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Aslan Genç H, Doenyas C, Aksu Y, Musaoğlu MN, Uzunay S, Mutluer T. Long-term Behavioral Consequences of the COVID-19 Pandemic for Autistic Individuals and Their Mothers. J Autism Dev Disord 2024; 54:2578-2590. [PMID: 37140744 PMCID: PMC10157142 DOI: 10.1007/s10803-023-05933-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/13/2023] [Indexed: 05/05/2023]
Abstract
Long-term effects of the COVID-19 pandemic on autistic individuals and their families are recently emerging. This study investigated these effects in 40 mother-child dyads by measuring the behavioral problems of autistic individuals (via Aberrant Behavior Checklist) and their mothers' anxiety levels (via Beck Anxiety Inventory) during the pre-pandemic period, one month after, and one year after its onset. One year into the pandemic, aberrant behaviors of autistic individuals worsened only for those whose mothers had high anxiety levels. The continued negative impact of the COVID-19 pandemic on the behavior of autistic individuals is related to their mother's anxiety level, highlighting the need to support maternal mental health in families with individuals with autism.
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Affiliation(s)
- Herdem Aslan Genç
- Department of Psychiatry, Koç University School of Medicine, Istanbul, Türkiye.
- Research Center for Translational Medicine, Koç University, Istanbul, Türkiye.
| | - Ceymi Doenyas
- Department of Psychological Counseling and Guidance, Yıldız Technical University, Istanbul, Türkiye
| | - Yasemin Aksu
- School of Medicine, Koç University, Istanbul, Türkiye
| | | | - Sena Uzunay
- School of Medicine, Koç University, Istanbul, Türkiye
| | - Tuba Mutluer
- Department of Psychiatry, Koç University School of Medicine, Istanbul, Türkiye
- Research Center for Translational Medicine, Koç University, Istanbul, Türkiye
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Lee V, Vashi N, Roudbarani F, Modica PT, Pouyandeh A, Sellitto T, Ibrahim A, Ameis SH, Elkader A, Gray KM, Kerns CM, Lai MC, Lake J, Thomson K, Weiss JA. Utility of a virtual small group cognitive behaviour program for autistic children during the pandemic: evidence from a community-based implementation study. BMC Health Serv Res 2024; 24:685. [PMID: 38816827 PMCID: PMC11140895 DOI: 10.1186/s12913-024-11033-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2023] [Accepted: 04/23/2024] [Indexed: 06/01/2024] Open
Abstract
BACKGROUND Autistic children often experience socioemotional difficulties relating to emotion regulation and mental health problems. Supports for autistic children involve the use of adapted interventions that target emotion regulation and social skills, alongside mental health symptoms. The Secret Agent Society Small Group (SAS: SG), an adapted cognitive behavioural program, has demonstrated efficacy through lab-delivered randomized control trials. However, research is still needed on its effectiveness when delivered by publicly funded, community-based autism providers under real-world ecologically valid conditions, especially within the context of a pandemic. The COVID-19 pandemic has disrupted access to community-based supports and services for autistic children, and programs have adapted their services to online platforms. However, questions remain about the feasibility and clinical utility of evidence-based interventions and services delivered virtually in community-based settings. METHODS The 9-week SAS: SG program was delivered virtually by seven community-based autism service providers during 2020-2021. The program included the use of computer-based games, role-playing tasks, and home missions. Caregivers completed surveys at three timepoints: pre-, post-intervention, and after a 3-month follow-up session. Surveys assessed caregivers' perception of the program's acceptability and level of satisfaction, as well as their child's social and emotional regulation skills and related mental health challenges. RESULTS A total of 77 caregivers (94% gender identity females; Mean = 42.1 years, SD = 6.5 years) and their children (79% gender identity males; Mean = 9.9 years, SD = 1.3 years) completed the SAS: SG program. Caregivers agreed that the program was acceptable (95%) and were highly satisfied (90%). Caregivers reported significant reduction in their child's emotion reactivity from pre- to post-intervention (-1.78 (95% CI, -3.20 to -0.29), p = 0.01, d = 0.36), that continued to decrease after the 3-month booster session (-1.75 (95% CI, -3.34 to -0.16), p = 0.02, d = 0.33). Similarly, improvements in anxiety symptoms were observed (3.05 (95% CI, 0.72 to 5.36), p = 0.006, d = 0.39). CONCLUSIONS As online delivery of interventions for autistic children remains popular past the pandemic, our findings shed light on future considerations for community-based services, including therapists and agency leaders, on how best to tailor and optimally deliver virtually based programming. TRIAL REGISTRATION This study has been registered with ISRCTN Registry (ISRCTN98068608) on 15/09/2023. The study was retroactively registered.
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Affiliation(s)
- Vivian Lee
- Department of Psychology, Carleton University, 214E Social Science Research Building, Ottawa, ON, K1S 5B6, Canada.
| | - Nisha Vashi
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Flora Roudbarani
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Paula Tablon Modica
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Ava Pouyandeh
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Teresa Sellitto
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Alaa Ibrahim
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
| | - Stephanie H Ameis
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Alex Elkader
- Kinark Child and Family Services, 7271 Warden Ave, Markham, ON, L3R 5X5, Canada
| | - Kylie M Gray
- Centre for Education Development, Appraisal, and Research, University of Warwick, Coventry, CV4 7AL, UK
| | - Connor M Kerns
- Department of Psychology, University of British Columbia, 2136 West Mall, Vancouver, BC, V6T 1Z4, Canada
| | - Meng-Chuan Lai
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Johanna Lake
- Centre for Addiction and Mental Health, 1001 Queen Street West, Toronto, ON, M6J 1H4, Canada
- Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, 250 College Street, 8th Floor, Toronto, ON, M5T 1R8, Canada
| | - Kendra Thomson
- Department of Applied Disabilities Studies, Brock University, 1812 Sir Issac Brock Way, St. Catherines, ON, L2S 3A1, Canada
- Azrieli Adult Neurodevelopmental Centre at the Centre for Addiction and Mental Health, 1451 Queen Street West, Toronto, ON, M63 1A1, Canada
| | - Jonathan A Weiss
- Department of Psychology, York University, 230 BSB, 4700 Keele St, Toronto, ON, M3J 1P3, Canada
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Gallinella F, Trotta F, Fortinguerra F. Impact of COVID-19 pandemic on prescription of psychotropic medications in the Italian paediatric population during 2020. Ital J Pediatr 2024; 50:102. [PMID: 38764095 PMCID: PMC11103882 DOI: 10.1186/s13052-024-01670-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/19/2024] [Accepted: 05/04/2024] [Indexed: 05/21/2024] Open
Abstract
BACKGROUND There is a global perception that psychotropic utilization in children and adolescents is increasing, especially with the onset of COVID-19 pandemic. Available literature data on paediatric psychotropic medication prescriptions in Italy are limited to one or few regions and not updated. The aim of this study was to provide updated data on psychotropic prescriptions referred to the whole Italian paediatric population, as overall and by subgroups of medications and to evaluate if the COVID-19 pandemic during 2020 had an impact on prescription rates. METHODS A descriptive study on psychotropic drug utilization in children and adolescents (< 18 years) resident in all Italian regions during 2020 was performed. Patients registered in the Pharmaceutical Prescriptions database with at least one prescription/dispensing of a psychotropic medication (antipsychotics-N05A), (antidepressants-N06A) and (psychostimulants-N06BA) during the study period were considered. The indicators used were the prescription rate (number of prescriptions per 1000 children) and prevalence of use (proportion of the paediatric population with at least one prescription in the relevant year). RESULTS During the 2020 the prevalence of psychotropic drug use in the paediatric population was 0.3%, increased of 7.8% if compared to 2019. The same trend was observed for the prescription rate, which recorded an average of 28.2 per 1000 children with an increase of 11.6% if compared to previous year, representing the 0.6% of the overall drug use in this age group. The data showed a growing trend prescription by age, reaching the peak in adolescents aged 12-17 years old, with a prescription rate of 65 per 1000 children and a prevalence of 0.71%. Considering the subgroups of psychotropic medications, the highest prevalence of use was found for antipsychotic drugs, received by the 0.19% of the paediatric population during 2020. CONCLUSIONS Psychotropic drug utilization in children and adolescents has grown during 2020 in Italy and worldwide, raising alarms from health care clinicians and patient advocates about the increase of burden of mental diseases in paediatric population during the COVID-19 pandemic. A more systematic monitoring of the use of psychotropic medications should be implemented in all countries for collecting relevant information about children and adolescents taking psychotropic drugs, in order to address the present and the future of the mental health of the paediatric population.
