Many children and adolescents with ADHD have ≥1 comorbid psychiatric disorder, for example an anxiety or mood disorder, autism spectrum disorder or a disruptive behaviour disorder (Faraone et al, 2015). The uncertainty, changes in routine and structure, and reduced social contact caused by the COVID-19 pandemic may worsen ADHD symptoms and associated comorbidities (Cortina et al, 2020). The aim of this study was to understand the impact of COVID-19 restrictions on Australian families of children and adolescents with ADHD.
Data were collected over a 4-week period in May 2020*; the study was advertised through ADHD organisations and support groups in Australia. Parents of a child aged 5‒17 years with ADHD were included in the study and were required to have data available for ≥1 variable of interest.†
In total, 213 parents of children or adolescents with ADHD (mean [standard deviation] age 10.59 [3.1] years; 76.4% male) participated in the study. Psychiatric comorbidities were common in children and adolescents with ADHD, with 59.5% presenting with anxiety. Other psychiatric comorbidities included learning disorder (28.3%), speech and language disorder (18.8%), oppositional defiant disorder (18.6%), autism spectrum disorder (17.5%), depression (11.2%), obsessive-compulsive disorder (7.0%), Tourette’s syndrome or tics (5.3%), and conduct disorder (1.2%). Most children and adolescents were prescribed ADHD medication (84.6%), and 88.4% of parents reported that their child was taking medication to assist with behavioural, emotional, learning or sleep difficulties.
At the time the study was conducted, no children or adolescents with ADHD or household family members were diagnosed with COVID-19. Restrictions on leaving home were described by parents as moderately/very/extremely stressful for 44% of children and adolescents with ADHD. The quality of family and social relationships were either reported as a little or a lot worse by 36% and 54% of parents, respectively. Positive changes due to COVID-19 restrictions were noted by 64% of parents.‡
Child physical and mental health and media use
As a consequence of the COVID-19 pandemic, parents reported that child and adolescent functioning had declined. Children and adolescents experienced less regular exercise (odds ratio [OR] 0.4; 95% confidence interval [CI] 0.3‒0.6), less outdoor time (OR 0.4; 95% CI 0.3‒0.6), increased television time (OR 4.0; 95% CI 2.5‒6.5), increased social media use (OR 2.4; 95% CI 1.3‒4.5), increased gaming (OR 2.0; 95% CI 1.3‒3.0), increased sad/depressed/unhappy mood (OR 1.8; 95% CI 1.2‒2.8), reduced enjoyment in usual activities (OR 6.5; 95% CI 4.0‒10.4), and increased loneliness (OR 3.6; 95% CI 2.3‒5.5).
Stress and worries
In this study, there was limited evidence of a unique relationship between COVID-19–related stress and worries and negative changes in outdoor time, physical activity and sleep. However, COVID-19–related stress, but not worries, did have negative effects on general mental health (p≤0.001).
Changes or barriers to healthcare
Of the parents who reported their child or adolescent taking medication to assist with behavioural, emotional, learning or sleep difficulties, 11% (16/152) had problems accessing medication during COVID-19 restrictions. Problems with accessing these medications were mostly due to the medication being out of stock (n=8) and difficulties obtaining prescriptions (n=4). Some parents reported that their child or adolescent had stopped taking their ADHD medication (16%; 24/148) during the restrictions. Stopping ADHD medication was mainly attributed to taking a medication break during the school holidays (n=5), not requiring medication due to school closure or remote learning (n=6), or stopping an ADHD medication to start another (n=3). In total, 13% of parents reported difficulties in accessing healthcare services for their child or adolescent during COVID-19 restrictions. Telehealth services were used by 107 families included in the study, of whom 42% rated these services as being of the same quality as face-to-face appointments, whereas 48% reported that these services were of a poorer quality.
Parent interest in online or smartphone interventions
Use of an online or smartphone intervention for child mental health support was of moderate/very/extreme interest to 69% of parents included in the study; 70% of parents were at least moderately interested in using an intervention to support parenting, 69% to support education and 60% to support sleep.
This study had several limitations. The lack of a control group may suggest that these results are not specific to children and adolescents with ADHD versus those in the general population or those with other mental health or neurodevelopmental disorders. Data for this study also relied on retrospective parent reports of their child or adolescent’s functioning prior to the COVID-19 pandemic. In addition, due to the online nature of this study, ADHD diagnoses and psychiatric comorbidities were not confirmed using standardised diagnostic tools, and the parent sample may not be representative of those help-seeking. Finally, child and adolescent functioning was based on parent reports and therefore may be more reflective of parents’ stress and worries due to COVID-19.
The authors of this study concluded that the COVID-19 restrictions in Australia in May 2020 had both negative and positive effects on children and adolescents with ADHD. Future studies may be required to monitor functioning of children and adolescents with ADHD throughout the COVID-19 pandemic as they transition back to school and as restrictions change, and to understand the long-term impact on families and the associated economic downturn.
*At the beginning of May 2020 in Australia, social distancing measures were in place, with residents required to work from home where possible. Residents were expected to stay at home except for essential reasons, such as shopping for food or accessing medical care. In most Australian states, children and adolescents were required to learn from home, although children of essential workers were permitted to physically attend school. A staggered relaxing of social distancing, including physical school attendance, was implemented in the majority of Australian states towards the end of May. By early June, all children were expected to physically return to school
†The study aimed to examine: life changes due to COVID-19 restrictions; differences in child physical health, media use and mental health before and during the pandemic; whether stress and worries related to COVID-19 had a negative impact; changes or barriers to healthcare due to COVID-19 restrictions; and parent interest in online interventions as a result of the restrictions
‡Positive changes included more family time, children and adolescents with ADHD being able to learn at home without distractions, parents being able to aid learning, parents being less busy and more relaxed by having more time at home, and less pressure and stress related to attending school
Cortina MA, Gilleard A, Deighton J. Emerging evidence: Coronavirus and children and young people’s mental health. Available at: https://www.ucl.ac.uk/evidence-based-practice-unit/sites/evidence-based-practice-unit/files/coronavirus_emerging_evidence_1_final.pdf. Accessed February 2021.
Faraone SV, Asherson P, Banaschewski T, et al. Attention-deficit/hyperactivity disorder. Nat Rev Dis Primers 2015; 1: 15020.
Sciberras E, Patel P, Stokes MA, et al. Physical health, media use, and mental health in children and adolescents with ADHD during the COVID-19 pandemic in Australia. J Atten Disord 2020; Epub ahead of print.