62
views
0
recommends
+1 Recommend
2 collections
    0
    shares
      • Record: found
      • Abstract: found
      • Article: not found

      Acute stress, behavioural symptoms and mood states among school-age children with attention-deficit/hyperactive disorder during the COVID-19 outbreak

      research-article

      Read this article at

      ScienceOpenPublisherPMC
      Bookmark
          There is no author summary for this article yet. Authors can add summaries to their articles on ScienceOpen to make them more accessible to a non-specialist audience.

          Abstract

          1 Introduction Attention deficit hyperactivity disorder (ADHD) is one of the most frequently occurred neurobehavioral disorder among children (American Academy of Pediatrics, 2000), which has negative impact on a wide range of aspects including learning ability, interpersonal relationships, self-esteem, and emotions (Lecendreux et al., 2011; Wang et al., 2017). Previous meta-analysis showed that the prevalence of ADHD among children and adolescents in China was 6 % (Wang et al., 2017). In the event of COVID-19 outbreak, schools in China are shut down and students are restricted to staying at homes. Primary and secondary schools in China open online official educational websites in order to allocate students to continue the education (Xinhua Net, 2020). Children with ADHD face noticeable challenges during this period. Firstly, the loss of daily routine and the lack of interpersonal and social interaction could work as potential risk factors for mental health problems or could worsen ADHD symptoms. In addition, majority of the ADHD children receive care from primary care settings (Patel et al., 2017; Subcommittee on Attention-Deficit/Hyperactivity et al., 2011). Children with ADHD could not get timely and professional care from home setting. Most of the parents of these children can be assumed not to be the domain experts but are forced upon the educational responsibility in addition to handle all the children’s emotional and behavioral problems 24/7. Moreover, the pandemic of COVID-19 is a serious challenge to everyone including the adults. Their worry of the situation may further exacerbate the children’s psychological wellbeing and worsen their behavioural problems. This study aims to investigate the mental health related conditions of children with ADHD during the COVID-19 outbreak. We hypothesised that children’s ADHD symptoms could be significantly worse compared to normal state during school closedown. In addition, we examined what key variables are associated with the changed behaviours in this special time. 2 Method A total of 241 parents of school aged children with ADHD diagnosis were invited to participate in this survey. The school aged children described in the study were 6–15 years old (M = 9.43, SD = 2.39), and there were 194 boys and 47 girls. The study obtained the ethical approval from Shanghai Xinhua Hospital. The following information were collected (1) ADHD behavioural symptoms were measured by Swanson, Nolan, and Pelham scale (SNAP-IV) – parent form, (Gau et al., 2008). (2) The acute responses of children in the event of 2019-nCoV breakout was measured using The Child Stress Disorders Checklist (CSDC) (Saxe et al., 2003). (3) Time allocation of children’s activities was measured the approximate time allocation on activities (including: studying, using electronic devices, entertainment without using electronic devices, and interacting with the parents). (4) Mood state of the children and parents were asked by a single item each, rated on a 1–4 scale, with higher score indicated worse mood. (5) Attention to media coverage of the 2019-nCoV outbreak how much attention the children and parent paid to media coverage of the 2019-nCoV outbreak was rated on a 1–4 scale. 3 Results Children’s ADHD behaviours during the COVID-19 outbreak were rated by their parents. A one-sample t-test revealed that the average of children’s ADHD behaviours (M = 2.25, SD = 0.54) were significantly worsened in comparison to their normal state (95 % CI = 2.18–2.32 which was significantly higher than the rating of “2”—no difference), t(240) = 7.11, p < .001. Fig. 1 presented the reported severity of ADHD behaviours in comparison to normal state. Fig. 1 Reported severity of ADHD behaviours in comparison to normal state. Note. Parents were asked to rate on their child’s behaviours in comparison to normal state in the following domains: Attention: Is your child’s ability to keep focused ___? Neatness: Is your child’s ability to keep their room neat ____? Quietness: Is your child’s ability to work quietly ____? Interrupt adults: Is your child’s ability to keep the adults uninterrupted ____? Listen to instructions: Is your child’s ability to listen to instructions ____? Anger frequency: Is your child’s anger frequency ____? Eating: Is your child’s eating behaviour ____? Sleeping: Is your child’s sleeping behaviour ____? Routine: Is your child’s ability to keep routine ____? Summary: the reported frequency of the 9 items were summarised in Fig. 1. There were 53.94 % parents reporting their children’s ability to keep focused worsened, 67.22 % on increased anger frequency, 56.02 % on worse daily routine. Conversely, more than half of the parents reported that children’s behaviours in other domains improved or maintained the same level. Fig. 1 The bivariate correlations among the study variables were summarised in Supplementary Table 1. To examine the relationship between child’s ADHD behaviours and acute stress, attention to media coverage, time allocation, and the mood state of children and parents, a stepwise regression analysis was conducted with ADHD behaviours treated as the DV and all the other variables IVs. The stepwise regression analysis determined a three-predictor model, with F(3, 237) = 31.73, p < .001, R2 = 0.29. In particular, children’s overall mood, B = 0.17, 95 % CI of B [0.11, 0.23], p < .001, parents’ overall mood state, B = 0.13, 95 % CI of B [0.06, 0.20], p < .001, and children’s study time, B = −0.09, 95 % CI of B [−0.15, −0.02], p = .010, significantly predicted children’s ADHD behaviours. 4 Discussion This is the first study focusing children with ADHD during the time of COVID-19 outbreak. During the COVID-19 outbreak, children’s ADHD behaviours significantly worsened in comparison to their normal state. In consistent with previous studies, we found children’s negative mood state was associated with ADHD symptoms. Our results showed that parent’s mood state also impact children’s ADHD symptom. Researchers have indicated that parents of ADHD children experienced high level of daily child-rearing stresses (Pelham Jr and Lang, 1999; Yousefia et al., 2011). The special arrangement of school close-down and children staying at home might bring elevated difficulties and stress for both the children and their parents. Our results have significant clinical implication in placing the importance of treatment and control of negative mood. The study time was negatively associated with the increase ADHD symptoms. During the COVID-19 duration, children are arranged to online studying at home. The results indicated that ADHD symptoms reduced with the longer study time. Although future studies are needed to confirm the results, this could be a potential strategy for decreasing ADHD symptoms for children at home. Conversely, the children who could use online study more effectively may be the ones who could focus longer; the mechanism of this association needs further investigation. In view of the rapid increase of online education accelerated by this pandemic, this direction of study is particularly useful. The current study has several limitations should be noted. First, this was a cross-sectional study, and the casual relationship between ADHD symptoms and related factors cannot be confirmed. Second, data were reported by parents, rather than reported by children directly. It is possible that children may rate their own emotional and behavioural responses differently. Finally, the relationship between the worsened behaviours among children with ADHD and their medication status was not directly tested. Some parents feedbacked their concerns of the limited access to psychiatric medicine for their children during this special period. Future study must include clear criterion testing this association. Nevertheless, the support of special medicine for special-need groups should be prioritized during crisis like this. In conclusion, during the COVID-19 outbreak, children’s ADHD symptoms were significantly worse compared to normal state. The results alerted the important of focusing special vulnerable group during the disease outbreak. Attention is required for the identification of appropriate approach for ADHD children in terms of disaster risk reduction activities. Financial disclosure This study support by Shanghai Top-Priority Clinical Key Discipline (2017ZZ02026). The funding body had no role in the design of the study and collection, analysis and interpretation of data and in writing the manuscript Declaration of Competing Interest None

