about 46%, so that's a lot of people using telehealth services.
07:30
The problem was that while so many people were accessing treatment and diagnosis and treatment by telehealth, nobody had really done any studies to demonstrate that ADHD assessed and treated on a telehealth platform is just as accurate as the current standard of care for diagnosing and treating ADHD, and so we decided to.
07:59
We felt very confident in the assessment that we've taken many years to develop and it's undergone many different iterations and enhancements, and we felt confident that we were doing a good job assessing ADHD. The other confounding issue is that in the United States there are currently no treatment guidelines for assessing and treating ADHD in adults. It's almost impossible to believe, but there aren't any formal guidelines. There are in other countries Canada has guidelines, europe has guidelines, australia has guidelines, and this is for adults, for for children we do have guidelines. The american academy of pediatrics, the family practice association, the developmental pediatric group they all have and the american academy of child and adolescent psychiatry have all developed treatment guidelines for treating ADHD in kids, but not in adults. That's being addressed right now by an organization called the American Professional Society for ADHD and Related Disorders, or APSARD, of which I'm a member, and they've been working on developing treatment guidelines for adult ADHD for a couple of years now and we're getting very close to the end in finishing those guidelines and releasing them.
09:27 - Sarah (None)
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10:32 - Dr. Herman (None)
So that's exciting news but again, because it's been the wild west out there in terms of diagnosing and treating ADHD in adults. And adult ADHD has only really come under focus in the last decade or so, with an increasing recognition about the fact that it really very much exists and it's underdiagnosed and undertreated and there are a lot of reasons why that's been the case, but it has been. It's been a focus of attention in recent years for sure, and it still continues to be a relatively underdiagnosed and undertreated disorder. All of that is a way of saying that there's been a push in telehealth, as I said, but nobody's ever really demonstrated that an online assessment for diagnosing ADHD in adults is just as accurate as what is considered the current standard of care for diagnosing ADHD in adults, which is a clinical interview. There are no blood tests or neuroimaging studies or genetic tests that can make a diagnosis of ADHD.
11:50
We still very much rely on clinicians to see a patient, gather a history and collateral information, to do a clinical interview and then be able to utilize the DSM the Diagnostic and Statistic Manual for Mental Disorders diagnostic criteria in order to make a diagnosis of ADHD in adults. And what we had seen and when I came to Mentavia a couple of years ago, the first thing that was apparent to me was that a lot of people were skeptical about our ability to accurately diagnose ADHD using our SMART assessment, which is also an asynchronous assessment, meaning the patient can take the assessment online without a clinician present and they can fill it out and then it undergoes review by one of our clinical psychologists a doctoral level clinical psychologist who can render a diagnosis. But it's all done asynchronously and there was a lot of skepticism, frankly, and some objections and pushback from people that we potentially could work with because of the fact that it wasn't validated.
13:08
And there wasn't any proof that it was just as accurate as the current standard of care. We set out to actually try to validate what we were doing, and we did that with a clinical study that we designed and conducted all last year, the results of which were available at the beginning of this year, and we were very excited to see that there was a high level of agreement between our assessment and between the current standard of care being a clinical interview. What we did is we compared our diagnostic process to an actual clinical interview conducted by a clinical psychologist expert in diagnosing ADHD, and we found the levels of agreement to be really high, frankly, and not only that, but some of the interesting findings, besides having approximately an 80% rate of agreement, which is high for a study, is we found that our assessment probably did a better job of diagnosing true cases of ADHD. Our false positive rate for the online assessment was only 12% compared to 56% for a clinical interview, and that says something right there, and that tells you that, without having the clinical guidelines available, a lot of clinicians out there are just really all over the map, and that's what I meant about the Wild West in terms of diagnosing ADHD.
14:53
The other issue, of course, was that there was a lot of bad press, frankly, about telehealth and the ease in getting an ADHD diagnosis and, more importantly, being able to get prescriptions for psychostimulant medications, which is a controlled substance, and there were a couple of companies that really weren't very good actors and were making it very easy, without really any kind of rigorous assessment or evaluation, to get a diagnosis and really easy to be able to get a prescription, and some of the bad press out there from the few companies that really were not operating in a professional way and were really making it difficult for companies like ours that really were trying to operate in a highly ethical, with high quality and safety in mind for patients.
16:03
We just decided we wanted to validate what we were doing, so it was a high degree, as I said, of agreement between our smart assessment and the clinical interview, and I'm happy to discuss other findings in the study, but the bottom line is that we were able to demonstrate that the assessment is both valid, meaning it's accurate, and it's reliable, meaning it can be replicated now over and over again to be accurate.
16:29
The other thing about our assessment was that we were probably a little more conservative in ruling out ADHD, meaning our rate of false positives I'm sorry, false negatives was a little higher than the clinical interview. And what that meant to me was that we were being very conservative in our approach to diagnosing ADHD and when we weren't sure, we would defer a diagnosis and recommend further diagnostic evaluation in order to be able to make a diagnosis. And that really meant that we were not over-diagnosing ADHD. So two things One is, if you received a diagnosis of ADHD using our assessment, you could be pretty sure you have a diagnosis of ADHD Very low false positive rate. And if you didn't receive a diagnosis of ADHD, we wouldn't tell you you don't have ADHD. What we would say is we're just not sure, we don't have enough clinical information right now to be able to make the diagnosis, so we're recommending that you have some further evaluation in order to really determine what is actually going on.
