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Tsai CS, Wang LJ, Hsiao RC, Yen CF, Lin CY. Psychological distress and related factors among caregivers of children with attention-deficit/hyperactivity disorder during the COVID-19 pandemic. Eur Child Adolesc Psychiatry 2024; 33:1197-1200. [PMID: 37162587 PMCID: PMC10170437 DOI: 10.1007/s00787-023-02220-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/23/2022] [Accepted: 04/27/2023] [Indexed: 05/11/2023]
Abstract
The present study examined the relationships of caregiver factors (including caregivers' age, sex and educational year), child-family interactions (caregivers' difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, children's conflict with elders and siblings, and parenting styles), and children's factors (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms) with psychological distress of the caregivers of children with ADHD in the COVID-19 pandemic. This study recruited 252 caregivers of children with ADHD to participate and complete a questionnaire collecting their psychological distress in the COVID-19 pandemic, demographics, difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, and parenting styles as well as children's conflict with elders and siblings, and the ADHD and ODD symptoms. Hierarchical regression models were constructed to examine the factors related to psychological distress among caregivers. Factors across caregiver, child, and child-family interaction dimensions, including children's conflict levels with elders and siblings, inattention symptoms, and caregivers' difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, female sex, and younger age were significantly associated with psychological distress among caregivers in various hierarchical regression models. Health professionals should take the relevant factors identified in this study when developing an intervention to relieve caregivers' psychological distress in the COVID-19 pandemic.
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Affiliation(s)
- Ching-Shu Tsai
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Liang-Jen Wang
- Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung, Taiwan
- School of Medicine, Chang Gung University, Taoyuan, Taiwan
| | - Ray C Hsiao
- Department of Psychiatry, Seattle Children's, Seattle, WA, USA
- Department of Psychiatry and Behavioral Sciences, School of Medicine, University of Washington, Seattle, WA, USA
| | - Cheng-Fang Yen
- Department of Psychiatry, School of Medicine College of Medicine, Kaohsiung Medical University, 100 Tzyou 1St Road, Kaohsiung, 80703, Taiwan.
- Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung, Taiwan.
- College of Professional Studies, National Pingtung University of Science and Technology, Pingtung, Taiwan.
| | - Chung-Ying Lin
- Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, 1 University Rd, Tainan, 70101, Taiwan.
- Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan, Taiwan.
- Department of Public Health, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
- Biostatistics Consulting Center, College of Medicine, National Cheng Kung University Hospital, National Cheng Kung University, Tainan, Taiwan.
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Dal-Pai J, Soares CB, de Fraga VC, Porto A, Foerster GP, Nunes ML. Consequences of the Covid-19 pandemic in children and adolescents with attention deficit hyperactivity disorder - a systematic review. J Pediatr (Rio J) 2024; 100:25-31. [PMID: 37640234 PMCID: PMC10751704 DOI: 10.1016/j.jped.2023.06.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/19/2022] [Revised: 06/27/2023] [Accepted: 06/27/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVE In this systematic review (SR), the authors aimed to identify the possible impact of the social restriction imposed by the Coronavirus Disease-19 (COVID-19) pandemic on children/adolescents with Attention Deficit Hyperactivity Disorder (ADHD). DATA SOURCES This SR was registered on PROSPERO CRD42021255569. Eligible articles were selected from PubMed, Embase, and LILACS, according to the following characteristics: ADHD patients < 18 years old, exposed to the COVID-19 pandemic, and the outcomes, medications, relationships, sleep, media use, remote learning, and comorbidities such as depression/sadness, inattention, anxiety, and irritability/aggressiveness. Newcastle-Ottawa Scale (NOS) for cohort, cross-sectional and case-control studies was used to assess methodological quality and the risk of bias. SUMMARY OF FINDINGS Of the 222 articles identified, 27 were included, with information on 7,235 patients. Most studies (n = 22) were cross-sectional and received a mean NOS 4.63/10 followed by longitudinal (n = 4) with 3.75/8 points and case-control (n = 1), with 3/9 points. The pandemic affected patients' access to treatment, behavior, and sleep. Difficulties in remote learning and increased use of social media were described, as well as significant and positive changes in relationships with family and peers. CONCLUSION Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ADHD were mostly manifested affecting their behavior and sleep patterns.
