COVID-19 Impacts Daily Lives of Adults With ADHD

Vladimir Maletic, MD, MS, clinical professor of neuropsychiatry and behavioral science, University of South Carolina School of Medicine, Greenville, discusses the impact the ongoing COVID-19 pandemic has had on the mental health of patients with attention-deficit/hyperactivity disorder (ADHD). Dr Maletic, ADHD section editor, Psych Congress Network, also explores the pandemic's effects on daily lives, such as work and maintaining relationships, of patients with adult ADHD. Dr Maletic is interviewed by Psych Congress Network's Associate Digital Editor, Meagan Thistle.

Meagan Thistle:  Hello, Psych Congress Network. I'm your Associate Digital Editor, Meagan Thistle. I'm sitting here today with Dr Vladimir Maletic, who is also our ADHD Section Editor. Vlad, if you'd like to further introduce yourself?

Vladimir Maletic, MD, MS:  I would be delighted, Meagan. As you have heard, my name is Vladimir Maletic. I'm a clinical professor of psychiatry at USC School of Medicine in Greenville, South Carolina. I'm delighted to be able to join you and talk about these very important topics related to ADHD in the face of COVID‑19 pandemic.

Thistle:  Thank you again for sitting with us today. We'll go ahead and get started. First question I have for you is, how has the ongoing COVID‑19 pandemic impacted the mental health of patients with adult ADHD?

Dr Maletic:  It's a very, very important question. The impact has been very significant, in a sense that ADHD is a condition that does get worse with stress. In looking at some of the manifestations that tend to be much more pronounced during stressful times, it's, interestingly enough, more inattentiveness than hyperactivity, impulsivity. The symptoms of inattentiveness would become more noted.

The other part is that ADHD, from its genetic to neurobiological basis, has very significant link with mood disorders, anxiety disorder, and substance use disorders. With exacerbation of stressful circumstances, patients suffering from ADHD develop even more emotional reactivity and difficulties with emotional regulation.

The other part is, it was associated with exacerbation of many of the comorbid conditions. There was a relatively dramatic increase in substance use. There was a pronounced increase in anxiety disorders, sleep disorders, and mood disorders, which were, again, all comorbid with ADHD.

In patients who were already established, it is something that would be noticed by clinicians right away. Unfortunately, with new patients, it was a different story, because then it became a novel challenge to discern what is really going on.

Is the patient primarily coming to us with a mood disorder? Are attentional difficulties part of the mood disorder? Or, are we missing ADHD as the common denominator explaining all these manifestations? Indeed, it was a very, very significant impact by COVID‑19 pandemic.

Thistle:  Thank you for bringing up the differentiation between those two groups of folks with adult ADHD. That's an important distinction to make. Now, if we could maybe go into a little further there with the impact. How has COVID‑19 impacted the daily lives? We're talking work, relationships, things like that of adult patients with ADHD.

Dr Maletic:  It's really interesting because, again, there has been a very significant impact. A part that is really problematic is recent research has noted that individuals who have ADHD are less likely to adhere to preventive measures. Likelihood of wearing a mask when appropriate or getting vaccinated was actually decreased by presence of ADHD symptoms.

Why would that be important? Let me just share with you some very simple epidemiologic facts. Based on the research that we read, incidence of COVID positive testing in ADHD patients was 60-70% higher than population at large. It is a very significant impact.

On the other hand, even pathology, we would not have assumed so, but pathology that is generated by COVID‑19 infection impacted differently individuals who have ADHD. They had up to 80% greater likelihood of developing severe symptoms and being hospitalized relative to population at large.

As a matter of fact, there was only a minor difference between individuals who have...We know that obesity is one of the known factors. ADHD contributing to risk of hospitalization and severe symptoms was just a little bit below obesity. Again, a very, very significant impact.

What else has changed in the lives of individuals who have ADHD? Adherence to daily schedule and sleep-wakefulness cycle became quite problematic. These individuals were staying up later. They were engaging more with Internet‑based programming, which in and of itself also became problematic.

There was a large study looking at thousands of individuals who have ADHD. They utilize an instrument that is called [the] Internet Addiction Test. There was a noticeable increase in problematic use of Internet during the ADHD pandemic.

The other aspects of these patients' lives were also influenced. They were much more likely to feel lonely and isolated than the population at large. There was the more pronounced financial impact on individuals who had ADHD versus control group.

There was much heightened risk of substance use in these instances. The overall quality of life declined more in patients who have ADHD versus typically developed individuals. Again, it was of a major, major impact in multiple areas of their lives.

Thistle:  Thank you. Thank you so much, Vlad, for sitting down with us. This is always a pleasure. Psych Congress Network, if you found this interesting and helpful to you, please check back in our ADHD topic center and center of excellence. Thank you so much.

Dr Maletic:  Very good. Again, always a pleasure chatting with you, Meagan. I also wish our audience health and prosperity in these difficult times and to know that their efforts are deeply appreciated.

Thistle:  Absolutely. Thank you so much, Vlad.

Dr Maletic:  Thank you.

Vladimir Maletic, MD, MS, is a clinical professor of psychiatry and behavioral science at the University of South Carolina School of Medicine in Greenville, and a consulting associate in the Division of Child and Adolescent Psychiatry, Department of Psychiatry, at Duke University in Durham, North Carolina. Dr Maletic received his medical degree in 1981 and his master’s degree in neurobiology in 1985, both from the University of Belgrade in Yugoslavia. He went on to complete a residency in psychiatry at the Medical College of Wisconsin in Milwaukee, followed by a residency in child and adolescent psychiatry at Duke University.