[How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?]

Evaluation of the Safer Use of Antipsychotics in Youth Study on Population Level Antipsychotic Initiation: An Interrupted Time Series Analysis

Background: Antipsychotics carry a higher-risk profile than other psychotropic medications and may be prescribed for youth with conditions in which other first-line treatments are more appropriate. This study aimed to evaluate the population-level effect of the Safer Use of Antipsychotics in Youth (SUAY) trial, which aimed to reduce person-days of antipsychotic use among participants. Methods: We conducted an interrupted time series analysis using segmented regression to measure changes in prescribing trends of antipsychotic initiation rates pre-SUAY and post-SUAY trial at four U.S. health systems between 2013 and 2020. Results: In our overall model, adjusted for age and insurance type, antipsychotic initiation rates decreased by 0.73 (95% confidence interval [CI]: 0.30, 1.16, p = 0.002) prescriptions per 10,000 person-months before the SUAY trial. In the first quarter following the start of the trial, there was an immediate decrease in the rate of antipsychotic initiations of 6.57 (95% CI: 0.99, 12.15) prescriptions per 10,000 person-months. When comparing the posttrial period to the pretrial period, there was an increase of 1.09 (95% CI: 0.32, 1.85) prescriptions per 10,000 person-months, but the increasing rate in the posttrial period alone was not statistically significant (0.36 prescriptions per 10,000 person-months, 95% CI: -0.27, 0.99). Conclusion: The declining trend of antipsychotic initiation seen between 2013 and 2018 (pre-SUAY trial) may have naturally reached a level at which prescribing was clinically warranted and appropriate, resulting in a floor effect. The COVID-19 pandemic, which began in the final three quarters of the posttrial period, may also be related to increased antipsychotic medication initiation.

Emotions and behaviours of child and adolescent psychiatric patients during the COVID-19 pandemic

BACKGROUND

Previous pandemics have had negative effects on mental health, but there are few data on children and adolescents who were receiving ongoing psychiatric treatment.

AIMS

To study changes in emotions and clinical state, and their predictors, during the COVID-19 pandemic in France.

METHOD

We administered (by interview) the baseline Youth Self-Report version of the CoRonavIruS Health Impact Survey v0.3 (CRISIS, French translation) to 123 adolescent patients and the Parent/Caregiver version to evaluate 99 child patients before and during the first 'lockdown'. For 139 of these patients who received ongoing treatment in our centre, treating physicians retrospectively completed longitudinal global ratings for five time periods, masked to CRISIS ratings.

RESULTS

The main outcome measure was the sum of eight mood state items, which formed a single factor in each age group. Overall, this score improved for each age group during the first lockdown. Clinician ratings modestly supported this result in patients without intellectual disability or autism spectrum disorder. Improvement of mood states was significantly associated with perceived improvement in family relationships in both age groups.

CONCLUSIONS

Consistent with previous studies of clinical cohorts, our patients had diverse responses during the pandemic. Several factors may have contributed to the finding of improvement in some individuals during the first lockdown, including the degree of family support or conflict, stress reduction owing to isolation, limitations of the outcome measures and/or possible selection bias. Ongoing treatment may have had a protective effect. Clinically, during crises additional support may be needed by families who experience increased conflict or who care for children with intellectual disability.

Experiences of children and young people with attention deficit hyperactivity disorder (ADHD) during COVID-19 pandemic and lockdown restrictions

PURPOSE

To explore the experiences of children and young people (CYP) with attention deficit hyperactivity disorder during the COVID-19 pandemic and lock down restrictions.

METHODS

Semi-structured, online interviews were conducted with 17 children and young people from the UK, Northern Ireland, aged 10-14 years with ADHD. Over half the participants had a co-existing diagnosis, such as autism spectrum disorder. Interviews were recorded and transcribed verbatim before being subjected to thematic analysis.

RESULTS

Four themes were identified; the emotional impact of the pandemic, adjustments to daily living, impact of remote learning and the effect on relationships. Many CYP citied feelings of sadness, loneliness and anxiety, others found the reduction in social demands favourable.

CONCLUSIONS

As one of few studies to capture the experiences of children and young people with ADHD during the COVID-19 pandemic, this research highlights the potential negative long-term impact on emotional welfare, schooling and relationships.Implications for rehabilitationHealth care professionals should be aware of the overall impact on health and well-being for children and young people with ADHD following the COVID-19 pandemic and lockdown restrictions to ensure that the effect of these are minimised and managed in the future.Educators and clinicians should be cognisant of the long term consequences of poor mental health during the COVID-19 pandemic and should put in place pro-active strategies to support children and young people with ADHD.Children and young people with ADHD may suffer greatly from reduced access to sports and leisure facilities. Policy makers should be conscious of the potential negative consequences of placing limitations on access to such facilities.

Mental health during the COVID-19 pandemic in children and adolescents with ADHD: A systematic review of controlled longitudinal cohort studies

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.

[Attention deficit hyperactivity disorder in children and adolescents: lessons from the COVID-19 pandemic]

To limit the spread of the coronavirus infection COVID-19, which has received the status of a pandemic, a lockdown was temporarily introduced. In conditions of isolation, children and adolescents suffering from attention deficit hyperactivity disorder (ADHD) were faced with forced changes in their daily routine in the form of a transition to distance learning, a decrease in physical activity, an increase in time in front of TV screens/computer monitors/tablets, etc. The review provides current evidence on the associations between social restrictions caused by the COVID-19 pandemic and behavioral problems in children and adolescents with ADHD. The main factors that can influence the severity of the disease in children and adolescents are analyzed. Particular attention is paid to the role of parental behavior and its influence on the manifestations of ADHD in children in isolation. The results of numerous observations and online surveys of relatives and children suffering from ADHD have demonstrated a multidirectional trajectory of the disease depending on numerous factors, including relationships with parents and immediate family. Despite the end of the COVID-19 pandemic, the effects of isolation during critical periods of childhood have the potential to increase the burden of mental illness. Treatment of children and adolescents with ADHD during the COVID-19 pandemic should be pathogenetic, taking into account the main symptoms of the disease. When choosing pharmacotherapy, priority should be given to drugs with verified effectiveness and a reliable safety profile.

The role of language in mental health during the transition from primary to secondary education

We report a preregistered analysis to test whether children meeting diagnostic criteria for language disorder (LD) have higher self-reported and/or parent-reported mental health symptoms during the transition from primary to secondary education. Data are from a UK-based longitudinal cohort study, The Surrey Communication and Language in Education Study (SCALES). SCALES oversampled children at risk of LD at school entry. Language was measured using a battery of standardised assessments in Year 1 (age 5-6 years, n = 529), and mental health symptoms were measured using self and parent report in Year 6 (age 10-11 years, n = 384) and Year 8 (age 12-13 years, n = 246). Social experiences were also measured using self-report measures in Year 6. Mental health symptoms were stable during the transition from primary to secondary school. Symptom rates did not differ between children with and without LD based on self-report, but children with LD had higher parent-reported mental health symptoms than their peers with typical language. Similarly, early language was negatively associated with parent-reported but not self-reported mental health symptoms. Early language was associated with fewer child-reported positive social experiences in Year 6, but social experiences did not mediate the association between language and mental health. We found poor agreement between parent and self-reported child mental health symptoms across language groups. Future studies should aim to determine sources of disagreement between parent and child report, particularly for children with communication difficulties who may struggle to accurately self-report mental health symptoms.

