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Title: [How do children and adolescents with Attention Deficit Hyperactivity Disorder (ADHD) experience lockdown during the COVID-19 outbreak?].
Author: Bobo E, Lin L, Acquaviva E, Caci H, Franc N, Gamon L, Picot MC, Pupier F, Speranza M, Falissard B, Purper-Ouakil D.
Journal: Encephale; 2020 Jun; 46(3S):S85-S92. PubMed ID: 32522407.
Abstract:
OBJECTIVES: During the COVID-19 pandemic, the French government has decided a general lockdown. This unprecedented situation has raised concerns about children's and adolescent's mental health. Children and adolescents diagnosed with attention deficit hyperactivity disorder (ADHD) may find this context of restrained activity particularly tricky. The objectives of our study are to gather information about the well-being and global life conditions of children and adolescents with ADHD during the COVID-19 outbreak in France. METHODS: We designed a survey including both open-ended questions and questionnaire items for parents of children and adolescents with ADHD. Parents responded to the following open-ended questions: 1) "How is your child doing since the lockdown?" 2) "How is life at home since the lockdown?" 3) "If you had a remote service provision with a mental health professional (e.g. by telephone or video technology), please share your thoughts and any suggestions with us" 4) "Please share any other items that you think are important about ADHD symptoms of your child and the lockdown situation". This survey was posted on social media on the 6th of April and disseminated by French ADHD-parent and patient organizations. The present article reports the descriptive, qualitative and textometrical analyses of the survey. RESULTS: Between day 20 and 30 of lockdown, 538 parents responded to the survey, and we included 533 responses in the final analysis. The vast majority of responders were women 95 % (95 % CI 93,50; 97,18) with children whose mean age was 10,5 (95 % CI 7.58; 13.44). Since the lockdown, 34.71 % (95 % CI 30.70; 38.94) of children experienced a worsening in well-being, 34.33 % (95 % CI 30.34; 38.56) showed no significant changes and 30.96 % (95 % CI 27.09; 35.10) were doing better according to their parents. The thematic analysis showed that an improvement of their children's anxiety was one of the main topics addressed by parents. This improvement related to less school-related strain and flexible schedules that respected their children's rhythm. Improved self-esteem was another topic that parents linked with a lesser exposure of their children to negative feed-back. Parents repeatedly reported both inattention and hyperactivity/impulsivity. However, optimal lockdown life conditions seemed to compensate for the impact of ADHD symptoms (e.g. sufficient space at home, presence of a garden). Some parents reported worsening of general well-being in their children, and this manifested as oppositional/defiant attitudes and emotional outbursts. Parents also cited sleep problems and anxiety in this context. As regards everyday life during lock-down, at-home schooling was another major topic-parents described that their children struggled to complete school-related tasks and that teachers seemed to have forgotten about academic accommodations. The lockdown situation seems to have raised parents' awareness of the role of inattention and ADHD symptoms in their children's learning difficulties. Due to potential selection biases, the results of our survey may not be generalizable to all children and adolescents with ADHD. The main strengths of this rapid survey-based study lies in the reactivity of the participants and the quality and diversity of their responses to the open-ended questions. CONCLUSIONS: According to their parents, most children and adolescents with ADHD experience stability or improvement of their well-being. An improvement in school-related anxiety and the flexible adjustment to the children's' rhythms as well as parents' increased awareness of the difficulties their children experience are among the key topics in parents' descriptions. OBJECTIFS: Le confinement général de la population française dans le contexte de la pandémie de COVID-19, liée au nouveau Coronavirus SARS-COV-2, est une situation potentiellement à risque pour les enfants avec un développement atypique. L’objectif de notre étude est de mieux comprendre l’état de santé mentale des enfants et adolescents avec le trouble déficit d’attention hyperactivité (TDAH) en période de confinement. MÉTHODES: Cinq cent trente-huit patients ont répondu à un sondage anonyme en ligne, proposé via les réseaux sociaux et relayé ou posté sur le site des associations de personnes concernées par le TDAH durant la période de confinement. RÉSULTATS: Une majorité des enfants et adolescents de notre enquête a connu soit un mieux-être soit un état général psychologique stable d’après leurs parents. Une diminution de l’anxiété est mise en lien avec l’interruption de la scolarité présentielle et un rythme « sur-mesure ». Pour certains, l’abandon des aménagements et le volume de tâches ont posé problème avec des attitudes d’opposition et d’évitement. Les parents décrivent également une prise de conscience des difficultés de leurs enfants, ce qui ressort comme un élément constructif. Les enfants dont l’état se dégrade ont à la fois des difficultés comportementales et émotionnelles. En ce qui concerne le recours aux soins, la téléconsultation comme outil de continuité de soins a été largement appréciée. CONCLUSIONS: Avant les contraintes liées à la crise sanitaire, les aspects scolaires sont cités comme principaux facteurs influençant l’état émotionnel de l’enfant et de l’adolescent avec TDAH dans le contexte de confinement.

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