| Bobo et al.77 Bobo E, Lin L, Acquaviva E, Caci H, Franc N, Gamon L, et al. [How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?]. Encephale. 2020 Jun; 46 (3S): S85-S92. 2020 (França) |
Observational (prospective cohort)
435 infants (377 M; 58 F) aged between 3 and <20 years. |
533 parents |
1) Mental health status; 2) environmental conditions of confinement; 3) feelings about the provision and continuity of care. |
Questionnaires with open and closed questions |
34.71% of parents reported worsening in their children’s behavior; 34.33% observed no noticeable changes and 30.96% an overall improvement in behavior. They also reported reduced anxiety, improvement of the child’s self-esteem, attention problems and agitation. In contrast, they described increased opposition or aggressiveness, sleep and emotional disturbances, and ADHD symptoms. The monitoring of schooling was the greatest challenge faced by parents during the lockdown. |
1) Influence of the results due to the subjectivity of the parents; 2) the study design does not allow to formulate causal relationships between confinement and the evolution of the state of the child with ADHD. |
Nonweiler et al.1212 Nonweiler J, Rattray F, Baulcomb J, Happé F, Absoud M. Prevalence and Associated Factors of Emotional and Behavioural Difficulties during COVID-19 Pandemic in Children with Neurodevelopmental Disorders. Children (Basel). 2020 Sep; 7 (9): 128. 2020
(Reino Unido) |
Observational (transversal)
453 infants (320 M; 133 F), aged 4 to 15 years. |
- |
1) Parents’ depressive symptoms and the different coping strategies they use to cope with lockdown during the pandemic; 2) emotional, behavioral and cognitive aspects of children with ADHD. |
SDQ |
When compared to a pre-COVID-19 mental health cohort, clinical sample scores evidence worse mental health in emotional symptoms, hyperactivity, and prosocial behavior. Compared with neurotypical controls, children with neurodevelopmental disorders had a higher prevalence of emotional symptoms, greater conduct problems, and lower prosocial behaviors. Children with ADHD had inflated conduct problems. |
1) The study design did not assess how the behaviors of children with ADHD changed relative to those of the general population; 2) individuals without internet access and who do not speak French were not represented by the sample; 3) the reported parental depression levels are only an underestimation of the extent of depression experienced during lockdown; 4) influence of the results due to the subjectivity of the parents. |
Zhang et al.1313 Zhang J, Shuai L, Yu H, Wang Z, Qiu M, Lu L, et al. Acute stress, behavioural symptoms and mood states among school-age children with attention-deficit/hyperactive disorder during the COVID-19 outbreak. Asian J Psychiatr. 2020 Jun; 51: 102077. 2020
(China) |
Observational (transversal)
241 children and teenagers (194M; 47F), aged between 6 and 15 years. |
241 parents |
1) Lifestyle changes due to lockdown, including impacts on parents’ work, finances, and social relationships; 2) differences in children’s physical health, media use, and mental health before and during the pandemic; 3) changes or barriers to health care during lockdown; 4) time of allocation of children’s activities; 5) mood status of parents and children; 6) impacts that media use has had on children with ADHD. |
SNAP-IV e CSDC |
53.94% of parents reported that their children’s ability to maintain focus worsened; 67.22% reported increased frequency of anger. On the other hand, more than half of parents reported that children’s behaviors in other domains improved or maintained the same level. ADHD symptoms decreased with longer study time. |
1) Influence of the results due to the subjectivity of the parents on the life of the child and/or adolescents in the preand pandemic period; 2) it is not possible to compare the effects of confinement between children with ADHD versus children in the general population with other neurodevelopmental and/or mental health disorders; 3) standardized diagnostic tools for ADHD and comorbid conditions were not used; 4) possible bias of the sample being composed of individuals with relatively high interest in seeking help; 5) individuals without internet access were not represented by the sample. |
Shuai et al.1414 Shuai L, He S, Zheng H, Wang Z, Qiu M, Xia W, et al. Influences of digital media use on children and adolescents with ADHD during COVID-19 pandemic. Global Health. 2021 Apr; 17 (1): 48. 2021
