{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,7,8]],"date-time":"2026-07-08T19:10:56Z","timestamp":1783537856154,"version":"3.55.0"},"reference-count":46,"publisher":"MDPI AG","issue":"21","license":[{"start":{"date-parts":[[2022,10,22]],"date-time":"2022-10-22T00:00:00Z","timestamp":1666396800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"funder":[{"DOI":"10.13039\/501100004663","name":"Ministry of Science and Technology, Taiwan","doi-asserted-by":"publisher","award":["MOST110-2635-B-182A-001"],"award-info":[{"award-number":["MOST110-2635-B-182A-001"]}],"id":[{"id":"10.13039\/501100004663","id-type":"DOI","asserted-by":"publisher"}]}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["IJERPH"],"abstract":"<jats:p>School closures during the COVID-19 pandemic have interfered with children\u2019s learning. The aim of this study was to investigate the difficulties in managing children\u2019s learning at home and attending afterschool learning programs and their related factors among caregivers of children with attention-deficit\/hyperactivity disorder (ADHD) during the COVID-19 pandemic. In total, 252 caregivers of children with ADHD completed a questionnaire collecting difficulties in managing children\u2019s learning, parenting styles, children\u2019s worsened symptoms of ADHD, oppositional defiant disorder (ODD) and emotion, and increased Internet use. Multivariate logistic regression models were used to examine the factors related to caregiver difficulties in managing children\u2019s learning and children\u2019s worsened ADHD, ODD, and emotional symptoms. In total, 85.3% of the caregivers had difficulty in asking their children to learn at home; 28.2% had difficulty in taking children to afterschool learning programs. Children\u2019s worsened anger was significantly associated with higher caregiver difficulty in asking children to learn at home, whereas parental overprotection was significantly associated with lower caregiver difficulty in asking children to learn at home. Worsened hyperactivity and opposition were significantly associated with higher caregiver difficulty in taking children to attend afterschool learning programs. Interventions for enhancing caregivers\u2019 skills to manage children\u2019s learning and children\u2019s behavioral and emotional symptoms should take the related factors found in this study into consideration.<\/jats:p>","DOI":"10.3390\/ijerph192113722","type":"journal-article","created":{"date-parts":[[2022,10,24]],"date-time":"2022-10-24T02:31:03Z","timestamp":1666578663000},"page":"13722","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":11,"title":["Difficulties in Managing Children\u2019s Learning among Caregivers of Children with Attention-Deficit\/Hyperactivity Disorder during the COVID-19 Pandemic in Taiwan: Association with Worsened Behavioral and Emotional Symptoms"],"prefix":"10.3390","volume":"19","author":[{"given":"Chao-Ying","family":"Chen","sequence":"first","affiliation":[{"name":"School of Physical Therapy and Graduate Institute of Rehabilitation Science, College of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"},{"name":"Department of Internal Medicine\/Pediatric, New Taipei City Tucheng Hospital (Chang Gung Medical Foundation), New Taipei City 23652, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-3187-9479","authenticated-orcid":false,"given":"Jung-Sheng","family":"Chen","sequence":"additional","affiliation":[{"name":"Department of Medical Research, E-Da Hospital, Kaohsiung 82445, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-2129-4242","authenticated-orcid":false,"given":"Chung-Ying","family":"Lin","sequence":"additional","affiliation":[{"name":"Institute of Allied Health Sciences, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Biostatistics Consulting Center, National Cheng Kung University Hospital, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Department of Public Health, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"},{"name":"Department of Occupational Therapy, College of Medicine, National Cheng Kung University, Tainan 70101, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ray C.","family":"Hsiao","sequence":"additional","affiliation":[{"name":"Department of Psychiatry and Behavioral Sciences, University of Washington School of Medicine, Seattle, WA 98295, USA"},{"name":"Department of Psychiatry, Seattle Children\u2019s, Seattle, WA 98105, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7371-1757","authenticated-orcid":false,"given":"Ching-Shu","family":"Tsai","sequence":"additional","affiliation":[{"name":"Department of Child and Adolescent Psychiatry, Chang Gung Memorial Hospital, Kaohsiung Medical Center, Kaohsiung 83301, Taiwan"},{"name":"School of Medicine, Chang Gung University, Taoyuan 33302, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"ORCID":"https:\/\/orcid.org\/0000-0003-1156-4939","authenticated-orcid":false,"given":"Cheng-Fang","family":"Yen","sequence":"additional","affiliation":[{"name":"Department of Psychiatry, Kaohsiung Medical University Hospital, Kaohsiung 80756, Taiwan"},{"name":"Department of Psychiatry, School of Medicine, Kaohsiung Medical University, Kaohsiung 80708, Taiwan"},{"name":"College of Professional Studies, National Pingtung University of Science and Technology, Pingtung 91201, Taiwan"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"1968","published-online":{"date-parts":[[2022,10,22]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","unstructured":"Ghanamah, R., and Eghbaria-Ghanamah, H. (2021). Impact of COVID-19 pandemic on behavioral and emotional aspects and daily routines of Arab Israeli children. