The Relationship Between Screen Time and Symptom Severity in Children with ADHD during COVID-19 Lockdown.

OBJECTIVES: To investigate the relationship between screen time and symptom severity in children with ADHD during the COVID-19 lockdown. METHODS: Caregivers of children with ADHD aged 7 to 16 years completed the screen time questionnaire and ADHD rating scales of the SNAP-IV-Thai version during and after the COVID-19 lockdown. The correlation between screen time and ADHD scores was assessed. RESULTS: Of the 90 children, aged 11.31 ± 2.29 years, enrolled, 74.4% were male, 64.4% were in primary school, and 73% had electronic screens in their bedrooms. After adjusting with other factors, recreational screen time, both on weekdays and on weekend days, were positively correlated with ADHD scores (both inattention and hyperactive/impulsive scores). Studying screen time, on the other hand, was not associated with ADHD symptom severity. Compared to during the lockdown, studying screen time decreased after the lockdown, but recreational screen time and ADHD scores were not changed. CONCLUSION: Increasing recreational screen time was associated with worsening ADHD symptoms.

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca.

BACKGROUND: Few studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning. METHODS: The Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children's version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects. RESULTS: The overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample. CONCLUSIONS: The prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

Features of attention deficit/hyperactivity disorder and antisocial behaviour in a general population-based sample of adults.

BACKGROUND: Attention deficit/hyperactivity disorder (ADHD) is known to be a risk factor for antisocial and delinquent behaviour, but there is still a lack of information on how features of ADHD relate to offending behaviour among adults not already defined by their offending. AIMS: Our aim was to add to knowledge about relationships between ADHD and antisocial behaviour among adults in the general population by answering the following questions: (A) Does the level of self-reported ADHD features relate to criminal and non-criminal antisocial behaviour? (B) To what extent are self-ratings of ADHD features independent of socio-demographic features previously identified as predictors of antisocial behaviour? METHODS: A sample of adults was originally recruited to study public response to the COVID-19 outbreak through an online panel to be representative of the Israeli population. Among other scales, the 2025 participants completed an ADHD self-report scale, an antisocial behaviour self-report scale and a socio-demographic questionnaire probing for age, gender, urbanity, place of birth, socioeconomic status (education and income), family status (being in a relationship and having children) and religiosity. RESULTS: Higher mean totals for the inattention and hyperactivity ADHD scale scores were associated with higher mean antisocial behaviour scores. These relationships were only slightly affected by socio-demographic variables, including sex, age, education and income. CONCLUSION: Our findings suggest that not only may features of ADHD, even below a diagnostic threshold, constitute a risk factor for antisocial behaviour, but also that the self-rated levels of these problems covary. These findings are important for informing the early detection of risk of antisocial behaviour in the general population and its prevention.

ADHD Symptoms Increased During the Covid-19 Pandemic: A Meta-Analysis.

OBJECTIVE: Emerging research suggests that the Covid-19 pandemic has disproportionately and adversely affected children with Attention-Deficit/Hyperactivity Disorder (ADHD). The purpose of this meta-analysis is to consolidate the findings from studies that examined changes in ADHD symptoms from before to during the pandemic. METHOD: Database searches of PsycINFO, ERIC, PubMed, and ProQuest were used to identify relevant studies, theses, and dissertations. RESULTS: A total of 18 studies met specific inclusion criteria and were coded based on various study characteristics. Twelve studies examined ADHD symptoms longitudinally and six studies assessed ADHD symptoms retroactively and during the pandemic. Data from 6,491 participants from 10 countries were included. Results indicated that many children and/or their caregivers reported an increase in child ADHD symptoms during the Covid-19 pandemic. CONCLUSIONS: This review points to a global increase in ADHD symptoms and has implications for the prevalence and management of ADHD during the post-pandemic recovery.

Attention Deficit Hyperactivity Disorder: What Are Pharmacists' Roles and Associated Outcomes?

Globally, the prevalence of attention deficit hyperactivity disorder (ADHD) is increasing. The treatment for ADHD is multifaceted and requires long-term care and support. Pharmacists are capable of assisting patients and their caretakers in achieving desired outcomes. This work discusses and summarizes pharmacists' roles in ADHD care and their associated outcomes. Overall, pharmacists are positioned to educate on ADHD, optimize medications in a collaborative practice model, manage and monitor side effects, and provide remote and virtual pharmaceutical care. Pharmacists could directly contribute to ensuring medication safety and increasing awareness regarding the optimal use of ADHD medications. Patients with ADHD can benefit from pharmacist involvement in a variety of ways, including, but not limited to, initial screening and referral, the provision of clinical consultation and feedback, and the improvement of self-management and self-awareness of the illness. Pharmacists also play a significant role in therapeutic decision making regarding the initiation, intensification, and monitoring of ADHD treatment to ensure its effectiveness and quality of life improvement. Lastly, pharmacists could help identify more cost-effective treatment approaches for ADHD patients based on the clinical scenario that is encountered.

