Attention-deficit/hyperactivity disorder (ADHD) is one of the most common neuropsychiatric conditions. The pooled worldwide prevalence of ADHD is estimated to be approximately 5% in school-aged children, and impairing symptoms have persisted in adulthood in up to 65% of cases. The pooled estimated prevalence of ADHD in adults is approximately 2.5% [1]. ADHD is characterized by a persistent and impairing pattern of inattention and hyperactivity/impulsivity that causes significant impairment across many domains of mental health [2]. Along with these 3 main symptoms, people with ADHD also present with deficits in executive functions, behavior and emotion regulation, and motivation [3].

In December 2019, an outbreak of a novel coronavirus pneumonia occurred in Wuhan (Hubei, China), and subsequently attracted worldwide attention [4]. As a result, countries around the world introduced public health policies that have been commonly called a lockdown. These policies, which include individuals isolating at home and only allowing necessary movement, were indented to reduce the spread of the virus. The United Kingdom was put into lockdown on March 23, 2020.

As the lockdown progressed, concerns were raised about the effect of this lockdown on the mental health of individuals [5]. A general population survey administered by Ipsos MORI [6] has revealed widespread concerns about the impact of social isolation and social distancing on a person’s well-being, such as increased anxiety, depression, stress, and other negative feelings.

The mechanism behind the impact of the lockdown can be understood by considering the lockdown as an event that has created stressful life events in a person’s life. Stressful life events are described as discrete, quantifiable circumstances that can have a severe negative impact. A wealth of published evidence has shown that life event stressors are associated with the onset of depressive episodes and that there is a dose-response relationship between these stressors and depressive episodes [7]. Stressors are associated with severe initial depressive symptoms in both adult patients [8] in nonpatient community samples [9].

Stress is generally conceptualized as a negative cognitive-emotional state caused by an individual’s perception of difficulty in adjusting to or managing life events [10]. Studies have shown that adults with ADHD have elevated physiological stress responses and higher levels of self-reported subjective stress compared to nondiagnosed controls [11,12]. In fact, the levels of stress for adults diagnosed with ADHD appear elevated in the presence of a stressor and in anticipation of the stressor. In addition, a study has suggested that adults with ADHD have greater difficulty in recovering from elevated stress levels than adults without ADHD [12], indicating that persons with ADHD may also face challenges in recovering from stress.

Based on this context, we believe that adults with ADHD are disproportionately affected by the lockdown compared to other populations. We therefore administered a survey to a group of adults with ADHD to investigate the psychological effects of the COVID-19 imposed lockdown on this population, understand this population’s needs, and provide appropriate support.

We conducted a cross-sectional survey study. The convenience sample was derived from the caseload of the ADHD and Autism Service at South West Yorkshire Partnership NHS Foundation Trust. The ADHD and Autism Service provides input to approximately 1.2 million people in West Yorkshire, England, for people with ADHD and autism. The ADHD and Autism Service can only offer pharmacological interventions to people with ADHD aged >25 years. Therefore, only people aged <25 years were eligible for this study. Our survey was considered a service improvement activity because the results of the survey were to be used to identify people who were suitable for COVID-19–specific psychological intervention.

Our cohort consisted of 94 individuals with a preestablished diagnosis of ADHD (male: n=75; female: n=19) who were first contacted on May 18, 2020, for a period of 2 weeks over the telephone. After 3 unsuccessful attempts of making contact with an individual, the person was considered not-responding, and no further attempts were made. All individuals were receiving pharmacological treatment.

For the people who did respond to the telephone call, after the purpose of the well-being survey was explained using a predetermined script, the Patient Health Questionnaire-9 (PHQ-9) [13], Generalized Anxiety Disorder Scale-7 (GAD-7) [14], Brief Adjustment Scale-6 (BASE-6) [15], Perceived Stress Scale (PSS) [16], and Multidimensional Scale of Perceived Social Support (MSPSS) [17] were administered.

The PHQ-9 and GAD-7 use a scale of 0 (not at all) to 3 (nearly every day) to measure the severity of self-reported depression and anxiety, respectively, within the last two weeks. They have 9 and 7 questions, respectively. PHQ-9 scores ranging from 0 to 5 represent mild depression, 6-10 represent moderate depression, 11-15 represent moderately severe depression, and 16-20 represent severe depression. GAD-7 scores of ≤4 predict no anxiety, 5-9 predict mild anxiety, 10-14 predict moderate anxiety, and 15-21 predict severe anxiety.

The BASE-6 measures a person’s general psychological adjustment within the last week, with ratings between 1 (not at all) and 7 (extremely) given for each of the 6 questions.

The PSS consists of 10 items designed to assess the degree to which common life situations in the past month are deemed stressful, and responses are made using a 5-point scale (0=never, 4=very often). Individual scores on the PSS can range from 0 to 40, with higher scores indicating higher perceived stress. Scores ranging from 0 to 13 indicate low perceived stress, 14-26 indicate moderate perceived stress, and 27-40 indicate high perceived stress.

The MSPSS measures the perception of support from the following 3 sources: family, friends, and a significant other. The scale is comprised of 12 items on a 7-point Likert scale, with 4 items for each subscale. Higher scores reflect more perceived social support. Mean scores ranging from 1 to 2.9 indicate low perceived support, 3-5 indicate moderate perceived support, and 5.1-7 indicate high perceived support.

The results from these scales, along with demographic information, were recorded using Microsoft Excel. The results were then exported to IBM SPSS statistical software for analysis.

Of the 94 individuals eligible for the survey, 75 were male and 19 were female. The mean age of the total sample was 22.05 years (SD 1.837 years). Of these 94 individuals, 70 (74%; male: n=57; female: n=13) were excluded from this study, either because they could not be contacted or because they refused to take part in this study. Of these 70, 18 (26%; male: n=16; female: n=2) declined to take part in this study and 52 (74%; male: n=41; female: n=11) could not be contacted. In total, 24 patients (male: n=18, 75%; female: n=6, 25%) were included in this study. 

There was no significant difference in age between males who were excluded from this study (mean 22.26 years, SD 1.86 years) and included males (mean 21.94 years, SD 1.74 years; t₇₃=0.64; P=.53). There was also no significant difference in age between females who were excluded from this study (mean 21.62 years, SD 2.18 years) and included females (mean 21.17 years, SD 1.83 years; t₁₇=0.47; P=.65).

For the 24 included participants, there were no missing data. The scores from the scales were checked for normality using the Kolmogorov-Smirnov test. All scores had a normal distribution. The mean age of all included patients was 21.75 years (SD 1.85 years). Based on our survey results, the mean PSS score was 21.5 (SD 7), the mean MSPSS score was 5.55 (SD 0.89), the mean GAD-7 score was 4.84 (SD 1.46), the mean PHQ-9 score was 10.88 (SD 6.83), and the mean BASE-6 score was 17.13 (SD 9.56).

A Pearson correlation coefficient was computed to assess the relationship between the variables. We found a positive correlation between PSS scores and GAD-7 (r=.623; P=.01), PHQ-9 (r=.572; P=.03), and BASE-6 (r=.553; P=.05) scores; GAD-7 scores and PSS (r=.623; P=.01), PHQ-9 (r=.872; P<.001) BASE-6 (r=.778; P<.001) scores; and PHQ-9 scores and PSS (r=.572; P=.03), GAD-7 (r=.872; P<.001), BASE-6 (r=.696; P<.001) scores. All correlations were significant at the .01 level and all tests were 2-tailed. There was no correlation between age or MSPSS scores with any other variables (Figure 1).