The latest of 13 pandemic check-in surveys fielded by ADDitude has revealed a striking increase in the number of children and adults receiving a formal Attention Deficit Hyperactivity Disorder (ADHD) diagnosis during the COVID-19 pandemic.
The survey shows that among ADDitude readers, 26% of adults and children have been diagnosed with ADHD in the last 12 months, with 17% of children and nearly 22% of adults starting ADHD medication for the first time.
What is ADHD?
ADHD is a neurodevelopmental disorder that occurs most often in children but it can also be diagnosed during the transition into adulthood (or in adulthood). It is estimated that around 7% of young people meet the criteria for diagnosis.
The average age of ADHD diagnosis is seven years, with signs and symptoms typically first appearing between three to six years.
Males and females can display very different ADHD symptoms, with males three times more likely to be diagnosed with ADHD than females.
13% of males will be diagnosed with ADHD during their lifetimes. This drops significantly to 4.2% for females, where symptoms are often easy to overlook because they present as ‘less typical’ ADHD behaviour. As a result, many females do not receive their initial diagnosis until adolescence or adulthood, if at all.
Common symptoms associated with ADHD include:
- trouble concentrating or focusing
- difficulty staying organised
- forgetful about completing tasks
- easily distracted
- tendency towards impulsiveness
- difficulty sitting still.
In the most recent edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the American Psychiatric Association describes three types of ADHD:
- Predominantly Hyperactive-Impulsive Type
- Predominately Inattentive Type (more often diagnosed in girls/women)
- Combined Type.
How common are ADHD symptoms during ‘normal’ times?
ADHD is more prevalent than health professionals previously believed, according to statistics from the Center for Disease Control and Prevention (CDC).
Even before the COVID-19 pandemic, non-specific symptoms of ADHD were pretty common in the general population, alongside a range of typically coexisting conditions, including anxiety, stress and depression.
However, the structures of going to work/school, socialising, exercising and other fixed routines provided some stability and effective coping strategies for many living with ADHD. They enabled individuals to more easily maintain a daily routine, manage their symptoms, and remain under the radar.
With life during the pandemic being highly stressful for most people – with lockdown measures, daily alarming news reports, major uncertainty and upheavals to daily routines – it is no surprise that ADHD symptom severity appears to have been exacerbated. ‘Cabin fever’ is known to have many symptoms similar to ADHD, with social isolation having many adverse effects on brain functioning.
Research has shown that the more anxious, stressed or depressed an individual is, the more ADHD symptoms they will experience (even if they have never previously been suspected of having ADHD).
Possible pandemic factors responsible for ADHD symptom escalation in children
With the removal of external daily structures, such as work, school and social interactions, parents and carers have witnessed first-hand their children’s attention and education difficulties and the impact pandemic factors are having on their children’s behaviour. This has led to an increase in parents seeking a diagnosis and treatment for their children.
Pandemic factors include:
- dramatically increased screen time (home quarantine, online remote schooling, cancelled off-screen activities)
- social isolation from friends and peers
- drastically reduced physical outlets
- emotional dysregulation intensified by stress, boredom and frustration of pandemic living
- lack of dedicated time and personal attention from in-person teachers, teaching assistants and peers, during virtual online schooling
- lack of daily routine and structure (including school day, meal times, sleep patterns and exercise)
- changes in the home situation (such as losing a loved one, getting a new pet, moving, parent separation, the arrival of a new sibling).
In the ADDitude survey, 26% of parents reported their child had been formally diagnosed with ADHD in the last 12 months. Another 15% of children were diagnosed with coexisting conditions since the pandemic began, with 14% experiencing symptom changes or still pursuing a formal evaluation.
Possible pandemic factors responsible for ADHD symptom escalation in adults
Adults prompted to seek an ADHD evaluation during the pandemic site the most common contributing factors causing their ADHD symptoms to flare up included:
- increased anxiety and stress related to the pandemic (including uncertainty and lack of control around lockdown measures, loss of employment, financial difficulties, etc.)