Admission rates and clinical profiles of children and youth with eating disorders treated as inpatients before and during the COVID-19 pandemic in a German university hospital

Introduction

Children and youth at risk for mental health disorders, such as eating disorders (ED), were particularly affected by the COVID-19 pandemic, yet evidence for the most seriously affected and thus hospitalized youth in Germany is scarce.

Methods

This crosssectional study investigated anonymized routine hospital data (demographic information, diagnoses, treatment modalities) of patients admitted (n = 2,849) to the Department of Child and Adolescence Psychiatry, Psychosomatics and Psychotherapy (DCAPPP) of a German University Hospital between 01/2016 and 02/2022. Absolute and relative number of inpatients with or without ED prior to (01/2016-02/2020) and during the COVID-19 pandemic (03/2020-02/2022) were compared. The effect of school closures as part of social lockdown measures for COVID-19 mitigation on inpatient admission rate was explored as it has been discussed as a potential risk factor for mental health problems in youth.

Results

During the COVID-19 pandemic, ED inpatient admission rate increased from 10.5 to 16.7%, primarily driven by Anorexia Nervosa (AN). In contrast to previous reports, we found no change in somatic and mental disorder comorbidity, age or sexratio for hospitalized youth with ED. However, we did observe a shortened length of hospital stay (LOS) for hospitalized youth with and without ED. In addition, non-ED admissions presented with an increased number of mental disorder comorbidities. In contrast to our hypothesis, school closures were not related to the observed increase in ED.

Discussion

In summary, the COVID-19 pandemic was associated with an increased rate of inpatient treatment for youth suffering from AN, and of youth affected by multiple mental disorders. Accordingly, we assume that inpatient admission was prioritized for individuals with a higher burden of disease during the COVID-19 pandemic. Our findings pinpoint the need for adequate inpatient mental health treatment capacities during environmental crises, and a further strengthening of child and adolescence psychiatry services in Germany.

Associations Between Anxiety and Home Learning Difficulties in Children and Adolescents with ADHD During the COVID-19 Pandemic

The COVID-19 pandemic has markedly impacted functioning for children and adolescents including those with attention-deficit/hyperactivity disorder (ADHD). We explored home learning difficulties (HLD) during COVID-19 restrictions in Australian children (aged 5-17) with ADHD, aiming to: (1) describe home learning experiences, and (2) examine associations between child anxiety (i.e., concurrent anxiety symptoms and pre-existing anxiety disorder status) and HLD. Baseline data from the longitudinal ADHD COVID-19 Survey were used (n = 122). Parents reported on school factors and HLD; pre-existing anxiety and co-occurring difficulties; anxiety, ADHD, and oppositional symptoms; demographics; and medications. Parents retrospectively reported more children often looked forward to school pre-pandemic, than during the pandemic. Anxiety symptoms, but not pre-existing anxiety disorder status, were associated with HLD after accounting for covariates. ADHD inattention symptoms were also associated with HLD. Results support recommendations to continue pre-pandemic supports to assist with ADHD symptoms during home learning, and strategies/supports for families are discussed.

The Effects of the First Phase of the Covid-19 Pandemic on the Mental Health of Children and Adolescents With preexisting Psychiatric Conditions

Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times.

The indirect health impacts of the COVID-19 pandemic on children and adolescents: A review

It is pertinent to examine potentially detrimental impacts of the coronavirus disease 2019 (COVID-19) pandemic on young people. We conducted a review to assess the health impacts of the COVID-19 pandemic on children and adolescents. Databases of MEDLINE, Embase and the Cochrane Library were searched in June 2020, using keywords for 'children', 'adolescents' and 'COVID-19'. English papers discussing young people in context to the COVID-19 pandemic were included. Quality of selected studies was evaluated and scored. Of the 2013 identified articles, 22 met the inclusion criteria, including 11 cohort studies, ten cross-sectional studies and one report. Five main issues emerged: Increased mental health conditions, declines in presentations to paediatric emergency departments, declines in vaccination rates, changes in lifestyle behaviour (mainly decreased physical activity for specific groups of children), and changes in paediatric domestic violence and online child sexual abuse. There are early indications that the COVID-19 pandemic is impacting the health of young people, and this is amplified for those with existing health conditions and vulnerabilities. Despite this, there is limited insight into the protective factors for young people's health and wellbeing, as well as how the impacts of the pandemic can be mitigated in both the short and long term.

Psychological impact of six weeks of strict home confinement in Spanish families having school-aged children with attention-deficit/hyperactivity disorder

After the COVID-19 outbreak, early publications reported worsening symptoms and increased caregiver burden in families having children with Attention-Deficit/Hyperactivity Disorder (ADHD). In the present study, we launched an online survey to examine the psychological impact of the 41 days of strict home confinement implemented in Spain in families having children with ADHD compared to families having children with typical development (TD). We achieved a representative sample of 190 school-aged children (NADHD =100 and NTD=90) from 181 families. Respondents were mainly mothers (≈96%). We found that mother reports of hyperactive-impulsive symptoms significantly increased during home confinement regardless of ADHD diagnosis. During the lockdown, we also found that perceived stress significantly increased in mothers of ADHD and TD children, but, unexpectedly, this increase was much more noticeable for the latter group. Moreover, our study suggests that children having parents working in frontline jobs or living in families with higher household conflicts might display increased ADHD symptoms during the lockdown, irrespective of ADHD diagnosis. Our results highlight the need to provide psychological support to families most exposed to the pandemic and target household problems and mothers' well-being at intervention processes, in both ADHD and TD families.

COVID-19 Vaccine Hesitancy: A Global Public Health and Risk Modelling Framework Using an Environmental Deep Neural Network, Sentiment Classification with Text Mining and Emotional Reactions from COVID-19 Vaccination Tweets

Popular social media platforms, such as Twitter, have become an excellent source of information with their swift information dissemination. Individuals with different backgrounds convey their opinions through social media platforms. Consequently, these platforms have become a profound instrument for collecting enormous datasets. We believe that compiling, organizing, exploring, and analyzing data from social media platforms, such as Twitter, can offer various perspectives to public health organizations and decision makers in identifying factors that contribute to vaccine hesitancy. In this study, public tweets were downloaded daily from Tweeter using the Tweeter API. Before performing computation, the tweets were preprocessed and labeled. Vocabulary normalization was based on stemming and lemmatization. The NRCLexicon technique was deployed to convert the tweets into ten classes: positive sentiment, negative sentiment, and eight basic emotions (joy, trust, fear, surprise, anticipation, anger, disgust, and sadness). t-test was used to check the statistical significance of the relationships among the basic emotions. Our analysis shows that the p-values of joy-sadness, trust-disgust, fear-anger, surprise-anticipation, and negative-positive relations are close to zero. Finally, neural network architectures, including 1DCNN, LSTM, Multiple-Layer Perceptron, and BERT, were trained and tested in a COVID-19 multi-classification of sentiments and emotions (positive, negative, joy, sadness, trust, disgust, fear, anger, surprise, and anticipation). Our experiment attained an accuracy of 88.6% for 1DCNN at 1744 s, 89.93% accuracy for LSTM at 27,597 s, while MLP achieved an accuracy of 84.78% at 203 s. The study results show that the BERT model performed the best, with an accuracy of 96.71% at 8429 s.