(China) |
Observational (transversal)
192 infants (140M; 52F), aged between 8 and 16 years. |
- |
1) Symptoms of dependence on the use of mobile phones; 2) severity of ADHD symptoms, oppositional defiant disorder, conduct disorder and emotional problems; 3) behaviors in the daily life of the children; 4) environmental and social characteristics; 5) mental health. |
SQPMPU, IAT, SNAP, BRIEF, ASLEC, FES-CV, SLMS, DSRSC, SCARED e HQIP |
The ADHD group with digital media use (PUMD) problems had significantly worse symptoms for inattention, oppositional defiant, conduct problem, and emotional problem, showing, considerably more life event disorders for relationship pressure and learning pressure compared to the ADHD group without PUMD. In addition, they also had more significant problems in learning motivation, including initiative, awareness, and goal. |
1) Small quantitative clinical sample; 2) use of a non-standardized questionnaire; 3) the data were reported by the mothers, and not directly by the children; 4) the relationship between altered behaviors among children with ADHD and their medication status has not been directly tested. |
Swansburg et al.1515 Swansburg R, Hai T, MacMaster FP, Lemay JF. Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada. Paediatr Child Health. 2021 May; 26 (5): e199-e207. 2021
(Canadá) |
Observational (cross-sectional) 587 children (412M; 166F; 9 others), with a mean age of 10.14 years. |
587 caregivers |
1) Family demographics; 2) mental health; 3) quality of life; 4) lifestyle habits. |
PHQ-9, GAD-7 e SNAP-IV. |
The PHQ-9 showed that 17.4% of the children had moderately depressed symptoms
severe to severe, while GAD-7 indicated that 14.1% had severe anxiety symptoms. In SNAP-IV, 73.7% of children had cutoff points for inattention, 66.8% for hyperactivity/impulsivity, and 38.6% for oppositional defiant disorder. Caregivers reported changes in sleep behaviors (77.5%), eating (58.9%), exercise (83.7%) and screen use (92.9%). |
1) Self-selective nature of recruitment, 2) the majority of survey responses were from the provinces of Alberta and Ontario; 3) the child’s perspective was not captured. |
Tessarollo et al.1616 Tessarollo V, Scarpellini F, Costantino I, Cartabia M, Canevini MP, Bonati M. Distance Learning in Children with and without ADHD: A Case-control Study during th COVID-19 Pandemic. J Attenn Disord. 2022 Apr; 26 (6): 902-14. 2021
(Itália) |
Observational (case-control)
276 children and teenagers (240M; 36F). 92 patients with ADHD and 184 controls without ADHD. Ages 6 to 15 |
276 mothers |
1) Sociodemographic data; 2) organization of distance learning; 3) attitude and behavior change of the child and 4) mothers’ difficulty and opinion about distance learning. |
DSM-5, K-SADS, CBCL, CPRS-R, CTRS-R e CGI-S |
Attention span was more limited in children with ADHD. During exposure to online teaching, about half of the students in both groups presented motor restlessness, with consequent interference in learning. Restlessness and anxiety were observed at greater intensity in the ADHD group. Aggressiveness, sleep disturbances and mood were equally reported for cases and controls. |
1) The data were reported by the mothers and not directly by the children; 2) the relationship between behavioral changes in children with ADHD and their drug status was not evaluated; 3) small sample size; 4) use of a non-standardized questionnaire. |
Werling et al.1717 Werling AM, Walitza S, Drechsler R. Impact of the COVID-19 lockdown on screen media use in patients referred for ADHD to child and adolescent psychiatry: an introduction to problematic use of the internet in ADHD and results of a survey. J Neural Transm (Vienna). 2021 Jul; 128 (7): 1033-43. 2021
(Suíça) |
Observational (prospective cohort)
126 children and teenagers (94M; 32F), aged between 10 and 18 years. |
126 parents |
1) Impact on the use of media in everyday life; 2) parents’ concern about problematic behaviors and 3) amount of time spent on digital activities. |
PUI-SQ |
46.8% of parents reported no change from ADHD, 33.3% improved and 19.8% worsened. 57.14% patients were classified as moderately, quite or very irritable, with estimated total media time higher than those who were classified as mildly/non-irritable. In addition, 46.82% of children and adolescents with low or very low ability to focus/concentrate had higher eTMT than patients with moderate or good concentration (53.17%). |
