How COVID-19 impacted the physical activity of families with ADHD

July 19, 2023

The findings are based on interviews with children with ADHD and their caregivers, marking a continuation of research that relies on building trust with these families.

Reduced physical activity, worsening mental health and a negative feedback loop that formed as a result make up some of the unique impacts felt by families raising children with attention deficit hyperactivity disorder (ADHD) during the COVID-19 pandemic.

That’s according to a new study from Western University researchers, published earlier this year in Brain Sciences, that sought to identify how COVID-19 impacted physical activity participation among these families.

The findings are based on interviews with children with ADHD and their caregivers, which explored their level of physical activity before and during the pandemic, physical activity barriers stemming from the pandemic and how these potential changes affected their children.

Education Assistant Professor and Canada Research Chair in The Science of Learning Barbara Fenesi is the study’s senior author. Her latest works marks a continuation of research that relies on building trust with families raising children with ADHD.

“I am always astounded at the level of vulnerability the families we work with are willing to engage in,” Fenesi said.

“While I am confident that our research group emanates compassion, empathy, respect and care during our interview process, creating a safe space to share hard stories, the praise for the quality of conversations truly belongs to the caregivers and children.”

The research group includes Erica Seal, a student in Western Education’s Master's in Counselling Psychology program; Julie Vu, a graduate of Western Social Science’s Psychology undergraduate program and Alexis Winfield, a graduate of Western Education’s Master's in Counselling Psychology.

Decreased physical activity for most

As researchers expected, most caregivers and children reported a reduction in physical activity levels during the pandemic.

Social distancing mandates were the most common reason why, as caregivers said these requirements shut down extracurricular activities that would have otherwise kept their children active.

“Because of COVID, I’ve kind of shut myself down. I spend less time outside and I’ve been doing a bunch of art, playing video games and just staying inside,” reported one child.

“I miss my gym. I used to go three to four times a week because I had a personal trainer. Now I have nothing,” one caregiver told researchers.

Decreased motivation came in a close second for physical activity-reducing factors, followed by facility closures and a decrease in overall health.

The decrease in overall health also led to the further diminishment of physical activity, which is where researchers saw a negative feedback loop start to form.

One such example is a reported increase in poor sleep habits among children, which stemmed from an excess of energy at the end of the day due to a lack of physical activity. This is especially problematic, researchers said, as children with ADHD already experience sleep difficulties.

Increased aches and pains and unhealthy weight again among children, along with a decline in the mental health of caregivers, further undermined the ability of participants to take part in physical activity, as well as other health-promoting behaviours.

Other families bucked the trend and instead reported an increase in physical activity, aided by at-home workouts and less structured daily routines.

Some of these positive outcomes were driven by families with caregivers who were retired, freeing them up to engage in physical activity with their children, according to Fenesi.

“These results also point to the creative potential of human beings during times of scarcity,” Fenesi added.

“Many caregivers became more resourceful, using YouTube videos and at-home workouts to engage in more physical activity. Many also became more attuned to the offerings of the outdoors and engaged in more activity through walking, hiking and biking.”

New barriers and worsening mental health

“For my son, [physical activity] only happens if it’s social,” is a caregiver quote that sums up the most common challenge reported by families during this study, with social isolation ranking as the top barrier to physical activity participation.

Increased intrapersonal difficulties, both within caregivers and their children, were other common barriers. These difficulties consisted of decreased self-efficacy with regards to adapting to new ways of being physically active and increased mental health struggles leading to diminished physical activity and health-promoting behaviours. Caregivers also reported decreased energy levels due to mental fatigue.

Increased screen time in children and a decrease in available time for caregivers stemming from their mounting responsibilities hindered physical activity participation as well.

On top of mounting responsibilities, caregivers also reported limited daycare and babysitting options, as well as a diminished social network, leaving them few opportunities for rest and self-care.

Lastly, children lost a source of comfort when their routines were turned upside down. Caregivers said dysregulated routines led to poor focus, poor sleep, mood disturbances and an overall decreased quality of life for both them and their children.

“I want to get my old schedule back, so I’m not doing random things each day,” one child reported.

Supports that could’ve helped

When asked about what supports were needed to address the issues reported, most caregivers said they wanted community supports to teach them how to keep their children physically active at home. Some caregivers suggested having a virtual class led by a live coach or teacher.

Others wanted community programming tailored to families raising children with ADHD to help lift some of the mental burden caregivers carry.

“I really wish there was a group of similarly struggling people that could come together and talk about their experiences and they how cope,” one caregiver said.

There was also a common sense of hopelessness among caregivers, who felt no supports could help and that the pandemic was something they simply needed to get through.

On the other hand, some caregivers felt they were sufficiently supported and that their lack of physical activity stemmed from decreased motivation as they became overwhelmed in other areas of their lives. This answer, researchers said, “highlights how caregivers felt unable to move beyond the constraints imposed upon them by public policy and social distancing mandates.”

Recommendations and next steps

From the study, three key factors emerged that are important for supporting physical activity among children with ADHD and their caregivers:

  1. Fun and engaging physical activity is essential for children with ADHD.
  2. Routine is imperative to help children with ADHD manage their symptoms and afford their caregivers opportunities for physical activity.
  3. Providing opportunities for these families to socially interact with peers can reduce mental burden and boost the likelihood of being physically active.

Researchers recommend these factors serve as guiding principles for supportive programming that could be organized through community centres, libraries and schools.

As for future research, researchers say it would help to understand where on the ADHD spectrum child participants were positioned, in order to provide nuance when interpreting new results. ADHD diagnostic information should be gathered from caregivers as well to better understand how families with multigenerational diagnoses could be better supported.

Lastly, the scope of the research should be expanded to include participants from more diverse backgrounds. This would account for the intersectional stressors that impact marginalized groups.

In the meantime, Fenesi says researchers need to lend a voice to families with neurodiverse children to learn how communities can best support them during times of crises.

“For many of these families, our interviews were the first time they spoke candidly about the impact of the pandemic on their lives,” Fenesi said.

“In many ways, there was a yearning to be heard and to share their struggles in the hopes of offering insight for others in similar situations.”