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Affiliation(s)
| | - Francesco Trotta
- Italian Medicines Agency (AIFA), Via del Tritone, 181, Rome, 00187, Italy
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Zhang L, Ren T, He H, Huang L, Huang R, Xu Y, Zhou L, Tan H, Chen J, Wu D, Yang H, Zhang H, Yu J, Du X, Dai Y, Pu Y, Li C, Wang X, Shi S, Sahakian BJ, Luo Q, Li F. Protective factors for children with autism spectrum disorder during COVID-19-related strict lockdowns: a Shanghai autism early developmental cohort study. Psychol Med 2024; 54:1102-1112. [PMID: 37997447 DOI: 10.1017/s0033291723002908] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/25/2023]
Abstract
BACKGROUND COVID-19 lockdowns increased the risk of mental health problems, especially for children with autism spectrum disorder (ASD). However, despite its importance, little is known about the protective factors for ASD children during the lockdowns. METHODS Based on the Shanghai Autism Early Developmental Cohort, 188 ASD children with two visits before and after the strict Omicron lockdown were included; 85 children were lockdown-free, while 52 and 51 children were under the longer and the shorter durations of strict lockdown, respectively. We tested the association of the lockdown group with the clinical improvement and also the modulation effects of parent/family-related factors on this association by linear regression/mixed-effect models. Within the social brain structures, we examined the voxel-wise interaction between the grey matter volume and the identified modulation effects. RESULTS Compared with the lockdown-free group, the ASD children experienced the longer duration of strict lockdown had less clinical improvement (β = 0.49, 95% confidence interval (CI) [0.19-0.79], p = 0.001) and this difference was greatest for social cognition (2.62 [0.94-4.30], p = 0.002). We found that this association was modulated by parental agreeableness in a protective way (-0.11 [-0.17 to -0.05], p = 0.002). This protective effect was enhanced in the ASD children with larger grey matter volumes in the brain's mentalizing network, including the temporal pole, the medial superior frontal gyrus, and the superior temporal gyrus. CONCLUSIONS This longitudinal neuroimaging cohort study identified that the parental agreeableness interacting with the ASD children's social brain development reduced the negative impact on clinical symptoms during the strict lockdown.
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Affiliation(s)
- Lingli Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Tai Ren
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hua He
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Like Huang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Runqi Huang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yixiang Xu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Li Zhou
- Psychology and Neuroscience of Cognition Research Unit, University of Liège, Liège, Belgium
| | - Hangyu Tan
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Jingyu Chen
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Danping Wu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Hanshu Yang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Haotian Zhang
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Juehua Yu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Center for Experimental Studies and Research, The First Affiliated Hospital of Kunming Medical University, Kunming, China
| | - Xiujuan Du
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yuan Dai
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Yiwei Pu
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Chunbo Li
- Shanghai Key Laboratory of Psychotic Disorders, Shanghai Mental Health Center, Shanghai Jiao Tong University School of Medicine, Shanghai, China
| | - Xiang Wang
- Department of Psychiatry, and National Clinical Research Center for Mental Disorders, The Second Xiangya Hospital of Central South University, Changsha, China
| | - Shenxun Shi
- Psychiatry Department of Huashan Hospital, Fudan University, Shanghai, China
| | - Barbara J Sahakian
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
- Department of Psychiatry and the Behavioural and Clinical Neuroscience Institute, University of Cambridge, Cambridge, UK
| | - Qiang Luo
- National Clinical Research Center for Aging and Medicine at Huashan Hospital, State Key Laboratory of Medical Neurobiology and MOE Frontiers Center for Brain Science, Institute of Science and Technology for Brain-Inspired Intelligence, Fudan University, Shanghai 200433, China
- MOE Key Laboratory of Computational Neuroscience and Brain-Inspired Intelligence, Institutes of Brain Science and Human Phenome Institute, Fudan University, Shanghai 200032, China
| | - Fei Li
- Department of Developmental and Behavioral Pediatric and Child Primary Care, Brain and Behavioral Research Unit of Shanghai Institute for Pediatric Research and Ministry of Education-Shanghai Key Laboratory for Children's Environmental Health, Xinhua Hospital, Shanghai Jiao Tong University School of Medicine, Shanghai, China
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Ludwig NN, Holingue C, Hong JS, Kalb LG, Pfeiffer D, Reetzke R, Menon D, Landa R. Diagnostic certainty during in-person and telehealth autism evaluations. JCPP ADVANCES 2024; 4:e12201. [PMID: 38486947 PMCID: PMC10933595 DOI: 10.1002/jcv2.12201] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/15/2022] [Accepted: 08/24/2023] [Indexed: 03/17/2024] Open
Abstract
Background Many diagnostic evaluations abruptly shifted to telehealth during the COVID-19 pandemic; however, little is known about the impact on diagnosis patterns for children evaluated for autism spectrum disorder (ASD). The purpose of this clinical research study was to examine (1) the frequency of diagnoses evaluated beyond ASD; (2) the frequency of diagnoses made, including ASD; and (3) clinician diagnostic certainty for all diagnoses evaluated for children who received an evaluation due to primary concerns about ASD via telehealth during the pandemic compared to those evaluated in person before the pandemic at an ASD specialty clinic. Methods The sample included 2192 children, 1-17 years (M = 6.5 years; SD = 3.9), evaluated by a physician/psychologist at an ASD specialty center. A total of 649 children were evaluated in-person September 1, 2019-March 13, 2020 (pre-pandemic) and 1543 were evaluated via telehealth March 14, 2020-July 26, 2021 (during pandemic). Upon completion of each evaluation, clinicians provided a final diagnostic determination (i.e., "Yes," "No," "Possible," or "Not Assessed") for the following DSM-5 conditions: ASD, attention-deficit/hyperactivity disorder (ADHD), intellectual developmental disorder (IDD), anxiety (ANX), depression (DEP), and behavioral disorder (BD). "Possible" indicated lower certainty and the diagnosis was not provided. "Not Assessed" indicated the disorder was not evaluated. Results Diagnostic certainty for ASD and ADHD was lower and clinicians evaluated for and made diagnoses of IDD less often during evaluations that occurred via telehealth during the pandemic versus in person before the pandemic. DEP and BD were diagnosed more frequently, diagnostic certainty of DEP was lower, and no differences in the frequency of ANX diagnoses emerged during evaluations conducted via telehealth during the pandemic compared to those conducted in person before the pandemic. Conclusions Differences emerged in the frequency of diagnoses evaluated and made and diagnostic certainty for evaluations conducted via telehealth during the pandemic compared to in person before the pandemic, which likely impacted patients and reflect real-word challenges. Future work should examine whether these patterns are generalizable and the mechanisms that contribute to these differences.
