November 19, 2024

Patterns of Child and Adolescent Psychiatric Admissions During COVID-19: Key Insights from Clinical Data

A recent study from Istanbul sheds light on how psychiatric admissions and diagnoses changed during the first few months of the pandemic compared to previous periods, offering critical insights for parents, clinicians, and policymakers. 

This study, conducted by a team of researchers led by Ozalp Ekinci, examined psychiatric admissions among children and adolescents during 2019 and 2020. 

By looking at diagnosis rates for various psychiatric conditions, the researchers aimed to pinpoint shifts in the mental health landscape as a direct response to the pandemic.

Findings: A Closer Look at Diagnosis Patterns

The analysis revealed several notable trends in psychiatric diagnoses among children and adolescents:

  1. Autism Spectrum Disorder (ASD): ASD diagnoses were notably higher in the early pandemic phase (6.4% in Group A) compared to the same period in the previous year (3.6%). This increase could reflect heightened stress or changes in routines that may have exacerbated underlying symptoms, leading to more frequent clinical presentations.
  2. Obsessive-Compulsive Disorder (OCD) and Tic Disorders: OCD and tic disorder diagnoses also saw a rise, increasing from 1.7% in 2019 to 2.9% during the pandemic’s onset. It’s possible that pandemic-driven anxieties and hygiene concerns, as well as disruptions to typical routines, may have worsened symptoms in those predisposed to OCD and similar disorders.
  3. Intellectual Disability (ID): Diagnoses for ID rose from 2.1% (Group C) to 3.7% (Group A). This increase highlights the challenges faced by children with developmental and intellectual disabilities, who may have experienced heightened difficulty adapting to the many changes imposed by the pandemic.
  4. Attention-Deficit Hyperactivity Disorder (ADHD): ADHD diagnoses were significantly higher in the pandemic phase (59.8% for Group A vs. 49.7% for Group B). With altered school structures, remote learning, and restricted socialization, ADHD symptoms could have been amplified, making it harder for children to concentrate and adhere to routines.
  5. Depression: Depression diagnoses also saw a rise (4.1% in Group A vs. 2.2% in Group C). Isolation, disruption of daily activities, and reduced social interactions likely contributed to increased depressive symptoms, particularly in adolescents who rely heavily on peer support.
  6. Conduct Disorder (CD): Interestingly, CD diagnoses were lower during the pandemic phase compared to pre-pandemic levels (3.6% in Group A vs. 6.4% in Group B). The reduction in face-to-face interactions and less exposure to traditional school settings may have lessened some of the typical triggers associated with conduct-related issues.
Implications

This study’s findings highlight some key takeaways that can guide mental health support efforts for children and adolescents:

  1. Increased Need for Early Support in Neurodevelopmental Disorders: The rise in ASD and ADHD diagnoses points to the need for specialized support in times of crisis, particularly for children who depend on routine and structure. Families and educators should work to create consistent environments that help manage symptoms.
  2. Addressing Pandemic-Induced Anxiety: With heightened cases of OCD and tic disorders, it’s clear that the pandemic’s emphasis on cleanliness and health may have intensified anxiety-driven behaviors. Future mental health responses should include strategies to manage health-related fears and equip children with coping skills.
  3. Supporting Emotional Resilience in Adolescents: Depression was notably higher among young people during the pandemic onset, suggesting a critical need for access to counseling and peer support, especially in times of isolation. Developing robust virtual mental health resources and promoting mental well-being in schools can help support children and adolescents both in and out of school.
  4. Recognizing the Complexity of Behavioral Changes: The drop in conduct disorder diagnoses during the pandemic suggests a link between behavioral disorders and social settings. Understanding these dynamics could lead to more tailored interventions that account for environmental factors impacting behavior.
Conclusion: 

As we continue to see the effects of the COVID-19 pandemic on mental health, studies like this one serve as important reminders of the unique mental health needs of young people. Supporting children and adolescents through proactive and targeted mental health services—especially during times of crisis—will be crucial to fostering resilience and well-being in future generations.

Ekinci O, Adak I, Suzer Gamli I, Orekici Temel G, Taylan G, Ece Toksoy Z, Kocabas S, Boztepe C, Karakoc S, Karakus OB. Patterns of Child and Adolescent Psychiatric Admissions Before and After the Onset of the COVID-19 Pandemic: Take Home Messages from a Clinical Population. Psychiatry Clin Psychopharmacol. 2024 Sep 1;34(3):245-251. doi: 10.5152/pcp.2024.23811. PMID: 39464688; PMCID: PMC11500439.

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Meta-analysis Finds Association Between Childhood Febrile Seizures and Subsequent ADHD

Febrile seizure (FS) is a type of childhood seizure accompanied by a fever. It is not caused by infection in the central nervous system or other triggers of acute seizures. It is the most common form of childhood seizure, with an occurrence of 2% to 5% in all infants and children between 6 months and 5 years old. 

Noting that “To the best of our knowledge, no systematic synthesis of literature has assessed the nature and magnitude of the association between FS and ADHD,” a Korean research team performed a systematic search of the medical literature followed by meta-analysis to explore any such association. 

Meta-analysis of twelve studies with a combined total of more than 950,000 persons found that childhood febrile seizures were associated with 90% greater odds of subsequent ADHD. Correcting for publication bias reduced this slightly to 80% greater odds of subsequent ADHD. 

