According to a study published in the Journal of Clinical Sleep Medicine, lockdowns due to the COVID-19 pandemic have exacerbated the maladaptive sleep-wake cycle and increased screen time exposure of many Italian children with attention deficit hyperactivity disorder (ADHD).
Previous studies showed changes in sleep patterns and increased screen load for the general population during lockdown restrictions. The study researchers specifically looked at the effects on children with ADHD, who often cannot tolerate enforced restrictions and may be at higher risk for unhealthy changes.
Parents of children and adolescents with ADHD conducted an anonymous survey in June 2020 on the effects of lockdown on their children’s sleep patterns and disorders, as well as on social media use and daily screen load, excluding hours spent attending online lessons were. Questions for the survey came from the Childhood Sleep Disorder Scale.
The survey responses represented 528 children (boys, 441; girls; 87; age range 5 to 11.11 years; mean age 9.1 years, standard deviation [SD]1.63 years) and 464 adolescents (boys 406; girls 58; age group 12 to 17.1 years; mean age 14.3 years, SD: 1.92 years).
Bedtime was delayed in 59.3% of the children and 69.4% of the teenagers, but 4 teenagers had earlier bedtime and the rest of the group kept their bedtime. Bedtime of 11 p.m. or later increased for children (12 before lockdown to 177 during) and adolescents (71 to 279 during).
The duration of sleep decreased in 19.9% of the children and increased in 21.4% of the children. Among the adolescents, 22% had shortened the duration of sleep, while 27.4% had lengthened the duration of sleep.
Bedtime delays and reduced sleep duration were associated with increased screen time exposure. The study researchers found that 64.2% of children and 72% of teenagers spent half or most of the time or day in front of a screen. Children watched more TV, while adolescents spent more time on the Internet and cell phones.
Parents reported that children had increased levels of nightmares, bed anxiety, and bruxism, and that adolescents were more drowsy during the day.
A delay in bedtime compared to maintaining bedtime was associated with daytime sleepiness in children (60/313) [19.2%] vs 26/215 [12.1%];; χ² = 4.681; P = 0.031) and adolescents (113/322) [35.1%] vs 27/138 [19.6%];; χ² = 15,934; P <0.001). A shorter sleep duration was also associated with increased daytime sleepiness in children (29/105) [27.6%] vs 39/310 [12.6%], respectively; χ² = 1.066; P = 0.004) and adolescents (44/102) [43.1%] vs 48/235 [20.4%], respectively; χ² = 15.934; P <0.001) compared to those who had the same length of sleep. Adolescents who increased their sleep duration were also more drowsy during the day than those who kept it up.
The limitations of the study did not include a specific assessment of the influence of psychiatric comorbidity and possible memory impairment in the parents.
The association between longer sleep and the increase in daytime sleepiness in adolescents was “alarming” because in Italy “regular school activities for adolescents have been interrupted and the persistence of this condition could be a risk factor for stabilizing sleep disorders. Screen addiction,” the authors concluded the study. They added that assessing whether ADHD patients experience “long-term disrupted sleeping habits” will be a significant challenge after the pandemic.
Bruni O., Giallonardo M., Sacco R., Ferri R., Melegari MG. The Effects of Lockdown on Sleep Patterns in Children and Adolescents with ADHD. J Clin Sleep Med. Published online April 1, 2021. doi: 10.5664 / jcsm.9296