The impact of Covid-19 pandemic on services for children and adolescents with ADHD: results from a survey of paediatricians in the United Kingdom

Michael O Ogundele; Hani F Ayyash; Cornelius Ani; Michael O Ogundele; Hani F Ayyash; Cornelius Ani

doi:10.3934/publichealth.2022037

AIMS Public Health

2022, Volume 9, Issue 3: 542-551. doi: 10.3934/publichealth.2022037

Previous Article Next Article

Research article Topical Sections

The impact of Covid-19 pandemic on services for children and adolescents with ADHD: results from a survey of paediatricians in the United Kingdom

1.
Halton Community Pediatrics Unit, Bridgewater Community Healthcare NHS Foundation Trust, Runcorn UK
2.
Essex Partnership University Hospitals NHS Foundation Trust (EPUT), Lighthouse Child Development Centre, Southend-On-Sea, Essex, UK
3.
Division of Psychiatry, Imperial College London, UK
4.
Surrey and Borders Partnership NHS Foundation Trust
5.
Scientific Committee Member, British Paediatric Surveillance Unit, Royal College of Paediatrics and Child Health, UK
6.
George Still Forum (National Network for Paediatric ADHD and related Neurodevelopmental disorders)

Received: 03 February 2022 Revised: 20 May 2022 Accepted: 17 June 2022 Published: 21 June 2022

Background
The Covid-19 pandemic has led to huge disruptions and multi-domain healthcare crisis, with additional impact on children and young people (CYP) affected by Attention Deficit and Hyperactivity Disorder (ADHD).
Methods
We conducted an online survey and obtained responses from 62 Paediatricians who provide ADHD services for CYP about their experience of Service disruption and adaptations during the first Covid-19 lockdown in the United Kingdom between March and June 2020. The responses were both quantitative and qualitative.
Results
The Paediatricians reported huge service disruptions such that almost half ceased the assessment of new patients with ADHD, and only 5% were able to offer physical monitoring for most patients. However, all respondents had adopted telemedicine, which allowed them to maintain high levels of non-physical service provision for existing patients. The Paediatricians used risk stratification strategies to determine which patients were more likely to benefit from the limited available face to face appointments for physical monitoring. The Paediatricians demonstrated clinical pragmatism to meet the needs of their patients such as starting medication without physical exam especially if the patient's behaviour was so challenging that it was presenting a crisis at home, and setting aside monthly limits for stimulant medications. Some respondents reported helpful cross-service collaborations to support CYP with ADHD and their families.
Conclusion
The Covid-19 pandemic has had adverse effect on many CYP with ADHD and caused huge disruption to the ADHD services that support them. As the pandemic continues to cause disruptions to ADHD services, the service adaptations emerging from the literature including some of those identified in this study could be useful to support more stable and sustainable ADHD services, both during and after the pandemic.
- Covid-19,
- ADHD,
- service provision,
- disruption,
- child and adolescent mental health,
- paediatrics,
- telemedicine,
- United Kingdom
Citation: Michael O Ogundele, Hani F Ayyash, Cornelius Ani. The impact of Covid-19 pandemic on services for children and adolescents with ADHD: results from a survey of paediatricians in the United Kingdom[J]. AIMS Public Health, 2022, 9(3): 542-551. doi: 10.3934/publichealth.2022037

Related Papers:

Abstract

Background

The Covid-19 pandemic has led to huge disruptions and multi-domain healthcare crisis, with additional impact on children and young people (CYP) affected by Attention Deficit and Hyperactivity Disorder (ADHD).

Methods

We conducted an online survey and obtained responses from 62 Paediatricians who provide ADHD services for CYP about their experience of Service disruption and adaptations during the first Covid-19 lockdown in the United Kingdom between March and June 2020. The responses were both quantitative and qualitative.