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Affiliation(s)
- Natasha N. Ludwig
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
| | - Calliope Holingue
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Ji Su Hong
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Luther G. Kalb
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Danika Pfeiffer
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Rachel Reetzke
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
| | - Deepa Menon
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of NeurologyJohns Hopkins School of MedicineBaltimoreMarylandUnited States
| | - Rebecca Landa
- Department of Psychiatry and Behavioral SciencesJohns Hopkins School of MedicineBaltimoreMarylandUSA
- Center for Autism and Related DisordersKennedy Krieger InstituteBaltimoreMarylandUSA
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Brunt S, Sadikova E, Pappagianopoulos J, Mazurek MO. The impact of COVID-19 on receipt of health services among children with and without autism. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2024; 28:580-586. [PMID: 37243353 PMCID: PMC10225807 DOI: 10.1177/13623613231176930] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 05/28/2023]
Abstract
ABSTRACT TThe COVID-19 pandemic disrupted a range of health services for children across the United States. Autistic children have well-documented deficits in health-related services compared to nonautistic children. Parents of autistic children reported an increase in mental health and behavior problems with the onset of the pandemic, increasing the need for supportive services. The current study used data from the National Survey of Children’s Health from 2019 and 2020 to conduct logistic regressions predicting the likelihood of having unmet service needs before and after the onset of the pandemic. Results suggested that autistic children were more likely to have unmet medical, dental, and mental health service needs across years compared to nonautistic children, but there were no interactions by year. All children experienced an increased likelihood of having unmet needs from pre- to post-pandemic. Results suggest that although the pandemic disrupted services across the board, autistic children lacked health services regardless of the pandemic, pointing to persisting disparities in service receipt. A discussion of ongoing barriers to services and issues related to virtual services is included. Future research should further investigate the feasibility of virtual services as well as ways of reducing barriers to all services for autistic children.
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Keefer A, Perrin J, Singh V, Holingue C, Winchell S, Vasa RA. A pilot, single-arm feasibility study of an integrated cognitive-behavioral treatment for anxiety in young autistic children. J Pediatr Psychol 2024; 49:131-141. [PMID: 38216125 DOI: 10.1093/jpepsy/jsad093] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2023] [Revised: 11/22/2023] [Accepted: 11/28/2023] [Indexed: 01/14/2024] Open
Abstract
OBJECTIVE Anxiety is prevalent in young autistic children under 7 years of age. Yet there is a paucity of empirically based interventions for this age group. DINO Strategies for Anxiety and Uncertainty Reduction (DINOSAUR) is an innovative cognitive behavioral intervention that seeks to optimize treatment response in young autistic children by targeting anxiety and the contributing mechanisms of intolerance of uncertainty and parental accommodation using a telehealth delivery model. This pilot, single-arm study examines the preliminary feasibility of DINOSAUR. METHODS Fourteen autistic children ages 4-6 years with average language and cognitive skills and their parents received the intervention. Quantitative and qualitative data pertaining to parent satisfaction and treatment outcomes were collected. RESULTS Attendance, retention, and parent satisfaction ratings offer preliminary support for the feasibility of the treatment model. Change in clinical severity ratings on a semi-structured parent interview of anxiety and parents' qualitative report suggests the potential to benefit young autistic children. CONCLUSIONS Results support future study of the DINOSAUR model in a larger, randomized controlled trial.
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Affiliation(s)
- Amy Keefer
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
| | - Jeremy Perrin
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Bloomberg School of Public Health, Johns Hopkins University, Baltimore, United States
| | - Sarah Winchell
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
| | - Roma A Vasa
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, United States
- Department of Psychiatry and Behavioral Sciences, Johns Hopkins University, Baltimore, United States
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Kaur A, Lall G, Abhilashi M, Naithani L, Verma M, Roy R, Juneja M, Gulati S, Taylor C, Leadbitter K, Patel V, Green J, Divan G. Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India. Front Public Health 2024; 12:1294538. [PMID: 38362218 PMCID: PMC10867826 DOI: 10.3389/fpubh.2024.1294538] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/14/2023] [Accepted: 01/12/2024] [Indexed: 02/17/2024] Open
Abstract
Introduction The onset of the COVID-19 pandemic and subsequent lockdowns in March 2020 disrupted the lives of families across India. The lockdown related restrictions brought forth a multitude of challenges including loss of employment, social isolation, school closures and financial burdens. Specifically, it also resulted in the restriction of health-care services for children with neurodevelopmental disabilities. Methods This qualitative study was conducted as a part of a larger trial in India to understand the experiences of families of young children with autism during the pandemic. In-depth interviews were carried out with 14 caregivers residing in New Delhi, India. Results Our findings identified pandemic and lockdown's universal impacts on family life and financial stability stemming from job loss, business closure, and salary deductions, affecting quality of life of families. Furthermore, COVID-19 pandemic's impact on autistic children was evident through limited access to essential services and financial challenges related service interruptions even after resumption of services. The lockdown's novelty also affected children's behavior, with both challenging behavioral changes and positive impacts. Primary caregivers, predominantly mothers, assumed additional responsibilities in household tasks, schooling, and therapy administration. While some these experiences were universally experienced, a few of these improved outcomes for autistic children. Despite challenges, parents expressed gratitude for their family's safety and well-being during the difficult time. Discussions These findings inform service provision for vulnerable families and offer implications for designing interventions such as credit schemes for families, guidance and resources for establishing and maintaining routines of children with autism, adopting flexible and adaptable approaches to service delivery, and special provisions for children with autism to be able to maintain their routines outside of home. Furthermore, the study highlights the need for comprehensive support, including educational resources and stress management counselling to empower parents in supporting essential care and routines for their children during such unprecedented times.
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Affiliation(s)
| | | | | | | | - Mamta Verma
- Sangath, Child Development Group, New Delhi, India
| | | | - Monica Juneja
- Maulana Azad Medical College Associated Lok Nayak Hospital, New Delhi, India
| | | | - Carol Taylor
- Department of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Kathy Leadbitter
- Department of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Vikram Patel
- Department of Global Health and Social Medicine, Harvard Medical School, Boston, MA, United States
| | - Jonathan Green
- Department of Psychology and Mental Health, University of Manchester, Manchester, United Kingdom
| | - Gauri Divan
- Sangath, Child Development Group, New Delhi, India
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Chen X, Tong J, Zhang W, Wang X, Ma S, Shi D, Yan D, Liu Y. Factors predicting depressive symptoms in parents of children with autism spectrum disorder in eastern China. BMC Public Health 2024; 24:226. [PMID: 38238720 PMCID: PMC10797873 DOI: 10.1186/s12889-024-17731-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2023] [Accepted: 01/10/2024] [Indexed: 01/22/2024] Open
Abstract
BACKGROUND Parents of children with autism spectrum disorder (ASD) are at a higher risk of depression than parents of typically developing children and those of children with other developmental disorders. Depression affects the well-being and quality of life of parents of children with ASD and has serious consequences for the long-term health outcomes of children with ASD. Therefore, this study explored the current status of depressive symptoms in parents of children with ASD in eastern China and further analyzed multiple aspects of the predictors of depressive symptoms. METHODS A multicenter cross-sectional survey was conducted among parents of children with ASD in the rehabilitation department of a large specialized hospital and 10 rehabilitation centers for children with special needs in Lianyungang, Jiangsu Province, Eastern China. A structured questionnaire that focused on child-related factors, parent-related factors, depressive symptoms, courtesy stigma, and social support was used to obtain data. Binary logistic regression was used to identify the independent predictors of depressive symptoms in parents of children with ASD. RESULTS A total of 409 parents of children with ASD were recruited, of whom 18.8% had depressive symptoms. Parents of children with ASD who raised a child who spoke few to no words (odds ratio [OR]: 2.747, 95% confidence interval [CI]: 1.026-7.357), claimed a high economic burden (OR: 3.215, 95% CI: 1.234-8.379), reported no change or increased severity of ASD in their children (OR: 2.518, 95% CI: 1.108-5.720), and those with a higher courtesy stigma score (OR: 1.189, 95% CI: 1.093-1.294) were more likely to have depressive symptoms. Conversely, parents of children with ASD who were employed (OR: 0.427, 95% CI: 0.201-0.907), satisfied with their current marital status (OR: 0.429, 95% CI: 0.221-0.834), and those with a higher social support score (OR: 0.973, 95% CI: 0.950-0.996) were less likely to have depressive symptoms. CONCLUSIONS Depressive symptoms are common in parents of children with ASD in eastern China. Therefore, screening and intervention for depressive symptoms in parents of children with ASD is necessary, especially for those with high-risk factors.
