Pandemic Affects Learning, Nutrition, and Relationships in Children With ADHD

Children with attention-deficit/hyperactivity disorder (ADHD) benefit from routine and leaving home for activities, thus the COVID-19 pandemic and virtual education had adverse effects on their learning and symptoms, says Ann Childress, MD, President of the Center for Psychiatry and Behavioral Medicine Inc in Las Vegas, Nevada.

Dr Childress and Vladimir Maletic, MD, MS, Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Grenville, South Carolina, converse about the pandemic’s effects on relationships, daily lives, and nutrition for pediatric ADHD.

In the upcoming part 2, they discuss the effects of increased screen time on children with ADHD.

Read the transcript:

Dr Vladimir Maletic:  Hello. My name is Vladimir Maletic. I'm a clinical professor of psychiatry at University of South Carolina School of Medicine. It is my great pleasure to introduce to you today Dr. Ann Childress. She is my dear friend and colleague and an expert in ADHD, both the diagnosis and treatment.

Ann, if you wouldn't mind providing a little bit more of introduction about the work that you have been doing. You're very well-known researcher in ADHD arena. Please share with our audience a little bit more about yourself.

Dr Ann Childress:  Sure. I'm a child and adolescent psychiatrist. Of course, all child psychiatrists also see adults, or are at least trained as adults. I treat mainly ADHD in children, adolescents and adults.

I am in Las Vegas, Nevada. About 80% of my time is clinical research, and the other 20% of my time is following patients who have finished our studies. Some of them I've been following for almost 20 years, which I guess means I'm old.

I'm also adjunct faculty at the University of Nevada, Las Vegas School of Medicine and also Touro University of Nevada. I get to hang out with the medical students and the residents, and that's fun. They keep me young, I think.

Dr Maletic:  I'm sure you've seen quite a bit of change in terms of how your patients with ADHD live their lives, how their relationships with peers and family changed during the lockdown or related to COVID-19 pandemic. I'm curious, what have you observed? How are their lives different, and how might it have impacted their condition and its presentation?

Dr Childress:  One is the big concerns is many of my patients are going to be a year behind, maybe a year and a half, from having to do online school. I have spent the past 20 years of my career trying to convince parents why it's a bad idea to do homeschool or virtual learning with their children with ADHD. Then, all of a sudden, overnight, we had to deal with that with everybody.

Even this past year, most of my patients continued on virtual learning. We did have some hybrids. Schools started back for the middle schoolers and the high schoolers after Easter this past year.

The problem was that they were only going to school a couple of hours a day. They'd go to school a couple of hours, and then they'd have to run home and do a couple of hours online. They were doing that a couple of days a week. I think that added even more problems. Most of my patients struggled with the online learning.

They couldn't figure out where they were supposed to turn in papers. They would do their work, they'd forget to hit “submit”. There were other kids in the house. Parents were having to work from home. There were a lot of distractions. It was hard for them to get things done. They were cooped up.

Most kids with ADHD, especially if they have hyperactivity, if they need to get out. We all need to get out. We need to be able to exercise and run around and do things. For a lot of those folks, they were stuck in the house. They weren't able to continue with some of the physical activities that they did and that added to their difficulties in school.

Dr Maletic:  There was a recent study published by a group in Alberta in Canada. I would like you to comment on some of their findings and see if it also reflects your experience. Here are some of the things that they noticed. Both in child and adolescent population, about 90% of children and adolescents had increased screen time.

Majority of them exercised less than one half an hour a day. About a fifth of them had increase in intake in processed foods. In addition to that, it seems that these behaviors, more processed food, more screen time, less exercise, correlated with increased not only in severity of ADHD symptoms, but depression and anxiety.

I'm curious. Is this something that you have observed? If you have, how do you approach it? How do you broach this topic with your patients and their families?

Dr Childress:  It has been a big problem. I saw a young man yesterday. He gained 25 pounds since January of this year, since January.

Dr Maletic:  Impressive.

Dr Childress:  He had gained probably another 20 pounds the past year before that. Obviously, he's overweight. I did his BMI calculations yesterday. He was in the 99th percentile. He's not a tall kid. He's 14 and he's in the 99th percentile for his BMI. He's 185 pounds. We had to talk about that.

I'm a psychiatrist, but we also have to talk about healthy eating, and exercise, and portion control. Get the parents on board with this, because the parents are gaining pounds too. I don't see too many people who have lost weight during this whole pandemic.

Dr Maletic:  No. By and large are parents and patients amenable, because I agree with you. More fresh food, more vegetables, better nutrition, more exercise, less screen time. However, putting it back in place, a little bit more of a challenge, at least with my patients, it has been. Please tell us, do you have any secrets?

Dr. Childress:  I don't have any secrets. One of the problems with the parents is many of them have not been going into the grocery store. You can do curbside pickup or delivery. I don't know about you, but I like to pick out. I like to handle my fruit. I've been very wary about doing that during the pandemic.

I don't want to be touching and putting cooties on other people's things they may buy, but it's harder to do the curbside pickup and buy those fresh fruits, because you don't know what you're going to get. Is the person who's picking out my food, am I going to get some nice tomatoes and some nice oranges and apples or am I going to get some stuff that isn't very appetizing?

Dr Maletic:  What I hear you're saying, there has been a challenge. It's not only a matter of motivation that parents would have. It's also access to fresh foods. That may be problematic.

Ann C. Childress, MD, is in private practice in Las Vegas, Nevada. She has adjunct faculty appointments at the University of Nevada Las Vegas, School of Medicine and Touro University Nevada College of Osteopathic Medicine. She is board certified in psychiatry, with a subspecialty in child and adolescent psychiatry. Her current research focuses on the treatment of children, adolescents, and adults with ADHD. Dr. Childress is a Distinguished Fellow of the American Psychiatric Association, President-elect of The American Professional Society of ADHD and Related Disorders, a member of the American Academy of Child and Adolescent Psychiatry and is Education Director for the Nevada Psychiatric Association.

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.