          Related collections

          Most cited references8

          • Record: found
          • Abstract: found
          • Article: not found

          Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale - parent form.

          This study aimed to establish the psychometric properties of parent ratings on the Chinese version of the Swanson, Nolan, and Pelham IV scale (SNAP-IV) in a school-based sample of 3534 students in grades 1 to 8 from two cities and two suburbs in Taiwan and 189 children diagnosed with attention deficit/hyperactivity disorder (ADHD) (aged 6 to 15) consecutively recruited from a medical center in Taipei. Parents completed the Chinese versions of the SNAP-IV, Strengths and Difficulties Questionnaire, and Child Behavior Checklist. The Chinese SNAP-IV demonstrated similar three factor structure (Inattention, Hyperactivity/Impulsivity, and Oppositional) as its English version, and satisfactory test-retest reliability (intraclass correlation = 0.59 approximately 0.72), internal consistency (alpha = 0.88 approximately 0.90), concurrent validity (Pearson correlations = 0.56 approximately 0.72), and discriminant validity. Boys scored higher than girls across the eight school grade levels. The SNAP-IV clearly distinguished children with ADHD from school-based participants. Comorbidity with oppositional defiant disorder/conduct disorder predicted higher SNAP-IV scores among children with ADHD. Our findings suggest that the Chinese SNAP-IV is a reliable and valid instrument for rating ADHD-related symptoms in both clinical and community settings in Taiwan. Copyright (c) 2008 John Wiley & Sons, Ltd.
            Bookmark
            • Record: found
            • Abstract: found
            • Article: found
            Is Open Access

            Prevalence of attention deficit/hyperactivity disorder among children and adolescents in China: a systematic review and meta-analysis