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Affiliation(s)
- Janise Dal-Pai
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil
| | - Carolina Boeira Soares
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil
| | - Viviane Cardoso de Fraga
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil
| | - Aline Porto
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil
| | - Gustav Peter Foerster
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil
| | - Magda Lahorgue Nunes
- Instituto do Cérebro do Rio Grande do Sul - Pontifícia Universidade Católica do Rio Grande do Sul (BraIns/ PUCRS), Porto Alegre, RS, Brazil; Escola de Medicina - Pontifícia Universidade Católica do Rio Grande do Sul (PUCRS), Porto Alegre, RS, Brazil.
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Dessain A, Parlatini V, Singh A, De Bruin M, Cortese S, Sonuga-Barke E, Serrano JV. Mental health during the COVID-19 pandemic in children and adolescents with ADHD: A systematic review of controlled longitudinal cohort studies. Neurosci Biobehav Rev 2024; 156:105502. [PMID: 38065419 DOI: 10.1016/j.neubiorev.2023.105502] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/17/2023] [Revised: 12/01/2023] [Accepted: 12/03/2023] [Indexed: 12/21/2023]
Abstract
Prior studies reported mixed effects of the COVID-19 pandemic on the mental health of children and adolescents with ADHD, but they were mainly cross-sectional and without controls. To clarify the impact, we searched Web of Science, EMBASE, Medline, and PsychINFO until 18/11/2023 and conducted a systematic review of controlled longitudinal cohort studies (Prospero: CRD42022308166). The Newcastle-Ottawa scale was used to assess quality. We identified 6 studies. Worsening of mental health symptoms was more evident in ADHD or control group according to symptom considered and context. However, those with ADHD had more persistent elevated symptoms and remained an at-risk population. Sleep problems deteriorated more significantly in those with ADHD. Lower pre-COVID emotion regulation skills and greater rumination were associated with worse mental health outcomes, and longer screen time with poorer sleep. Quality was rated as low in most studies, mainly due to self-report outcome measures and no information on attrition rates. Despite these limitations, results suggest a predominantly negative impact on youths with ADHD and may guide clinical practice and policy.
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Affiliation(s)
- Amabel Dessain
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK; South London and Maudsley NHS Foundation Trust, London, UK.
| | - Valeria Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Anjali Singh
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Michelle De Bruin
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
| | - Samuele Cortese
- Centre for Innovation in Mental Health, School of Psychology, Faculty of Environmental and Life Sciences, University of Southampton, Southampton, UK; Clinical and Experimental Sciences (CNS and Psychiatry), Faculty of Medicine, University of Southampton, Southampton, UK; Solent NHS Trust, Southampton, UK; DiMePRe-J-Department of Precision and Rigenerative Medicine-Jonic Area, University of Bari "Aldo Moro", Bari, Italy; Department of Child and Adolescent Psychiatry, New York University Grossman School of Medicine, New York, USA
| | - Edmund Sonuga-Barke
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK; Department of Child & Adolescent Psychiatry, Aarhus University, Denmark; University of Hong Kong, Hong Kong Special Administrative Region
| | - Julio Vaquerizo Serrano
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, Kings College London, UK
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Melegari MG, Ferri R, Giallonardo M, Donfrancesco R, Bruni O. Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders. Sleep Med 2023; 101:183-189. [PMID: 36402003 PMCID: PMC9637012 DOI: 10.1016/j.sleep.2022.11.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/16/2022] [Revised: 10/15/2022] [Accepted: 11/02/2022] [Indexed: 11/07/2022]
Abstract
OBJECTIVE To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD). METHODS Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores. RESULTS Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups. CONCLUSION Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems.
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Affiliation(s)
- Maria Grazia Melegari
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy; Consortium Humanitas, Lumsa University, Rome, Italy.
| | - Raffaele Ferri
- Sleep Research Centre, Oasi Research Institute - IRCCS, Troina, Italy.
| | - Martina Giallonardo
- Independent Researcher (previously at Department of Developmental and Social Psychology) Sapienza University, Rome, Italy.
| | | | - Oliviero Bruni
- Department of Developmental and Social Psychology, Sapienza University, Rome, Italy.
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