Physicians are seeing an uptick in the number of parents who are seeking ADHD evaluations for their children — and if that could be playing a role in remote learning struggles.
That’s according to the Children and Adults with Attention-Deficit Hyperactivity Disorder (CHADD), an organization that operates a helpline to answer questions about ADHD.
Calls to the helpline have increased by nearly 62% since the start of the pandemic, with more than half of calls from parents asking for a referral to see a doctor who specializes in ADHD, according to the organization.
That comes as no surprise to Dr. Peter Smith, a physician specializing in Developmental and Behavioral Pediatrics with UChicago Medicine. Smith said he recently saw an example of this — a concerned mom who brought in her son after his struggles became more evident with remote schooling.
“With the pandemic and his mom sitting with him more often, she could see the problems firsthand that he was having, so it became more obvious that maybe something was going on,” Smith said. “With this one-on-one experience, she picked up on some stuff and decided to have him be evaluated.”
Recent reports show that about half of all public schools in Illinois are still in remote learning. In Northwest Indiana, while some districts have opened their doors again to in-person learning, many students remain at home.
The Gary Community School Corp., for example, welcomed its students back into classrooms for the first time at the end of February, yet only about 46% of families opted to send their children back to schools.
Whether attention difficulties can be attributed to ADHD or simply a change in environment is complicated to determine, health professionals say.
“All of us can pay attention to things better that interest us, and that’s a natural part of our attention span,” Smith said. “When you take an entire group of schoolchildren and make them watch the computer in a certain way to get their schooling, that’s not going to be as interesting as an in-person teacher.”
How common is ADHD?
Dr. Radhika Chillarige, a pediatrician with the Franciscan Physician Network’s St. John Health Center, said ADHD, or Attention Deficit Hyperactivity Disorder, is prevalent in about 9% to 15% of school-age children.
“ADHD is one of the most common disorders in children,” she said. “It is more common in boys than girls.”
As the name indicates, children with ADHD often exhibit hyperactivity and a lack of attention, she said.
“These symptoms can be manifested as difficulty waiting for their turn, interrupting, unable to sit at one place and a lack of focus,” she said. “Parents often say they are like the Energizer Bunny, always on the go.”
Adding to the challenge of identifying ADHD during a pandemic is the fact that other conditions can mimic ADHD, and any periods of stress such as a pandemic can cause similar symptoms. Conditions that mimic ADHD include Autism spectrum disorder, learning disability oppositional defiant disorder, anxiety, hearing impairments and sleep disorders, Chillarige said.
“During this pandemic, almost all children are affected in one way or the other, not just children with ADHD,” she said.
Children with ADHD may suffer more than usual as well.
“Even adults are struggling to make sense of all this and finding it difficult to handle,” Chillarige said. “Children can sense anxiety and stress in the family, which can add to the struggles they are already facing with ADHD.”
What conditions can influence behavior?
Dr. Ragini Bielski, an internal medicine practitioner and a Community Care Network pediatrician, said it’s important to differentiate anxiety, depression, grief, stress and disruption of normal patterns from true ADHD.
“Before labeling a child as having ADHD, we need to consider individual situations,” she said. “For example, should it be considered normal for a child to sit perfectly still in front of a computer without individualized attention for hours without being distracted or fidgety? The answer, depending on the child’s age, is typically no.”
Bielski, who is on staff at St. Mary Medical Center in Hobart and the Community Stroke and Rehabilitation Center in Crown Point, said a question that must be asked is whether the child is acting abnormally or if the expectations are abnormal.
“I would even venture to say most adults cannot focus with as much concentration as we are now asking of our children during this pandemic,” she said. “We need to understand what, as parents, our desires are for a child’s behavior as opposed to the child’s actual capabilities. As teachers, adults and parents who are stressed ourselves, we may have less patience for children who seem to be inattentive.”
That’s why Bielski said it’s important for parents to speak to their pediatricians about what healthy normal child development looks like and become familiar with pediatric milestones.
“Many parents may find that what seems like difficult behavior is actually developmentally normal for a child that age,” she said.
For those who are concerned about ADHD, a trained clinical child psychologist, psychiatrist or pediatrician can begin the assessment process and develop a path toward determining a diagnosis, Bielski said.
How do physicians recognize ADHD?
ADHD is a clinical diagnosis, meaning children must meet certain criteria in order to be diagnosed with ADHD, Smith said.
“In general, you have to have two different places in your life where you have impairment, such as socially or academically, that’s due to your inattention or inattention with impulsivity,” he said.
While formal metrics helped mental health experts diagnose an individual with ADHD prior to the pandemic, a change in learning environment for many has impacted how those metrics are viewed today, he says.
“It is certainly the case where some kids would meet criteria now, but when the world goes back to normal, they wouldn’t fit the criteria,” Smith said.
On the other hand, some students may have been less likely to be diagnosed prior to the pandemic.
“A diagnosis doesn’t mean that it’s caused by the pandemic, but it’s rather revealed by the pandemic,” he said.
Now, he said, Smith takes into consideration several factors on an individual basis, from stress that families may be experiencing to support systems in place and sudden changes in behavior.
“You want to make sure there’s not a separate cause like anxiety or depression,” Smith said. “If they say they’re doing fine and all of a sudden they’re not, you worry that there is an acute change in the family. That’s part of the assessment — figuring out what the child has going on in his life.”
If parents are worried, Smith said he urges them to make an appointment with their pediatrician.
“Parent intuition is important, and they’re often right,” he said. “If they’re worried, I think they should trust themselves.”
Bielski said it’s also critical to acknowledge any frustration in children and validate a child’s emotions — an important tool in determining what could be causing a child to fall behind in school.
“Children appreciate and need honesty from the adults in their lives,” she said. “They typically feel more comfortable sharing their struggles if they feel listened to and validated.”
“Even adults are struggling to make sense of all this and finding it difficult to handle. Children can sense anxiety and stress in the family, which can add to the struggles they are already facing with ADHD.” — Dr. Radhika Chillarige