Smartphone and internet overuse and worsened psychopathologies in children with attention‐deficit/hyperactivity disorder during the COVID‐19 pandemic

Dear Editor,

Maintaining social distance and avoiding crowded places have been recommended to prevent the spread of coronavirus disease 2019 (COVID-19).¹ With proactive containment efforts and comprehensive contact tracing, only 88 domestic COVID-19 cases were reported in Taiwan before May 2021; the number of confirmed cases was lower in Taiwan than in other countries with widespread outbreaks. Therefore, schools were not closed in Taiwan before May 2021. However, the fear of contracting COVID-19 was prevalent among the public. Many parents asked children to reduce outdoor activities and social interactions. Children may be naturally spending more time using smartphones and browsing the Internet to kill time and have fun during the COVID pandemic than before. Smartphones and the Internet can be used to cope with the psychological stress resulting from the outbreak.² Children with attention-deficit/hyperactivity disorder (ADHD) constitute a risk group in which Internet addiction should be prevented.³ Whether smartphone and Internet overuse (SIOU) is accompanied by the exacerbation of psychopathologies in children with ADHD during the COVID-19 pandemic warrants examination.

We invited the caregivers of children with ADHD to complete an online questionnaire by posting an advertisement for the study and a link to the online questionnaire on the Facebook and LINE (messaging app) groups of three representative associations for the caregivers of children with ADHD in Taiwan between October 13, 2020 and May 12, 2021.⁴ The caregivers were asked whether their child's level of smartphone and Internet use and the symptoms of inattention, hyperactivity, impulsivity, anger, opposition, depression, and anxiety differed before and during the pandemic. Each item was rated as 0 (improved), 1 (no change), 2 (mildly worsened), or 3 (significantly worsened). Respondents who rated 0 or 1 and 2 or 3 were classified as having no symptoms and SIOU or worsened symptoms, respectively. Demographics, adherence to medication for ADHD, and worsened psychopathologies were compared between children with and without SIOU by using χ² and t tests. Because of multiple comparisons, a two-tailed p value of <0.005 indicated statistical significance.

Data from 161 respondents were analyzed. Of all the caregivers, 30 (18.6%) reported that their child with ADHD had SIOU during the COVID-19 pandemic. Children with SIOU were more likely to have worsened inattention, impulsivity, anger, and anxiety compared with those without SIOU. No differences in demographics; adherence to medication for ADHD; and worsened hyperactivity, opposition, and depression were observed between those with and without SIOU (Table 1).

TABLE 1 Comparisons of demographics, adherence to medication for treating ADHD, and worsened psychopathologies between children with and without smartphone and internet overuse (N = 161).

[Table omitted. See PDF]

Abbreviations: ADHD, attention-deficit/hyperactivity disorder; SD, standard deviation.

Although the cross-sectional study design limited the possibility of determining the temporal relationship between SIOU and worsening psychopathologies, SIOU and worsening psychopathologies may be reciprocally caused. Children with ADHD may experience changes in their routine lives, worry about contracting COVID-19, and thus, have worsened ADHD and mood symptoms. SIOU may be a limited coping strategy that children could adopt during the COVID-19 pandemic. Alternatively, SIOU may exacerbate children's ADHD and mood symptoms by disturbing children's sleep hygiene, daily activities, and family interactions. Both SIOU and worsened psychopathologies might result from the shortage of social and medical support for children with ADHD and their caregivers during the COVID-19 pandemic.⁵

Adequate leisure activities and social interactions for children with ADHD are necessary to prevent SIOU during the pandemic. Prompt mental and social support for children with ADHD and their caregivers should be provided to prevent SIOU and worsened psychopathologies during the COVID-19 pandemic.

CONFLICT OF INTEREST

The authors declare no conflicts of interest.