Trends in Stimulant Prescription Fills Among Commercially Insured Children and Adults - United States, 2016-2021.

Prescription stimulant use, primarily for the treatment of attention-deficit/hyperactivity disorder (ADHD), has increased among adults in the United States during recent decades, while remaining stable or declining among children and adolescents (1,2). MarketScan commercial claims data were analyzed to describe trends in prescription stimulant fills before and during the COVID-19 pandemic (2016-2021) by calculating annual percentages of enrollees aged 5-64 years in employer-sponsored health plans who had one or more prescription stimulant fills overall and by sex and age group. Overall, the percentage of enrollees with one or more prescription stimulant fills increased from 3.6% in 2016 to 4.1% in 2021. The percentages of females aged 15-44 years and males aged 25-44 years with prescription stimulant fills increased by more than 10% during 2020-2021. Future evaluation could determine if policy and health system reimbursement changes enacted during the pandemic contributed to the increase in stimulant prescriptions. Stimulants can offer substantial benefits for persons with ADHD, but also pose potential harms, including adverse effects, medication interactions, diversion and misuse, and overdoses. Well-established clinical guidelines exist for ADHD care, but only for children and adolescents* (3); clinical practice guidelines for adult ADHD could help adults also receive accurate diagnoses and appropriate treatment.

Treatment with stimulants and the risk of COVID-19 complications in adults with ADHD.

Adults with attention deficit hyperactivity disorder (ADHD) have shown higher infection rates and worse outcomes from COVID-19. Stimulant medications are prescribed as the first-line treatment for ADHD in adults and mitigate risk of negative ADHD-related health outcomes, but little is known about the association between stimulant medications and COVID-19 outcomes. The objective of this study was to assess the risks of severe COVID-19 outcomes among people with ADHD who were prescribed stimulant medications versus those who were not. This retrospective cohort study used electronic health records in the TriNetX research database. We assessed records of adults with ADHD diagnosed with COVID-19 between January 1, 2020 and June 30, 2021. The stimulant cohort consisted of 28,011 people with at least one stimulant prescription; the unmedicated cohort comprised 42,258 people without prescribed stimulants within 12 months prior to their COVID infection. Multiple logistic regression modeling was utilized to assess the presence of critical care services or death within 30 days after the onset of COVID diagnoses, controlling for patient demographics, and comorbid medical and mental health conditions. The stimulant cohort was less likely to utilize emergency department, hospital, and intensive care services than the unmedicated cohort, and had significantly lower 30-day mortality. Further research, including prospective studies, is needed to confirm and refine these findings.

Can We Expand the Pool of Youth Who Receive Telehealth Assessments for ADHD? Covariates of Service Utilization.

BACKGROUND: During the COVID-19 pandemic, telehealth became widely utilized for healthcare, including psychological evaluations. However, whether telehealth has reduced or exacerbated healthcare disparities for children with Attention-Deficit/Hyperactivity Disorder (ADHD) remains unclear. METHODS: Data (race, ethnicity, age, insurance type, ADHD presentation, comorbidities, and distance to clinic) for youth with ADHD (Mage = 10.97, SDage = 3.42; 63.71% male; 51.62% White) were extracted from the medical record at an urban academic medical center. Three naturally occurring groups were compared: those evaluated in person prior to COVID-19 (n =780), in person during COVID-19 (n = 839), and via telehealth during COVID-19 (n = 638). RESULTS: Children seen via telehealth were significantly more likely to be older, White, have fewer comorbid conditions, and live farther from the clinic than those seen in person. CONCLUSIONS: The current study suggests that telehealth has not eliminated barriers to care for disadvantaged populations. Providers and institutions must take action to encourage telehealth use among these groups.

Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders.

The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (ß = 0.8 [0.2,1.4], p = 0.01) and ASD (ß = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (ß = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (ß = 1.3 [0.2,2.5], p = 0.03) and females with ASD (ß = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.

