Effects of online distance learning in the setting of COVID-19 on academic performance and behavioral symptoms in pediatric patients with ADHD

ABSTRACT

Purpose of Study As COVID-19 cases rose in spring of 2020, schools faced the unprecedented challenge of providing safe and effective education during a global pandemic. With most institutions transitioning to remote instruction, teachers, students, and parents had to cope with changes that came with online distance learning (ODL). Children with learning or behavioral disabilities, such as ADHD, may have faced setbacks. The aim of the study was to examine parents' observations of their children with ADHD transitioning from in-person classroom instruction to ODL in regards to their academic performance and ADHD symptoms during the COVID-19 pandemic. Methods Used The study utilized a cross-sectional design and recruited patients from a pediatric clinic in Houston, TX. Participants included parents of school-age children with an ADHD diagnosis. Parents were emailed a novel survey that utilized questions from the Vanderbilt Assessment Scale via Qualtrics in February 2021, and again in May 2021. Responses were anonymously collected until August 2021. Children using ODL during some or all of fall 2020 were included in the study. Parents reported semester grades for fall 2019 and fall 2020, and Vanderbilt Survey responses from the same time frame. Grades were measured on a 0-100 sliding scale, and behavioral responses were weighted (1-symptom decreased, 2-symptom did not change, 3-symptom increased). The study was IRB-approved. Summary of Results Eighty-one parents of children in grades 1-12 with ADHD were identified and contacted to take part in the survey via email. Sixty of these parents received followup phone calls. Twenty-four started surveys. Twenty-one parent-child dyads met the study criteria, completed surveys, and were enrolled in the study. Semester averages in math, science, language arts/reading, and social studies appeared to all decrease from fall 2019 to fall 2020 (-3.5,-5.3,-2.8,-1.6), with the most prominent decrease in science (p=0.08). Overall, ADHD symptoms varied from fall 2019 to fall 2020. Parents reported increases in the following lack of follow through with directions and failure to finish activities(62%), forgetfulness in daily activities(57%), and lack of attention to detail and making careless mistakes(57%). Most parents reported no change in relationships. Two-thirds of parents reported that their child did not benefit at all from ODL;however, 10% of parents said their child benefitted from less distraction, and 10% said their child preferred computer-based learning. Parents reported the following challenges with ODL staying focused/organized and boredom(43%), lack of 1-on-1 instruction and ability to ask questions(33%), and social isolation( 14%). Conclusions During the COVID-19 pandemic, pediatric patients with ADHD seemed to perform worse academically in a virtual school setting compared to an in-person classroom. In this same population and time frame, ADHD behavioral symptoms appeared to either increase, especially those that were task-oriented, or remain unchanged.