ADHD: Strategies for Developing a Further Dialogue - Episode 5
A discussion on the general impact of the COVID-19 pandemic on pediatrics with ADHD (attention deficit hyperactivity disorder).
Harlan R. Gephart, MD:I wanted to go back to the virtual class. One of my daughters is a special education reading teacher, and it’s been a disaster for them, unfortunately, because a lot of their kids have fallen behind. She’s seeing kids who she got up to speed last year, and now they’re way behind again, and it’s very difficult.
Tim Wilens, MD: Harlan, that point you bring up is absolutely critical. I was wondering Ann, you’ve been thinking about what Harlan was saying, what is this pandemic doing to kids with ADHD [attention-deficit/hyperactivity disorder], or other kids who we may be seeing, many of them who Harlan’s daughter works with, now that they’re stuck at home.
Ann Childress, MD: For many kids and families, it’s an absolute disaster. My children with generalized anxiety, they’re hunkered down at home. They’re happy as clams. They're not having to go out, they can turn off the camera, if they answer a question, they can do it on chat, so you don’t hear their voice stuttering. I just saw a patient right before this visit, the daughter doesn’t have ADHD, she’s 6, she’s falling behind. She was getting As in kindergarten last year for whatever that’s worth. Her brother, who was getting As and Bs last year, is having a really hard time. He’s 14 and mom can’t watch him all the time on the computer. Somehow, he missed a class today, we’re not sure how that happened. And when she walks in there will be other windows up on the browser, and he’s playing video games. The little guys can’t sit in front of the camera. I’ve got kids who are getting in trouble, they can’t figure out what link they’re supposed to go to for the next class. They’re running around the house.
Parents are trying to work from home, so that’s been difficult. I’ve had a couple of families where the mom said, “I think I’m going to have to quit my job until we can get the kids back in school,” because they’re falling behind. And I’m afraid by the time we get back to school that they’re going to be a couple of years behind.
Tim Wilens, MD: What are some of the difficulties with remote learning? Is this the same quality education you think that they would get if they were in person? Is it making up for that? What do we do around that? Bob, maybe you lead?
Robert L. Findling, MD, MBA: I’m going to say something different, which is, it’s true for kids in general, and maybe accentuated in kids with ADHD who might have other strengths. By being home alone, what you also lose is the ability to be a kid with other kids, and learn how to be social and develop your social graces. And as you get older those skills need to be honed and tempered to your maturity level and your developmental level.
For a lot of kids with ADHD, despite the challenges that folks have been talking about, oftentimes they may have other strengths that you won’t be able to see through a video conference. In many ways, these kids also now have lost the chance to succeed in a domain that they might have been successful at when life was in person and not via screen. In many ways it’s the emotional life and the social life and the development of the social skills that is such a vital part of school and being around other kids that I think it impacts kids in general, never mind kids with ADHD in particular.
Yes, school matters. My mother was a school teacher, so yes, school matters. There are other things I think that matter as well beyond academics.
Tim Wilens, MD: I’d be interested, Mark and Harlan, what your sense is when parents are coming to you as pediatricians and asking about these questions, or school districts coming to you because many pediatricians work with school districts. What are you saying to them?
Harlan R. Gephart, MD: There are so many complications because they don’t want to move around and get exposed. I’m really concerned because kids by fourth grade you need to be able to read at grade level because people aren’t going to keep tutoring you to read from then on. So you’re behind the eight ball if you’ve hit fourth grade and you’re still 2 years behind in learning to read, or if you’ve lost a year or this year because of the coronavirus disease 2019 [COVID-19].
Mark Wolraich, MD: The only thing you can possibly do in terms of some of the social interactions is doing what we’re doing here, which is you have a Zoom meeting where kids can at least interact in terms of oral communication with each other. It’s not as good as when they get together, but in addition to the remote learning focusing on the academic part, trying to build in some social activities is important also.
-Dr. Findling receives or has received research support, acted as a consultant and/or has received honoraria from Acadia, Adamas, Aevi, Afecta, Akili, Alkermes, Allergan, American Academy of Child & Adolescent Psychiatry, American Psychiatric Press, Arbor, Axsome, Daiichi-Sankyo, Emelex, Gedeon Richter, Genentech, Idorsia, Intra-Cellular Therapies, Kempharm, Luminopia, Lundbeck, MedAvante-ProPhase, Merck, MJH Life Sciences,NIH, Neurim, Otsuka, PaxMedica, PCORI, Pfizer, Physicians Postgraduate Press, Q BioMed, Receptor Life Sciences, Roche, Sage, Signant Health, Sunovion, Supernus Pharmaceuticals, Syneos, Syneurx, Takeda, Teva, Tris, and Validus.
-Dr Gephart is retired from the practice of medicine. He is on the faculty of the REACH Institute for a course entitled “Patient Centered Mental Health in Primary Care.” He receives a stipend for serving as a virtual consultant to Course graduates who call in and present difficult cases. He has no other financial contracts to report.
-Dr Childress reports receipt of research or writing support, participation on advisory boards, and service as a consultant or speaker for Adlon Therapeutics, Aevi Genomic Medicine, Akili Interactive, Allergan, Arbor Pharmaceuticals, Cingulate Therapeutics, Emalex Biosciences, Ironshore Pharmaceuticals, Jazz Pharmaceuticals, KemPharm, Lundbeck, Neos Therapeutics, Neurovance, NLS Pharma, Otsuka, Pearson, Pfizer, Purdue Pharma, Rhodes Pharmaceuticals, Sunovion, Supernus Pharmaceuticals, Takeda, and Tris Pharma.
-Dr Wolraich is professor emeritus from the University of Oklahoma Health Sciences Center. He is on the steering committee and a faculty member of the REACH Institute, a non-profit organization providing CME training on mental health to primary care physicians. He has no affiliations or investments where he receives any compensation, and he is no longer in any clinical practice.
-Dr Wilens is Chief, Division of Child and Adolescent Psychiatry and Co-Director of the Center for Addiction Medicine at Massachusetts General Hospital. He receives or has received grant support from NIH(NIDA). He is or has been a consultant for Arbor, Otsuka, Ironshore, KemPharm and Vallon. He is the author of Straight Talk About Psychiatric Medications for Kids (Guilford Press). He is co-editor of ADHD in Adults and Children (Cambridge University Press), Massachusetts General Hospital Comprehensive Clinical Psychiatry (Elsevier); and Massachusetts General Hospital Psychopharmacology and Neurotherapeutics (Elsevier). He is co-owner of a copyrighted diagnostic questionnaire (Before School Functioning Questionnaire) and has a licensing agreement with Ironshore (BSFQ Questionnaire). He serves as a clinical consultant to the US National Football League (ERM Associates), U.S. Minor/Major League Baseball; Gavin Foundation and Bay Cove Human Services.