Difficulties in Managing Children's Learning among Caregivers of Children with Attention-Deficit/Hyperactivity Disorder during the COVID-19 Pandemic in Taiwan: Association with Worsened Behavioral and Emotional Symptoms.

School closures during the COVID-19 pandemic have interfered with children's learning. The aim of this study was to investigate the difficulties in managing children's learning at home and attending afterschool learning programs and their related factors among caregivers of children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic. In total, 252 caregivers of children with ADHD completed a questionnaire collecting difficulties in managing children's learning, parenting styles, children's worsened symptoms of ADHD, oppositional defiant disorder (ODD) and emotion, and increased Internet use. Multivariate logistic regression models were used to examine the factors related to caregiver difficulties in managing children's learning and children's worsened ADHD, ODD, and emotional symptoms. In total, 85.3% of the caregivers had difficulty in asking their children to learn at home; 28.2% had difficulty in taking children to afterschool learning programs. Children's worsened anger was significantly associated with higher caregiver difficulty in asking children to learn at home, whereas parental overprotection was significantly associated with lower caregiver difficulty in asking children to learn at home. Worsened hyperactivity and opposition were significantly associated with higher caregiver difficulty in taking children to attend afterschool learning programs. Interventions for enhancing caregivers' skills to manage children's learning and children's behavioral and emotional symptoms should take the related factors found in this study into consideration.

Association Between ADHD and COVID-19 Infection and Clinical Outcomes: A Retrospective Cohort Study From Electronic Medical Records.

OBJECTIVE: Though psychiatric illnesses have been associated with increased COVID-19 infection risk, limited information exists about the relationship between ADHD and COVID-19. METHODS: Using the TriNetX COVID-19 Research Network, we examined the impact of ADHD diagnosis and treatment on COVID-19 infection rates and outcomes. RESULTS: ADHD patients had greater risk of COVID-19 (risk ratio (RR) 1.11, 95% CI [1.09, 1.12]). Increased risk was higher in females than males, and highest among Asian and Black patients. Within 60 days after COVID-19 diagnosis, ADHD patients had lower rates of hospitalization (RR 0.91, 95% CI [0.86, 0.96]) and mechanical ventilation (RR 0.69, 95% CI [0.58, 0.83]), and a nonsignificant reduced death rate (RR 0.65, 95% CI [0.42, 1.02]). Patients who recently received ADHD medication had higher rates of COVID-19 (RR 1.13; 95% CI [1.10, 1.15]). CONCLUSION: ADHD poses increased risk for COVID-19, but may reduce risk of severe outcomes. ADHD medications modestly impacted COVID-19 risk.

Adolescents with ADHD are at increased risk for COVID-19 vaccine hesitancy.

Identifying factors that influence adolescent intentions for COVID-19 vaccination is essential for developing strategic interventions to increase uptake, particularly in subgroups of at-risk adolescents. Attention-deficit/hyperactivity disorder (ADHD) in adolescence is characterized by difficulties regulating attention and behavior, social impairment, and impulsive risk-taking behaviors, which may impact vaccine hesitancy and vaccine uptake. This study examined hesitancy toward COVID-19 vaccines among adolescents with and without ADHD, and explored how ADHD status interacted with malleable social mechanisms and other social determinants of health in predicting vaccine hesitancy. Participants were 196 U.S. adolescents (44.4% male), 45.6% diagnosed with ADHD. Adolescents reported their confidence and willingness toward COVID-19 vaccines from March to May 2021. Adolescents with ADHD reported greater hesitancy and less confidence in COVID-19 vaccine safety compared to adolescents without ADHD (p < .01). Only 61.8% of adolescents with ADHD reported vaccine acceptance, compared to 81.3% of adolescents without ADHD. For all adolescents, those who identified as Black or Latinx and with lower family income had greater hesitancy and reduced confidence, whereas greater COVID-19 concerns, media use, and perceived negative impact on relationships was associated with greater vaccination willingness. Social contextual processes significantly interacted with ADHD status such that for adolescents without ADHD, concerns about COVID-19 were associated with increased confidence in vaccine safety. Being noncompliant with social distancing guidelines was associated with greater vaccine hesitancy, only for adolescents with ADHD. A concerted effort is needed to increase trust, confidence, and social relevance among adolescents, especially those with ADHD and from lower socio-economic backgrounds.

Primary Care Diagnosis and Treatment of Attention-Deficit/Hyperactivity Disorder in School-Age Children: Trends and Disparities During the COVID-19 Pandemic.