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18062946"},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"e288","DOI":"10.1097\/DBP.0000000000001085","article-title":"Remote and hybrid schooling during COVID-19: Associations with child behavior and sleep","volume":"43","author":"Levitt","year":"2022","journal-title":"J. Dev. Behav. Pediatr."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"98","DOI":"10.1016\/j.jad.2021.02.001","article-title":"Associations between feelings\/behaviors during COVID-19 pandemic lockdown and depression\/anxiety after lockdown in a sample of Chinese children and adolescents","volume":"284","author":"Liu","year":"2021","journal-title":"J. Affect. Disord."},{"key":"ref_4","doi-asserted-by":"crossref","unstructured":"Segre, G., Campi, R., Scarpellini, F., Clavenna, A., Zanetti, M., Cartabia, M., and Bonati, M. (2021). Interviewing children: The impact of the COVID-19 quarantine on children\u2019s perceived psychological distress and changes in routine. BMC Pediatr., 21.","DOI":"10.1186\/s12887-021-02704-1"},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"44","DOI":"10.1007\/s10964-020-01332-9","article-title":"Risk and protective factors for prospective changes in adolescent mental health during the COVID-19 pandemic","volume":"50","author":"Magson","year":"2021","journal-title":"J. Youth Adolesc."},{"key":"ref_6","doi-asserted-by":"crossref","first-page":"190","DOI":"10.1016\/j.jpsychires.2021.02.009","article-title":"Top problems of adolescents and young adults with ADHD during the COVID-19 pandemic","volume":"136","author":"Sibley","year":"2021","journal-title":"J. Psychiatr. Res."},{"key":"ref_7","doi-asserted-by":"crossref","unstructured":"Scarpellini, F., Segre, G., Cartabia, M., Zanetti, M., Campi, R., Clavenna, A., and Bonati, M. (2021). Distance learning in Italian primary and middle school children during the COVID-19 pandemic: A national survey. BMC Public Health, 21.","DOI":"10.1186\/s12889-021-11026-x"},{"key":"ref_8","doi-asserted-by":"crossref","unstructured":"Bourion-B\u00e9d\u00e8s, S., Rousseau, H., Batt, M., Tarquinio, P., Lebreuilly, R., Sorsana, C., Legrand, K., Tarquinio, C., and Baumann, C. (2022). The effects of living and learning conditions on the health-related quality of life of children and adolescents during the COVID-19 lockdown in the French Grand Est region. BMC Public Health, 22.","DOI":"10.1186\/s12889-022-12941-3"},{"key":"ref_9","doi-asserted-by":"crossref","unstructured":"Bosch, R., Pagerols, M., Prat, R., Espa\u00f1ol-Mart\u00edn, G., Rivas, C., Dolz, M., Haro, J.M., Ramos-Quiroga, J.A., Ribas\u00e9s, M., and Casas, M. (2022). Changes in the mental health of children and adolescents during the COVID-19 lockdown: Associated factors and life conditions. Int. J. Environ. Res. Public Health, 19.","DOI":"10.3390\/ijerph19074120"},{"key":"ref_10","doi-asserted-by":"crossref","first-page":"671","DOI":"10.1007\/s00787-021-01744-3","article-title":"Mostly worse, occasionally better: Impact of COVID-19 pandemic on the mental health of Canadian children and adolescents","volume":"31","author":"Cost","year":"2022","journal-title":"Eur. Child Adolesc. Psychiatry"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"e2124092","DOI":"10.1001\/jamanetworkopen.2021.24092","article-title":"The association between school closures and child mental health during COVID-19","volume":"4","author":"Hawrilenko","year":"2021","journal-title":"JAMA Netw. Open"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1037\/spq0000437","article-title":"Distance learning during the COVID-19 lockdown in Italy: The role of family, school, and individual factors","volume":"37","author":"Pozzoli","year":"2022","journal-title":"Sch. Psychol."},{"key":"ref_13","doi-asserted-by":"crossref","first-page":"40","DOI":"10.1186\/s12992-021-00693-5","article-title":"Study problems and depressive symptoms in adolescents during the COVID-19 outbreak: Poor parent-child relationship as a vulnerability","volume":"17","author":"Wang","year":"2021","journal-title":"Global Health"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"259","DOI":"10.1016\/S0022-4405(02)00100-0","article-title":"Academic underachievement and attention-deficit\/hyperactivity disorder: The negative impact of symptom severity on school performance","volume":"40","author":"Barry","year":"2002","journal-title":"J. School Psychol."},{"key":"ref_15","doi-asserted-by":"crossref","first-page":"183","DOI":"10.1080\/02796015.2007.12087939","article-title":"School-based interventions for students with attention deficit hyperactivity disorder: Current status and future directions","volume":"36","author":"DuPaul","year":"2007","journal-title":"School Psych. Rev."