17 Aug 2021

Swansburg R et al. Paediatr Child Health 2021; 26: 5

The COVID-19 pandemic created an environment of social restrictions and modified lifestyle habits, with mental and physical health implications. This study investigated the impact of the pandemic on lifestyle habits, mental health symptoms and ADHD behaviours in children with ADHD in Canada.

An online survey, with 113 questions related to family demographics, mental health, quality of life, and lifestyle habits, was advertised online and in ADHD clinics across Canada and distributed via email to families with children with ADHD. Inclusion criteria included respondents needing to be a caregiver of a child with ADHD aged 5 to 18 years living in Canada with the ability to read and write English. The survey used questionnaires to assess depression, using the Patient Health Questionnaire 9 (PHQ-9) (Kroenke et al, 2001); anxiety, using Generalised Anxiety Disorder 7 (GAD-7) (Spitzer et al, 2006); ADHD, using the Swanson, Nolan, and Pelham (SNAP-IV) 26-question scale (Swanson et al, 1999); and lifestyle choices. The survey questions enabled the tracking of changes in sleep, eating, exercise and screen-use behaviours based on experience working with children with ADHD. The survey was available from 11 May to 15 June 2020 and, of responses completed, ≥90% were included in analyses.

A total of 587 of 663 survey submissions were retained for this study. Mean (standard deviation [SD]) child age was 10.14 (3.06) years consisting of 166 females (28.3%), 412 males (70.2%), and 9 other (1.5%). Most respondents were from Alberta (40.9%) and Ontario (31.3%). At the time of response, approximately one third (33.6%) of children and/or their parents were participating in therapy (e.g., cognitive behavioural therapy, socials skills training), with a higher proportion of girls (39.8%) in therapy than boys (31.1%) (Chi-square: 4.008; p=0.045). A significantly higher proportion of boys (77.2%) were taking medication than girls (66.3%) (Chi-square: 6.804; p=0.009). A change in medication dosage was reported by 35.3% of respondents, impacting a higher proportion of girls (42.7%) than boys (32.5%) (Chi-square: 3.754; p=0.053), and younger children (46.2%) more than older children (33.0%) and adolescents (23.1%) (Chi-square: 13.800; p=0.001).

Mental health during the COVID-19 pandemic

The PHQ-9 indicated that 17.4% of children met criteria for moderately severe to severe depression symptoms, with severe depression impacting more boys (6.9%) than girls (2.5%) (Chi-square: 4.159; p=0.041). The GAD-7 indicated that 14.1% of children displayed severe anxiety symptoms. More girls (24.7%) showed an increase in anxious behaviour compared with boys (17.5%) (Chi-square 4.407; p=0.036). The SNAP-IV indicated that 73.7% of children met cut-off scores for inattention, 66.8% for hyperactivity/impulsivity and 38.6% for oppositional defiant disorder (ODD) behaviours. A total of 221 (38.4%) and 314 (54.8%) caregivers reported an increase in their child’s depression and anxiety symptoms during the pandemic, respectively.

Lifestyle habits during the COVID-19 pandemic

Caregivers reported changes in their children’s sleep (77.5%), eating (58.9%), exercise (83.7%) and screen use (92.9%), with this change occurring in adolescents the most. Furthermore, 16.5% of children spending more than 6 hours per day watching TV and/or playing videogames was reported. Sleeping fewer hours per night, eating more processed foods, and watching TV or playing videogames for more than 3.5 hours per day correlated with greater depression, anxiety and ADHD symptoms (p<0.01). Exercising <1 hour/day correlated positively with depression symptoms (p<0.01) and negatively with hyperactivity/impulsivity (p<0.05). Reduced sleep correlated with greater hyperactivity/impulsivity, ODD behaviours and increased reports of depression, anxiety and ADHD symptoms (p<0.01).

There were some limitations of this study. The recruitment process was self-selecting in nature, and families in crisis were less likely to complete the survey than families in less difficulty. Furthermore, the majority of survey respondents were located in Alberta and Ontario alone, and the child’s perspective was not captured by the survey.

The authors suggested that the COVID-19 pandemic has impacted Canadian children with ADHD, resulting in less healthy lifestyle habits and increased mental health symptoms. The authors recommended that more studies be carried out to improve the understanding of relationships between these factors and the possible benefits of healthy lifestyle interventions.

Read more about the impact of COVID-19 on children with ADHD here

Disclaimer: The views expressed here are the views of the author(s) and not those of Takeda.

Kroenke K, Spitzer RL, Williams JBW. The PHQ-9: validity of a brief depression severity measure. J Gen Intern Med 2001; 16: 606-613.

Spitzer RL, Kroenke K, Williams JBW, et al. A brief measure for assessing generalized anxiety disorder: the GAD-7. Arch Intern Med 2006; 166: 1092-1097.

Swansburg R, Hai T, MacMaster FP, et al. Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada. Paediatr Child Health 2021; 26: e199-e207.

Swanson J, Lerner M, March J, et al. Assessment and intervention for attention-deficit/hyperactivity disorder in the schools: lessons from the MTA study. Pediatr Clin North Am 1999; 46: 993-1009.

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