As the COVID-19 pandemic continues to spread, many schools have opted to function completely online or in a hybrid format, with some days of in-person learning and the rest online. This format is new to most schools, parents and children. This new way of educating children is daunting enough for parents, but especially challenging for parents of children with attention-deficit/hyperactivity disorder (ADHD).

Now, children must face an extended period of no socialization with their friends and peers, canceled sports, clubs and other activities, and being stuck at home for months without any assurance of a date that they can get back to “normal.” They may be having to face a new normal that looks different than the comfort of their past routines, except that no vision of what this new normal will be is available.

Impact of COVID-19 on Children’s Lives

Having our regular routine disrupted unsettles all of us. Anxiety, mood, ability to learn and more are all affected. When a scary pandemic is the cause, our emotional and mental reactions are even more heightened. Frustration and confusion are common. Just having the news on can cause anxiety in an adult, but for children, it may cause even more confusion and fear. 

Take care of your family and your community. Stopping the spread of COVID-19 is the bottom line. Follow whatever guidelines are being made, from reputable sources like the American Academy of Pediatrics and the Centers for Disease Control and Prevention (CDC). In those areas of COVID-19 “hot spots,” stay home if you can and keep your children at home unless necessary to leave. If you have to go out, wear a mask, be sure your children properly wear a mask, and stay at least six feet away from other people. For most kids, unfortunately, that means not getting together in person with friends for now as well as canceled sports, clubs and other social activities.

Challenges of Uncertainty for Children, Especially Children with ADHD

Children mentally process things differently than adults. Uncertainty is abstract for kids. Be realistic but also reassuring about the pandemic and how it personally affects them and your family. Encourage discussion often and questions. Children often need straightforward answers to their questions first. Avoid oversharing and flooding with facts. Then wait and see what further questions your responses elicit. Answer those in the same way—brief and to the point, honest, and reassuring.

Using Mindfulness to Normalize Mood

Though you can’t change the pandemic and school situation, you can work on keeping your children mentally settled. Trying mindfulness may help normalize their daily lives. Mindfulness builds resilience during stressful and difficult times by giving deliberate attention to how we relate to what is happening in our lives each moment. 

The level to which you can employ mindfulness with children depends on age. Teenagers are likely to be able to fully grasp the concept and practice on their own. Younger children may need more planting of seeds of mindfulness, where you normalize the experience of awareness. Then the practice of mindfulness grows over time. 

If your child is receptive to the idea, set aside a few minutes a day to start for a mindfulness practice. Don’t force it as this may make your child resist the idea completely. Find a guided practice online if needed, or a book or app. Make it a family activity and schedule mindfulness “breaks” during the day and evening.

For kids (and parents), focus on keeping mood or emotions close to neutral. Think of mood on a scale of one to 10. A settled, calm, “normalized” mood is a five. You and your child will slide a bit over and a bit under and that’s normal. What you want to avoid is a huge swing one way or the other, closer or at a one or a 10. Big swings can lead to heightened emotions and distraction.

There is nothing you need to expect to happen. The purpose is to gently guide children back to their present awareness when they get distracted. Keep mindfulness breaks unforced and fun, and let the practice develop at its own pace. 

Schedule, Schedule, Schedule

Create structure and routine. Both adults and children are happier with a daily schedule. For families, post it somewhere for everyone to see, whether on a piece of paper or using an online family calendar. Posting a hard copy will be easier for younger children who do not have access to an online calendar or know how to use one.

1. Exercise. Our mental health is connected to our physical routines. Exercise daily, even if your children complain. Regular exercise has a positive outcome on mood, energy level, learning and more. 
2. Sleep. A consistent routine of wake up and bedtimes encourages better sleep.
3. Eat healthy. Don’t use food as bribes or to keep kids happy. Stick with a balanced diet. 
4. Limit screen time. The more screen time kids have the more wound up and agitated children get. No limits lead to arguing with you over putting a device away. Set a total amount of time or a set time period during the day and stick to it. 
5. Keep up with relationships. One place screen time is very useful and helpful is in sustaining relationships with friends and family. Support is there for you and children when you reach out regularly during this challenging time.
6. Create a chore schedule to keep to reduce the stress of a messy home, keep a routine and teach responsibility.
7. Schedule and prioritize everything else if you wish, like family time, outdoor time, hobbies, art, etc.

