23 Aug 2020

Merzon E et al. J Atten Disord 2020; Epub ahead of print

The coronavirus (COVID-19) pandemic has spread rapidly to almost every country in the world (World Health Organization, 2020) since the outbreak was initially noted in late 2019 (Li et al, 2020). The highly infectious virus is thought to be transmitted via respiratory droplets and through direct contact with contaminated objects and surfaces (Van Doremalen et al, 2020). Strategies for reducing the spread of the virus include quarantine, self-isolation, physical distancing, wearing face masks and frequent hand washing. These measures, however, can be challenging to follow for individuals with ADHD, particularly younger individuals. This study evaluated whether the risk for COVID-19 infection was higher in individuals with ADHD compared with those without ADHD, and whether treatment with ADHD medications would reduce the rate of COVID-19 infection.

Medical records of individuals who were registered with Leumit Health Services (an Israeli health maintenance organisation) between 1 February and 30 April 2020 and had at least one COVID-19 test were evaluated. Demographic data including socioeconomic status (as defined according to the child’s home address), smoking history and relevant health conditions such as obesity, asthma, chronic obstructive pulmonary disease, diabetes, hypertension and other chronic medical diagnoses (including psychiatric disorders) were collected. Individuals who purchased at least three consecutive ADHD prescriptions during the past 12 months were defined as medically treated subjects.

A total of 14,022 individuals aged 2 months to 103 years who had been tested for COVID-19 were included in the study; 1416 (10.1%) of them tested positive at least once while 12,606 (89.9%) tested negative. Based on multivariate analysis, those who tested positive were younger (adjusted odds ratio [OR] 2.08; 95% confidence interval [CI] 1.61–2.68; p < 0.001), more likely to be male (adjusted OR 1.18; 95% CI 1.01–1.37; p < 0.05) and had a lower socioeconomic status (adjusted OR 1.96; 95% CI 1.63–2.36; p < 0.001) than those who had tested negative. Chronic lung disease was the only factor found to be negatively associated with COVID-19 infection based on the multivariate analysis (adjusted OR 0.58; 95% CI 0.45–0.76; p < 0.001). Higher rates of COVID-19 infection in younger individuals may be due to the tendency of this group to attend large gatherings and not comply with social distancing recommendations. The relationship between higher rates of COVID-19 in those with lower socioeconomic status may be attributed to higher population density in lower income areas. Medical conditions such as diabetes, hypertension and chronic lung diseases that had been linked to increased rates of fatality in individuals with COVID-19 were not associated with higher rates of infection in this study, possibly due to “stay at home” recommendations in these vulnerable populations.

Among mental health conditions, only ADHD was found to be higher in individuals who tested positive for COVID-19 (adjusted OR 1.58 (95% CI 1.27–1.96; p < 0.001) compared with those who tested negative, irrespective of age, gender, socioeconomic status and the presence of other chronic mental and physical disorders. This may be related to the hallmark features of ADHD (inattention, hyperactivity and impulsivity), which may hinder compliance with COVID-19 prevention measures. Individuals with untreated ADHD were more likely to have tested positive for COVID-19 (adjusted OR 1.68; 95% CI 1.37–2.10; p < 0.001), while treated individuals had lower COVID-19 rates (adjusted OR 0.85; 95% CI 0.54–1.34; p = 0.707) that were even lower than rates in individuals without ADHD.

Limitations of the study include the retrospective database design. In addition, data on the severity of ADHD symptoms, presentation type (predominantly inattentive, predominantly hyperactive or combined), presenting symptoms, severity of COVID-19 infection and adverse clinical outcomes were not available in the database.

In summary, ADHD may be a risk factor for COVID-19 infection, independently of other risk factors. The study showed that treatment of ADHD may moderate the risk of infection, hence adherence to treatment should be encouraged to reduce the spread of COVID-19.

Read more about ADHD and risk for COVID-19 here

Li H, Liu SM, Yu XH, et al. Coronavirus disease 2019 (COVID-19): current status and future perspective. Int J Antimicrob Agents 2020; 55: 105951.

Merzon E, Manor I, Rotem A, et al. ADHD as a risk factor for infection with Covid-19. J Atten Disord 2020; Epub ahead of print.

Van Doremalen N, Bushmaker T, Morris DH, et al. Aerosol and surface stability of SARS-CoV-2 as compared with SARS-CoV-1. N Engl J Med 2020; 382: 1564-1567.

World Health Organization. Novel Coronoavirus (2019-nCoV) Situation Report – 12. Available at: https://www.who.int/docs/default-source/coronaviruse/situation-reports/20200201-sitrep-12-ncov.pdf?sfvrsn=273c5d35_2. Accessed September 2020.

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