Prospective impact of COVID‐19 on mental health functioning in adolescents with and without ADHD: protective role of emotion regulation abilities

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Video abstract from Dr. Rosanna Breaux on her paper ‘Prospective impact of COVID‐19 on mental health functioning in adolescents with and without ADHD: protective role of emotion regulation abilities’.

Authors; Rosanna Breaux, Melissa R. Dvorsky, Nicholas P. Marsh, Cathrin D. Green, Annah R. Cash, Delshad M. Shroff, Natalie Buchen, Joshua M. Langberg, Stephen P. Becker

First published: 04 February 2021.  .


Rosanna Breaux
Rosanna Breaux

Dr. Breaux’s research focuses on the emotional, academic, and social functioning of children and adolescents, particularly those with ADHD, with a focus on emotion regulation. She is also interested in understanding the role parents play in shaping children and adolescent’s social-emotional development. She utilizes a multi-method of assessing emotional development and parenting behaviors. Additionally, Dr. Breaux is working to evaluate and disseminate the RELAX intervention, which targets emotion dysregulation and interpersonal conflict. Image and bio via Virginia Tech


Hello, my name is Rosanna Breaux and recently my colleagues and I published an article in the journal Child Psychology and Psychiatry entitled Prospective Impact of Covid-19 on Mental Health Functioning in Adolescents with and without ADHD, the protective role of emotion regulation abilities. Today I’m going to walk you through our study and our findings. In this study we utilised a sample of adolescents, approximately half of whom were comprehensively diagnosed with ADHD, who we had been originally following pre-Covid with five pre-Covid time-points with that last time-point ending in February 2020 right before the onset of the Covid-19 pandemic in the United States.

We fortunately had asked for consent for families who were interested in being contacted should we conduct a follow-up for that original longitudinal study, and so we’re able to contact those families early in the onset of the pandemic, around April 2020, to see if they were interested in participating in our Covid-19 follow-up. So this study was specifically looking at pre-Covid mental health that last time, right before the onset of the covid-19 pandemic, and with two covid-19 time- points. One conducted in spring 2020 during stay at home orders or when lockdown orders were in place, and one in summer 2020 after those lockdown orders had largely been lifted, and what we were looking at was both parent and adolescent report of adolescence mental health functioning.

Specifically, we looked at adolescents self-report of their internalising symptoms, things like anxiety, depression, as well as sluggish cognitive tempo and looked at parent report of the more externalising symptoms, things like ADHD symptoms, of hyperactivity and impulsivity as well as inattention, and also looked at parent report of oppositionality and defiance.

And what we found, not surprisingly, was that from pre-Covid to that spring 2020 stay at home order time -point, we saw significant elevations in both internalising and externalising symptoms. In fact, there was an increase in every aspect of mental health function that we looked at besides hyperactivity, impulsivity from pre-Covid to spring 2020. Fortunately, however, we also found that those rates significantly decreased for all mental health functioning symptoms, except for inattention from spring to summer 2020.

Meaning that even though we saw this initial increase on the onset of the pandemic during the stay at home orders, that there’s a recent, early preliminary evidence that perhaps these symptoms were only short -term elevation’s during lockdown but then improved once the lockdown orders were lifted in summer. However, what this paper also adds is the focus on are there certain aspects that we can intervene and target to try to help improve mental health functioning, and we looked specifically at emotion regulation abilities.

Now, emotion regulation is a person’s ability to manage and adapt their behavioural and emotional response to fit with the magnitude of the situation. So all of us, you know, of course, were experiencing some anxiety, some sadness during the pandemic, but some people are better able to manage and deal with that. Whereas others may have a harder time and really kind of get stuck in those negative thinking patterns or engage in problematic behaviours to try to cope with those negative emotions.

And so that’s what we were looking at, was whether pre-Covid emotion regulation abilities predicted mental health functioning during the pandemic, and what we found was that adolescents who had poor pre-Covid emotion regulation abilities were at increased risk for both those internalising, anxiety, depression and sluggish cognitive tempo, as well as externalising symptoms, hyperactivity, impulsivity, inattention, as well as oppositionality and defiance, and we also found what we would call additive risk between ADHD status and emotion regulation abilities, such that the adolescents with ADHD who also had poor pre-Covid emotion regulation abilities were at the greatest risk for the higher levels of externalising symptoms.

Again, this includes things like inattention and hyperactivity/ impulsivity. So even among adolescents with ADHD, those who had poor emotion regulation pre-Covid were doing worse in terms of externalising mental health functioning relative to adolescents with ADHD who had better emotional regulation abilities. So what these findings really suggest is the importance of teaching, coping and emotion regulation skills to adolescents to help them better cope in times of chronic stress like the covid-19 pandemic.

Fortunately, there’s lots of brief interventions that are possible, including via tele-health which is important during the ongoing pandemic to help equip adolescents with these skills. It is important to note, however, that since these data were only collected in the early stages of the pandemic, spring and summer 2020, it’s important for us to continue looking to see changes in mental health functioning as the pandemic has gone on and whether this early promising findings of improvements in summer 2020 was simply a result of school being out of session for these adolescents. The decreased rates in the country in terms of Covid infection during the summer relative to spring and fall 2020 or a mix of lots of factors.

So encouragingly, at least with this sample, we do have two additional Covid timelines that we’ve now been able to collect in fall 2020, as well as one that we just finished collecting in spring of 2021. So we can look to see how mental health functioning has changed over the course of a year during the pandemic.

Thank you so much for listening and I just want to take a moment to thank my colleagues who are part of this study, particularly Stephen Becker at Cincinnati Children’s Hospital, as well as Melissa Dvorsky who’s at Children’s National Hospital in George Washington University, and Josh Langberg who’s at Virginia Commonwealth University.

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