},{"key":"ref_16","doi-asserted-by":"crossref","first-page":"271","DOI":"10.1111\/j.1600-0447.2010.01568.x","article-title":"A systematic review of prospective studies on attention problems and academic achievement","volume":"122","author":"Polderman","year":"2010","journal-title":"Acta Psychiatr. Scand."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1177\/00222194070400010401","article-title":"ADHD and achievement: Meta-analysis of the child, adolescent, and adult literatures and a concomitant study with college students","volume":"40","author":"Frazier","year":"2007","journal-title":"J. Learn. Disabil."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"769","DOI":"10.1016\/j.jadohealth.2020.09.002","article-title":"Remote learning during COVID-19: Examining school practices, service continuation, and difficulties for adolescents with and without attention-deficit\/hyperactivity disorder","volume":"67","author":"Becker","year":"2020","journal-title":"J. Adolesc. Health"},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"902","DOI":"10.1177\/10870547211027640","article-title":"Distance learning in children with and without ADHD: A case-control study during the COVID-19 pandemic","volume":"26","author":"Tessarollo","year":"2022","journal-title":"J. Attent. Disord."},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"912","DOI":"10.1080\/15374416.2019.1644645","article-title":"Examining ODD\/ADHD symptom dimensions as predictors of social, emotional, and academic trajectories in middle childhood","volume":"49","author":"Evans","year":"2020","journal-title":"J. Clin. Child Adolesc. Psychol."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"623","DOI":"10.1177\/1087054719833167","article-title":"Trajectories of emotional and conduct problems and their association with early high school achievement and engagement for adolescents with ADHD","volume":"25","author":"Zendarski","year":"2021","journal-title":"J. Atten. Disord."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1177\/1087054713494005","article-title":"The relation of poor emotional awareness and externalizing behavior among children with ADHD","volume":"20","author":"Factor","year":"2016","journal-title":"J. Atten. Disord."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"27","DOI":"10.1007\/s12402-014-0142-1","article-title":"Comorbid mental disorders in children and adolescents with attention-deficit\/ hyperactivity disorder in a large nationwide study","volume":"7","author":"Jensen","year":"2015","journal-title":"Atten. Defic. Hyperact. Disord."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"1213","DOI":"10.1097\/00004583-199609000-00019","article-title":"Hyperactivity and conduct problems as risk factors for adolescent development","volume":"35","author":"Taylor","year":"1996","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1132","DOI":"10.1111\/jcpp.13382","article-title":"Prospective impact of COVID-19 on mental health functioning in adolescents with and without ADHD: Protective role of emotion regulation abilities","volume":"62","author":"Breaux","year":"2021","journal-title":"J. Child Psychol. Psychiatry"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"469580211049065","DOI":"10.1177\/00469580211049065","article-title":"Online learning performances of children and adolescents with attention deficit hyperactivity disorder during the COVID-19 pandemic","volume":"58","author":"He","year":"2021","journal-title":"Inquiry"},{"key":"ref_27","first-page":"1","article-title":"Associations between anxiety and home learning difficulties in children and adolescents with ADHD during the COVID-19 pandemic","volume":"15","author":"Jackson","year":"2022","journal-title":"Child Psychiatry Hum. Dev."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"688","DOI":"10.1080\/00048670701449187","article-title":"Parental and family factors for attention-deficit hyperactivity disorder in Taiwanese children","volume":"41","author":"Gau","year":"2007","journal-title":"Aust. N. Z. J. Psychiatry"},{"key":"ref_29","unstructured":"Cassidy, J., and Shaver, P.R. (2008). Handbook of Attachment: Theory, Research and Clinical Applications, The Guilford Press."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"549","DOI":"10.1177\/1087054720978549","article-title":"Physical health, media use, and mental health in children with ADHD during the COVID-19 pandemic in Australia","volume":"26","author":"Sciberras","year":"2022","journal-title":"J. Atten. Disord."},{"key":"ref_31","doi-asserted-by":"crossref","unstructured":"American Psychiatric Association (2013). Diagnostic and Statistical Manual of Mental Disorders, American Psychiatric Association. [5th ed.].","DOI":"10.1176\/appi.books.9780890425596"},{"key":"ref_32","doi-asserted-by":"crossref","unstructured":"Tseng, H.-W., Tsai, C.-S., Chen, Y.-M., Hsiao, R.C., Chou, F.-H., and Yen, C.