Factors Associated with Increased or Decreased Stress Level in French Children during the First COVID-19 Lockdown

In spring 2020, governments of many countries implemented lockdown measures to prevent the spread of the COVID-19 pandemic. Worldwide, the pandemic forced about 1.5 billion children to stay at home for several weeks and to experience homeschooling. The objective of this study was to assess the variation in stress levels and associated factors in school-aged children in France during the first COVID-19 lockdown. A cross-sectional study using an online questionnaire was designed by an interdisciplinary team involving hospital child psychiatrists and school doctors. Between 15 June and 15 July 2020, Educational Academy of Lyon (France) invited the parents of school-aged children to participate in this survey. The first part of the questionnaire concerned the children with data on lockdown conditions, socio-demographic data, daily rhythms (eating and sleeping), perceived stress variations, and feelings. The second part assessed parental perspectives on their child's psychological state and use of the mental health care system. Multivariate logistic regression was performed to identify factors associated with stress variation (increased or decreased). A total of 7218 questionnaires were fully completed by children from elementary school to high school with a balanced sex ratio. In summary, 29% of children reported a higher stress level during the lockdown, 34% reported a lower stress level, and 37% reported no stress variation in the usual situation prior to COVID-19. Parents were most often able to identify signs of increased stress levels in their children. The most influential factors in the variation of stress for children were academic pressure, family relationships, and fear of being infected or infecting a family member with SARS-CoV-2. Our study underlines the high impact of school attendance stressors on children in usual conditions and encourages vigilance for children whose stress levels have decreased during the lockdown but who may have increased difficulty re-exposing themselves upon deconfinement.

How parents share and limit their child’s access to information about COVID-19: A mixed methods online survey study

This study aimed to understand the role that parents play in sharing or limiting their child's access to information about coronavirus disease 2019 (COVID-19). A subset of data from an international mixed methods online survey study was analysed to elucidate the findings from Brazil. An online survey, conducted between April and June 2020, gathered closed and open text views from parents of children aged 7-12 years old. Quantitative data were analysed using descriptive statistics. Qualitative open text data were analysed using the three stages of the Bardin content analysis framework: pre-analysis (data organisation and initial full-content reading); exploration of the material (thematic coding to identify major motifs and develop thematic categories) and interpretation (treating the data as significant and valid). The sample consisted of 112 (89%) mothers and 14 (11%) fathers. The analysis of the parents open text resulted in two categories: 'How parents share information with their children about COVID-19' and 'How parents limit information to their children about COVID-19'. Some parents reported adopting an honest and open approach on how they shared information with their children, whilst some parents chose to minimise their child's access to information about the pandemic over concerns of the mortality related to COVID-19.

Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders

The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (β = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.

Remote assessment of ADHD in children and adolescents: recommendations from the European ADHD Guidelines Group following the clinical experience during the COVID-19 pandemic

The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.

Attention Deficit Hyperactivity Disorder: What Are Pharmacists' Roles and Associated Outcomes?

Globally, the prevalence of attention deficit hyperactivity disorder (ADHD) is increasing. The treatment for ADHD is multifaceted and requires long-term care and support. Pharmacists are capable of assisting patients and their caretakers in achieving desired outcomes. This work discusses and summarizes pharmacists' roles in ADHD care and their associated outcomes. Overall, pharmacists are positioned to educate on ADHD, optimize medications in a collaborative practice model, manage and monitor side effects, and provide remote and virtual pharmaceutical care. Pharmacists could directly contribute to ensuring medication safety and increasing awareness regarding the optimal use of ADHD medications. Patients with ADHD can benefit from pharmacist involvement in a variety of ways, including, but not limited to, initial screening and referral, the provision of clinical consultation and feedback, and the improvement of self-management and self-awareness of the illness. Pharmacists also play a significant role in therapeutic decision making regarding the initiation, intensification, and monitoring of ADHD treatment to ensure its effectiveness and quality of life improvement. Lastly, pharmacists could help identify more cost-effective treatment approaches for ADHD patients based on the clinical scenario that is encountered.

Understanding the Impact of Home Confinement on Children and Young People with ADHD and ASD During the COVID-19 Pandemic

To understand whether the mental health of children and young people (CYP) with and without attention-deficit/hyperactivity disorder (ADHD) and/or autism spectrum disorder (ASD) were differentially affected by COVID-19. We analysed data (n = 6507) from the Co-Space study, a UK web-based longitudinal survey. CYP with ADHD (n = 160;2.5%), ASD (n = 465;7%), and ADHD + ASD (n = 155;2.4%) were compared with a reference group (n = 5727;88%) using parent-completed questionnaires [Strengths and Difficulties Questionnaire (SDQ) & Pandemic Anxiety Scale (PAS)]. Baseline to 1-month follow-up differences were compared using linear regression models. CYP with ADHD and/or ASD had higher scores at baseline than other CYP. At follow-up, CYP with ASD showed small but significant improvements in symptoms (SDQ), compared with the reference group. CYP with ASD experienced a worsening of disease anxiety (PAS) and CYP with ADHD a deterioration in functional impairment. These findings indicate a mixed pattern of pandemic-related impact for CYP with ADHD and/or ASD.

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

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.

Psychological impact during COVID-19 lockdown in children and adolescents with previous mental health disorders

OBJECTIVE

During the COVID-19 pandemic, authorities confined adults, adolescents and children to their homes. Recent articles warn of possible long-term consequences on mental health, especially for those who suffer from underlying psychiatric conditions and for vulnerable sections of the population. The present study explores the psychological impact of the COVID-19 quarantine on outpatients at the Centre of Child and Adolescent Mental Health (CAMHS), which is based in Barcelona.

METHODS

A total of 441 caregivers answered an online ad-hoc survey on their sociodemographic and economic situation, perceived stress, and clinical changes and coping strategies observed in their children during lockdown. The Chi-square test was used to compare the response percentages for each behaviour or symptom between age, gender and diagnostic groups. Variance and post-hoc test were also analyzed, as was the Pearson correlation.

RESULTS

The use of electronic devices has significantly increased. There has also been an increase in symptoms such as attentional problems, fatigue and irritability, among others. Differences were found between age and gender groups. The diagnostic groups most affected by confinement were Autism Spectrum Disorders and Conduct Disorders. The survey also discovered a relationship between the loss of family income, parental stress and increased symptoms in children.

CONCLUSION

Confinement has increased externalizing symptoms and behaviours as well as COVID-19 related concerns, somatic problems and anxieties. It is important to observe the fluctuation of symptoms and how young people adapt to the pandemic in order to reach a better understanding of the situation and devise new strategies to reduce the psychological impact of the pandemic.

The Impact of the COVID-19 Pandemic on Pediatric Mental Health Emergency

OBJECTIVE

The aim of this study was to compare pre/post-coronavirus disease 2019 pandemic changes in mental health-related visits to the pediatric emergency department.

MATERIALS AND METHODS

We conducted a retrospective analysis of all mental health-related pediatric emergency department visits to a tertiary general hospital between June and September 2019, 2020, and 2021. We described pre/post-coronavirus disease 2019 changes in the use of pediatric emergency departments, such as timing of visits, sex discrepancies, diagnostic distribution, discharge planning, and others.

