COVID-19 Pandemic Impacting Lifestyle of Pediatric ADHD Patients

The COVID-19 pandemic upended the routine of many in a number of ways, including sleep, diet, and exercise. While many have struggled with this change, it was particularly challenging for patients with attention-deficit/hyperactivity disorder (ADHD).

A team, led by Rose Swansburg, MBT, Cumming School of Medicine, Department of Pediatrics, University of Calgary, examined the impact of the pandemic on lifestyle habits and mental health symptoms for pediatric patients with ADHD in Canada.

In the study, the researchers conducted an online survey across Canada to caregivers of pediatric patients with ADHD between 5-18 years old. The surveys assessed depression (PHQ-9), anxiety (GAD-7), ADHD (SNAP-IV), and lifestyle behaviors.

The data was analyzed based on gender and age group—5-8, 9-12, and 13-18. The investigators also conducted Spearman’s correlations between lifestyle habits and mental health outcomes.

Overall, there were 587 surveys analyzed from responders with a mean age of 10.14 years old.

The researchers found 17.4% and 14.1% of respondents met the criteria for moderately severe to severe depression and anxiety symptoms respectively. The pediatric patients who met the SNAP-IV cut-off scores for inattention (73.7%), hyperactivity/impulsivity (66.8%), and oppositional defiant disorder (38.6%) behaviors.

The caregiver respondents reported changes in sleep (77.5%), eating (58.9%), exercise (83.7%), and screen use (92.9%) in their ADHD child.

However, the researchers found greater depression, anxiety, and ADHD symptoms were linked to sleeping fewer hours per night, eating more processed foods, and watching TV or playing video games more than 3.5 hours per day, while exercising less than 1 hour per day was correlated with just depression symptoms (P <0.01).

“The COVID-19 pandemic has resulted in less healthy lifestyle habits and increased mental health symptoms in Canadian children with ADHD,” the authors wrote. “Longitudinal studies to better understand the relationship between these factors are recommended.”

In data was presented in a poster during the 2021 American Psychiatric Association Annual Meeting, researchers suggest a further understanding as to why patients with ADHD suffer from greater rates of sleep issues, including insomnia and excessive sleepiness.

Impaired sleep is a known risk factor for several negative health outcomes, such as deficits in executive function, attention, and impulse control, which all happen to be symptoms of ADHD. About half of ADHD patients report sleep disturbances, with delayed sleep onset being the most commonly reported symptom.

Sleep deprivation is also linked to reduced dorsolateral prefrontal activity, as well as difficulty regulating attentional resources. This could help explain the inability to attend to a stimulus in the presence of distractions or engage in goal-directed behavior.

Overall, the patients with ADHD reported greater impairment on sleep quality (P = 0.009), insomnia (P = 0.004), and sleepiness (P = 0.029).

The patients with higher sleep quality scores also had lower SHAPS scores, regardless of ADHD diagnosis (β = -0.235; P = 0.012).

The association of ADHD diagnosis and sleepiness scores was influenced by SHAPS scores (b = 0.199, P = 0.039), to where the significance of the relationships increased with higher SHAPS scores.

The study, “Impact of COVID-19 on lifestyle habits and mental health symptoms in children with attention-deficit/hyperactivity disorder in Canada,” was published online in Paediatrics & Child Health.