Longitudinal patterns of attention-deficit/hyperactivity disorder children in Shanghai, China

This study aimed to assess dynamic changes in emotional and behavioral problems among children with Attention-Deficit/Hyperactivity Disorder (ADHD) in Shanghai, China. Using a longitudinal design, school-aged children with ADHD were enrolled and followed, with emotional and behavioral measures repeatedly assessed. Due to varying COVID-19 measures and changing epidemics, and no intervention was admitted, an event-based longitudinal design was adopted, using calendar time from the enrollment of the first participant. Data collection spanned various pandemic control stages, including the Shanghai lockdown (March 28-May 31, 2022). Emotional and behavioral trends were analyzed using a Generalized Additive Model to capture the nonlinear dynamics effectively. Overall, 1102 children with ADHD (mean: 9.2 ± 2.4 years, 83% boys) were enrolled. Emotional and behavioral issues fluctuated over time. Behavioral problems, including inattention, hyperactivity, and conduct issues, peaked around day 260 of isolation and then declined but resurged after the Shanghai lockdown. Emotional issues, such as anxiety and depression, showed a dual-peak pattern, with early pandemic rises and a second peak around day 400. Symptoms rebounded after lockdown and persisted for an extended period. Sub-analyses revealed that boys had higher scores in hyperactivity and oppositional defiance than girls, with no significant gender differences in emotional problems. ADHD-PI children had higher emotional problem scores, while ADHD-HI children exhibited more severe behavioral issues. This study highlights the substantial impact of prolonged COVID-19 measures on emotional and behavioral problems in ADHD children, particularly increased adaptive pressures post-lockdown. Phase-specific, individualized interventions are crucial to mitigate these challenges.