RESULTS

Compared with the corresponding months before the pandemic (n = 187), mental health-related pediatric emergency department visits decreased by 20.8% in June-September 2020 (n = 148) and increased by 12.2% in 2021 (n = 210). The distributions of age, sex, timing of visits, reasons for presentations, hospitalization, and outpatient clinic appointment rates were not statistically significant between the years. Self-harm in females and aggression/violence in males were the most common reasons for presentation to pediatric emergency departments in each year. In the post-pandemic period, ambulance use and patients referred by other hospitals for psychiatric consultation increased, while the completion time of consultations decreased (P < .05). The frequency of attention-deficit hyperactivity disorder and depression decreased, but obsessive-compulsive disorder and anxiety disorders were more common in the post-pandemic period than in the corresponding months before the pandemic (P < .05).

CONCLUSION

Our results suggest that the coronavirus disease 2019 pandemic resulted in a significant change in mental health-related visits to the pediatric emergency department. Those in the groups with reduced visits may be at risk for delayed access to treatment for their mental and behavioral difficulties.

How COVID-19 Phases Have Impacted Psychiatric Risk: A Retrospective Study in an Emergency Care Unit for Adolescents

Dramatic events during the COVID-19 pandemic have acutely impacted the psychosocial environment worldwide, with negative implications for mental health, particularly for more vulnerable children and adolescents with severe psychiatric illnesses. Some data suggest that the pandemic waves may have produced different psychopathological consequences, further worsening in the second phase of the pandemic, compared to those in the first lockdown, soon after March 2020. To test the hypothesis of a further worsening of psychiatric consequences of COVID-19 in the second lockdown compared to the first lockdown, we focused our analysis on a consecutive sample of youth referred to a psychiatric emergency unit for acute mental disorders in the time period between March 2019-March 2021. The sample, consisting of 241 subjects (123 males and 118 females, ranging in age from 11 to 17 years), was divided into three groups: Pre-Lockdown Group (PLG, 115 patients); First Lockdown Group (FLG, 65 patients); and Second Lockdown Group (SLG, 61 patients). Patients in the SLG presented more frequently with non-suicidal self-injuries (NSSIs), suicidal ideation, and suicidal behavior, while no significant differences in self-harm were found between PLG and FLG. Eating disorders were more frequent in both the FLG and SLG, compared to the PLG, while sleep problems were higher only in the SLG. Furthermore, patients in the SLG presented with more frequent psychological maltreatments and neglect, as well as with psychiatric disorders in the parents. Adverse traumatic experiences and internalizing disorders were significantly associated with an increased risk of suicidality. Intellectual disability was less represented from the PLG to SLG, and similarly, the rate of ADHD was lower in the SLG. No differences were found for the other psychiatric diagnoses. This information may be helpful for a better understanding and management of adolescents with severe emotional and behavioral disorders after the exposure to long-lasting collective traumas.

Lockdown Fatigue in Pediatric Respiratory Patients: Lessons from the First COVID-19 Year

Lockdown policies have been implemented worldwide to limit the spread of COVID-19. “Lockdown fatigue” is a state of exhaustion related to the accumulating effects of repeated lockdowns. The aim of the current study was to examine the effects of repeated lockdowns on children with respiratory disorders. Data on children aged 0−18 years old with respiratory disorders were collected by an electronic survey during the third lockdown in Israel. The retrieved information included demographics and baseline medical status, respiratory clinical status during the third lockdown compared to pre-lockdown periods, lockdown adherence, lifestyle modifications and caregiver emotional status. The results were compared to those of a similar questionnaire distributed during the first lockdown. A total of 234 patients (62% males, 37% females, mean age 6.8 years (confidence interval 6.1−7.5)) were enrolled. Respiratory symptoms and exacerbation frequency were reduced in 76 (35.5%) and 58 (27.4%) patients, respectively, compared to the pre-lockdown period and similar to the first lockdown (p = 0.840 and p = 0.063, respectively). However, compared to the first lockdown, the third lockdown was associated with greater use of reliever medications (p = 0.006), less use of inhaled corticosteroids as routine treatment (p = 0.027), and more pediatric emergency room visits and hospitalizations (p = 0.001 and p < 0.001, respectively). The results also showed an increase in sedentary lifestyle (e.g., reduced physical activity (p = 0.025), less healthy eating habits (p = 0.001)) and reduced adherence to lockdown policies (p < 0.001). These data show that the continuing stability of clinical improvement during lockdown was accompanied by deleterious sequelae that potentially indicate “lockdown fatigue” among children with respiratory disorders.

Parental Factors That Confer Risk and Resilience for Remote Learning Outcomes During the COVID-19 Pandemic Among Children With and Without Attention-Deficit/Hyperactivity Disorder

OBJECTIVE

To test whether parental factors including internalizing symptoms, parenting style, and confidence in assisting with remote learning conferred risk/resilience for children with/without ADHD's learning and emotional outcomes during the COVID-19 pandemic.

METHOD

291 parents of children (ages 6-13; n = 180 males) with (n = 148) and without ADHD completed questionnaires online (April-July 2020).

RESULTS

Structural equation modeling identified parental risk/resilience factors. Across groups, risk predicted greater difficulties with learning, internalizing and externalizing symptoms, while parent confidence in educating their child predicted better outcomes. A positive association was observed between parental involvement and child difficulties, which was stronger in families of children with ADHD. Children with/without ADHD did not differ in remote learning difficulties.

CONCLUSION

Parent factors impacted child emotional and learning outcomes during the pandemic. With increases in remote learning practices, there is a need for improved understanding of how parent factors impact outcomes of children with/without ADHD.

Saúde mental de crianças na pandemia da COVID-19

Objetivo: analisar as evidências científicas sobre as repercussões da pandemia da COVID-19 para a saúde mental de crianças e suas estratégias de enfrentamento. Método: estudo do tipo revisão integrativa de literatura nas bases de dados SciELO, Lilacs, Scopus e Medline. A busca resultou em um total de 6.094 artigos; após aplicação dos critérios de elegibilidade, 12 artigos compuseram a revisão. Resultados: os resultados mostraram que as principais repercussões para a saúde mental foram: ansiedade, estresse, sintomas depressivos, hiperatividade, irritabilidade, alterações no padrão do sono, estados de humor, distanciamento social, alterações de comportamento, diminuição ou ausência de conexão com os pares e aumento do tempo em tela. Foram apontadas como estratégias de enfrentamento: diálogos abertos e explicativos entre pais e filhos acerca da pandemia e do coronavírus, regulação do padrão de sono e do tempo em tela, prática de atividade física regular, melhora da qualidade do ensino remoto e universalidade do acesso às aulas e implementação de políticas públicas e ações em saúde. Conclusão: concluiu-se que as crianças já estão sofrendo com essas repercussões, as quais poderão afetar sua saúde mental e física, surgindo a necessidade de organizar estratégias de enfrentamento a nível populacional que minimizem os danos no período pós-pandemia.

Addressing the Treatment and Service Needs of Young Adults with Attention Deficit Hyperactivity Disorder

The transition from adolescence to adulthood is a complex period in which multiple changes take place (education, work, independent living, and social relations). This stage is especially difficult for adolescents suffering from attention deficit hyperactivity disorder (ADHD), who have to move on from child and adolescent mental health services to adult mental health services. This review analyzes developmental and environmental risk and protective factors as well as critical variables such as executive functioning and self-monitoring that influence the course of ADHD in transitional age youth and guide the priorities for an optimal transition of care. The influence of the COVID-19 pandemic is also discussed. We reflect on the unmet needs for an optimal transition of care and propose practice and policy recommendations to achieve this goal.