Adjusting to Virtual School 

Almost all kids can get off-track or miss details without strong adult supervision and guidance. Expect your child will need additional home supervision and guidance while working online. The success of online learning in previously in-person learning environments is unknown, and some to many teachers have little experience in this area. There will be a learning curve for students, parents and teachers. Try not to form preconceived ideas of how much progress will be made during this initial learning curve. 

If your child has ADHD, remember he or she has difficulty with self-management and lag behind the non-ADHD norm. Children with ADHD need more structure and direct involvement than their peers to complete online work. Inform your child’s teacher and work with your child’s teachers and administrators and counselors to keep an open line of communication. Your child may have an Individual Education Plan (IEP). Contact the school to see how this will impact your child with online learning. Ask for support early and often, and if your child is still struggling, ask your school’s counselor or administrator for advice on what to try next or additional resources.

Your school will likely send out a supply list. If you don’t receive one, ask the teacher. Even though they are learning at home, your child will need many items for the virtual learning to support his or her learning and classroom lessons.

Find out what virtual classroom platform your school will be using. Get comfortable with using it so you can help your child when needed. If your school is not offering tutorials and your child needs one, you can find many online. Many schools are using Zoom, which can record class sessions for students who are unable to attend due to family obligations or other scheduling conflicts or who wish or need to review the material again at a later time.

Ideally, students should have access to learning anytime, anywhere. Teachers of younger students may also work with families to determine the specific needs of their children, including built-in time for completing assignments away from the computer that may differ from what is given in the daily schedules.

Synchronous and Asynchronous Learning

Synchronous learning takes place in real-time with a group and the teacher either live in person or live via videoconferencing, such as Zoom meetings.

Positives:

• Frequent live interaction with teachers and peers
• Questions can be answered quickly
• Feedback is immediate
• Closest format achievable in a virtual setting to replicate in-person learning

Challenges:

• Less flexible schedule; students need to be online at specific times to learn
• Feedback given in a large group setting may not be specific to each child

Asynchronous learning is anytime, anywhere learning that provides students with structured and engaging independent practice and possibly pre-recorded lessons. Examples include independent reading, video lessons, online assignments and discussion boards.

Positives:

• Students choose the time and place that they learn
• Students have more time to review and reflect on their learning
• Students can follow the learning pathway in whatever way meets their personal learning needs
• Many traditional learning strategies such as group discussions, individual student conferences and assessments are accessible in an online format 

Challenges:

• Students need a degree of self-motivation or adult support to stay on task
• Presents additional challenges for ADHD children and their parents
• Lack of live interaction with others

Setting up Your Home School Environment

• Set aside a time for school. This may be dictated by your school except for offline learning activities (asynchronous learning), which you will have to schedule.
• Create a dedicated school work area for your child with a minimum of distraction. Take away phones, turn off TVs and music and shut down anything else that is distracting. 
• At the start of the day, check school assignments posted online. Make a to-do list from it. Play time must wait until that list is complete.
• Supervise schoolwork. You are a parent, not a teacher, but most kids need an adult around to stay efficient. Kids have immature self-management skills by definition and ADHD kids have even less self-management skills and computers are distracting to even adults.
• Use timers if necessary. Children may find it easier to focus and behave if they know when a break is due. If not already defined by the teacher, define for your child what he or she is to do at the start of each work period. For example, for the next 20 minutes, do only this math sheet. Make the timer visible to them.
• End each school day by having your child clean and organize his or her work space, just as it would be in school. 
• Emphasize “recess” daily. Remember the benefits of exercise, as this will help your child learn.
• Encourage reading to promote academic success. Read with your kids and have them read alone. They can even read aloud to pets. Schedule it each day. 
• Limit non-school screen time, as mentioned earlier.

