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SA Society of Psychiatrists: Pandemic’s online learning and working sees increase in ADHD symptoms

Technology has enabled remote working, learning and social connections during the COVID-19 pandemic, but increases of up to 80% in time spent in front of screens has seen a rise in Attention Deficit Hyperactivity Disorder (ADHD) symptoms such as lack of focus, poor concentration, and restlessness among both adults and children.

Excessive screen time, either watching television or using devices including laptops, mobile phones and tablets, negatively affects concentration, memory and learning and contributes to problems with sleep, obesity, depression and anxiety – and aggravates the symptoms of ADHD.

Psychiatrist Professor Renata Schoeman, convenor of the ADHD special interest group of the SA Society of Psychiatrists (SASOP), said studies in a number of countries, including China, India, Australia, Canada, the USA and UK, had pointed to excessive screen time during the pandemic associated with worsening of ADHD symptoms.

At the same time, she said, there has been a rise in the number of adults experiencing ADHD-type symptoms and in parents requesting ADHD assessments for their children.

Schoeman said that excessive screen time as a result of the challenges of the pandemic was particularly problematic for children and adults with ADHD.

“Children and adults with more severe ADHD symptoms, especially inattention, are at greater risk of indulging in excessive screen time, with harmful consequences including internet addiction or problematic digital media use,” she said.

ADHD is the most common psychiatric disorder in children, affecting about one in 20 children, and follows about 65% of them into adulthood, affecting about a million adults in South Africa.

ADHD is characterised by a persistent pattern of inattention, hyperactivity and impulsivity that impair development and functioning, and are often coupled with behavioural, cognitive and social problems that can lead to difficulties in interpersonal relationships and in school and work performance.

Schoeman said online schooling and technology during the pandemic had some positive impacts for children with ADHD.

“Some of these children flourished in the more self-paced and flexible environment without the day-to-day social stresses and distractions in the physical school environment, experiencing less anxiety, pressure and negative feedback. But for others, the lack of structure, support and routine was problematic.

“On the negative side, children had to adapt to social isolation and the lack of their usual outlets for physical activity such as school sport. Screen time had a positive side in enabling them to stay socially connected, but the downside is the impact of excessive screen time on concentration, memory and learning, and problems in sleeping and in managing emotions.

“There has also been a distinct difference in impact on children in underprivileged areas, where the technology resources are not there and access to treatment and support has been hampered by lockdowns,” she said.

Since the start of the pandemic, adolescents with ADHD and parents of children with ADHD worldwide have reported more problems with maintaining routines and managing remote learning, struggles with boredom and motivation, changes in sleeping patterns and trouble sleeping, more stress, anxiety and depression.

“These symptoms were significantly worse where the ADHD patient had substantially increased their time spent on digital media, gaming and social media, with less time on physical exercise. This places them at greater risk of addiction, and it is crucial that parents seek out healthy, offline alternatives for children with ADHD in this challenging time,” Schoeman said.

She said the increase in parents seeking professional help for possible ADHD diagnosis was probably due to working from home and supervising online schooling, and experiencing first-hand the behaviours that their children’s teachers may have alerted them to previously.

“For adults, working from home, juggling childcare and additional stresses, may have highlighted their difficulties with memory, concentration, organisation and motivation, leading them to seek professional help and being diagnosed with adult ADHD,” she said.

Although an increase in ADHD diagnosis in South Africa has not yet been researched, Schoeman said countries across the world had reported increases in ADHD symptoms and diagnosis.

In the USA, the ADHD-focused magazine ADDitude reported in April this year that a quarter of its adult readers had been diagnosed with ADHD in only the past year, and 26% said their children had received a formal diagnosis of ADHD within the past year.

She said that excessive screen time could cause ADHD-like symptoms – especially inattention, lack of focus, restlessness and sleeping problems – without the person necessarily having ADHD. But the symptoms could also indicate a previously unnoticed condition or aggravate symptoms in those already diagnosed with ADHD.

She emphasised that it was important to consult a health professional like a paediatrician, psychiatrist or psychologist for a formal diagnosis of ADHD, or to determine if there were another cause (such as sleep-deprivation, depression, anxiety, excessive screen time, or medical conditions), and to obtain appropriate treatment.

In managing their children’s and their own screen time, Schoeman advised parents to “take screen time out of mealtime”, promoting time spent together as a family and encouraging healthy eating behaviours.

Devices and televisions are best placed in common areas where their use can be monitored, as there is considerable evidence that children with a TV, and especially online devices, in their bedrooms are at greater risk of obesity, poor sleeping habits, depression and substance use. With online devices there is the added risk of exposure to unsafe or inappropriate content and contacts.

“Studies have shown that the children of parents who control the length of time spent on screens, were more likely to engage in physical activities and spend time reading, so it is important that parents set limits, and do so consistently.

“With younger children, parents selecting suitable content and co-viewing it with their children enables parents to emphasise key messages and values, encourages them to ask questions and enhance the educational value of the content through parent-child interaction,” she said.

She encouraged parents to model healthy behaviour by limiting their own screen time, engaging in physical activities and reading. She also recommended developing a healthy Family Media Use Plan tailored for each family member, creating goals, times and purposes for digital media use in line with their own values.

The American Academy of Paediatrics has an online tool to create a personalised family media plan at www.healthychildren.org/MediaUsePlan

For help in managing ADHD symptoms, call the SA Depression and Anxiety Group (SADAG) ADHD Helpline on 0800 55 44 33.

Issued by the ADHD special interest group of the SA Society of Psychiatrists

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