Challenges of children and adolescents with attention-deficit/hyperactivity disorder during the COVID-19 pandemic

OBJECTIVE

We aimed to understand the challenging effect of the pandemic on children and adolescents with ADHD.

METHODS

100 children and adolescents with ADHD aged 7-18 years were included in the study. They were evaluated in terms of internet addiction diagnostic criteria. Symptom severity was assessed using the CBCL, CPRS, and SNAP-IV.

RESULTS

We found that 42% spent less time outdoors, and 26% spent more time watching TV. 57% had increased internet use and 28% were diagnosed as having internet addiction. There was a significant difference in terms of symptom severity between the groups depending on whether the children took part in sports activity before the pandemic.

CONCLUSIONS

Children and adolescents with ADHD have experienced challenges in many areas, especially internet use in the pandemic. The positive long-term effects of exercise in children with ADHD are thought to be protective in terms of symptom management during the COVID-19 pandemic.

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

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.

Impact of the COVID-19 pandemic on mental health and family situation of clinically referred children and adolescents in Switzerland: results of a survey among mental health care professionals after 1 year of COVID-19

The aim of this study was to assess the impact of the COVID-19 pandemic on mental well-being of clinically referred children and adolescents and on their families from the perspective of mental health care professionals in Switzerland during the first year of the pandemic. Psychiatrists and psychologists for children and adolescents participated in an anonymous survey conducted online in April/May 2021. The survey was completed by 454 mental health care professionals, most of them working in outpatient clinics for child and adolescent psychiatry or in independent practices. Most participants indicated an important increase of referrals for depression (86.8% of respondents), anxiety disorders (81.5%), crisis interventions (76.2%), psychosomatic disorders (66.1%), suicidality (63.8%), and behavioral addictions, e.g., excessive gaming (64.6%). In contrast, referrals or treatment demands for disorders such as autism spectrum disorder or psychosis showed no substantial change or a slight decrease, respectively. According to 69% of respondents, patients experienced the highest psychological burden in January/February/March 2021. Family problems very frequently reported by mental health professionals were parents' worries about loneliness/isolation of the child (49%), child's education and academic future (33%), increased media use due to missing options of recreational activities (37.6%), as well as multiple stresses of mothers (36.3%). To conclude, the pandemic has substantially changed the pattern of disorders and the number of clinical referrals of children and adolescents with mental health problems, which has serious consequences for the treatment supply in Switzerland.

Lockdown in France: Impact on Families of Young Children With Special Needs

Background

Families with young children have faced serious challenges during the first lockdown as a result of the COVID-19 pandemic. In addition to remote working, parents have had to monitor their children’s schoolwork and manage their daily lives. When one of the children also has neuro-developmental disorders, this results in an increased burden. We can therefore wonder how these families with one or more young children (under 6 years old) with special needs have experienced and dealt with this lockdown.

Aim of the Study

In this context, the “COVJEUNENFANT” study focused more specifically on the subjective experience, as a parent, of those who cared for children with special needs (i.e., with developmental disorders, neurodevelopmental disorders, proven disabilities or chronic health conditions) compared to the general population. We wished to see if the consequences of the health crisis were significantly different from those perceived by respondents in the general population (n = 490) and if the sociodemographic structure of these families differed from those of other respondents.

Methods

Ninety three French families with at least one child under 6 years old and one with developmental difficulties or a chronic illness, from a cohort of 490 control families, participated in a web-based survey during the first lockdown, from the 28th April 2020 to 29th May 2020.

Results

After presenting the participants’ sociodemographic characteristics, the results show that these French families (n = 93) are less wealthy than the control population “without special needs” (n = 397), have felt more pressures originating from their environment (families, friends, colleagues, media, social networks…), have suffered from more health issues (other than COVID-19), have taken more measures to protect themselves (social-distancing), and were less likely to feel happy. A significantly larger number of them lamented the lack of free time and voiced a larger need for information regarding children’s education. However, their parental role was felt as being more satisfying and their family relations strengthened more than in the general population of participants.

Conclusion

It is apparent that urgent prioritisation is needed in order to support and care for these families by continuing to provide care for their children in one way or another, and by ensuring that their need to adapt again does not exceed their own abilities and resources, especially as young children, who have high levels of requirements, are present in the home.

Behavioral symptoms among children and adolescents with attention deficit hyperactivity disorder during COVID-19 outbreak: a retrospective prospective cohort study

Background

Attention deficit hyperactivity disorder (ADHD) is one of the most prevalent neurodevelopmental conditions in children, and with the coronavirus pandemic, ADHD children now pose obvious challenges. This retrospective prospective cohort study was conducted on 150 ADHD children and adolescents that had previously attended the child unit of the Psychiatry Department, Zagazig University Hospitals, Sharkia, Egypt, and diagnosed as ADHD patients using the research diagnostic criteria of DSM-5 which administrated by experienced psychiatrists and evaluated by The Arabic version of Conner’s Parent Rating Scale Revised-short version (CPRS-48) before the onset of COVID-19 pandemic. We collected the other data of the study by applying an Arabic language questionnaire which included the data related to the COVID -19 pandemic and the Arabic version of CPRS-48 by which we reevaluated the behavioral symptoms of the subjects who participated in the study during COVID-19 pandemic. This research aimed to evaluate the behavioral symptoms among ADHD children and adolescents and detect the change in these symptoms during the COVID-19 pandemic by comparing them before and during the pandemic.

Results

One hundred fifty ADHD children were included in the study with a mean age of 10 years old. The male gender was predominant and represented 76.7% of the sample. Ninety percent were living in urban areas with more low social class (50%), 84.7% of parents were married, 60% of the family member of our subjects had COVID-19 while 12% lost one or more of their relative by the pandemic (64.7%). The fathers continued working as normal, while 40.7% of the mothers stopped working because of COVID-19. 62.7% of the parents were verbally and physically abusive to their children. Unfortunately, 100% of the subjects stopped attending their behavioral therapy center, 96.0% stopped their Follow up with a psychiatrist, and 55% stopped complying with their medications. As we presumed, we found a statistically significant change in the behavioral and psychological symptoms measured by Conner’s Parent Rating Scale Revised-short version (CPRS-48) during the COVID-19 pandemic compared to the period before. The worsening of the symptoms was associated with age, sex, residency, social class, father and mother present working and couple status, having positive cases or losses of COVID-19 among family members, and patient maltreatment.

Conclusions

To conclude, this study suggests that the lockdown caused by the COVID-19 pandemic has worsened symptoms in a significant number of children and adolescents with ADHD, which needs clinical attention. Moreover, the patients’ psychiatric follow-up and compliance with their medications were markedly affected. Additionally, the lockdown has also led to an increase in the abusive behavior of the parents towards their children.