Results

The Paediatricians reported huge service disruptions such that almost half ceased the assessment of new patients with ADHD, and only 5% were able to offer physical monitoring for most patients. However, all respondents had adopted telemedicine, which allowed them to maintain high levels of non-physical service provision for existing patients. The Paediatricians used risk stratification strategies to determine which patients were more likely to benefit from the limited available face to face appointments for physical monitoring. The Paediatricians demonstrated clinical pragmatism to meet the needs of their patients such as starting medication without physical exam especially if the patient's behaviour was so challenging that it was presenting a crisis at home, and setting aside monthly limits for stimulant medications. Some respondents reported helpful cross-service collaborations to support CYP with ADHD and their families.

Conclusion

The Covid-19 pandemic has had adverse effect on many CYP with ADHD and caused huge disruption to the ADHD services that support them. As the pandemic continues to cause disruptions to ADHD services, the service adaptations emerging from the literature including some of those identified in this study could be useful to support more stable and sustainable ADHD services, both during and after the pandemic.

Abbreviations

ADHD

Attention deficit and hyperactivity disorder

CAMHS

Child and adolescent mental health services

CYP

Children and young people

GSF

George-still forum

PPE

Personal protective equipment

Acknowledgments

We than members of GSF who participated in the survey.

Conflict of interest

The authors have no conflict of interest to declare.