-F. (2021). Poor mental health in caregivers of children with attention-deficit\/hyperactivity disorder and its relationships with caregivers\u2019 difficulties in managing the children\u2019s behaviors and worsened psychological symptoms during the COVID-19 pandemic. Int. J. Environ. Res. Public Health, 18.","DOI":"10.3390\/ijerph18189745"},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"582","DOI":"10.1016\/j.ijnurstu.2010.10.008","article-title":"Psychometric properties of the Chinese version of the Parental Bonding Instrument","volume":"48","author":"Liu","year":"2011","journal-title":"Int. J. Nur. Stud."},{"key":"ref_34","doi-asserted-by":"crossref","first-page":"138","DOI":"10.1192\/bjp.134.2.138","article-title":"Parental characteristics in relation to depressive disorders","volume":"134","author":"Parker","year":"1979","journal-title":"Br. J. Psychiatry"},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"35","DOI":"10.1002\/mpr.237","article-title":"Psychometric properties of the Chinese version of the Swanson, Nolan, and Pelham, version IV scale\u2013parent form","volume":"17","author":"Gau","year":"2008","journal-title":"Int. J. Methods Psychiatr. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"168","DOI":"10.1097\/00004583-200102000-00011","article-title":"Clinical relevance of the primary findings of the MTA: Success rates based on severity of ADHD and ODD symptoms at the end of treatment","volume":"40","author":"Swanson","year":"2001","journal-title":"J. Am. Acad. Child. Adolesc. Psychiatry"},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"1214","DOI":"10.1080\/07420528.2020.1785487","article-title":"Chronotypes and trauma reactions in children with ADHD in home confinement of COVID-19: Full mediation effect of sleep problems","volume":"37","author":"Kahraman","year":"2020","journal-title":"Chronobiol. Int."},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"719","DOI":"10.1002\/kjm2.12550","article-title":"Smartphone and Internet overuse and worsened psychopathologies in children with attention-deficit\/hyperactivity disorder during the COVID-19 pandemic","volume":"38","author":"Huang","year":"2022","journal-title":"Kaohsiung J. Med. Sci."},{"key":"ref_39","doi-asserted-by":"crossref","unstructured":"Nonweiler, J., Rattray, F., Baulcomb, J., Happ\u00e9, F., and Absoud, M. (2020). Prevalence and associated factors of emotional and behavioural difficulties during COVID-19 pandemic in children with neurodevelopmental disorders. Children, 7.","DOI":"10.20944\/preprints202007.0636.v1"},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"1036","DOI":"10.1097\/00004583-199708000-00011","article-title":"Gender differences in ADHD: A meta-analysis and critical review","volume":"36","author":"Gaub","year":"1997","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"1012","DOI":"10.1542\/peds.2012-0689","article-title":"Age, academic performance, and stimulant prescribing for ADHD: A nationwide cohort study","volume":"130","year":"2012","journal-title":"Pediatrics"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"399","DOI":"10.1007\/s10802-007-9186-4","article-title":"Academic achievement over 8 years among children who met modified criteria for attention-deficit\/hyperactivity disorder at 4-6 years of age","volume":"36","author":"Massetti","year":"2008","journal-title":"J. Abnorm. Child Psychol."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"73","DOI":"10.1177\/1087054714566076","article-title":"Long-term outcomes of ADHD: Academic achievement and performance","volume":"24","author":"Arnold","year":"2020","journal-title":"J. Atten. Disord."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"423","DOI":"10.1016\/j.jaac.2018.11.014","article-title":"Attention-deficit\/hyperactivity disorder, school performance, and effect of medication","volume":"58","author":"Jangmo","year":"2019","journal-title":"J. Am. Acad. Child Adolesc. Psychiatry"},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"412","DOI":"10.1016\/S2352-4642(20)30110-3","article-title":"ADHD management during the COVID-19 pandemic: Guidance from the European ADHD Guidelines Group","volume":"4","author":"Cortese","year":"2020","journal-title":"Lancet Child Adolesc. Health"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"983","DOI":"10.1093\/jpepsy\/jsaa085","article-title":"Implementing group parent training in telepsychology: Lessons learned during the COVID-19 pandemic","volume":"45","author":"Fogler","year":"2020","journal-title":"J. Pediatr. Psychol."}],"container-title":["International Journal of Environmental Research and Public Health"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/13722\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,10,11]],"date-time":"2025-10-11T01:00:44Z","timestamp":1760144444000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/1660-4601\/19\/21\/13722"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2022,10,22]]},"references-count":46,"journal-issue":{"issue":"21","published-online":{"date-parts":[[2022,11]]}},"alternative-id":["ijerph192113722"],"URL":"https:\/\/doi.org\/10.3390\/ijerph192113722","relation":{},"ISSN":["1660-4601"],"issn-type":[{"value":"1660-4601","type":"electronic"}],"subject":[],"published":{"date-parts":[[2022,10,22]]}}}