Adults with ADHD: Can virtual clinics and AI fill the void in care?

Agave Health claims to be the first virtual clinic to offer comprehensive care for adults with ADHD.

In his freshman year of graduate school, Dr David Sitt was diagnosed with ADHD.

“It blew my mind,” he told Health Tech World. “It opened my eyes and also gave me this fear of ‘How am I going to do this?’, ‘How am I going to get through five years of grad school with this quote-unquote disability?’.”

This was 20 years ago. There was very little support for adults with ADHD as the majority of care was directed towards children and adolescents with the condition.

Experiencing first-hand the void in the mental health space, Dr Sitt dedicated his career to building better treatments for adults with ADHD.

In the early 2000s, he was part of an early community of clinicians and specialists who were contributing to the knowledge base of the adult ADHD experience.

“[My ADHD] has very much informed my professional growth and development,” he said. “Knowing it so well, I use that in my work with my clients.

“I’m very transparent.

“I tell people about my depressions that I go through, the anxiety, the procrastination and the heights and the growth and the creativity and the ability to work under pressure and the ability to innovate, and the ability to connect with people and to read multiple experiences at once. I integrate all of that into helping my clients.”

Now, Dr Sitt is bringing this knowledge to a new digital tool that is helping adults with ADHD manage their condition.

Traditional treatment methods have typically centred around medication and talk therapy, but these methods alone often fail to “move the needle”.

Dr Sitt said: “I can’t tell you how many clients come to me and say ‘I’ve been in therapy for years and years, and we talked about the depression and […] the anxiety, they talked about my procrastination, but they never gave me the tools.’”

Agave integrates cognitive behavioural therapy (CBT), mindfulness practices and executive function skill-building tools into the platform.

Emotional wellbeing is another key focus, offering support for the emotional aspects often overlooked in traditional therapies.

Dr Sitt says these traditional therapies sometimes fall short by offering only verbal guidance without practical tools.

As an advisor to the company, Dr Sitt brought to the platform his expertise in mindfulness and CBT along with his personal experience living with ADHD.

Dr David Sitt

“I have ADHD myself, so when I designed the programme, I was very much thinking about the experience, the UX, of someone with ADHD,” he said.

“Are they likely to engage in something if it doesn’t have a novelty to it? Are they likely to engage in something if it’s too long?

“How do we create some accountability? How do we create a feedback loop? How do we create elements that scaffold on their own personal experience?”

During the research phase, Dr Sitt looked at other players in the market, but found their approaches “fell flat”.

Users had information, studies and data “thrown” at them. For someone with ADHD, this is a surefire way to lose their interest.

“It was very disengaging,” Dr Sitt said. “[With Agave], I felt deeply that the content needed to be interwoven.

“You figure out a way for it to be experienced by the adult with ADHD, and that will make it stick better. Experiential growth and experiential learning.”

Awareness is growing but stigma remains

The stigma around ADHD, which often leads to misunderstandings and misdiagnoses, is gradually diminishing as awareness grows. But there is still a long way to go.

“It’s only in the past three to five years that we’ve started to have the conversation about the stigma.

“I think until then, everyone just kind of kept it under wraps. In the past five years, the adult ADHD space is exploding.”

Five years ago, Dr Sitt was writing his book, ADHD Refocused, a resource targeted specifically at adults with ADHD.

Back then, he struggled to find any similar books on the market. Now, there are hundreds, he said.

The stigmas are starting to loosen up,” he added.

“But the stigma is very real. Some of the things we hear people say is that it’s not real, some people say we all have it.”

This is connected to the rise in what Dr Sitt calls “techno ADD”, a term he coined in his book to describe the ADHD-like symptoms people are experiencing as a result of technology, social media and screen addiction.

“We have to battle that and explain to people, no, this is an organically, biologically, genetically-driven condition.”

Can AI bring ADHD care to the masses?

In the UK, ADHD in adults was only officially recognised in 2008, eight years after ADHD in children.

According to ADHD Action, 3 per cent of adults are affected by the condition.

A sharp rise in referrals in recent years has led to soaring waiting lists.

According to the BBC, in some parts of the country, it can take up to five years to receive an assessment. While this is an extreme case, a two-year wait is still common across the country.

As a result, many are turning to private practices, forking out hundreds or sometimes thousands of pounds on assessments, psychiatric appointments and additional treatment post-diagnosis.

There is a similar landscape in the US. Historically, adults with ADHD have gone undiagnosed, but growing awareness, in part thanks to social media, has led to a surge in referrals that practices are unable to keep up with.

Agave is aiming to “rebalance the scale” by bringing generative AI together with human intervention while keeping costs affordable.

A membership costs just under $100 per month.

When the average therapist rate floats around the $200 mark, Agave is seeking to lower the barriers to entry, both in terms of cost and in how the treatment is delivered.

The virtual clinic challenges traditional paradigms by offering a more tailored and flexible approach to ADHD care.

The platform offers one-to-one coaching via the app along with AI-enhanced text-based coaching and over 100 CBT lessons that aim to dig deeper into the most challenging areas of ADHD.

Dr Sitt is the author of most of these programmes with additional input from Agave’s clinicians and coaches.

“Improving [users’] executive functioning skill set is part of our foundation,” Dr Sitt said.

“Helping people develop tools around how to manage their time, how to manage their tasks better, how to work on becoming more self-aware when it comes to communication styles.

“We also weave in the cognitive behavioural therapy tools […]  to help with the emotion management.”

Mindfulness exercises also come into play which are often missed in traditional therapeutic approaches.

An additional community feature allows users to connect and meet with other people living with ADHD, whether they are discussing their condition or co-working to help them maintain focus.

“We’re creating a check-in feature to allow people to check in with each other within the community on their emotional state and review their progress over time,” Dr Sitt added.

“We have all these toolboxes that we’re working to develop to leverage things like timers, things like ADHD-friendly meditations, helping people to tame the emotional overwhelm, things like worksheets to help with project planning.

“I think what we’re doing is very unique in this space.”

“Agave marries technology with human intervention,” said the company’s co-founder Eve Lise Mamane.

“We believe that the best care is fully personalised and that is best achieved by combining both approaches.

“A ‘technology only’ approach would limit the personalisation, while a ‘human only’ approach wouldn’t be scalable.

“So we use technology, a mix of ML and AI, to enhance our coaches’ ability to attend to a large number of members without giving them standardised care, as well as to provide CBT in an accessible way.”

The platform is proving successful. Of the hundreds of members that use the service each day, 84 per cent report experiencing significant improvements in their focus following its CBT programmes, while nine out of ten say they apply the tools they’ve learned in their work.

The potential of technology in mental health and neurodevelopmental care is “great”, said Agave co-founder Ori Fruhauf, but stressed that generative AI cannot fully replace the “empathy, experience and flexibility” required to support ADHD and mental health challenges.

“The potential is great, for sure, but it also comes at a risk if improperly used.

“Our approach is that technology should be used in parallel to human care,” Fruhauf said.