For middle school and high school students:

• Focus on behavior management instead of “brain breaks.” When it comes to middle and high schoolers with ADHD, they need help sustaining their motivation and attention versus preventing learning burnout (which is where “brain breaks” come into play in the classroom or live online environment). Getting these students engaged to start with may be the most challenging aspect at home.
• Choose the best time and place to remove distractions from their environment. Though having a dedicated work space is very helpful, a change of scenery may be useful if they are having trouble staying focused. If it’s nice outside, perhaps a school day outside in fresh air is an option.
• Allow teens to use electronics (usually their phone) for fun only if they have completed all of their academic tasks for the day. Parents will need to develop a strategy of how they can monitor student performance consistently. Some schools have academic parent “portals” and even text and email reminders of assignments that are due, what is outstanding, what has been turned in and grades. Check if your school uses this extremely helpful tool and sign up.
• Help your teens plan out their work in advance and use time management strategies. 
• Dividing their work into smaller chunks is helpful while being sure they are aware of expectations. Then monitor whether it’s completed.
• Recognize and praise your teens for staying on-task and getting work done. 
• Refrain from micromanaging or taking over for them. This behavior is tempting for many parents, especially when they become impatient and have their own work to get done. 
• Do not give in to attempts to get out of work.

This school year is going to be challenging for everyone, with extra challenges for children with ADHD and their parents. The ADHD, Mood & Behavior Center is always available to help you, whether providing resources or visits with an online psychiatrist or online therapist. Contact us with questions and concerns or to make an appointment.

Life has drastically changed for all of us as a result of the outbreak of coronavirus disease 2019 (COVID-19). At times, all of these changes can result in overwhelming feelings of fear, anxiety, sadness, and also grief. Many of us have experienced many losses over these past four weeks – from the loss of our ability to see our loved ones whenever we wish and the loss of seeing our co-workers in person, to the loss of jobs and the loss of loved ones. Some of us are struggling with the fear of having to go to work at grocery stores, pharmacies, gas stations, hospitals, banks, post offices, etc etc. Those of us who are not essential workers might be struggling with feelings of guilt – of feeling like we’re not doing enough. For parents working from home, it can also be very difficult having to balance your own work responsibilities with your child’s/children’s teaching responsibilities. IT’S A LOT. We, at the ADHD, Mood, & Behavior Center, would like to provide our patients, and anyone else looking for some guidance at this difficult time, with some tips on how to cope with these feelings and how to differentiate between a normal stress response and a response that may require professional help. We are currently offering video appointments with our psychiatrists and therapists for our current patients, as well as anyone else who is looking to initiate care at this time. Please do not hesitate to reach out for help if you need it.

Ways for adults to cope:
• Make sure to take breaks from COVID-19 related news stories or social media stories.
• Try to maintain a daily schedule if your day is now significantly less structured. Have a consistent bedtime and waking time. Have well-balanced and regularly scheduled meals. Exercise regularly.
• Make time to relax and engage in activities you enjoy. Try to get some fresh air when you can, while maintaining social distancing practices.
• Try to maintain social connections using video chats and phone calls. There are many apps now that allow you to have group video chats with friends and family.
• Take space when you feel you need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take breaks and get space when we need it.
• Avoid unhelpful coping strategies, like substance use and high-risk behaviors.
• Seek out help from a professional if you are struggling.

Ways for parents to help their children cope:
• Limit the amount of television or news children watch as the news can be frightening and disturbing to them. Instead, find accurate and age-appropriate information and have an honest discussion with them using language they can understand. Answer any of their questions honestly.
• Try to maintain a regular routine, as children feel more secure when there is structure to their day.
• Help facilitate video chats and/or phone calls with their friends and family.
• Make sure children get some fresh air whenever they can, while maintaining social distancing practices. Try to implement some sort of daily physical activity.
• It can be very difficult for children to be stuck inside, especially when the weather is beginning to get nicer. Try to come up with fun activities for the family to engage in. Have game nights. Have children help in meal preparation or menu planning. Encourage them to learn a new skill. There are many free online classes available now.
• Give children choices when possible, as this will give them a sense of control during a time when there is little they can control.
• Give them space when they need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take a break and get space when we need it.

Common stress responses in adults:
• Changes in sleep or eating patterns
• Difficulty concentrating
• Changes in energy levels
• Avoidance of activities previously enjoyed

Common stress responses in children and teens:
• Excessive crying, irritability, or acting out
• Regressive behaviors or returning to behaviors they have outgrown such as bedwetting
• Changes in sleep or eating habits
• Poor school performance or avoidance of school related tasks
• Difficulty concentrating
• Avoidance of activities previously enjoyed

When to seek out help:
• If any of these responses persist for longer than 1-2 weeks and/or start to get in the way of an individual’s function, it is likely time to seek out professional help from a psychiatrist or therapist.
• If you or your child becomes preoccupied with or has intrusive thoughts or worries surrounding COVID-19 or death.