Promoting Wellness Practices May Help Curb Pandemic-Related Stressors in Children With ADHD

Ann Childress, MD, President of the Center for Psychiatry and Behavioral Medicine Inc in Las Vegas, Nevada and Vladimir Maletic, MD, MS, Clinical Professor of Psychiatry, University of South Carolina School of Medicine, Grenville, South Carolina, discuss curbing the increased screen time among children with attention-deficit/hyperactivity disorder (ADHD) and treating the adverse mental health symptoms linked with COVID-19 pandemic outcomes and disruptions.

In the upcoming part 3, they discuss children with ADHD transitioning back to school and managing disruptive behaviors in the classroom.

Watch Part 1: Pandemic Affects Learning, Nutrition, and Relationships in Children With ADHD

Read the transcript:

Dr Vladimir Maletic: In many of my patients, I've seen that screen time is a big struggle. Especially, since parents many times continued with their work remotely.

They were having to wear many hats, parent their children, sometimes assist with their education at home, monitoring...Many times if parents are working virtually, it is very tempting to give children a free rein. “Play a game, watch TV, keep yourself busy.”

Would you have any thoughts about what would be some of the best practices, given the environment during lockdown? What can be done? What are some of the things maybe that you advise your patients and their families?

Dr Ann Childress:  I'm thinking about the guy that came in yesterday, my 14 year-old, and mom said, "This is my nemesis," and holds up his tablet that she had held hostage in her purse. "This is my nemesis." “He can't go out, but he's actually able to go to summer camp now. I'm hoping that some of those pounds are going to come off.”

She said, "I'm not letting him have it." I said, "Well, maybe there's a better way to do things," because he's not doing his chores. This is a family that's been hit by the pandemic. He was staying with his grandparents and his grandfather contracted COVID right after Christmas. He died in January.

His mother also contracted COVID and she wound up in the hospital for several days. You can imagine how scary that was, because they just lost granddad. Mom's doing much better. She's out of the hospital, but she still says she's very tired and she still has some COVID fog. So, it's hard to get him to do his chores and some of the things that he needs to do around the house now.

One of the things we're talking about is rather than taking things away, have them earn them. Start with nothing. Let's not wait until the end of the week. Let's do this on a daily basis.

If he's making his bed, he can earn a few minutes. If he's attending to his hygiene, because a lot of these kids if they are not getting out and seeing other people, they're not thinking that they need to brush their teeth. If they're wearing their mask, it's like, "Well, why do I need to brush my teeth? I'm wearing a mask."

I always say what a friend of mine would say who is a dental technician. She'd say, "You don't need to brush all your teeth, just the one you want to keep." “So, If you don't like this one right up front here, skip over him.”

If he's doing his hygiene, if he's taking out the trash, if he's doing the chores, he can earn some screen time for all of those things. That will help decrease some of the conflict in the home.

He'll be happy because he's able to get his screen time. If he doesn't get his screen time, it's his own fault because he's not helping and being a part of the family and doing the things. We talked about Mom probably doesn't like to cook, right? There are places you're going. You're going to camp now. She has to drive you there, get you there and back.

There are all sorts of things that we have to do just to be part of the family and make life easier on each other. Hopefully, they will take that advice, and the next time I won't have to see the iPad held up as a hostage.

Dr Maletic:  That's a very, very insightful and clever method. Maybe using some of the less desirable behaviors as reinforcement, as a motivator for more adaptive and desirable behaviors. Help around the house, exercise, do more schoolwork and that will be the way to earn some of the screen time. It's a wonderful idea.

Now, You've mentioned that your patient has suffered losses. The literature suggests also that changes in habit, lack of peer relationships, more screen time translates into more anxiety and depressive symptomatology. Clearly, losses like this would also add to depression.

Would you maybe have some suggestion for our colleagues? If patients who have ADHD during COVID-19 pandemic and lockdown are experiencing more anxious and depressive symptoms, what do we do? Do we treat them? Do we think about adding SSRIs? Would be a different way that you would approach those scenarios?

Dr. Childress:  It's really important to talk about what's going on and figure out where are things coming from. Even though I'm a psychiatrist, I do clinical research, I do pharmaceutical trials, I'm not one to throw a pill at something, especially if something we know what the origin is, and we know that we can do some things to make things better.

My kids with ADHD, we know that exercise helps decrease some of the ADHD symptoms. That along with the restlessness may help them get out, get anxiety under better control, being able to talk about the losses, and what's going on, and the difficulties they're having at home. One of the nice things about kids in today's environment is they're used to a lot of texting.

They may be playing their games online. They may be contacting other kids through text, or through FaceTime, or some sort of video chat. I encourage them to talk to their friends, to not be isolated that way. Las Vegas has pretty much opened up.

We weren't wearing masks in the casinos, although just last week the city has recommended that we start to wear masks again when we're out indoors with other folks. Our cases are creeping up. That's another source of anxiety. I had a young man yesterday with anxiety. He's going to have to go back to school. He has GAD. He came by it honestly. He had it long before COVID came.

He was doing pretty well. He's getting out, going to the water park, doing some things. I asked him if COVID had any impact on his anxiety right now. He's had his vaccines. He said, "Well, I'm worried about the Delta variant." All of us are. Are we going to be able to get back to normal?

We're planning on school in person this year in Las Vegas. I don't know what's happening in South Carolina where you are. All of that could change pretty quickly.

About a month ago, our cases were about 150 a day in Clark County. I looked this morning, and they were 2,000 in three days over the weekend. That's close to 600-and-something a day. Then another 560 yesterday. We're definitely creeping up.

Dr. Maletic:  I like your approach. It's not throwing all anxiety and depression in the same bucket and having the knee-jerk response to add more medicine to address it, but rather explore these experiences and emotions with a patient to see what may be contributing factors.

You have mentioned psychotherapy as a way of dealing with those. You have also mentioned that re-establishing some of the peer relationships may be helpful as well as some health and wellness practices. Let's pay more attention to diet, fresh food, but also exercise. That is a very important aspect. I like your approach much more than what happens more often. There is something interesting.