Review Article

Relation between ADHD and COVID-19: A Narrative Review to Guide Advancing Clinical Research and Therapy

Abstract

Objective: To cope with the COVID-19 pandemic, national health authorities temporarily closed cultural, religious, and educational institutions such as universities and schools. Children and adolescents with ADHD were challenged with the restrictions caused by the Covid-19 pandemic such as homeschooling and reduced physical activity. The present narrative review aimed to summarize the state-of-the-art regarding associations between COVID-19-related social restrictions and possible psychological and behavioral issues in children and adolescents with ADHD. Additionally, we discussed the underlying possible reasons of the association focusing on the role of parental influence and physical activity, vulnerabilities of individuals with ADHD to Covid-19 infection and to school closure and remote learning. Method: To collect data for the present narrative review, recent publications on these topics between February 1st, 2020 and January 10th, 2021 were retrieved from the most popular search engines (PubMed; Scopus; Google Scholar; Psych Info; Embase) through a comprehensive search using relevant keywords.

Results: During confinement, children and adolescents with ADHD reported increased behavioral and ADHD-related symptoms and overall decreased psychological well-being. Factors negatively impacting children’s and adolescents’ behavioral symptoms and well-being were: less physical activity, adverse parental behavior, difficulties in coping with preventive guidelines, and school closure and remote learning consequences.

Conclusion: Children and adolescents with ADHD and their caregivers faced both specific and general psychological issues related to the school lockdowns and homeschooling. Additionally, Individuals with ADHD seem to be more vulnerable to Covid-19 infection which highlights the need for better healthcare adaptation.