            Background Attention deficit/hyperactivity disorder (ADHD), the most common childhood neurobehavioural disorder, can produce a series of negative effects on children, adolescents, and even adults as well as place a serious economic burden on families and society. However, the prevalence of ADHD is not well understood in China. The goal of this study was to estimate the pooled prevalence of ADHD among children and adolescents in China using a systematic review and meta-analysis. Methods A systematic literature search was conducted in PubMed, Web of Science, MEDLINE, CNKI, Wanfang, Weipu and CBM databases, and relevant articles published from inception to March 1, 2016, that provided the prevalence of ADHD among children and adolescents in China were reviewed. The risk of bias in individual studies was assessed using the Risk of Bias Tool for prevalence studies. Pooled-prevalence estimates were calculated with a random-effects model. Sources of heterogeneity were explored using subgroup analyses. Results Sixty-seven studies with a total of 275,502 individuals were included in this study. The overall pooled-prevalence of ADHD among children and adolescents in China was 6.26% (95% CI: 5.36–7.22%) with significant heterogeneity (I2 = 99.0%, P < 0.001). The subgroup analyses showed that, the variables “geographic location” and “source of information” partially explained of the heterogeneity in this study (P < 0.05). The prevalence of ADHD-I was the highest of the subtypes, followed by ADHD-HI and ADHD-C. Conclusions The prevalence of ADHD among children and adolescents in China is generally consistent with the worldwide prevalence and shows that ADHD affects quite a large number of people under 18 years old. However, a nationwide study is needed to provide more accurate estimations. Electronic supplementary material The online version of this article (doi:10.1186/s12888-016-1187-9) contains supplementary material, which is available to authorized users.
              Bookmark
              • Record: found
              • Abstract: found
              • Article: not found

              Prevalence of attention deficit hyperactivity disorder and associated features among children in France.

              Earlier studies point to the prevalence of attention deficit hyperactivity disorder (ADHD) to be similar around the world. There is, however, a wide variety in estimates. The prevalence of ADHD in youth has never been examined in France. Starting with 18 million telephone numbers, 7,912 numbers are randomly selected. Among the 4,186 eligible families, 1,012 (24.2%) are successfully recruited. A telephone interview is administered to all families about a child in the 6 to 12 age range. It covered family living situation, school performance, symptoms of ADHD, conduct disorder (CD), and oppositional-defiant disorder (ODD), and other features of ADHD. The prevalence of ADHD in France is between 3.5% and 5.6%. The population prevalence of treatment for ADHD is 3.5%. ADHD youth are more likely to be men than women, and, compared to non-ADHD children, ADHD children are more likely to have CD and ODD. Having ADHD is associated with a family history of the disorder. The ADHD youth are more likely to have had learning difficulties, to have repeated a grade, and to be functioning academically below grade level. The epidemiology of ADHD in French children is similar to the epidemiology of ADHD in other countries. The disorder occurs in between 3.5% to 5.6% of youth and is more common among boys than among girls. The authors replicate the well-known association of ADHD with CD, ODD, and indices of school failure. The impact of ADHD symptoms on school performance highlights the importance of screening for such symptoms in schools.
                Bookmark

                Author and article information

                Contributors
                Journal
                Asian J Psychiatr
                Asian J Psychiatr
                Asian Journal of Psychiatry
                Elsevier B.V.
                1876-2018
                1876-2026
                9 April 2020
                June 2020
                9 April 2020
                : 51
                : 102077
                Affiliations
                [a ]Department of Medical Psychology, Xinhua Hospital Affiliated to Shanghai Jiao Tong University School of Medicine, Shanghai, China
                [b ]Ministry of Education-Shanghai Key Laboratory of Children's Environmental Health, Shanghai, China
                [c ]Division of Psychology, Faculty of Health and Life Sciences, De Montfort University, Leicester, UK
                [d ]Department of Psychiatry, The Second Xiangya Hospital, Central South University, Central South University, National Clinical Research Centre on Mental Disorders (Xiangya), Hunan Medical Center for Mental Health, Changsha, Hunan, China
                Author notes
                [* ]Corresponding author. yuanyuan.wang@ 123456dmu.ac.uk
                [1]

                Contributed equally.

                Article
                S1876-2018(20)30188-X 102077
                10.1016/j.ajp.2020.102077
                7195413
                32315967
                99ad7d89-1b89-4aaa-9d6a-a18a99f40137
                © 2020 Elsevier B.V. All rights reserved.

                Since January 2020 Elsevier has created a COVID-19 resource centre with free information in English and Mandarin on the novel coronavirus COVID-19. The COVID-19 resource centre is hosted on Elsevier Connect, the company's public news and information website. Elsevier hereby grants permission to make all its COVID-19-related research that is available on the COVID-19 resource centre - including this research content - immediately available in PubMed Central and other publicly funded repositories, such as the WHO COVID database with rights for unrestricted research re-use and analyses in any form or by any means with acknowledgement of the original source. These permissions are granted for free by Elsevier for as long as the COVID-19 resource centre remains active.

                History
                : 1 April 2020
                : 2 April 2020
                Categories
                Article

                adhd,covid-19,acute stress
                adhd, covid-19, acute stress

                Comments

                Comment on this article