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When clinical psychologist Maggie Sibley thinks about the impact of the coronavirus pandemic on children and adolescents with attention-deficit/hyperactivity disorder, she worries most about the older teens who may drop out of high school and those kids who may be experiencing depression.
It would be hard to argue that this year hasn't been difficult for everyone, and that may be even more true for people who struggle with neurodevelopmental or mental health issues.
"I think there's a lot more risk factors right now for becoming depressed, and people with ADHD are already at a higher risk of becoming depressed. I worry about those things in terms of negatives," said Sibley, who is a clinical psychologist at the Center for Child Health, Behavior, and Development at Seattle Children's Research Institute.
In a study published online Feb. 14 in the Journal of Psychiatric Research, Sibley and others looked at a group of 134 adolescents and young adults, and found they reported problems with social isolation, difficulties engaging in online learning, motivation issues and boredom that increased during the pandemic.
"I'm not surprised to hear that [about social isolation] because whereas most teenagers have friends that they interact with outside of school, teenagers with ADHD are at risk for only getting their peer interactions in school," said Sibley, who is affiliated with the nonprofit group Children and Adults with Attention-Deficit/Hyperactivity Disorder (CHAAD).
"Another issue was having trouble with the remote learning experience. And I think part of that is remote learning is not as engaging, naturally, and people with ADHD really needing engaging environments to learn well," she said. "And they also lose the structure that I think a lot of people with ADHD rely on, and the consistent schedule."
Numerous studies have shown an increase in symptoms during the pandemic for both kids and adults with ADHD, according to a recent review in the Journal of Adolescent Health from researchers who included Rosanna Breaux, a professor at Virginia Polytechnic Institute and State University in Blacksburg.
That includes an increase in new diagnoses of ADHD, especially among teen boys, according to a separate survey published by Athenahealth last year. ADHD is a neurodevelopmental disorder with symptoms that include trouble paying attention and controlling impulsive behaviors, according to the U.S. Centers for Disease Control and Prevention. It can be treated with medications or therapies that include strategies for promoting good behavior at home and teaching adolescents skills for coping with symptoms.
Lack of structure has pros and cons
"Nationally, there has been data released showing that there are increases of people coming in for either a first-time ADHD diagnosis or to ask about taking medication, even if they had an ADHD diagnosis but hadn't been medicated in the past," Sibley said.
There may be people who were struggling already, but only when they were home during the pandemic and their parents were observing them all day did they realize how much of a struggle it was, Sibley noted.
Others may not have experienced issues in normal school settings, but when they lost the structure and gained the stressors involved in the pandemic, they started having problems.
"I think it's a big question mark whether those people really have ADHD. As we think about ADHD, it's sort of a lifespan experience that doesn't just show up in the hard times, but those people still need help," Sibley said.
"It's good for them to be evaluated for ADHD and for a professional who's trained in giving a good diagnosis to help them figure out what their next steps are, regardless of if they meet criteria for ADHD," she added.
Not all parts of this experience have been negative.
"One way we could look at this is that this is an opportunity for people with ADHD to learn how to cope better with their own symptoms," Sibley said.
According to Maryland psychologist Carey Heller, a silver lining of distance learning during the pandemic is that the tasks that made these changes challenging for children and adolescents with ADHD have also helped them to build stronger executive function skills.
How to help your teen stay focused
"Weaknesses in executive functioning underlie many of the core deficits associated with ADHD," Heller wrote in a blog for CHAAD. He serves on the organization's board of directors.
This includes planning, organizing and working memory, which kids have been called upon to use in various platforms for online classes and work, Heller noted.
"I think everyone's different. There are some kids with ADHD that in some ways are actually thriving with distance learning or the hybrid model because teachers are more consistent with putting stuff online," Heller said. "I think there are other kids that are struggling far more because they do a lot better with the in-person cues for remembering to do things or paying attention. It's easier to withdraw if you just turn off your camera."
For parents and kids who are still struggling, it can be helpful to set a structured routine. Having the kids collaborate on the routine, even for those as young as 4 or 5, is helpful, Heller said.
Sibley suggested creating positive rewards for good effort during the day. Also, make sure that accommodations that children with ADHD are entitled to are being followed in remote learning.
If families are now worried about their child possibly having ADHD, the first step is to talk to their child's pediatrician, Sibley said. The doctor can connect the family with a psychologist who can do a thorough evaluation.
"I think that there is a potential for huge growth during this time," Heller said. "I think kids have to have the supports in place and the tools to be able to be successful with it."
SOURCES: Margaret Sibley, PhD, associate professor, psychiatry and behavioral sciences, University of Washington School of Medicine, and clinical psychologist, Center for Child Health, Behavior, and Development, Seattle Children's Research Institute; Carey Heller, PsyD, clinical psychologist, The Heller Psychology Group, Bethesda, Md.; Journal of Psychiatric Research, Feb. 18, 2021; Journal of Adolescent Health, December 2020; "More Pediatricians Talking About ADHD During COVID-19," Athenahealth report, May 29, 2020
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