17:50 - Sarah (None)
Yeah, sounds so reasonable. The skeptics from before. Have any of them reacted to this clinical validation and changed their minds?
17:59 - Dr. Herman (None)
No, I'll tell you. What's exciting about this is. We have now presented the data from this study at the 10th World Congress on ADHD, which was held in May in Prague, czech Republic, and it's basically the international gathering of all the thought leaders in the ADHD space. They all come from different areas like academia, research, clinical practice, and they all get together and present really the cutting edge research and data on ADHD in one place. We were able to present our poster of the data at that conference. It was really exciting, got a lot of positive response to it and at the same time, we submitted a manuscript to a peer-reviewed journal to get it published.
18:55 - Sarah (None)
And.
18:55 - Dr. Herman (None)
I'm happy to say that the journal has accepted our manuscript for publication. We're waiting any day now to hear when it will actually be in print, but we're hoping that it will happen sometime by the end of the summer and if not, it'll be early in the fall, and so that's very exciting. I can tell you, just based on the early press release about our results and the fact that we were able to present the study at the World Congress, we have received a lot more attention now and interest in our assessment, more proof that what we were doing was really scientifically valid. They're now expressing a lot of interest in utilizing our assessment and it comes from a lot of different sectors and groups, whether it's providers or provider groups or just individual practitioners or other companies. Payers are even expressing some interest, so it's a very exciting time for us. Frankly.
20:09 - Sarah (None)
And you had alluded to this earlier the lack of access. So, now that all these strides have been made, how do you see that going for the adults struggling with access?
20:19 - Dr. Herman (None)
I think what we're. Honestly, one of the reasons I love working at Mentavi is because I know that we're helping people who would otherwise not have access to diagnosis and treatment, and to date, we've actually assessed over 200,000 people. So we just reached that milestone about a month ago ago and we're also treating actively treating on our platform anywhere from maybe 20,000 to 40,000 active patients, so we're taking care of a lot of people right now. The other thing about our assessment and the way that we operate is that we've decoupled assessment from treatment. There's no requirement, if you get an assessment on our platform, that you get treated by us, so you can take that assessment and use it in whatever way is best for you as a patient, meaning you can take it to a provider of your choice, who can then treat you or provide you with an accommodation letter or whatever it is that your needs are, or you have the option to be able to continue treatment on our platform.
21:28
We offer assessment in all 50 states and we can treat patients in 40 states currently, so we are providing that access to many patients who would otherwise not have access.
21:42
The other thing is it's really affordable, and so for under $200, you get a diagnostic evaluation and it's a very thorough evaluation. Patients spend anywhere from one to three hours taking the assessment online because, depending on their responses, the assessment is dynamically modeled so that each subsequent question is dependent on the previous response by the patient, so each journey through our assessment engine is unique to that patient and so it's very individualized and there's no waits like there is in the real world right now. You've probably heard from so many people how long it takes to get in to see someone, to get an evaluation, to get treatment. You can get online, take our assessment and in less than five days you're going to have a diagnostic assessment report. That, to me, is really cool. That is why I became a psychiatrist, why I became a physician. I wanted to help people, and we're helping thousands of people now who I know would otherwise not have access to what we have to offer.
23:09 - Sarah (None)
Yeah, absolutely, and I've heard it myself from listeners just how hard it is to spend waiting seven months, so it's exciting to listen to this.
23:17 - Dr. Herman (None)
I'll tell you what was interesting about our clinical study. 80% of the participants in our study were female.
23:26 - Speaker 1
Wow.
23:26 - Dr. Herman (None)
That's almost unheard of in clinical studies, but it tells you something about the high rate of unmet medical need in women with ADHD, and you've probably heard this and discussed this on your podcast with many folks about the fact that women are often overlooked and often significantly underdiagnosed, and it starts in childhood and they're undiagnosed in childhood, it persists through adulthood and they just have never received a diagnosis.
24:00
There are a lot of reasons for this, but I like to think that being able to access an asynchronous online assessment removes some of that implicit bias in diagnosing ADHD in women, and so women, I think, who often are making the healthcare decisions for themselves and for their families anyway and are much more attuned often to health care issues, they're more likely to seek diagnostic services with our assessment than men do, or they're probably encouraging their spouses or partners or friends or relatives do their male counterparts to do likewise.
24:47
But I like to think that our assessment not only accomplishes being able to provide an accurate diagnosis, but it really takes some of those biases out of the picture, because the assessment doesn't know whether you're male or female. They just know the responses to the questions and they're basing the diagnosis on those responses and matching those against the diagnostic criteria. So our diagnosis is actually comprised of a number of validated screening instruments and also quite a number of free text questions that are aligned with the DSM-5 diagnostic criteria and technically you could end up answering as many as 400 questions. Nobody has to answer 400 questions because, as I said, the questions will shift based on your responses and we can currently diagnose a wide variety of mental health conditions, so it's not just ADHD.
25:54 - Sarah (None)
That is very interesting, very wonderful to hear on the consumer end. Thank you very much for being on the show. This is all very good information to have.
26:05 - Dr. Herman (None)
Delighted to be here, Sarah.
26:06 - Speaker 1
Give this assessment a try and to save $40, you can visit ADHDonlinecom, slash adultingwithadhd and use the promo code adultingadhd40.
