Holidays During a Pandemic: Challenges Faced by Youth With ADHD

In this video, Adelaide Robb, MD, discusses the challenges faced by children and adolescents with attention-deficit/hyperactivity disorder (ADHD) during the 2020 holiday season, amid the COVID-19 pandemic. Dr. Robb is Chair of Child and Adolescent Psychiatry at Children's National Hospital in Washington, DC.

Read the transcript:

Hi, my name is Dr. Adelaide Robb. I am the Chair of Child and Adolescent Psychiatry at Children's National Hospital in Washington, DC. Today, I'm talking about a really important topic, which is holiday season for youth with ADHD, in the context of COVID-19.

One of the biggest challenges in all 3 age groups—I'm talking about elementary, middle, and high school—is online learning. For our patients with ADHD, it's even tougher than being in the classroom because they're on the WiFi.

While the teacher is talking on and on about whatever educational topic, they can click to another channel on WiFi and watch YouTube videos, play a game, turn their camera off, go get a drink of water and a snack, and you've lost half of English class in the third grade.

It's been very difficult for people to remain engaged. The longer online education goes on, the harder it is for students.

Beyond the classroom, the other big thing is missing their friends, especially for middle and high school students where they enjoy peer interactions.

You hang out. You go to the mall. You talk to people. You have lunch with them. You play sports at lunchtime. None of that is going on. People are missing all of the normal developmental interaction that they get at school for growth and development.

It's even harder for ADHD kids where physical activity is a great thing to do, to help recenter their minds. If you can't go and play soccer, basketball, or on the jungle gym and in the playground if you're younger, it makes it tougher to sit still for eight hours of online learning.

I also think the lack of educational instruction for special needs kids, whether it's a 504 plan or an IEP, has been tougher for our people that we take care of with ADHD.

Beyond that, one of the hardest age groups is actually the high school students. Even though they've had the most experience in school and they know how to do their homework and their schoolwork, they're all busy applying to college and getting ready to take ACTs and SATs.

Without a guidance counselor on hand and enough educational support, people are putting off applying to college or not filling in the applications. The deadlines are passing. There's no urgency anymore for those students because they think, "I'm not going anyway because of COVID. Why bother going to college?" It's been making it harder.

The other age group where we've really struggled are the younger children with ADHD, those kindergarten, first grade, second grade where all children in that age group have a shortened attention span.

But for kids with ADHD, with or without learning disabilities, where they're trying to be educated in kindergarten or first grade, it's almost impossible to get anything out of that educational experience.

I really worry that our kindergarteners and first and second-graders are going to lose an entire year of school. If we think about it, at least where I am in DC, on Friday the 13th in March, schools shut down.

If you're in kindergarten or first grade, you haven't had an education since then. That's very tough. I'm wondering how our schools are going to make up the lost time for our youngest learners.

The final thing that's tough at this time of year is kids get all excited and they look forward to holiday. For many of our kids with ADHD, they've been working really hard at school. The reward is seeing families and celebrating the holiday as a family get-together and reward for a job well done.

With many families having financial difficulties and losses, whether it's the loss of a job or a family member to COVID, I don't think the winter holidays, whether it's Christmas, Hanukkah, or any other end of the year holiday, they're not going to be the same as they were a year ago.

That's also tough. It's hard for parents and grandparents to explain “why can't we all sit together and eat that special holiday meal.”

Thanksgiving just happened, and many families had visitors come for the holiday. Now, we're having people coming down with COVID because they celebrated like they normally do and they let their guard down. I think that's also hard for all our kids.

You may, as a clinician, have parents calling you saying, "I'd like to try medication for ADHD now. I've tried the educational interventions. We've tried to tutor, but we're just not able to learn online. We'd like to have another conversation about medication."

Or you may have kids that were previously well-controlled on a lower dose of stimulant or nonstimulant medication. Their parents are calling up and saying, "It's not working." The demands for attention and focus in online schooling are higher than they are in in-person schooling.

There's less engagement in learning. You may have to adjust your treatment for patients as we approach the holiday after basically 3 months of online schooling this fall.

I want to thank you for listening. I'm sure we will hear more topics about ADHD in the new year. Thanks very much.