1) Classification of change was based on retrospective evaluations of parents; 2) objective data on socioeconomic status and cultural context were not collected; 3) diagnostic categories were self-assessed. |
Bobo et al.1818 Bobo E, Fongaro E, Lin L, Gétin C, Gamon L, Picot MC, et al. Mental Health of Children With Attention Deficit and Hyperactivity Disorder and Their Parents During the COVID-19 Lockdown: A National Cross-Sectional Study. Front Psychiatry. 2022 Jun; 13: 902245. 2022
(França) |
Observational (transversal)
435 children, (377M; 58F) with a mean age of 10.5 years. |
533 parents |
1) Difficulties of children with ADHD in the emotional, conduct and hyperactivity dimensions; 2) depressive symptoms of the parents; 3)
strategies used by parents to cope with the pandemic. |
Questionnaires SDQ, PHQ-2 e BRIEF COPE |
Of the children, 56.5% had hyperactivity scores, 57.6% behavior scores above the clinical cutoff point and 32.3% pathological emotional score. 55% of children were concerned about the pandemic and 52% were apprehensive about the health of their loved ones. As for the parents, 54.6% reported sleep problems and 50.1% of irritability in their children. |
1) A study did not evaluate how the behaviors of children with ADHD changed in relation to that of the general population; 2) the sample was not representative; 3) the increase in family time during lockdown may have altered the parents’ perception of the child; 4) the study occurred in the initial stage of the first lockdown. |
Sasaki et al.1919 Sasaki Y, Sasaki S, Sunakawa H, Toguchi Y, Tanese S, Saito K, et al. Evaluating the daily life of child and adolescent psychiatric outpatients during temporary school closure over COVID-19 pandemic: a single-center case-control study in Japan. Global Health Med. 2022 Jun; 4 (3): 159-65. 2022
(Japão) |
Observational (case-control)
184 children and teenagers who visited the study site at different periods, 92 from the research group (March to May 2020) and 92 from the control group (April 2017 to March 2020). The two groups were compared in each age category: patients from elementary school aged between 6 and 12 years and from high school between 12 and 15 years. |
- |
1) Functions of daily life and limitations throughout the day; 2) the child’s behavior; 3) ADHD symptoms; 4) diagnostic criteria for ADHD; 5) depression scale and 6) symptoms of anxiety disorders. |
QCD, TABS, ADHD-RS, ODBI, DSRS e SCAS |
In elementary school students, there were no significant differences in the TABS, ADHD-RS, ODBI, DSRS and SCAS scores between the two groups. In high school students, there were no significant differences in TABS, ODBI, DSRS and SCAS scores between the two groups. The “ADHD-RS” scores indicating ADHD symptoms were 16.78 ± 12.69 in the case group and 11.80 ± 10.40 in the control group. In elementary school students, the QCD scores indicating functionality or disability during school hours were 3.31 ± 2.52 in the case group and 4.52 ± 2.33 in the control group. For high school, there were no significant differences in QCD scores between the two groups. |
1) Measurement bias and selection bias can be identified; 2) small sample size in the group of cases; 3) a study conducted in a single district. |
| Sciberras et al.88 Sciberras E, Patel P, Stokes MA, Coghill D, Middeldorp CM, Bellgrove 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. 2022 Feb; 26 (4): 549-62. 2022 (Austrália) |
Observational (longitudinal)
213 children and teenagers, (162M; 51F) |
213 parents |
1) Life changes due to COVID-19 restrictions; 2) barriers in health care; 3) stress and worry of the child. |
CRISIS questionnaires and open-ended questions |
54% of parents reported that the quality of family and social relationships worsened. 63.84% reported positive changes in their children’s lives: more time with family, ability to learn at home without distractions, parents being able to help with learning. In contrast, increased sad/depressed/unhappy mood, reduced pleasure in usual activities, and increased loneliness were also reported. |
1) Study used retrospective reports of parents; 2) absence of a control group; 3) online study with low confidence in the diagnosis of ADHD and in the conditions of comorbidities; 4) no data available on parents’ COVID-19 stress and concerns. |
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