1.Wang G, Zhang Y, Zhao J, Zhang J, Jiang F. Mitigate the effects of home confinement on children during the COVID-19 outbreak. Lancet. 2020;395(10228):945-7.
2. Liu JJ, Bao Y, Huang X, Shi J, Lu L. Mental health considerations for children quarantined because of COVID-19. Lancet Child Adolesc Health. 2020;4(5):347-9.
3. Brooks SK, Webster RK, Smith LE, Woodland L, Wessely S, Greenberg N, et al. The psychological impact of quarantine and how to reduce it: rapid review of the evidence. Lancet. 2020;395(10227):912-20.
4. Melegari MG, Giallonardo M, Sacco R, Marcucci L, Orecchio S, Bruni O. Identifying the impact of the confinement of Covid-19 on emotional-mood and behavioural dimensions in children and adolescents with attention deficit hyperactivity disorder (ADHD). Psychiatry Res. 2021;296:113692.
5. Saurabh K, Ranjan S. Compliance and Psychological Impact of Quarantine in Children and Adolescents due to Covid-19 Pandemic. 2020;87(7):532-6.
6. Wang Q, Xu R, Volkow ND. Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry. 2021;20(1):124-30.
7. Merzon E, Manor I. ADHD as a Risk Factor for Infection With Covid-19. J Atten Disord. 2021;25(13):1783-90.
8. Shinn AK, Viron M. Perspectives on the COVID-19 Pandemic and Individuals With Serious Mental Illness. J Clin Psychiatry. 2020;81(3).
9. Polanczyk GV, Willcutt EG, Salum GA, Kieling C, Rohde LA. ADHD prevalence estimates across three decades: an updated systematic review and meta-regression analysis. Int J Epidemiol. 2014;43(2):434-42.
10. Alavi A, Mohammadi MR, Joshaghani N, Mahmoudi-Gharaei J. Frequency of Psychological Disorders amongst Children in Urban Areas of Tehran. Iran J Psychiatry. 2010;5(2):55-9.
11. Khademi M, Rajeziesfahani S, Noorbakhsh S, Panaghi L, Davari-Ashtiani R, Razjouyan K, et al. Knowledge and Attitude of Primary School Teachers in Tehran/Iran towards ADHD and SLD. Glob J Health Sci. 2016;8(12):141-49.
12. Ahmed R, Borst JM, Yong CW, Aslani P. Do parents of children with attention-deficit/hyperactivity disorder (ADHD) receive adequate information about the disorder and its treatments? A qualitative investigation. Patient Prefer Adherence. 2014;8:661-70.
13. Davari-Ashtiani R, Jazayeri F, Arabgol F, Razjouyan K, Khademi M. Psychometric Properties of Persian Version of Conners’ Adult Attention Deficit/Hyperactivity Disorder Rating Scale (Screening Form-Self Reporting). Iran J Psychiatry Clin Psychol. 2014;20(3):243-51.
14. 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;46(3s):S85-s92.
15. 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. 2020:1087054720978549.
16. McGowan G, Conrad R, Potts H. 51.2 CHALLENGES WITH MANAGING CHILDREN AND ADOLESCENTS WITH ADHD DURING THE COVID-19 PANDEMIC: A REVIEW OF THE LITERATURE. J Am Acad Child Adolesc Psychiatry. 2020;59(10):S251.
17. Fegert JM, Vitiello B, Plener PL, Clemens V. Challenges and burden of the Coronavirus 2019 (COVID-19) pandemic for child and adolescent mental health: a narrative review to highlight clinical and research needs in the acute phase and the long return to normality. Child Adolesc Psychiatry Ment Health. 2020;14:20.
18. 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. 2020;7(9).
19. 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;51:102077.
20. Wolraich ML, Lambert W, Doffing MA, Bickman L, Simmons T, Worley K. Psychometric properties of the Vanderbilt ADHD diagnostic parent rating scale in a referred population. J Pediatr Psychol. 2003;28(8):559-67.
21. Gau SS, Shang CY, Liu SK, Lin CH, Swanson JM, Liu YC, et al. Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form. Int J Methods Psychiatr Res. 2008;17(1):35-44.
22. Shah R, Raju VV, Sharma A, Grover S. Impact of COVID-19 and Lockdown on Children with ADHD and Their Families-An Online Survey and a Continuity Care Model. J Neurosci Rural Pract. 2021;12(1):71-9.
23. Kirov R, Brand S. Sleep problems and their effect in ADHD. Expert Rev Neurother. 2014;14(3):287-99.
24. Çetin FH, Uçar HN. Chronotypes and trauma reactions in children with ADHD in home confinement of COVID-19: full mediation effect of sleep problems. 2020;37(8):1214-22.
25. Becker SP, Gregory AM. Editorial Perspective: Perils and promise for child and adolescent sleep and associated psychopathology during the COVID-19 pandemic. J Child Psychol Psychiatry.2020;61(7):757-9.
26. Keshavarzi Z, Bajoghli H, Mohamadi MR, Salmanian M, Kirov R, Gerber M, et al. In a randomized case-control trial with 10-years olds suffering from attention deficit/hyperactivity disorder (ADHD) sleep and psychological functioning improved during a 12-week sleep-training program. World J Biol Psychiatry. 2014;15(8):609-19.
27. Hupp SD, Reitman D, Northup J, O'Callaghan P, LeBlanc M. The effects of delayed rewards, tokens, and stimulant medication on sportsmanlike behavior with ADHD-diagnosed children. Behav Modif. 2002;26(2):148-62.