Psychological consequences of the COVID-19 pandemic: A qualitative study

Multiple psychological health problems related to the COVID-19 pandemic among both the general public and health-care workers have been identified in the scientific literature. However, most studies used quantitative methods with scales selected on the basis of the researchers’ pre-established knowledge derived from the experience of other situations and which can therefore induce biases. The dual aim of the present study was to explore qualitatively the perceived psychological consequences of lockdown on members of the general public and the perceived psychological consequences of COVID-19 on health-care workers. We recruited 241 participants from the general public and 120 health-care workers. They consented online to participate and completed open-ended questions evaluating the consequence of the health crisis on their life as a couple, on their friendships, family life, work, studies, psychological health, stress, and vision of the future. Finally, participants were asked to add any further consequences that had not been mentioned. We used double coding to process the data. We identified five main themes among the participants from the general public: improved and maintained social relationships, deterioration of health, improved health, personal growth, and lack of direct social contact. We also identified five main issues among the health-care workers: psychological and emotional impact, adjusting, negative impact on work, worries, and uncertainty about the future. The results confirmed the existence of psychological health problems related to the COVID-19 pandemic. They also highlighted positive consequences. Health-care workers tended to perceive more negative consequences than the participants from the general public.

Attention-Deficit/Hyperactivity Disorder as a Risk Factor for COVID-19 Infection

OBJECTIVE

To postulate that ADHD is a potential risk factor for COVID-19 infection; to evaluate the COVID-19 risk factor on drug-treated ADHD subjects.

METHODS

A retrospective chart review was performed on ADHD subjects aged 6 to 18 years in Israel, who had undergone at least one COVID-19 test during the study period.

RESULTS

Of the 64,409 subjects included in the study, 6,207 (9.64%) had at least one positive COVID-19 test result, 13,300 (20.65%) were diagnosed with ADHD, and of whom 1,751 (13%) had purchased at least two ADHD medications 3 months prior to COVID-19 testing and were defined as being medically treated. Medically-treated ADHD subjects had a significantly lower likelihood to be infected with COVID-19 than untreated subjects.

CONCLUSION

Untreated ADHD patients seem to constitute a risk group for COVID-19 infection. Drug treatment ameliorates risk of spreading COVID-19 infection within the pediatric population and secondary spread in the general population.

Caregivers' Difficulty in Managing Smartphone Use of Children with Attention-Deficit/Hyperactivity Disorder during the COVID-19 Pandemic: Relationships with Caregiver and Children Factors

This study examined the difficulty encountered by caregivers of children with attention-deficit/hyperactivity disorder (ADHD) in managing children’s smartphone use during the coronavirus disease 2019 (COVID-19) pandemic and the caregiver- and children-related factors that influence this difficulty. In total, 252 caregivers of children with ADHD were recruited into this study. The caregivers completed a research questionnaire to provide data regarding the difficulty they encountered in managing the smartphone use of children during the COVID-19 pandemic, their general mental health and parenting styles, and the ADHD and oppositional defiant disorder (ODD) symptoms of the children they are caring for. The results indicated that almost 45% of the caregivers of children with ADHD sometimes or often found it difficult to manage the smartphone use of children with ADHD during the COVID-19 pandemic. For the caregivers, a short duration of education, poor general mental health, unaffectionate/uncaring and overprotective parenting styles, older children, and inattention and ODD symptoms were significantly associated with increased difficulty in managing their children’s smartphone use during the COVID-19 pandemic. On the basis of the relevant factors identified in this study, an intervention should be developed to enhance the skills of caregivers of children with ADHD with respect to the management of children’s smartphone use during the COVID-19 pandemic.

Fighting the waves; Covid-19 family life interference in a neurodevelopmental disorder-caregiver population

Introduction

The current COVID-19 pandemic interferes with family lives across the world, particularly families of children with neurodevelopmental disorders (NDDs) are at a greater risk for being negatively impacted by the pandemic. Together with representatives from this caregiver population the aim was to explore the interference associated with normal family life caused by the COVID-19 pandemic.

Method

This is a descriptive study using a cross-sectional design. Following a strategic network sampling strategy, a user-developed national survey was completed by a larger sample (N = 1,186) of parents and informal caregivers of children with NDDs. The survey utilized a combination of both closed and open-ended questions, and a logistic regression analysis was carried out to assess the association between family characteristics, characteristics of the child, and COVID-19 related family life interference. Before carrying out the regression an inductive content analysis of the open-ended question on `How has the isolation affected the family´ was carried out to construct the outcome variable.

Results

The initial analysis indicated that the COVID-19 pandemic induced a shift in everyday family life and a lack of guidance and support related to managing the challenges they were facing. Caregivers who reported that COVID-19 had significantly interfered with their family life, were more likely to report having anxious children, and to have experienced an increased number of conflicts at home. The logistic regression showed that both anxious children and increased conflicts considerably increased the risk for reporting family life interference compared to those that reported no increased conflicts or anxious children.

Discussion

Considering how the COVID-19 related increased conflicts at home and anxious children threaten the family life of the NDD caregiver population, as an external source of family stress, which might lead to negative impact on their mental and physical well-being, the need for further research in collaboration with user representatives is apparent. Our study suggests that more information should be provided to healthcare providers, social professionals, peers, people with NDDs, and caregivers of people with NDDs about the potential threats that a stressful life event such as the current pandemic can pose to their mental and physical health and their family life.

Supplementary Information

The online version contains supplementary material available at 10.1186/s12913-022-07836-3.

Distance Learning in Children with and without ADHD: A Case-control Study during the COVID-19 Pandemic

OBJECTIVE

This research involved the parents of ADHD students to explore how their children coped with online distance learning during COVID-19 pandemic and what implications this schooling method had on their emotional and behavioral well-being.

METHOD

Data were collected during lockdown using an online questionnaire addressed to 100 mothers and were compared with 184 matched controls from a national survey launched in the same period.

RESULTS

Attention span, spontaneous commitment, and autonomy in distance learning was found to be more limited in ADHD group. Compared to controls, 21.7% of ADHD students were not assessed and 40.9% did not receive grades. Behavioral changes were reported in both groups (64.2%), represented mainly by restlessness, aggressiveness, and anxiety.

CONCLUSION

Distance education increases academic difficulties, especially in ADHD pupils. The effects of lockdown should be adequately evaluated upon school reopening and appropriate recovery interventions should be planned.

Changes in the Mental Health of Children and Adolescents during the COVID-19 Lockdown: Associated Factors and Life Conditions

This study investigated the psychological impact of the coronavirus disease 2019 (COVID-19) among youth by analyzing their emotional/behavioral problems before and during the long-lasting lockdown in Spain. For that purpose, 699 parents with children aged 6–17 and 552 adolescents aged 12–17, who completed the parent and adolescent version of the Strengths and Difficulties Questionnaire at the beginning of 2019, responded to a survey from 26 May to 15 June 2020 that assessed psychological well-being and life conditions during quarantine (i.e., sociodemographic characteristics, situation before the lockdown, physical environment and accompaniment during the lockdown, COVID-related variables). According to both parent- and self-reports, children and youth experienced a significant worsening in emotional symptoms, conduct problems, hyperactivity/inattention, peer problems, and total difficulties subscales. Findings also suggested that impairment was mainly associated with variables related to the child’s situation prior to home quarantine, the quality and quantity of the child’s social networks during the lockdown, the daily routines the child followed, the concerns the child had about health, and the presence of economic and learning problems caused by the COVID-19. Thus, the present investigation emphasizes the need for carefully monitoring the mental health of younger people, provides guidance for the development of interventions that mitigate some of the psychological difficulties faced in a situation of confinement, and highlights the importance of paying special attention to high-risk groups.

