Externalizing and Internalizing Behaviors in Children with ADHD during Lockdown for COVID-19: The Role of Parental Emotions, Parenting Strategies, and Breaking Lockdown Rules

Abstract

Lockdown experience for COVID-19 pandemic significantly affected children and adolescents with Attention-Deficit/Hyperactivity Disorder (ADHD) exacerbating or promoting the onset of externalizing and internalizing symptoms. However, few studies have considered how externalizing and internalizing behaviors changed in relation to parental emotions and parenting strategies. In the present study, 992 caregivers of children and adolescents with ADHD from 5 to 18 years were presented with an online survey evaluating youths’ externalizing and internalizing behaviors, their non-compliance with lockdown rules, and parental factors related to parental emotions and parenting strategies. Two hierarchical linear regression models were performed to examine the contribution of children’s non-compliance with lockdown rules, parental emotions, and parenting strategies on children’s externalizing and internalizing behaviors. Results revealed that externalizing behaviors were higher in children and adolescents with ADHD non-compliant with lockdown rules. Moreover, positive parenting strategies moderated the relationship between non-compliance with lockdown rules and externalizing behaviors. Differently, higher internalizing behaviors were observed in children with ADHD who had parents reporting more negative emotions and positive parenting strategies. In this case, parents’ negative emotions had a moderator effect in the association between internalizing behaviors and non-compliance to lockdown measures. The clinical implications of these two different patterns of relations are discussed.

Parenting a Child with a Neurodevelopmental Disorder during the Early Stage of the COVID-19 Pandemic: Quantitative and Qualitative Cross-Cultural Findings

“…On the other hand, the urgency of caring and rearing children with NDD without the usual external support may have led to overwhelm and increased parental stress, which in turn may have biased the judgement of children's externalizing behaviors. However, independently from the reasons why the externalizing behaviors were perceived as worsened, it is important to carefully consider the parents' perceptions, as there is a well-documented reciprocal influence between the severity of child behavioral difficulties and caregiver burden [20,56,57]. Our results corroborate this relation.…”

Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders

“…Again, children with internalizing behaviors resulted susceptible to remission of some sleep problems; conversely, this did not happen with children with externalizing behaviors. Studies on patients with ADHD during lockdown reported significantly increased disruptive behaviors in around 50% of them, and altered child/parents interaction characterized by marked increase in irritability, shouts and verbal abuse, and punishments [ 19 , 22 , 32 , 33 ]. Altogether the results suggest that sleep problems could contribute to exacerbate or promote the externalizing behaviors considering that, other studies highlighted a positive association with the externalizing behaviors but not with the internalizing ones [ 33 ].…”

“…Studies on patients with ADHD during lockdown reported significantly increased disruptive behaviors in around 50% of them, and altered child/parents interaction characterized by marked increase in irritability, shouts and verbal abuse, and punishments [ 19 , 22 , 32 , 33 ]. Altogether the results suggest that sleep problems could contribute to exacerbate or promote the externalizing behaviors considering that, other studies highlighted a positive association with the externalizing behaviors but not with the internalizing ones [ 33 ]. Conversely, the hypothesis of a bidirectional relationship between some sleep problems and internalizing symptoms reported in recent studies seems also to be supported [ 5 ].…”