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Affiliation(s)
- Xu Chen
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Jiao Tong
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Weijing Zhang
- National Health Commission Contraceptives Adverse Reaction Surveillance Center, NO.277 Fenghuang west Street, Gulou District, 210036, Nanjing, Jiangsu, China
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China
| | - Xin Wang
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Shan Ma
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Dongdong Shi
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China
| | - Dongmei Yan
- Lianyungang Maternal and Child Health Hospital, 669 Qindongmen Street, Haizhou District, 222000, Lianyungang, Jiangsu, China.
| | - Yan Liu
- National Health Commission Contraceptives Adverse Reaction Surveillance Center, NO.277 Fenghuang west Street, Gulou District, 210036, Nanjing, Jiangsu, China.
- Jiangsu Health Development Research Center, Nanjing, Jiangsu, China.
- Jiangsu Provincial Medical Key Laboratory of Fertility Protection and Health Technology Assessment, Nanjing, Jiangsu, China.
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Milea-Milea AC, Fernández-Pérez D, Toledano-González A. The psychological impact of the COVID-19 pandemic on children/adolescents with ASD and their family environment: a systematic review. Eur Child Adolesc Psychiatry 2024; 33:203-228. [PMID: 36757483 PMCID: PMC9909131 DOI: 10.1007/s00787-023-02151-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/12/2022] [Accepted: 01/26/2023] [Indexed: 02/10/2023]
Abstract
The main objective of the review is to analyze the impact of the pandemic in children/teenagers with Autism spectrum disorder (ASD) and in their family environment. An electronic search was carried out in different databases (PsycInfo, Web of Science and Scopus) in order to find publications associated with the aim of this project. The search terms used were derived from the combination of the following search string: "((Pandemic OR Epidemic OR Outbreak OR COVID-19 OR Coronavirus) AND (Children OR Adolescents OR Youth OR Child OR Teenager) AND (Autism OR ASD OR Autism Spectrum Disorder))''. In total, 21 articles were included in this review. The findings of the different investigations included in this review show that the pandemic has produced a negative psychological impact in children/teenagers with ASD. Therefore, long-term follow-up studies should be carried out with the objective of creating effective interventions to treat this problematical.
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Affiliation(s)
| | - Dolores Fernández-Pérez
- Department of Psychology, Faculty of Medicine, University of Castilla-La Mancha, Albacete, Spain.
- Neurological Disabilities Research Institute, Albacete, Spain.
| | - Abel Toledano-González
- Department of Psychology, Faculty of Health Sciences, University of Castilla-La Mancha, Talavera de la Reina, Spain
- Neurological Disabilities Research Institute, Albacete, Spain
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11
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Parlatini V, Frangou L, Zhang S, Epstein S, Morris A, Grant C, Zalewski L, Jewell A, Velupillai S, Simonoff E, Downs J. Emotional and behavioral outcomes among youths with mental disorders during the first Covid lockdown and school closures in England: a large clinical population study using health care record integrated surveys. Soc Psychiatry Psychiatr Epidemiol 2024; 59:175-186. [PMID: 37353579 PMCID: PMC10799796 DOI: 10.1007/s00127-023-02517-w] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/16/2023] [Accepted: 06/06/2023] [Indexed: 06/25/2023]
Abstract
PURPOSE Emotional and behavioral problems in children and young people (CYP) have increased over the pandemic. Those with pre-existing mental disorders are more vulnerable but have been understudied. We investigated emotional and behavioral outcomes in this population; differences across diagnostic groups; and social, educational, and clinical determinants. METHODS We invited 5386 caregivers and CYP (aged 5-17) under child mental health services pre-pandemic to complete an online survey on CYP's emotional/behavioral symptoms and pandemic-related circumstances, and integrated responses with clinicodemographic information extracted from electronic health records. We compared four parent-rated outcomes (total emotional/behavioral scores and emotional/behavioral changes as compared to before the pandemic) across the three most common diagnostic groups in our population (Attention Deficit Hyperactivity Disorder (ADHD), Autism Spectrum Disorder (ASD) and emotional disorders (EmD)). We then estimated the association of clinicodemographic and pandemic-related characteristics with emotional/behavioral outcomes. RESULTS A total of 1741 parents (32.3%) completed the survey. Parents of CYP with ADHD or ASD reported more behavioral difficulties (t(591) = 5.618 (0.001); t(663) = 6.527 (0.001)); greater emotional deterioration (t(591) = 2.592 (0.009); t(664) = 4.670 (< 0.001); and greater behavioral deterioration (t(594) = 4.529 (< 0.001); t(664) = 5.082 (< 0.001)) as compared to the EmD group. Those with ASD and EmD showed more emotional difficulties than ADHD (t(891) = - 4.431 (< 0.001); t(590) = - 3.254 (0.001)). Across diagnoses, poor parental mental health and challenges with education were most strongly associated with worse outcomes. CONCLUSIONS Within our clinical population, CYP with ADHD/ASD were the most adversely affected during lockdown. Enhancing clinical service provision that tackles parental stress and supports education may help mitigate the impact of future restrictions.
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Affiliation(s)
- V Parlatini
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK.
| | - L Frangou
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Zhang
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - S Epstein
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - A Morris
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
| | - C Grant
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- Department of Epidemiology and Public Health, University College London, London, UK
| | - L Zalewski
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - A Jewell
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - S Velupillai
- Department of Biostatistics and Health Informatics, Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| | - E Simonoff
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
| | - J Downs
- Department of Child and Adolescent Psychiatry, Institute of Psychiatry, Psychology and Neuroscience, King's College London, 16 De Crespigny Park, London, SE5 8AF, UK
- National Institute for Health Research (NIHR) Biomedical Research Centre, South London and Maudsley NHS Foundation Trust, London, UK
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Gerber AH, Keluskar J, Lerner MD. Longitudinal Impact of the Pandemic on Social Disruption and Loneliness in Autistic and Non-Autistic Youth. JOURNAL OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY : THE OFFICIAL JOURNAL FOR THE SOCIETY OF CLINICAL CHILD AND ADOLESCENT PSYCHOLOGY, AMERICAN PSYCHOLOGICAL ASSOCIATION, DIVISION 53 2023:1-13. [PMID: 37956102 PMCID: PMC11089075 DOI: 10.1080/15374416.2023.2272933] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/15/2023]
Abstract
OBJECTIVE The coronavirus pandemic drastically increased social isolation. Autistic youth already experience elevated social isolation and loneliness, making them highly vulnerable to the impact of the pandemic. We examined trajectories of social disruption and loneliness in autistic and non-autistic youth during a six-month period of the pandemic (June 2020 until November 2020). METHOD Participants were 76 youth, ages 8 through 17, (Mage = 12.82, Nautistic = 51) with an IQ ≥ 70. Youth completed a biweekly measure of loneliness (Revised UCLA Loneliness Scale) and their parent completed a measure of pandemic-related family social disruption (Epidemic Pandemic Impacts Inventory). RESULTS There were no time trends in loneliness across all youth, however, social disruption displayed linear, quadratic, and cubic trends. Non-autistic youth reported relatively greater declines in social disruption compared to autistic youth. Additionally, autistic youth reported relatively greater declines in loneliness relative to non-autistic youth. Greater social disruption was associated with higher loneliness, however, autistic youth demonstrated a relatively stronger relationship between social disruption and loneliness compared to non-autistic youth. CONCLUSIONS The current study was one of the first to investigate social disruption and loneliness in autistic youth during the COVID-19 pandemic. Results indicated that autistic youth experienced relative decreases in loneliness during this time, perhaps due to reductions in social demands. Nonetheless, when autistic youth did experience social disruption, they reported relatively higher levels of loneliness. This work contributes to our understanding of risk factors for loneliness and highlights the need to understand the benefits, as well as the challenges, to remote schooling and social interactions.