The Impact of COVID-19 on Illinois Early Intervention Services

PURPOSE

We sought to understand the extent of the nationwide disruption to Part C Early Intervention services due to COVID-19 and the subsequent shift to telehealth, primarily through a focused examination of providers' perspectives on this disruption in a single state, which is Illinois.

METHOD

To examine the impact of coronavirus disease (COVID-19) on Early Intervention service provision and implementation, 385 Early Intervention Illinois providers completed a web-based survey. Archival data were used to determine changes in number of Illinois Early Intervention referrals following the pandemic onset and to compare Illinois' telehealth and stay-at-home policies to those of other states.

RESULTS

The majority (85%) of Illinois Early Intervention providers reported a disruption in service provision during COVID-19. The number of sessions delivered and the number of children per caseload decreased significantly. Provider confidence also decreased significantly. Only 28% of providers reported high confidence with telehealth. Identified benefits of telehealth included increased accessibility and caregiver involvement, whereas limitations included perceived lack of caregiver buy-in. New Illinois Early Intervention referrals and cases were lower during COVID-19 than in the previous year. Prior to 2020, 33 states did not have a permanent reimbursement policy for providing telehealth Early Intervention services. For states with a suspension of in-person Early Intervention services due to COVID-19, time to approval for telehealth reimbursement varied (0-22 days).

CONCLUSIONS

The shift to telehealth in Illinois resulted in decreases in service provision and provider confidence across disciplines. However, providers identified some benefits to telehealth. Telehealth may represent a means to increase Early Intervention accessibility following the pandemic.

SUPPLEMENTAL MATERIAL

https://doi.org/10.23641/asha.19119539.

Emotional Status and Quality of Life in Women With ADHD During COVID-19

COVID-19 affects emotional status and quality of life (QOL) as reported in various countries. Less is known about the relations between gender, emotional status, and QOL in vulnerable groups. The objectives of this study is to compare emotional status and QOL between women with and without ADHD, during COVID-19, to correlate between emotional status, daily life, and QOL of women with ADHD, and to predict their QOL by COVID-19 constraints and emotional status. This cross-sectional online survey included 46 with ADHD and 183 typically functioning women, aged 19 to 60, who completed the sociodemographic-health and daily life during COVID-19 questionnaires; the Depression, Anxiety, and Stress Scale - 21, and the WHOQOL-BREF. Women with ADHD had significantly higher stress and anxiety and lower physical and psychological QOL. Emotional status and daily constraints predicted their QOL. COVID-19 emotional impacts should receive greater attention in vulnerable groups, as women with ADHD, to enhance resilience, participation, and QOL.

Media use and emotional distress under COVID-19 lockdown in a clinical sample referred for internalizing disorders: A Swiss adolescents' perspective

The COVID-19 outbreak has profoundly affected adolescents' life. Adolescents with pre-existing psychiatric disorders have been at particular risk of increased mental health problems and problematic media use. 178 patients, aged 12-18 years, referred before the COVID-19 outbreak to child and adolescent psychiatry, participated in an anonymous online survey on the impact of the lockdown on media use and mental well-being. The survey was conducted approximately one month after the first easing of restrictions following a six-week lockdown in Switzerland. Based on self-report, half of the patients had been diagnosed with internalizing disorders (ID; depression or anxiety disorder) and the other half with other disorders (non-ID, e.g. ADHD, autistic spectrum disorder). Patients with ID reported higher emotional distress during the lockdown, and a larger number of patients with ID indicated a deterioration of pre-existing symptoms compared to non-ID patients. Although more patients with ID than with non-ID indicated spending a large amount of time on social media, social media time per day in hours was not significantly higher in ID. Patients with ID indicated a higher impact of media use on well-being and mood in everyday life during the lockdown. Social media time was higher in worsened than in improved non-ID patients, while the opposite was found in ID patients, indicating a possible protective effect of media use at least for some ID patients. The results confirm positive as well as negative associations between mental health, emotional well-being and media use for adolescents with ID during the lockdown.

Physical Health, Media Use, and Mental Health in Children and Adolescents With ADHD During the COVID-19 Pandemic in Australia

OBJECTIVE

To examine the impact of COVID-19 restrictions among children with attention-deficit/hyperactivity disorder (ADHD).

METHODS

Parents of 213 Australian children (5-17 years) with ADHD completed a survey in May 2020 when COVID-19 restrictions were in place (i.e., requiring citizens to stay at home except for essential reasons).

RESULTS

Compared to pre-pandemic, children had less exercise (Odds Ratio (OR) = 0.4; 95% CI 0.3-0.6), less outdoor time (OR = 0.4; 95% 0.3-0.6), and less enjoyment in activities (OR = 6.5; 95% CI 4.0-10.4), while television (OR = 4.0; 95% CI 2.5-6.5), social media (OR = 2.4; 95% CI 1.3-4.5), gaming (OR = 2.0; 95% CI 1.3-3.0), sad/depressed mood (OR = 1.8; 95% CI 1.2-2.8), and loneliness (OR = 3.6; 95% CI 2.3-5.5) were increased. Child stress about COVID-19 restrictions was associated with poorer functioning across most domains. Most parents (64%) reported positive changes for their child including more family time.

CONCLUSIONS

COVID-19 restrictions were associated with both negative and positive impacts among children with ADHD.

Mental Health of Children With Attention Deficit and Hyperactivity Disorder and Their Parents During the COVID-19 Lockdown: A National Cross-Sectional Study

The coronavirus disease 2019 (COVID-19) pandemic has caused a real disruption of children's lives. Children with neurodevelopmental disorders and their parents seem to be particularly vulnerable to adverse mental health effects due to lockdown policies. This study explores the psychological state of children with Attention Deficit Hyperactivity Disorder (ADHD) and their parents during the first lockdown in France. A national prospective cross-sectional parent-reported study was conducted using an online survey disseminated through different social networks of French ADHD associations during the first lockdown. The survey consisted of open-ended, multiple-choice questions and standardized questionnaires such as the Strengths and Difficulties Questionnaire (SDQ), the coping self-report questionnaire (Brief COPE) and the Patient Health Questionnaire-2 (PHQ-2). A total of 538 parents completed the online survey between the 6th and the 15th of April 2020. These results suggest that most children (65.29%) did not experience a worsening of their behavior but still had pathological levels of hyperactivity (56.47%) and behavioral (57.60%) symptoms at the time of the first lockdown. In addition, some parents (26.27%) showed responses indicating possible major depressive disorder. Positive parental coping strategies were associated with both improved child behavior and fewer parental depressive symptoms. Strengthening parents' coping strategies may be an effective intervention to protect both parents and children with ADHD from the negative psychological effects of lockdown. In times of pandemic, psychological care modalities must evolve to provide quality online interventions for families of children with ADHD.

