COVID-19 and Continuity of Care in ADHD

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COVID-19 and Continuity of Care in ADHD
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Studies have shown that approximately 50% of children with ADHD show some level of motor impairment1,2

Studies have shown that over 50% of children with ADHD show some level of motor impairment1,2

Executive function contributes flexibility and fluency to motor control. Therefore children with attention-deficit/hyperactivity disorder (ADHD) who have deficiencies in executive function may lack the ability to appropriately modulate motor responses.3

  • An “overflow” of gross motor movement is often seen in ADHD, making children with the condition more vulnerable to accident and injury3,4

Motor speed and dynamic balance (which is involved in activities such as jumping) are generally affected in children with ADHD, as is fine motor coordination.2

Sequencing of simple motor movements into complex patterns and arrangements is frequently difficult for pediatric patients with ADHD.3 The manual dexterity involved in handwriting in particular is impacted, with ~60% of children with ADHD exhibiting poorer handwriting than non-ADHD peers.1

  • Children with more severe hyperactive symptoms tend to have poorer visual-spatial skills, which correlate with difficulties in written ability1

  • Handwriting may be labeled as “messy” or “careless” by teachers or parents, leading to issues with self-confidence1

Deficits in motor skills have been shown to improve with pharmacologic treatment of ADHD, even normalizing in those with mild symptoms.2

Tic disorders and Tourette syndrome are more common in children with ADHD

Tic disorders and Tourette syndrome occur in up to 30% of pediatric patients with ADHD.5 The presence of tic disorders makes the treatment plan for children with ADHD more complex. Prolonged observation may be needed to differentiate “fidgeting” seen in ADHD from bouts of multiple tics.6

  • Although stimulants are often considered first-line treatment in ADHD, they may be contraindicated in patients with tic disorders/Tourette syndrome7
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References: 1. Racine MB, Majnemer A, Shevell M, Snider L. Handwriting performance in children with attention deficit hyperactivity disorder (ADHD). J Child Neurol. 2008;23(4):399-406. 2. Kaiser M-L, Schoemaker MM, Albaret J-M, Geuze RH. What is the evidence of impaired motor skills and motor control among children with attention deficit hyperactivity disorder (ADHD)? Systematic review of the literature. Res Devel Disabilities. 2015;36:338-357. 3. Barkley RA. Behavioral inhibition, sustained attention, and executive functions: constructing a unifying theory of ADHD. Psychol Bull. 1997;121(1):65-94. 4. Barkley RA, Fischer M. The Milwaukee longitudinal study of hyperactive (ADHD) children. In: Hechtman L, ed. Attention Deficit Hyperactivity Disorder: Adult Outcome and Its Predictors. New York, NY: Oxford University Press; 2016:63-104. 5. Jensen CM, Steinhausen H-C. Comorbid mental disorders in children and adolescents with attention-deficit/hyperactivity disorder in a large nationwide study. Atten Defic Hyperact Disord. 2015;7(1):27-38. 6. American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Washington, DC: American Psychiatric Publishing Inc; 2013. 7. Clemow DB, Bushe C, Mancini M, Ossipov MH, Upadhyaya H. A review of the efficacy of atomoxetine in the treatment of attention-deficit hyperactivity disorder in children and adult patients with common comorbidities. Neuropsychiatr Dis Treat. 2017;13:357-371.