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Affiliation(s)
- Alan H. Gerber
- Department of Psychology, Stony Brook University, Stony Brook, NY
- Child Study Center, Yale School of Medicine, New Haven, CT
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13
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Courreges A, Kouros CD, Ekas NV, Levy S. Remote vs. In-person Schooling during the COVID-19 Pandemic and Internalizing Symptoms among Children on the Autism Spectrum. RESEARCH IN AUTISM SPECTRUM DISORDERS 2023; 109:102284. [PMID: 38009124 PMCID: PMC10673621 DOI: 10.1016/j.rasd.2023.102284] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/28/2023]
Abstract
Background Children on the autism spectrum encountered interruptions to their education due to the COVID-19 pandemic (White et al., 2021). This study examined the extent to which autistic children's anxiety and depressive symptoms during the pandemic were associated with the school format they attended in October 2020 (remote, in-person/hybrid, homeschool), controlling for their pre-pandemic symptoms. Pre-pandemic peer victimization and autism symptom characteristics were tested as moderators. Method Participants were 81 verbally-fluent autistic children (Mage = 14.71 years, 77.8% males), without an intellectual disability, and their mothers; families were part of an ongoing, longitudinal study that began before the pandemic. Results School format did not significantly predict children's anxiety or depressive symptoms. Results indicated that the only significant predictors of children's anxiety and depressive symptoms during the pandemic were their pre-pandemic symptom levels. Conclusions School format did not significantly contribute to variability in children's anxiety and depressive symptoms during the pandemic, over and above their pre-pandemic symptoms. The results contribute quantitative findings to the growing body of research on pandemic-related effects on autistic children, and underscore the need to account for pre-pandemic child functioning when drawing conclusions about pandemic-level effects.
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Affiliation(s)
- Audrey Courreges
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
| | - Chrystyna D. Kouros
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
| | - Naomi V. Ekas
- Department of Psychology, Texas Christian University, TCU Box 298920, Fort Worth, TX, 76129, USA
| | - Sam Levy
- Department of Psychology, Southern Methodist University, PO Box 750442, Dallas, TX, 75275, USA
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14
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Sartor T, Sons S, Kunina-Habenicht O, Tröster H, Kuhn JT. Demands and stress before and during the COVID-19 pandemic of parents to children with autism spectrum disorder. Front Psychol 2023; 14:1212556. [PMID: 37854145 PMCID: PMC10580071 DOI: 10.3389/fpsyg.2023.1212556] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/27/2023] [Accepted: 09/19/2023] [Indexed: 10/20/2023] Open
Abstract
Introduction Parents to children with Autism Spectrum Disorder (ASD) face diverse daily demands that can lead to stress. The aim of this study was to examine to which extent stress in parents to children with ASD can be explained by daily demands before and during the COVID-19 pandemic (after lockdowns; first half of 2022), and whether there are differences between the two time periods in this regard. Methods Data from parents to children with ASD living in Germany from two independent questionnaire studies (before the pandemic: N = 168, during the pandemic: N = 105) were matched for comparability. Simple and multiple linear regression analyses were used to answer the research question. Results Parental stress as well as all demands examined showed higher levels during the COVID-19 pandemic than before. Significant predictors of parental stress before and during the COVID-19 pandemic were (1) the daily demands to deal with the child's problem behavior, (2) the restriction of one's personal way of life, and (3) the challenge to cooperate with the partner. During the COVID-19 pandemic, the child's problem behavior was particularly relevant. It was also found that the demand to deal with stigmatizing reactions did not explain parental stress during the COVID-19 pandemic whereas before the pandemic it had been a significant predictor. Discussion Although parental stress and the demands of daily life increased during the pandemic, most of the stress can be explained by the same demands. It is suggested that the increased levels may be due to an increase in the child's ASD symptomatology, which is why it is advisable to install therapeutic and care structures that prepare children with ASD for future crises.
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15
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Castro-Kemp S, Orcid AM. Silver linings of the Covid-19 pandemic… for some! Comparing Experiences and Social demographic characteristics of autistic and non-autistic children with SEND in England. J Autism Dev Disord 2023; 53:3968-3979. [PMID: 35945387 PMCID: PMC9362987 DOI: 10.1007/s10803-022-05628-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 05/27/2022] [Indexed: 10/30/2022]
Abstract
Several studies on the impact of Covid-19 on children's wellbeing have been published, including for those with Special Educational Needs and Disabilities. However, limited evidence is available on who these children may be, their socioeconomic background, age, gender or type of school attended. This study examines the role of socio-demographic characteristics on the experiences of Autistic Children, compared to non-Autistic children, to assess the detrimental impact of the pandemic, but also potential silver linings. Primary-school aged Autistic children were more likely to mention a silver lining (for mental health), as well as younger non-Autistic children from more affluent backgrounds. Similar effects were observed for older non-Autistic boys with special needs attending mainstream settings (regarding physical health).
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Affiliation(s)
- Susana Castro-Kemp
- UCL Institute of Education, London, United Kingdom.
- Psychology and Human Development, 26 Woburn Square, WC1H 0AA, London, United Kingdom.
| | - Arif Mahmud Orcid
- School of Education, University of Roehampton, London, United Kingdom
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Palmer M, Chandler S, Carter Leno V, Mgaieth F, Yorke I, Hollocks M, Pickles A, Slonims V, Scott S, Charman T, Simonoff E. Factors associated with mental health symptoms among UK autistic children and young people and their parents during the COVID-19 pandemic. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:2098-2111. [PMID: 36847345 PMCID: PMC9974376 DOI: 10.1177/13623613231153694] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/01/2023]
Abstract
LAY ABSTRACT What is already known about the topic: The COVID-19 pandemic and the associated restrictions impacted all of society. There is emerging evidence showing a range of impacts on autistic children and young people and their families. Further research that looks at how individuals coped during the pandemic while considering how they were doing before the pandemic is needed.What this paper adds: This article explores whether how well autistic youth were doing before the pandemic influenced how they coped during the pandemic. It also looked at how well their parents were doing during the pandemic and whether any pre-pandemic factors influenced how they coped. Samples of both primary-school-aged autistic children and autistic teenagers and their parents were surveyed to answer these questions. More engagement and enjoyment in education provision during the pandemic and getting outside more were linked with better child and parental mental health during the pandemic. More attention deficit hyperactivity disorder before the pandemic was linked with more attention deficit hyperactivity disorder and behavioural problems during the pandemic in primary-school-aged autistic children, and more emotional problems during the pandemic in autistic teenagers. Parents with more mental health problems during the pandemic had more mental health problems before the pandemic.Implications for practice, research or policy: Encouraging engagement and enjoyment in education and promoting physical exercise are key intervention targets. Ensuring access to attention deficit hyperactivity disorder medication and support is important, especially if this is managed jointly across school and home.
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Affiliation(s)
| | | | | | | | | | | | | | | | | | - Tony Charman
- King’s College London, UK
- South London and Maudsley NHS Foundation Trust, UK
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17
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Samuels A, Avital-Magen A, Schusheim G. The Effects of the First Phase of the Covid-19 Pandemic on the Mental Health of Children and Adolescents With preexisting Psychiatric Conditions. Clin Pediatr (Phila) 2023; 62:1008-1017. [PMID: 36726020 PMCID: PMC9899673 DOI: 10.1177/00099228221150157] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/03/2023]
Abstract
Few studies have examined the impact of the initial school closures and stay-at-home orders on those vulnerable children and adolescents with preexisting psychiatric conditions. In our study, we explore the impact on this population and identify risk and resilience factors by looking both at those children who were impacted negatively as well as those who were impacted positively by this period. Questionnaires were administered by child and adolescent psychiatrists to 101 parents of child and adolescent outpatients in a mental health clinic as well as 75 of the adolescents, themselves, during the initial stay-at-home orders in Israel. Parents and their children were asked how the situation changed the symptoms for which the children are being treated at our clinic. Information regarding demographic, family, and individual factors was also gathered. The largest group of parents (44%) reported improvement in their child's symptoms during this period, whereas 33% reported no change and 25% reported worsening. Risk factors included parental stress and level of child preoccupation with Covid-19. The major protective factor was parental presence. Although home confinement during the Covid-19 pandemic can lead to worsening mental health status among children, it can also provide an opportunity for those with previous mental health conditions to improve and strive. For these children to improve during such a period, decreased social and academic demands and increased parental presence seem to be key factors. For those who deteriorate, identifying and targeting parental stress can be as important as targeting the child's stress during such times.
