ABSTRACT
The COVID-19 pandemic led ADHD services to modify the clinical practice to reduce in-person contact as much as possible to minimise viral spread. This had far-reaching effects on day-to-day clinical practice as remote assessments were widely adopted. Despite the attenuation of the acute threat from COVID, many clinical services are retaining some remote practices. The lack of clear evidence-based guidance about the most appropriate way to conduct remote assessments meant that these changes were typically implemented in a localised, ad hoc, and un-coordinated way. Here, the European ADHD Guidelines Group (EAGG) discusses the strengths and weaknesses of remote assessment methods of children and adolescents with ADHD in a narrative review based on available data and expert opinions to highlight key recommendations for future studies and clinical practice. We conclude that going forward, despite remote working in clinical services functioning adequately during the pandemic, all required components of ADHD assessment should still be completed following national/international guidelines; however, the process may need adaptation. Social restrictions, including changes in education provision, can either mask or exacerbate features associated with ADHD and therefore assessment should carefully chart symptom profile and impairment prior to, as well as during an ongoing pandemic. While remote assessments are valuable in allowing clinical services to continue despite restrictions and may have benefits for routine care in the post-pandemic world, particular attention must be paid to those who may be at high risk but not be able to use/access remote technologies and prioritize these groups for conventional face-to-face assessments.
Subject(s)
Attention Deficit Disorder with Hyperactivity , COVID-19 , Humans , Child , Adolescent , Pandemics , Attention Deficit Disorder with Hyperactivity/diagnosis , Attention Deficit Disorder with Hyperactivity/therapy , Delivery of Health CareABSTRACT
COVID-19 limitation strategies have led to widespread school closures around the world. The present study reports children's mental health and associated factors during the COVID-19 school closure in France in the spring of 2020. We conducted a cross-sectional analysis using data from the SAPRIS project set up during the COVID-19 pandemic in France. Using multinomial logistic regression models, we estimated associations between children's mental health, children's health behaviors, schooling, and socioeconomic characteristics of the children's families. The sample consisted of 5702 children aged 8-9 years, including 50.2% girls. In multivariate logistic regression models, children's sleeping difficulties were associated with children's abnormal symptoms of both hyperactivity-inattention (adjusted Odds Ratio (aOR) 2.05;95% Confidence Interval 1.70-2.47) and emotional symptoms (aOR 5.34;95% CI 4.16-6.86). Factors specifically associated with abnormal hyperactivity/inattention were: male sex (aOR 2.29;95% CI 1.90-2.76), access to specialized care prior to the pandemic and its suspension during school closure (aOR 1.51;95% CI 1.21-1.88), abnormal emotional symptoms (aOR 4.06;95% CI 3.11-5.29), being unschooled or schooled with assistance before lockdown (aOR 2.13;95% CI 1.43-3.17), and tutoring with difficulties or absence of a tutor (aOR 3.25;95% CI 2.64-3.99;aOR 2.47;95% CI 1.48-4.11, respectively). Factors associated with children's emotional symptoms were the following: being born pre-term (aOR 1.34;95% CI 1.03-1.73), COVID-19 cases among household members (aOR 1.72;95% CI 1.08-2.73), abnormal symptoms of hyperactivity/inattention (aOR 4.18;95% CI 3.27-5.34) and modest income (aOR 1.45;95% CI 1.07-1.96;aOR 1.36;95% CI 1.01-1.84). Multiple characteristics were associated with elevated levels of symptoms of hyperactivity-inattention and emotional symptoms in children during the period of school closure due to COVID-19. Further studies are needed to help policymakers to balance the pros and cons of closing schools, taking into consideration the educational and psychological consequences for children.
ABSTRACT
Background COVID-19 limitation strategies led to widespread school closures around the world. The present study aims to provide a description of children's mental health and associated factors during the COVID-19 school closure in France. Methods We conducted a cross-sectional analysis in the SAPRIS study during the COVID-19 pandemic in France, relying on 2 ongoing national birth cohorts, ELFE and EPIPAGE 2. Using weighted multinomial logistic regression models, we estimated associations between children's mental health (i.e., hyperactivity/inattention and emotional symptoms;assessed by the Strengths and Difficulties Questionnaire), children's health behaviors, schooling, as well as sociodemographic and socioeconomic characteristics of children family. Results The sample consisted of 5702 children aged 8 - 9 years and 49.3% girls. Sleep disturbance and parents' dominant socio-professional category were associated with both hyperactivity-inattention (adjusted Odds Ratio (aOR)=2.10 95%Confidence Interval [1.85-2.38];aOR=0.45 [0.33-0.61] respectively) and emotional symptoms and (aOR=6.33 [5.26-7.63];aOR=0.62 [0.39-0.98] respectively). Specifically associated with hyperactivity/inattention were: male sex (aOR=2.51 [2.24-2.82]), presence of regular care and its pursuit during school closure (aOR=1.69 [1.33-2.15]), emotional symptoms (aOR=2.74 [2.23-3.37]), school situation (aOR=2.19 [1.69-2.82]), presence of tutoring and difficulties with it (aOR=2.56 [2.13-3.08]), type of housing (aOR=0.79 [0.70-0.89]). Factors associated with emotional symptoms were: presence of covid cases in the household (aOR=2.33 [1.92-2.82]), hyperactivity/inattention (aOR=2.94 [2.45-3.52]) and financial difficulties (aOR=1.71 [1.39-2.11]). Conclusions Policy makers need to balance pros and cons of closing schools, taking into consideration educational and psychological consequences for children and the various factors associated with mental health.