References

[1]	Gruber J, Prinstein MJ, Clark LA, et al. (2021) Mental health and clinical psychological science in the time of COVID-19: Challenges, opportunities, and a call to action. Am Psychol 76: 409. https://doi.org/10.1037/amp0000707
[2]	Merzon E, Weiss MD, Cortese S, et al. (2022) The Association between ADHD and the Severity of COVID-19 Infection. J Atten Disord 26: 491-501. https://doi.org/10.1177/10870547211003659
[3]	Moreno C, Wykes T, Galderisi S, et al. (2020) How mental health care should change as a consequence of the COVID-19 pandemic. Lancet Psychiat 7: 813-824. https://doi.org/10.1016/S2215-0366(20)30307-2
[4]	Kavoor AR, Mitra S (2021) Managing Attention deficit hyperactivity disorder during COVID-19 pandemic. JNRP 12: 001-002. https://doi.org/10.1055/s-0040-1721206
[5]	Cortese S, Coghill D (2018) Twenty years of research on attention-deficit/hyperactivity disorder (ADHD): looking back, looking forward. Evid-Based Ment Heal 21: 173-176. https://doi.org/10.1136/ebmental-2018-300050
[6]	Arlington VA American Psychiatric AssociationDiagnostic and statistical manual of mental disorders (5th ed.) (2013). https://doi.org/10.1176/appi.books.9780890425596
[7]	McGrath J (2020) ADHD and Covid-19: Current roadblocks and future opportunities. Irish J Psychol Med 37: 204-211. https://doi.org/10.1017/ipm.2020.53
[8]	BACCH/RCPCHCovering all bases Community Child Health: A paediatric workforce guide. RCPCH Sept 2017, London. Available from: https://www.rcpch.ac.uk/sites/default/files/2018-03/covering_all_bases_community_child_health_-_a_paediatric_workforce_guide.pdf
[9]	Rajkumar RP (2022) Is There a Relationship Between ADHD and COVID-19 Prevalence and Mortality Indices? An Analysis of Data From 156 Countries. J Atten Disord 26: 1069-1077. https://doi.org/10.1177/10870547211056894
[10]	Pollak Y, Shoham R, Dayan H, et al. (2022) Symptoms of ADHD predict lower adaptation to the COVID-19 outbreak: Financial decline, low adherence to preventive measures, psychological distress, and illness-related negative perceptions. J Atten Disord 26: 735-746. https://doi.org/10.1177/10870547211027934
[11]	Merzon E, Manor I, Rotem A, et al. (2021) ADHD as a risk factor for infection with Covid-19. J Atten Disord 25: 1783-1790. https://doi.org/10.1177/1087054720943271
[12]	Hollingdale J, Adamo N, Tierney K (2021) Impact of COVID-19 for people living and working with ADHD: A brief review of the literature. AIMS Public Health 8: 581. https://doi.org/10.3934/publichealth.2021047
[13]	McGowan G, Conrad R, Potts H (2020) 51.2 Challenges with managing children and adolescents with ADHD during the COVID-19 pandemic: A review of the literature. J Am Acad Child Psy 59: S251. https://doi.org/10.1016/j.jaac.2020.08.412
[14]	Mallik CI, Radwan RB (2021) Impact of lockdown due to COVID-19 pandemic in changes of prevalence of predictive psychiatric disorders among children and adolescents in Bangladesh. Asian J Psychiatr 56: 102554. https://doi.org/10.1016/j.ajp.2021.102554
[15]	Shah R, Raju VV, Sharma A, et al. (2021) Impact of COVID-19 and lockdown on children with ADHD and their families—an online survey and a continuity care model. J Neurosci Rural Pra 12: 071-079. https://doi.org/10.1055/s-0040-1718645
[16]	McNicholas F, Kelleher I, Hedderman E, et al. (2021) Referral patterns for specialist child and adolescent mental health services in the Republic of Ireland during the COVID-19 pandemic compared with 2019 and 2018. BJPsych Open 7. https://doi.org/10.1192/bjo.2021.48
[17]	Cortese S, Coghill D, Santosh P, et al. (2020) Starting ADHD medications during the COVID-19 pandemic: recommendations from the European ADHD Guidelines Group. Lancet Child Adolesc 4: e15. https://doi.org/10.1016/S2352-4642(20)30144-9
[18]	Valentine AZ, Hall SS, Young E, et al. (2021) Implementation of telehealth services to assess, monitor, and treat neurodevelopmental disorders: systematic review. J Med Internet Res 23: e22619. https://doi.org/10.2196/22619
[19]	Spencer T, Noyes E, Biederman J (2020) Telemedicine in the Management of ADHD: Literature Review of Telemedicine in ADHD. J Atten Disord 24: 3-9. https://doi.org/10.1177/1087054719859081
[20]	Ogundele M, Ani C (2021) Effect of COVID-19 pandemic on the blood pressure of children and adolescents with ADHD: implications for clinical practice. Arch Dis Child 106: A148-A149. https://doi.org/10.1136/archdischild-2021-rcpch.258
[21]	Braun V, Clarke V (2006) Using thematic analysis in psychology. Qual Res Psychol 3: 77-101. https://doi.org/10.1191/1478088706qp063oa
[22]	Scott AM, Kolstoe S, Ploem MC, et al. (2020) Exempting low-risk health and medical research from ethics reviews: comparing Australia, the United Kingdom, the United States and the Netherlands. Health Res Policy Sy 18: 1-8. https://doi.org/10.1186/s12961-019-0520-4
[23]	Wang Q, Xu R, Volkow ND (2021) Increased risk of COVID-19 infection and mortality in people with mental disorders: analysis from electronic health records in the United States. World Psychiatry 20: 124-130. https://doi.org/10.1002/wps.20806
[24]	Nigg JT (2013) Attention-deficit/hyperactivity disorder and adverse health outcomes. Clin Psychol Rev 33: 215-228. https://doi.org/10.1016/j.cpr.2012.11.005
[25]	Shah R, Chakrabarti S, Sharma A, et al. (2019) Participating from homes and offices: Proof-of-concept study of multi-point videoconferencing to deliver group parent training intervention for attention-deficit/hyperactivity disorder. Asian J Psychiatr 41: 20-22. https://doi.org/10.1016/j.ajp.2019.03.006
[26]	Salinas CM, Bordes Edgar V, Berrios Siervo G, et al. (2020) Transforming pediatric neuropsychology through video-based teleneuropsychology: an innovative private practice model pre-COVID-19. Arch Clin Neuropsych 35: 1189-1195. https://doi.org/10.1093/arclin/acaa101

Reader Comments

Your name:*

Email:*
© 2022 the Author(s), licensee AIMS Press. This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0)