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Affiliation(s)
- Ayol Samuels
- Department of Psychiatry, Emek Medical
Center, Afula, Israel
- Department of Psychiatry and Behavioral
Sciences, Albert Einstein College of Medicine, Bronx, NY, USA
| | | | - Guy Schusheim
- Department of Psychiatry, Emek Medical
Center, Afula, Israel
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18
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Lyu K, Li JS, Chen M, Zhang W, Hu M. Effect of COVID-19 on autism spectrum disorders: A bibliometric analysis based on original articles. Medicine (Baltimore) 2023; 102:e35310. [PMID: 37773860 PMCID: PMC10545382 DOI: 10.1097/md.0000000000035310] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/28/2023] [Accepted: 08/30/2023] [Indexed: 10/01/2023] Open
Abstract
BACKGROUND The objective of this bibliometric inquiry was to scrutinize domains that delve into the repercussions of the 2019 coronavirus disease (COVID-19) pandemic on individuals afflicted with autism spectrum disorder (ASD), worldwide scholarly findings of interrelated research, and forthcoming trajectories. METHODS To conduct a literature analysis, use the web of science core collection database, search for ASD and COVID-19-related literature published Utilize CiteSpace and VosViewer to visually analyze documents and create networks of authors, organizations. The CiteSpace and VosViewer to visually analyze documents and create networks of authors, organizations, countries, and keywords. RESULTS This study collected 771 papers and shows an increasing trend in publications. The United States had the most relevant literature (281), followed by the United Kingdom (115) and Italy (76). The United States had the most relevant literature (281), followed by the United Kingdom (115) and Italy (76). The University of London had the most papers (53, 6.87%), and Happe_Francesca was the most productive researcher (6). J AUTISM DEV DISORD was the main journal for research on the impact of COVID-19 on ASD, with 22 related articles. Keyword co-occurrence analysis has revealed that "parenting stress," "enhancing adherence," "acute stress disorder," "COVID-19 Italian lockdown," "neurodevelopmental disorder," and "occupational therapy" have garnered significant attention recently. Notably, the burst keywords suggest that "interventions," "qualitative research," "Disabilities Monitoring Network," "neurodevelopmental disabilities," "perceived stress," and "barriers" are potential areas of investigation for future research. CONCLUSION This bibliometric analysis delineates the fundamental structure for assessing the impact of COVID-19 on ASD by scrutinizing crucial indicators such as Our analysis reveals that COVID-19 impact on autism has garnered the interest of an Future research could explore the stress, anxiety, and strategies for individuals with ASD and their The use of telemedicine can be studied in depth, as a new idea for ASD diagnosis and intervention training, it is worthwhile. The use of telemedicine can be studied in depth, as a new idea for ASD diagnosis and intervention training, it is worth exploring, such as Disabilities Monitoring Network, etc.
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Affiliation(s)
- Kaifeng Lyu
- Faculty of Chinese Medicine, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Jiang-shan Li
- College of Acupuncture, Moxibustion, Massage and Rehabilitation, Hunan University of Traditional Chinese Medicine, Changsha, Hunan, China
| | - Min Chen
- Faculty of Chinese Medicine and State Key Laboratory of Quality Research in Chinese Medicines, Macau University of Science and Technology, Macau, Macau SAR, China
| | - Wei Zhang
- Pediatrics one, The First Affiliated Hospital of Heilongjiang University of Traditional Chinese Medicine, Harbin Heilongjiang, China
| | - Meichao Hu
- Rehabilitation Department, Chifeng Obstetrics and Gynecology Hospital, Chifeng Inner Mongolia, China
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Plak R, Rippe R, Merkelbach I, Begeer S. Psychosocial Outcomes in Autistic Children Before and During the COVID-19 Pandemic. J Autism Dev Disord 2023:10.1007/s10803-023-06101-8. [PMID: 37690082 DOI: 10.1007/s10803-023-06101-8] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/05/2023] [Indexed: 09/12/2023]
Abstract
Studies on the impact of the COVID-19 pandemic on autistic children's psychosocial outcomes have shown mixed results. In the current study we aimed to gain a better insight into the effect of the COVID-19 pandemic by comparing psychosocial outcomes collected pre-pandemic with data collected during the pandemic. We used the Strengths and Difficulties Questionnaire (SDQ) to examine change over time in psychosocial outcomes of autistic children from pre-pandemic (T0) to lockdown I (T1) and lockdown II (T2) in the Netherlands. We expected a deterioration in psychosocial outcomes. There were 224 participants in T0 and T1, of which 141 also participated in T2. The results showed a surprising improvement in psychosocial outcomes from T0 to T1. Special education and female gender were associated with increased difficulties over time, while higher age was associated with decreased difficulties. At the subdomain level we found that emotional problems remained stable, while hyperactivity, conduct problems, and peer problems decreased, and prosocial behavior increased. Attending special education predicted increased peer problems over time, while higher age predicted both decreased conduct problems and increased prosocial behavior over time. The COVID-19 pandemic may have temporarily improved the fit between the psychosocial needs and the environment for children with autism in the Netherlands.
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Affiliation(s)
- Rachel Plak
- Clinical Neurodevelopmental Sciences, Institute of Education and Child Studies, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands.
| | - Ralph Rippe
- Research Methods and Statistics, Institute of Education and Child Studies, Faculty of Social and Behavioral Sciences, Leiden University, Leiden, The Netherlands
| | - Inge Merkelbach
- Erasmus School of Social and Behavioural Sciences, Erasmus University Rotterdam, Rotterdam, The Netherlands
| | - Sander Begeer
- Department of Clinical, Neuro- & Developmental Psychology, Faculty of Behavioural and Movement Sciences, Vrije Universiteit Amsterdam, Amsterdam, The Netherlands
- Amsterdam Public Health Research Institute, Amsterdam, The Netherlands
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Macdonald O, Green A, Walker A, Curtis H, Croker R, Brown A, Butler-Cole B, Andrews C, Massey J, Inglesby P, Morton C, Fisher L, Morley J, Mehrkar A, Bacon S, Davy S, Evans D, Dillingham I, Ward T, Hulme W, Bates C, Cockburn J, Parry J, Hester F, Harper S, O'Hanlon S, Eavis A, Jarvis R, Avramov D, Parkes N, Wood I, Goldacre B, Mackenna B. Impact of the COVID-19 pandemic on antipsychotic prescribing in individuals with autism, dementia, learning disability, serious mental illness or living in a care home: a federated analysis of 59 million patients' primary care records in situ using OpenSAFELY. BMJ MENTAL HEALTH 2023; 26:e300775. [PMID: 37714668 PMCID: PMC11146375 DOI: 10.1136/bmjment-2023-300775] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 05/30/2023] [Accepted: 08/07/2023] [Indexed: 09/17/2023]
Abstract
BACKGROUND The COVID-19 pandemic affected how care was delivered to vulnerable patients, such as those with dementia or learning disability. OBJECTIVE To explore whether this affected antipsychotic prescribing in at-risk populations. METHODS With the approval of NHS England, we completed a retrospective cohort study, using the OpenSAFELY platform to explore primary care data of 59 million patients. We identified patients in five at-risk groups: autism, dementia, learning disability, serious mental illness and care home residents. We calculated the monthly prevalence of antipsychotic prescribing in these groups, as well as the incidence of new prescriptions in each month. FINDINGS The average monthly rate of antipsychotic prescribing increased in dementia from 82.75 patients prescribed an antipsychotic per 1000 patients (95% CI 82.30 to 83.19) in January-March 2019 to 90.1 (95% CI 89.68 to 90.60) in October-December 2021 and from 154.61 (95% CI 153.79 to 155.43) to 166.95 (95% CI 166.23 to 167.67) in care homes. There were notable spikes in the rate of new prescriptions issued to patients with dementia and in care homes. In learning disability and autism groups, the rate of prescribing per 1000 decreased from 122.97 (95% CI 122.29 to 123.66) to 119.29 (95% CI 118.68 to 119.91) and from 54.91 (95% CI 54.52 to 55.29) to 51.04 (95% CI 50.74 to 51.35), respectively. CONCLUSION AND IMPLICATIONS We observed a spike in antipsychotic prescribing in the dementia and care home groups, which correlated with lockdowns and was likely due to prescribing of antipsychotics for palliative care. We observed gradual increases in antipsychotic use in dementia and care home patients and decreases in their use in patients with learning disability or autism.