Limiting the meta-analysis to the subset of four studies with over 33,000 participants that adjusted for known confounders strengthened the association. Children who had febrile seizures had greater than 2.6-fold greater odds of subsequently developing ADHD. There was no sign of publication bias, but there was substantial divergence in individual study outcomes (heterogeneity). 

Further limiting the meta-analysis to two studies with a combined 654 participants in which clinical ADHD diagnoses were made by specialists – the gold standard – produced the exact same outcome. In this case, heterogeneity dropped to zero. 

The team concluded, “Overall, our systematic review and meta-analysis has shown a significant positive association between childhood FS and later occurrence of ADHD. Our findings add to the growing body of evidence questioning the notion that childhood FS are universally benign. In addition, the results highlight the need for longitudinal studies to better understand the association between FS and ADHD.”  

August 26, 2025

Meta-analysis Finds Little Evidence in Support of Game-based Digital Interventions for ADHD

ADHD treatment usually involves a combination of medication and behavioral therapy. However, medication can cause side effects, adherence problems, and resistance from patients or caregivers. 

Numerous systematic reviews and meta-analyses have evaluated the effects of non-pharmacological interventions on ADHD. With little research specifically examining game-based interventions for children and adolescents with ADHD or conducting meta-analyses to quantify their treatment effectiveness, a Korean study team performed a systematic search of the peer-reviewed medical literature to do just that.  

The Study: 

To be included, studies had to be randomized controlled trials (RCTs) that involved children and adolescents diagnosed with ADHD. The team excluded RCTs that included participants with psychiatric conditions other than ADHD.  

Eight studies met these standards. Four had a high risk of bias.  

Meta-analysis of four RCTs with a combined total of 481 participants reported no significant improvements in either working memory or inhibition from game-based digital interventions relative to controls. 

Likewise, meta-analysis of three RCTs encompassing 160 children and adolescents found no significant improvement in shifting tasks relative to controls. 

And meta-analysis of two RCTs combining 131 participants reported no significant gains in initiating, planning, organizing, and monitoring abilities, nor in emotional control

The only positive results were from two RCTs with only 90 total participants that indicated some improvement in visuospatial short-term memory and visuospatial working memory.  

There was no indication of effect size, because the team used mean differences instead of standardized mean differences.  

Conclusion:

The team concluded, “The meta-analysis revealed that game-based interventions significantly improved cognitive functions: (a) visuospatial short-term memory … and (b) visuospatial working memory … However, effects on behavioral aspects such as inhibition and monitoring … were not statistically significant, suggesting limited behavioral improvement following the interventions.” 

Simply put, the current evidence does not support the effectiveness of game-based interventions in improving behavioral symptoms of ADHD in children and adolescents. The only positive results were from two studies with a small combined sample size, which does not qualify as a genuine meta-analysis. All the other meta-analyses performed with larger sample sizes reported no benefits. 

Understanding Teen Health and Well-being in ADHD: A Fresh Perspective from the CDC

Recent research from the Centers for Disease Control and Prevention (CDC) highlights distinct health and social-emotional challenges faced by teens diagnosed with Attention-Deficit/Hyperactivity Disorder (ADHD). This study, published in the Journal of Developmental and Behavioral Pediatrics, offers critical insights directly from the teens themselves, providing a unique view often missed when relying solely on parent or clinical reports. 

Researchers analyzed nationally representative data from July 2021 through December 2022, comparing self-reported experiences of teens aged 12 to 17 with and without ADHD. Approximately 10% of teenagers had an ADHD diagnosis, and the findings reveal specific areas where teens with ADHD face notable difficulties. 

Teenagers with ADHD reported significantly higher rates of bullying victimization and struggles in making friends compared to their peers. Surprisingly, they were less likely to report a lack of peer support, suggesting complexities in how they perceive friendships and social networks. The study underscores the importance of directly engaging teens in assessing their social relationships, rather than solely relying on parental perspectives. 

Sleep difficulties emerged as another critical issue for teens with ADHD. About 80% reported problems like difficulty waking up and irregular wake times, markedly higher than their non-ADHD counterparts. Such disruptions can exacerbate attention difficulties and emotional regulation issues, further complicating daily life for these teens. 

Excessive screen time also stood out, with nearly two-thirds of teens with ADHD spending over four hours daily on screens, excluding schoolwork. This high screen usage is concerning, given its potential negative impact on physical and mental health, including sleep quality and social interactions. 

Notably, the study found no significant differences in physical activity levels or concerns about weight between teens with and without ADHD. This finding contrasts with previous studies that have highlighted lower physical activity among children with ADHD, suggesting the need for continued research on how physical activity is measured and encouraged in this population. 

The study’s authors emphasize the importance of health promotion interventions tailored specifically for teens with ADHD. By directly engaging teens and considering their unique perspectives, interventions can better address social-emotional well-being and healthy lifestyle behaviors, ultimately improving long-term outcomes for this vulnerable group. 

Overall, this research provides compelling evidence for healthcare providers, educators, and families to focus on supporting teens with ADHD in areas of social skills, sleep hygiene, and healthy screen time habits. Such targeted support can significantly enhance the quality of life and health outcomes for adolescents navigating the challenges of ADHD.