28. Ludyga S, Gerber M, Mücke M, Brand S, Weber P, Brotzmann M, et al. The Acute Effects of Aerobic Exercise on Cognitive Flexibility and Task-Related Heart Rate Variability in Children With ADHD and Healthy Controls. J Atten Disord. 2020;24(5):693-703.
29. Hoza B, Smith AL, Shoulberg EK, Linnea KS, Dorsch TE, Blazo JA, et al. A randomized trial examining the effects of aerobic physical activity on attention-deficit/hyperactivity disorder symptoms in young children. J Abnorm Child Psychol. 2015;43(4):655-67.
30. Taylor AF, Kuo FE. Children with attention deficits concentrate better after walk in the park. J Atten Disord. 2009;12(5):402-9.
31. Liu Q, Zhou Y, Xie X, Xue Q, Zhu K, Wan Z, et al. The prevalence of behavioral problems among school-aged children in home quarantine during the COVID-19 pandemic in china. J Affect Disord. 2021;279:412-6.
32. Ghosh R, Dubey MJ, Chatterjee S, Dubey S. Impact of COVID -19 on children: special focus on the psychosocial aspect. Minerva Pediatr. 2020;72(3):226-35.
33. Morelli M, Cattelino E, Baiocco R, Trumello C, Babore A, Candelori C, et al. Parents and Children During the COVID-19 Lockdown: The Influence of Parenting Distress and Parenting Self-Efficacy on Children's Emotional Well-Being. Front Psychol. 2020;11:584645.
34. Mojtahedi D, Dagnall N, Denovan A, Clough P, Hull S, Canning D, et al. The Relationship Between Mental Toughness, Job Loss, and Mental Health Issues During the COVID-19 Pandemic. Front Psychiatry. 2020;11:607246.
35. Spinelli M, Lionetti F, Pastore M, Fasolo M. Parents' Stress and Children's Psychological Problems in Families Facing the COVID-19 Outbreak in Italy. Front Psychol. 2020;11:1713.
36. Cortese S, Asherson P, Sonuga-Barke E, Banaschewski T, Brandeis D, Buitelaar J, et al. Management approaches for ADHD during the COVID-19 virus pandemic: guidance from the European ADHD Guidelines Group (EAGG). Lancet Child Adolesc Health. 2020;4(6):412-14.
37. Marchetti D, Fontanesi L, Di Giandomenico S, Mazza C, Roma P, Verrocchio MC. The Effect of Parent Psychological Distress on Child Hyperactivity/Inattention During the COVID-19 Lockdown: Testing the Mediation of Parent Verbal Hostility and Child Emotional Symptoms. Front Psychol. 2020;11:567052.
38. Wendel M, Ritchie T, Rogers MA, Ogg JA, Santuzzi AM, Shelleby EC, et al. The Association Between Child ADHD Symptoms and Changes in Parental Involvement in Kindergarten Children’s Learning During COVID-19. School Psych Rev. 2020;49(4):466-79.
39. Pollak Y, Dayan H, Shoham R, Berger I. Predictors of non-adherence to public health instructions during the COVID-19 pandemic. 2020;74(11):602-4.
40. Aliabadi B, Davari-Ashtiani R, Khademi M, Arabgol F. Comparison of Creativity between Children with and without Attention Deficit Hyperactivity Disorder: A Case-Control Study. Iran J Psychiatry. 2016;11(2):99-103.
41. Arbel Y, Fialkoff C, Kerner A, Kerner M. Can Increased Recovery Rates from Coronavirus be explained by Prevalence of ADHD? An Analysis at the US Statewide Level. J Atten Disord. 2021;25(14):1951-4.
42. Saline S. Thriving in the New Normal: How COVID-19 has Affected Alternative Learners and Their Families and Implementing Effective, Creative Therapeutic Interventions Smith Coll Stud Soc Work.. 2021;91(1):1-28.
43. Becker SP, Breaux R, Cusick CN, Dvorsky MR, Marsh NP, Sciberras E, et al. Remote Learning During COVID-19: Examining School Practices, Service Continuation, and Difficulties for Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Adolesc Health. 2020;67(6):769-77.
44. Thorell LB, Skoglund C, de la Peña AG, Baeyens D, Fuermaier ABM, Groom MJ, et al. Parental experiences of homeschooling during the COVID-19 pandemic: differences between seven European countries and between children with and without mental health conditions. Eur Child Adolesc Psychiatry. 2021:1-13.
45. Powell V, Riglin L, Hammerton G, Eyre O, Martin J, Anney R, et al. What explains the link between childhood ADHD and adolescent depression? Investigating the role of peer relationships and academic attainment. Eur Child Adolesc Psychiatry. 2020;29(11):1581-91.
Files
IssueVol 17 No 1 (2022) QRcode
SectionReview Article(s)
DOI https://doi.org/10.18502/ijps.v17i1.8055
Keywords
Attention Deficit Disorder with Hyperactivity COVID-19 Mental Health Psychiatry Review

Rights and permissions
Creative Commons License This work is licensed under a Creative Commons Attribution-NonCommercial 4.0 International License.
How to Cite
1.
Davoody S, Goeschl S, Dolatshahi M, Davari-Ashtiani R, Saffarpour R, Sodeifian F, Brand S. Relation between ADHD and COVID-19: A Narrative Review to Guide Advancing Clinical Research and Therapy. Iran J Psychiatry. 2021;17(1):110-117.