Helping children with ADHD readjust to in-person learning and socializing

The COVID-19 pandemic has created unique learning challenges for children with attention-deficit/hyperactivity disorder (ADHD). The transition to remote learning changed schedules and routines for a group of children who need consistency.¹ Now back at school, these children continue to face problems academically and socially.

The challenges these children have faced transitioning to new remote learning were illustrated in studies including the Journal of Attention Disorders and Research on Child and Adolescent Psychopathology which show that during the height of the pandemic children with ADHD had more sleep problems, difficulty with distance learning, greater rule-breaking actions related to COVID-19 rules, family conflict, and were not as prepared for the following school year as their peers.^1,2

Another recent study from Child Psychiatry and Human Development found that children with ADHD had greater home learning difficulties compared to children without ADHD during the pandemic.³ However, it’s important to note that every child with ADHD is different and remote learning experiences varied from child to child.

One factor to learning success was support at home, says Fadiyla Dopwell, MD, a developmental-behavioral pediatrician at Pediatrix Developmental Medicine of Dallas, Texas. “I’ve seen many of our kids, not just with ADHD, but any special needs, who have flourished being at home because they’ve had one-on-one attention from their parents. They were able to go at their own pace. So, they weren’t as easily distracted.”

Dopwell noted that if children were not able to receive support from their parents, especially if they had additional developmental disorders, children were more likely to struggle. “There are a lot of children with ADHD that have learning difficulties. So, if the parent can’t support the learning differences and the child finds it hard to learn through the virtual medium while not receiving one-on-one support, the child may struggle even moreso with learning. When learning virtually, children with learning difficulties are expected to learn differently and may not get the support from their teacher the same way they may if they were in school.”

Similar to how children with ADHD did during the pandemic, the current learning status of these children varied from child to child based upon the support they received and if they had a learning disability in addition to their ADHD diagnosis added Dopwell.

As a pediatrician, Dopwell believes the best way to support a child with ADHD in September 2022 is “making sure that the child has support for their diagnosis in place.” Pediatricians should check with caregivers to make sure academic supports such as a 504 plan, an IEP, behavioral strategies, and therapy are utilized. Dopwell continued to say that parents should encourage their children to use those supports and to communicate with the school to ensure that the plan in place is being used and that progress is being made.

Dopwell noticed that children with ADHD didn’t only academically suffer from the pandemic but also socially. When children were not able to socialize with their peers, they were not able to practice navigating social situations. It made it hard for them to practice avoiding “impulsive engagement” and maintain “personal space.” Pediatric health care providers should recommend that caregivers offer opportunities for children to practice social situations that prepare them for school in the fall.

Dopwell emphasized the importance of behavioral therapy and counseling for any child who struggled during the pandemic, with or without learning challenges. The strategies that children learn will help them navigate school and social interactions and help control their impulse behaviors as well.

When children have a difficult time with home education, it can increase anxiety and make ADHD symptoms more apparent. Using behavioral therapy or other strategies can be helpful to manage their ADHD symptoms. Dopwell noted that some of these children need to talk through their anxiety to their health care providers or school professionals.She felt that, if possible, these strategies could be done before medication changes were made.

As Dopwell observed, youth with ADHD already faced multiple challenges before the pandemic and this recent study from the Journal of Attention Disorders noted that it did not improve with the pandemic. “As such, we also found children with ADHD were reported by their parents to be significantly less prepared for the upcoming school year during Spring 2020 than reported by parents in the control group. Thus, pandemic interruptions to schooling may have exacerbated existing educational challenges faced by youth with ADHD.”¹

Dopwell and other experts in the area have seen the impact that the pandemic has had on children with ADHD. One of the unifying factors that these experts commented on was how parental involvement affected how a child performed during and after the pandemic. Other factors were school involvement and family conflict. The best thing pediatric health care providers can do to help these patients now that they are back to live learning is ensuring academic supports are in place, encourage cargivers to provide socialization opportunities, and offer behavioral therapy.

REFERENCES:

1. Rosenthal E, Franklin-Gillette S, Jung HJ, et al. Impact of COVID-19 on youth with ADHD: Predictors and moderators of response to pandemic restrictions on daily life. J Attent Disord. 2022;26(9):1223-1234. doi:10.1177/10870547211063641

2. Dvorsky MR, Breaux R, Cusick CN, et al. Coping with COVID-19: longitudinal impact of the pandemic on adjustment and links with coping for adolescents with and without ADHD. Res Child Adolesc Psychopathol. 2022;50(5):605-619. doi:10.1007/s10802-021-00857-2

3. Jackson A, Melvin GA, Mulraney M, et al. Associations between anxiety and home learning difficulties in children and adolescents with ADHD during the COVID-19 pandemic. Child Psychiatry Hum Dev. 2022:1-13. doi:10.1007/s10578-022-01338-3