- working from home without the usual external motivators for focus, organisation and productivity
- additional/new/different sources of distraction from being isolated at home
- extended time at home with family members living with ADHD – highlighting symptom similarities
- spending more time on social media platforms, including those with ADHD channels where more information was available
- lack of daily routine and structure (including meal times, sleep patterns and exercise)
- some significant life changes during the pandemic (including ending of a relationship, losing a loved one, moving house, having a new baby, losing/starting a new job, etc.).
In the ADDitude survey, many adults noted that being at home all day, whether with family or alone, eliminated their usual coping strategies and heightened anxiety and stress issues. Problems with motivation, memory and organisation – that had been simmering beneath the surface – were suddenly highlighted by the isolation of staying at home.
Challenges for ADHD diagnoses and treatment during COVID-19
The COVID-19 pandemic has had a significant impact on the provision of mental health services for those living with ADHD (or seeking a formal diagnosis) and there has been an urgent need to find effective new ways of working. Some of the challenges faced include:
- Postponement of new patient assessments (difficulties in finding/seeing an ADHD specialist due to pandemic restrictions, health insurance issues, lack of specialist nearby, etc.)
- Changes to treatment teams, meaning inconsistent care
- Initiating medication in newly diagnosed patients (lack of adequate physical monitoring online)
- Lack of teacher input on behaviours/response to medication in the case of children (due to school closures)
- Adjusting and monitoring medications in previously diagnosed patients remotely
- Providing services online/Telepsychiatry (e.g. access to adequate internet service, technical glitches, loss of face-to-face connection)
- Medication access (e.g. supply chain issues, difficulty affording brand-name medications due to loss of health insurance for those who have lost their jobs, etc.)
- Misuse of prescription stimulant drugs.
Treatments for ADHD
There are many options available in the treatment of ADHD in teenagers and young adults. ADHD treatment is well researched and, in conjunction with psychotherapy, can make a significant difference to the lives of young people.
A detailed medical history and family history will be taken prior to deciding on the must appropriate treatment for any young person.
Additionally, parent support and parent training can assist parents in learning about ADHD and help to manage ADHD behaviours. Positive interactions between members of the family can help to reduce conflict and negative impact on the family system.
www.nice.org.uk provides information and resources together with recommendations for ADHD treatment.
Finding an ADHD specialist and receiving a proper diagnosis is the first step on the treatment journey, whether in-person or online. A combination of self-reporting, family reporting and educational reporting may be used to understand how some symptoms may change based upon the environment. (ADHD can respond positively to changes in the environment and strategies that can be put into place at home and at school.)
ADHD medication may be prescribed. FDA medications that are helpful following a diagnosis of ADHD include those that belong to Stimulant and Non-Stimulant Groups.
Deciding which medication is right for each young person takes time and should be undertaken with the support of an ADHD treatment team. As with all medications, there can be less desirable effects. Monitoring the positive changes, together with any unpleasant effects, will help the treatment team to reach the most effective dose for each young person.
At The Wave Clinic, Dr Rasyid works with families to develop treatment plans, including medication, that meet their specific needs. ‘Taking a good medical history and really getting to know the young person is essential in finding answers. Schools and parents are an invaluable resource, although it is often the young person themselves who is most aware’.
Evans, S., Sarno Owens, J., & Bunford, N. (2014). Evidence-based psychosocial treatments for children and adolescents with attention-deficit/hyperactivity disorder. Journal of Clinical Child and Adolescent Psychology.
Fiona Yassin is the International Clinical Director at The Wave Clinic, Kuala Lumpur.
She is trained in CBT-e (The Oxford Group, CREDO), FREED, EMDR (EMDRIA) and is an Accredited Clinical Supervisor (UNCG). Fiona is a Fellow of ACCPH and a member of IAEDP, FDAP and ANZMH. Fiona is an accredited Child and Family Trauma Professional and an accredited UK Psychotherapist, MICP #361609.