Impact of COVID-19 and Lockdown on Children with ADHD and Their Families—An Online Survey and a Continuity Care Model

Abstract

Background Little is known about the impact of the coronavirus disease 2019 pandemic on children with attention-deficit hyperkinetic disorder (ADHD). This study aimed to assess the impact of lockdown on children with the ADHD, and their families. Additionally, feasibility of carrying out “text message-based” intervention was evaluated. Methods An online survey was performed to evaluate the impact of lockdown on children with ADHD and their family members. Additionally, a “text message”-based intervention was performed over 2 weeks. Along with the text-based intervention, we also provided reading materials and an option of telephonic consultation. Results Of the 80 parents who initially consented to participate, 48 filled the baseline survey, and 41 agreed to receive intervention. Out of 41, 29 filled satisfaction survey. During the lockdown period, there was worsening of symptoms of ADHD in the form of increase (slight or marked) in the activity level (50.1%), irritability (45.8%), and disturbing or disruptive behavior (47.7%) in children. In terms of behavior of family members, there was marked/slight increase in irritability (37.5%), and shouting at the child (43.8%), verbal abuse (25%), and punishing the child (27.1%). Additionally, there was an increase in the praising (67.6%) and spending time with the child (72.9%). Text-based messages on a scale of 0 to 10 were rated as 5.79 for the content, 5.76 for the usefulness, and 6 for satisfaction. Conclusion Lockdown resulted in worsening of symptoms among children of ADHD and it had impact on the interaction pattern of the children and parents. A “text message”-based intervention is a feasible and possibly acceptable option to deal with the behavioral problem of the children and adolescents with ADHD.

Quality of Life Changes during the COVID-19 Pandemic for Caregivers of Children with ADHD and/or ASD

“…In populations with neurodevelopmental disorders, our findings align with studies that indicated caregivers of ASD children suffered from increased stress, distress, fear, anxiety, depression, emotional dysregulation, and decreased mood during the COVID-19 period [ 9 , 21 , 50 , 51 , 52 , 53 ]. Other empirical studies investigating the impact of the COVID-19 pandemic on caregiver quality of life in families with ADHD are limited, though Shah et al reported that caregivers of ADHD children noted a higher frequency of negative interactions with their children, including increased irritability, verbal abuse, and punishment [ 54 ].…”

“…Behavioral parent training is a well-established psychosocial treatment with the strongest evidence base showing positive outcomes in children with ADHD and improvements in parenting [ 62 , 63 , 64 , 65 , 66 ]. A preliminary study implementing telepsychology group behavioral parent training for ADHD children during the COVID-19 pandemic resulted in mostly positive outcomes with efficacy, high treatment fidelity, and parental satisfaction comparable to in-person sessions [ 67 ], and a pilot study implementing a text-message based intervention with behavioral parent training principles for ADHD proved feasible and led to satisfaction in a proportion of the caregivers [ 54 , 66 , 68 ]. While remote parent-guided programs and interventions in families with children with ADHD and/or ASD show promising results in potentially improving caregivers’ quality of life [ 57 , 63 , 67 , 69 ], these virtual strategies and interventions are still in their infancy and require further exploration [ 54 , 57 , 59 , 60 , 67 ].…”

The negative psychological impact of COVID-19 pandemic on mothers of children with attention deficit hyperactivity disorder (ADHD): a cross-section study

“…In line of our results, Zhang and colleagues' study found that children's ADHD symptoms significantly deteriorated during the COVID-19 pandemic compared to their normal state [48]. Also, inconsistent with the study of Shah, R. and colleague, who found that the lockout caused by the COVID-19 pandemic was related to deteriorating the symptoms of ADHD in half of their study participants, which was in the form of a rise in the level of activity (slight or significant), irritability, or disruptive conduct behavior [49].…”

Addressing Pediatric Mental Health Using Telehealth During Coronavirus Disease-2019 and Beyond: A Narrative Review

“…57 Some families of youth with ADHD expressed appreciation for text messages helping them manage their child's symptoms. 58 Patient telehealth use during the COVID-19 pandemic posed challenges 51,59,60 (e.g., technological issues, privacy concerns, scheduling conflicts, and engaging patients physically/emotionally), with such reasons also being endorsed for missed appointments. 59 On the other hand, clinicians effectively transitioning to telehealth care reported supervisor support, and ability to adjust to technological challenges as factors contributing to their success.…”