Introduction:
The COVID-19 pandemic has dramatically accelerated the adoption of telemedicine across various medical disciplines, including psychiatry. In Norway, however, this trend did not naturally extend to psychiatric services, particularly in the area of ADHD assessments, which continued to experience heightened demand and extended waiting lists. This situation is exacerbated by a shortage of healthcare providers specialized in ADHD, leading to lower prioritization of ADHD assessments in public healthcare services. Additionally, Norway's geographical size  and diverse climate conditions presents another layer of complexity. Access to specialized diagnostic centers is particularly challenging for patients residing in remote locations. This circumstance contributes to the increased complexity of ADHD assessment

Objective:
The primary objective of this experience was to investigate the efficacy and efficiency of a telemedicine-based approach for diagnosing Adult Attention Deficit Hyperactivity Disorder (ADHD) in Norway. Given the existing barriers—long waiting lists, scarcity of specialized healthcare providers, and geographical constraints—the experience aimed to streamline the diagnostic process. By leveraging digital technology, we intended to expedite assessments, improve accessibility for patients in remote areas, and maintain the diagnostic rigor typically associated with in-person evaluations.

Methods:
In this experience, we employed a digital team-based approach to conduct ADHD assessments in a single, intensive session. Our team consisted of a psychiatrist and a psychiatric nurse specialized in ADHD. This session was designed to be time compressed, conducted over  approximately 3 hours in a single day, through a digital platform. This intensive approach was designed to streamline the assessment process, making it more accessible and time-efficient for patients. 

Pre-Assessment Screening:
Several days before the digital encounter, candidates underwent a pre-assessment screening process. The inclusion criteria were adults aged 18 or above, with no severe psychiatric history or substance abuse. Candidates were required to complete and submit a series of questionnaires and  blood tests.

Digital Encounter:
The evaluation was carried out entirely via a secure online platform, utilizing a computer as the primary interface. A significant portion of this digital session involved a psychiatric interview and associated evaluations, lasting approximately 3 hours in total. During this time, a digital MOXO d-CPT test was also administered to the patient. Due to the inability to maintain uninterrupted visual contact using the computer's camera during the MOXO test, patients were instructed to place a mobile device at an approximate distance of three meters from themselves. This mobile device was then used for maintaining contact via WhatsApp or FaceTime with us, allowing the clinical team to continue with uninterrupted, ongoing visual observation of the patient  during the MOXO test as well.

Results:
During our study, the specialized ADHD assessment team successfully conducted evaluations for a cohort comprising 52 patients. In this group, 43 patients (82.7%) were diagnosed with ADHD upon a single digital consultation, while an additional 4 patients (7.7%) received their diagnosis over the course of multiple appointments. ADHD was confidently ruled out in 3 patients (5.8%) after just one appointment, and in 2 patients (3.8%) after multiple appointments. In summary, 47 patients (90.4%) were diagnosed with ADHD, whereas 5 patients (9.6%) were excluded from this diagnostic category.Digital evaluations took more time than traditional in-person assessments, with an average increase of 15 minutes. 

Conclusions:
The specialized and digital approach adopted for ADHD assessments has proven to be an effective and promising alternative. While digital assessments did require a slightly increased time investment compared to in-person evaluations, the substantial advantages of this approach—such as its ability to reach patients in remote locations, the reduction of carbon footprint associated with travel, and patient comfort—make this extra investment of time entirely warranted. In summary, our specialized and digital approach not only validates its diagnostic effectiveness but also emphasizes how innovation can effectively address critical challenges in modern ADHD assessment. This method emerges as a valuable tool for streamlining and enhancing the diagnostic process for individuals seeking ADHD assessment.