Changes in Youth Mental Health, Psychological Wellbeing, and Substance Use During the COVID-19 Pandemic: A Rapid Review

Since the onset of the COVID-19 pandemic, researchers around the world have made efforts to assess its impact on youth mental health; however, the breadth of this topic has impeded a clear assessment of pandemic outcomes. This study aimed to address this gap by reviewing changes in youth (age ≤ 25) mental health, psychological wellbeing, substance use, and the use or delivery of relevant services during the pandemic. PubMed and Embase were searched in May 2021 to conduct a rapid review of the literature. The results encompass 156 primary publications and are reported using a narrative synthesis. Studies of mental health (n = 122) and psychological wellbeing (n = 28) generally indicated poor outcomes in many settings. Publications regarding substance use (n = 41) noted overall declines or unchanged patterns. Studies of service delivery (n = 12) indicated a generally positive reception for helplines and telehealth, although some youth experienced difficulties accessing services. The findings indicate negative impacts of the pandemic on youth mental health, with mixed results for substance use. Services must support marginalized youth who lack access to telehealth.

SUPPLEMENTARY INFORMATION

The online version contains supplementary material available at 10.1007/s40894-022-00185-6.

Emotional and Behavioral Impact of the COVID-19 Epidemic in Adolescents

PURPOSE OF REVIEW

This review of the literature aims to explore the impact of the COVID-19 pandemic and the lockdown on teenagers' mental health. We distinguish two groups: adolescents who had already been diagnosed with a mental disorder and the general population of adolescents.

RECENT FINDINGS

An increase in the number of mental health-related difficulties in adolescents has already been reported in previous health crises. Accordingly, the perceived well-being of teenagers declined during the COVID-19 pandemic. Adolescents with mental disorders were significantly more affected by the lockdown than those in the general population. The effect of the COVID-19 crisis on the mental health of adolescents has been heterogeneous. The first pandemic wave was essentially associated with an increase of internalizing symptoms in adolescents, particularly anxiety, depression and eating disorders. The impact on externalizing symptoms was less clear, and seem to concern mostly adolescents with pre-existing behavioral disorders. During the second and later waves of the pandemic, an upsurge of suicidal ideation and attempts among adolescents have been reported in many countries.

Situations de vulnérabilités familiales et pandémie COVID 19

Contexte

Conscient·e·s des difficultés engendrées par la pandémie de COVID-19 pour de nombreuses familles ayant des enfants de 6 ans ou moins, l’étude se focalise sur trois contextes de vulnérabilités familiales : familles monoparentales, avec enfants ayant des difficultés développementales et celles en situation de pauvreté.

Méthode

Un questionnaire, composé de 69 questions, a été transmis, au niveau national durant le premier confinement (du 17 mars au 10 mai 2020). Parmi l’échantillon d’étude (n = 490), 36 foyers sont monoparentaux et 93 familles ont un enfant présentant des difficultés développementales. De novembre 2020 à juin 2021, une approche qualitative complémentaire a été menée pour atteindre les publics les plus pauvres (n = 23).

Résultats

La méthodologie mixte adoptée permet de relever des modalités du vécu qui rassemblent les familles dans les trois contextes (relations intrafamiliales davantage renforcées et investissement des mesures de protection, par exemple), et d’autres qui apparaissent plus spécifiques : pression ressentie et besoin d’informations pour les foyers monoparentaux et avec enfants à difficultés développementales, charge liée à l’école à la maison pour les foyers monoparentaux et les plus pauvres, isolement social pour les foyers monoparentaux, difficultés à maintenir le budget alimentaire antérieur pour les plus pauvres.

Conclusion

Les diverses pressions ressenties, les conditions de logement (avec ou sans espaces extérieurs) et de travail, la crainte d’être malades, les sentiments négatifs, etc. doivent inciter les pouvoirs publics à mettre en œuvre des dispositifs de soutien psychologique, notamment pour les foyers les plus vulnérables afin que n’adviennent pas des problèmes de santé physique et/ou psychique ultérieurs voire des symptômes post-traumatiques des parents et de leurs enfants.

Risk and protective factors related to children's symptoms of emotional difficulties and hyperactivity/inattention during the COVID-19-related lockdown in France: results from a community sample

OBJECTIVE

The COVID-19 epidemic has spread worldwide since December 2019. To contain it, preventive measures including social distancing, economic shutdown, and school closures were introduced, carrying the risk of mental health burden in adults and children. Although the knowledge base regarding children's response to trauma and adverse events in general has broadened, descriptions of their mental health during epidemics remain scarce. In particular, the role of family socioeconomic characteristics and parental mental health are poorly understood.

METHODS

We assessed the correlates of children's emotional difficulties and symptoms of hyperactivity/inattention during the COVID-19 lockdown in a French community-based sample. Data came from 432 community-based parents (27-46 years, TEMPO cohort) and their children (mean age 6.8 ± 4.1) interviewed online. Children's symptoms of emotional difficulties and hyperactivity/inattention were assessed using the parent-reported Strengths and Difficulties Questionnaire during the 5th week of home confinement. Family socioeconomic characteristics and parental mental health and substance use were assessed weekly during the first 5 weeks of home confinement. Data were analyzed using logistic regression models.

RESULTS

7.1% of children presented symptoms of emotional difficulties and 24.7% symptoms of hyperactivity/inattention. Family financial difficulties and parental symptoms of anxiety and depression, as well as children's sleeping difficulties and screen time, were associated with the presence of psychological difficulties.

CONCLUSION

Children's emotional and behavioural difficulties are associated with parental mental health and socioeconomic difficulties. In the unprecedented situation of the COVID-19 epidemic, parents and professionals involved in caring for children should pay special attention to their mental health needs.

Working Conditions, Work Productivity, Quality of Life, and Depressive Symptoms in Undiagnosed Adults with and without Attention-Deficit/Hyperactivity Disorder (ADHD) Symptoms During the COVID-19 Pandemic

PURPOSE

This study aims to evaluate the impact of the COVID-19 pandemic on employment status, work productivity, quality of life (QOL), and depressive symptoms in undiagnosed adults with and without attention-deficit/hyperactivity disorder (ADHD) symptoms in Japan.

METHODS

An observational study used baseline data from a Japanese Medilead Healthcare Panel before the COVID-19 pandemic (October-December 2019). Eligible panel participants were then surveyed during the pandemic (March 2021). ADHD symptoms were screened using the Adult ADHD Self-Report Scale. Changes in QOL (EuroQol 5-Dimensions 5-Levels; EQ-5D-5L) and productivity impairment (Work Productivity and Activity Impairment scale; WPAI) from before to during the pandemic were analyzed in undiagnosed adults with and without ADHD symptoms. Unemployment rate and depressive symptoms (Patient Health Questionnaire; PHQ-9) during the pandemic were compared between groups.

RESULTS

Participants with (N=949) and without (N=942) ADHD symptoms completed the survey. The unemployment rate was not significantly different between participants with and without ADHD symptoms. Participants with ADHD symptoms were more likely to change jobs or employers during the pandemic. PHQ-9 scores in participants with ADHD symptoms were significantly higher than in those without ADHD symptoms (8.96 vs 3.57, respectively) during the pandemic. Before the pandemic, WPAI scores were significantly higher and EQ-5D-5L scores lower in participants with ADHD symptoms than in those without. Productivity improved and QOL was not altered during the pandemic in both groups, but productivity and QOL remained poorer among participants with ADHD symptoms than in those without.

CONCLUSION

Productivity was improved among all participants during the COVID-19 pandemic, contrary to expectations. However, adults with ADHD symptoms consistently had lower productivity, poorer QOL, and more depressive symptoms than those without ADHD symptoms.