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Affiliation(s)
- Orla Macdonald
- Pharmacy, Oxford Health NHS Foundation Trust, Oxford, UK
| | - Amelia Green
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Alex Walker
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Helen Curtis
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Richard Croker
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Andrew Brown
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Ben Butler-Cole
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Colm Andrews
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Jon Massey
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Peter Inglesby
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Caroline Morton
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Louis Fisher
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Jessica Morley
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Amir Mehrkar
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Sebastian Bacon
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Simon Davy
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - David Evans
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Iain Dillingham
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Tom Ward
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - William Hulme
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | | | | | | | | | | | | | | | | | | | | | | | - Ben Goldacre
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
| | - Brian Mackenna
- Nuffield Department of Primary Care, Oxford University, Oxford, UK
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21
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Mahmoodi Z, Rostami M, Bahrami G, Rasouli F, Ghavidel N. Predictor factors affecting emotional and behavioral problems in school-aged (6-12 years) children during the COVID-19 pandemic: a cross-sectional study. BMC Psychiatry 2023; 23:633. [PMID: 37644456 PMCID: PMC10466850 DOI: 10.1186/s12888-023-05125-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/31/2023] [Accepted: 08/21/2023] [Indexed: 08/31/2023] Open
Abstract
OBJECTIVES The prolonged outbreak of COVID-19 has caused psychological problems in the community, especially in children. Given that limited studies have been conducted on this vulnerable group in Iran, we conducted this study to determine the predictor factors affecting emotional and behavioral problems in school-aged (6-12 years) children during the COVID-19 pandemic. METHODS We conducted a cross-sectional study on 322 mothers of elementary school-aged children (6-12 years) from April 21 to June 21, 2021, in Karaj, Alborz, Iran. Sociodemographic checklist, socioeconomic status scale (SES), Depression, Anxiety, and Stress Scale (DASS-21), Corona Disease Anxiety Scale (CDAS), and the Rutter Children's Behavior Questionnaire (RCBQ) were used to evaluate the children's behavioral symptoms, the mental health of their mothers, and sociodemographic factors. RESULTS In total, 17.7% of children (male = 27.0%, female = 11.7%) had behavioral problems. Results showed income (p-value = 0.007, 95%CI (-3.85- -0.607)), and physical activity of the child (p-value = 0.026, 95%CI (-1.03- -0.067)), were indirectly associated with children's behavioral symptoms. Having underlying disease (p-value = 0.00, 95%CI (1.712-5.949)), breastfeeding (p-value = 0.027, 95%CI (0.335-5.61)), corona-related anxiety (p-value = 0.00, 95%CI (0.158-0.318)), and DASS score (p-value = 0.00, 95%CI (0.149-0.334)) in the mothers, as well as male gender (p-value = 0.003, 95%CI (0.724-3.471)) were directly associated with children's behavioral symptoms. The most factors involved in the behavioral symptom score of children were corona-related anxiety (β = .298), DASS (β = 0.273), underlying disease of mothers (β = 0.163), income (β = -0.154), child's gender (β = 0.142) and physical activity (β = -0.101), and breastfeeding (β = 0.099) respectively. CONCLUSION Study findings showed that some factors affect the emotional and behavioral problems of school-aged (6-12 years) children during the COVID-19 pandemic. These data may help future researchers and policymakers with early intervention.
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Affiliation(s)
- Zohreh Mahmoodi
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Mahnoosh Rostami
- Health Systems Evaluation and Evidence, Provincial Clinical Excellence, Alberta Health Services, Alberta, Canada
| | - Giti Bahrami
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Fatemeh Rasouli
- Non-Communicable Diseases Research Center, Alborz University of Medical Sciences, Karaj, Iran
| | - Nooshin Ghavidel
- Social Determinants of Health Research Center, Alborz University of Medical Sciences, Karaj, Iran.
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22
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刘 惠, 孙 文, 陈 强, 陈 柏, 毕 鸿. [A review of research on psychological and behavioral problems in children with autism spectrum disorder during the coronavirus disease 2019 epidemic]. ZHONGGUO DANG DAI ER KE ZA ZHI = CHINESE JOURNAL OF CONTEMPORARY PEDIATRICS 2023; 25:877-883. [PMID: 37668038 PMCID: PMC10484076 DOI: 10.7499/j.issn.1008-8830.2302153] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Subscribe] [Scholar Register] [Received: 02/25/2023] [Accepted: 06/12/2023] [Indexed: 09/06/2023]
Abstract
Since December 2019, coronavirus disease 2019 (COVID-19) has been rapidly spreading worldwide and affecting the physical and mental health of the general population. It may have even more serious potential harm to children with autism spectrum disorder (ASD). This paper provides a literature review on the psychological and behavioral problems experienced by children with ASD during the COVID-19 epidemic, as well as the factors influencing these issues. The findings of this review can serve as a basis for clinical research on ASD children.
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Affiliation(s)
| | | | | | - 柏宇 陈
- 山东中医药大学中医文献与文化研究院,山东济南250355
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23
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Day TC, Gerber A, McNair ML, Reicher D, Lerner MD. Trajectories of internalizing symptoms among autistic and nonautistic youth during the COVID-19 pandemic. Autism Res 2023; 16:1403-1412. [PMID: 37222243 PMCID: PMC10524859 DOI: 10.1002/aur.2959] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/06/2022] [Accepted: 05/14/2023] [Indexed: 05/25/2023]
Abstract
The COVID-19 pandemic elicited increases in anxiety and depression in youth, and youth on the autism spectrum demonstrate elevations in such symptoms pre-pandemic. However, it is unclear whether autistic youth experienced similar increases in internalizing symptoms after the COVID-19 pandemic onset or whether decreases in these symptoms were present, as speculated in qualitative work. In the current study, longitudinal changes in anxiety and depression during the COVID-19 pandemic in autistic youth were assessed in comparison to nonautistic youth. A well-characterized sample of 51 autistic and 25 nonautistic youth (ageM = 12.8, range = 8.5-17.4 years, IQ > 70) and their parents completed the Revised Children's Anxiety and Depression Scale (RCADS), a measure of internalizing symptoms, repeatedly, representing up to 7 measurement occasions from June to December 2020 (N ~ 419 occasions). Multilevel models were used to evaluate changes in internalizing symptoms over time. Internalizing symptoms did not differ between autistic and nonautistic youth in the summer of 2020. As reported by youth themselves, internalizing symptoms decreased in autistic youth, both overall and compared to nonautstic peers. This effect was driven by decreases in generalized anxiety, social anxiety, and depression symptoms in autistic youth. Reductions in generalized anxiety, social anxiety, and depression in autistic youth may be due to COVID-19 pandemic-specific differences in response to social, environmental, and contextual changes that unfolded in 2020. This highlights the importance of understanding unique protective and resilience factors that may be evident in autistic individuals in response to broad societal shifts such as those seen in response to COVID-19.