OBJECTIVE: The aim of this study was to assess rates of primary care provider (PCP) diagnosis and treatment of school-age children with attention-deficit/hyperactivity disorder (ADHD) during the COVID-19 pandemic compared with prepandemic years and to investigate disparities in care. METHOD: We retrospectively analyzed electronic health records from all primary care visits (in-person and telehealth) of children aged 6 to 17 years seen between January 2016 and March 2021 in a community-based primary health care network (n = 77,298 patients). Study outcomes are as follows: (1) number of primary care visits, (2) number of visits with ADHD diagnosis (ADHD-related visits), (3) number of PCP prescriptions for ADHD medications, (4) number of patients with first ADHD diagnoses, and (5) number of first PCP prescriptions of ADHD medications. Interrupted time series analysis evaluated changes in rates of study outcomes during 4 quarters of the pandemic year (March 15, 2020-March 15, 2021) compared with prepandemic years (January 1, 2016-March 14, 2020). Patient demographic characteristics during prepandemic and pandemic years were compared. RESULTS: ADHD-related visits dropped in the first quarter of the pandemic year by 33% (95% confidence interval, 22.2%-43.6%), returning to prepandemic rates in subsequent quarters. ADHD medication prescription rates remained stable throughout the pandemic year. Conversely, rates of first ADHD diagnoses and first medication prescriptions remained significantly lower than prepandemic rates. The proportion of ADHD-related visits for patients living in low-income neighborhoods was lower in the pandemic year compared with prepandemic years. CONCLUSION: Ongoing treatment for school-age children with ADHD was maintained during the pandemic, especially in high-income families. Socioeconomic differences in ADHD-related care emphasize the need to improve access to care for all children with ADHD in the ongoing pandemic and beyond.

Caregivers' Difficulty in Managing Smartphone Use of Children with Attention-Deficit/Hyperactivity Disorder during the COVID-19 Pandemic: Relationships with Caregiver and Children Factors.

This study examined the difficulty encountered by caregivers of children with attention-deficit/hyperactivity disorder (ADHD) in managing children's smartphone use during the coronavirus disease 2019 (COVID-19) pandemic and the caregiver- and children-related factors that influence this difficulty. In total, 252 caregivers of children with ADHD were recruited into this study. The caregivers completed a research questionnaire to provide data regarding the difficulty they encountered in managing the smartphone use of children during the COVID-19 pandemic, their general mental health and parenting styles, and the ADHD and oppositional defiant disorder (ODD) symptoms of the children they are caring for. The results indicated that almost 45% of the caregivers of children with ADHD sometimes or often found it difficult to manage the smartphone use of children with ADHD during the COVID-19 pandemic. For the caregivers, a short duration of education, poor general mental health, unaffectionate/uncaring and overprotective parenting styles, older children, and inattention and ODD symptoms were significantly associated with increased difficulty in managing their children's smartphone use during the COVID-19 pandemic. On the basis of the relevant factors identified in this study, an intervention should be developed to enhance the skills of caregivers of children with ADHD with respect to the management of children's smartphone use during the COVID-19 pandemic.

Impact of COVID-19 on Youth With ADHD: Predictors and Moderators of Response to Pandemic Restrictions on Daily Life.

We examined COVID-19 symptoms and infection rates, disruptions to functioning, and moderators of pandemic response for 620 youth with ADHD and 614 individually matched controls (70% male; Mage = 12.4) participating in the Adolescent Brain and Cognitive Development study. There were no group differences in COVID-19 infection rate; however, youth with ADHD were more likely to exhibit COVID-19 symptoms (d = 0.25), greater sleep problems (d = -0.52), fear and negative emotions to infection risk (d = -0.56), trouble with remote learning (d = -0.54), rule-breaking behavior related to COVID-19 restrictions (d = -0.23), family conflict (d = -0.13), and were less prepared for the next school year (d = 0.38). Youth with ADHD were less responsive to protective environmental variables (e.g., parental monitoring, school engagement) during the pandemic and may need more specialized support with return to in-person schooling and daily activities.

Long-term outcomes of females with attention-deficit hyperactivity disorder: increased risk for self-harm.

Although long-term outcomes of girls with attention-deficit hyperactivity disorder are understudied, high risk for adolescent and young-adult self-harm is salient. We present data on predictors and mediators of such risk, highlighting a recent dual-process model involving trait impulsivity plus family- and peer-related contributors. We conclude with recommendations for assessment and preventive intervention.