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Affiliation(s)
- Talena C. Day
- Psychology Department, Stony Brook University, Stony Brook, NY
| | - Alan Gerber
- Psychology Department, Stony Brook University, Stony Brook, NY
| | | | - Debra Reicher
- Psychiatry Department, Stony Brook University, Stony Brook, NY
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24
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Stankova M, Kamenski T, Ivanov I, Mihova P. Emotional and Behavioral Problems of Children with ASD-The Lessons That We Learned from the Pandemic. CHILDREN (BASEL, SWITZERLAND) 2023; 10:969. [PMID: 37371201 PMCID: PMC10297218 DOI: 10.3390/children10060969] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 05/23/2023] [Accepted: 05/23/2023] [Indexed: 06/29/2023]
Abstract
The data available for changes in the behavior and emotional state of children with ASD (autism spectrum disorder) in lockdown situations are controversial and scarce. In our research, we compare results before the first COVID-19 lockdown of 21 children with ASD and 21 typically developing children, four to five years of age with those obtained immediately after. The study attempts to answer the question of whether there are changes in the levels of emotional and behavioral problems in children with ASD after the lockdown and how these new living conditions affect some aspects of their functioning. The instruments used for data analysis are the Childhood Autism Spectrum Test (CAST); Child Behavior Checklist (CBCL); Survey on the consequences of COVID-19 on the life and development of the participants. No significant differences in the emotional and behavioral state of the participants were found, except for attention deficit/hyperactivity problems where ASD children showed lower levels after the lockdown. ASD group parents' answers to the survey pointed towards more positive consequences of staying at home. Some reported they had more time for learning together, communicating, playing, and assisting the learning process through online therapy. As negatives, the parents of ASD children reported low physical activity, increased time with electronic devices, and time spent with the same people. Caregivers of typically developing children agreed that the lockdown had only negative effects. To conclude, for children with ASD in the study, the lockdown period demonstrated that more time spent with parents in structured everyday activities is an opportunity that can lead to positive results in their behavior.
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Affiliation(s)
- Margarita Stankova
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
| | - Tsveta Kamenski
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
| | - Ivan Ivanov
- College of Veterinary Medicine & Biomedical Sciences, Texas A&M University, College Station, TX 77843, USA;
| | - Polina Mihova
- Department of Health Care and Social Work, New Bulgarian University, 1618 Sofia, Bulgaria; (T.K.); (P.M.)
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25
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Rhodes SM, Eaton CB, Oldridge J, Rodgers J, Chan S, Skouta E, McKechanie AG, Mackie L, Stewart TM. Lived experiences of depression in autistic children and adolescents: A qualitative study on child and parent perspectives. RESEARCH IN DEVELOPMENTAL DISABILITIES 2023; 138:104516. [PMID: 37141676 DOI: 10.1016/j.ridd.2023.104516] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/01/2022] [Revised: 02/22/2023] [Accepted: 04/19/2023] [Indexed: 05/06/2023]
Abstract
BACKGROUND Depression is highly prevalent in autistic children and adolescents. Despite this, little is known about the nature of the autistic child's subjective experience of depression and the impact of depression on their lives. METHODS We therefore conducted a qualitative study using thematic analysis with 7 autistic children and adolescents and their parents to identify common themes and individual differences. All children had previously experienced at least one depressive episode. RESULTS Six main themes were identified: (1) Autism related experiences; (2) Difficulties with peer relationships; (3) Co-occurring relationships between anxiety and depression; (4) Impactful pessimism and anhedonia; (5) Impactful difficulties with focus and concentration and (6) Feelings of irritability, including aggressive behaviours. Parent's accounts of their children's experience of depression mirrored the child's perspective. Novel findings included reports of depression related restriction of diet variety and masking of mental health difficulties. Children and parents linked being autistic and developing depression, referring to the difficulties of being autistic in a complex, neurotypical world. CONCLUSIONS These results highlight key challenges that autistic children and their families experience, calling for increased awareness of the impact of depression on autistic young people.
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Affiliation(s)
- Sinead M Rhodes
- Child Life and Health, University of Edinburgh, UK; Centre for Clinical Brain Sciences, University of Edinburgh, UK.
| | - Christopher B Eaton
- Division of Psychological Medicine and Clinical Neurosciences, MRC Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, Wales, UK
| | - Jessica Oldridge
- Clinical Psychology, School of Health and Wellbeing, University of Glasgow, UK
| | - Jacqui Rodgers
- Population Health Sciences Institute, Faculty of Medical Sciences, Newcastle University, UK
| | - Stella Chan
- School of Psychology and Clinical Language Sciences, University of Reading, UK
| | - Ereni Skouta
- NHS CAMHS South London and Maudsley, Snowsfield Adolescent Unit, Maudsley Hospital, London, UK
| | | | - Leila Mackie
- NHS Paediatric Speech and Language Therapy Service, Lothian, UK
| | - Tracy M Stewart
- Moray House School of Education and Sport, University of Edinburgh, UK
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26
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Artificial intelligence evaluation of COVID-19 restrictions and speech therapy effects on the autistic children's behavior. Sci Rep 2023; 13:4312. [PMID: 36922527 PMCID: PMC10016168 DOI: 10.1038/s41598-022-25902-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/01/2022] [Accepted: 12/06/2022] [Indexed: 03/17/2023] Open
Abstract
In the present study, we aimed to quantify the effects of COVID-19 restrictions and speech treatment approaches during lockdowns on autistic children using CBCL and neuro-fuzzy artificial intelligence method. In this regard, a survey including CBCL questionnaire is prepared using online forms. In total, 87 children with diagnosed Autism spectrum disorders (ASD) participated in the survey. The influences of three treatment approaches of in-person, telehealth and public services along with no-treatment condition during lockdown were the main factors of the investigation. The main output factors were internalized and externalized problems in general and their eight subcategory syndromes. We examined the reports by parents/caregivers to find correlation between treatments and CBCL listed problems. Moreover, comparison of the eight syndromes rating scores from pre-lockdown to post-lockdown periods were performed. In addition, artificial intelligence method were engaged to find the influence of speech treatment during restrictions on the level of internalizing and externalizing problems. In this regard, a fully connected adaptive neuro fuzzy inference system is employed with type and duration of treatments as input and T-scores of the syndromes are the output of the network. The results indicate that restrictions alleviate externalizing problems while intensifying internalizing problems. In addition, it is concluded that in-person speech therapy is the most effective and satisfactory approach to deal with ASD children during stay-at-home periods.
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27
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Shakeshaft A, Blakey R, Kwong ASF, Riglin L, Davey Smith G, Stergiakouli E, Tilling K, Thapar A. Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders. J Psychiatr Res 2023; 159:230-239. [PMID: 36753897 PMCID: PMC9885110 DOI: 10.1016/j.jpsychires.2023.01.029] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 01/11/2023] [Accepted: 01/26/2023] [Indexed: 01/31/2023]
Abstract
The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (β = 0.8 [0.2,1.4], p = 0.01) and ASD (β = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (β = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (β = 1.3 [0.2,2.5], p = 0.03) and females with ASD (β = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.
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Affiliation(s)
- Amy Shakeshaft
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK
| | - Rachel Blakey
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Alex S F Kwong
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK; Division of Psychiatry, University of Edinburgh, UK
| | - Lucy Riglin
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK
| | - George Davey Smith
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Evie Stergiakouli
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Kate Tilling
- Population Health Sciences and MRC Integrative Epidemiology Unit, University of Bristol, Bristol, UK
| | - Anita Thapar
- Division of Psychological Medicine and Clinical Neurosciences, Centre for Neuropsychiatric Genetics and Genomics, Cardiff University, UK; Wolfson Centre for Young People's Mental Health, Cardiff University, UK.
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28
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Zhao Y, Luo Y, Zhang R, Zheng X. The impact of COVID-19 pandemic on emotional and behavioral problems of children with autism spectrum disorder and developmental delay aged 1-6 years in China. Front Psychiatry 2023; 14:1134396. [PMID: 36911121 PMCID: PMC9998531 DOI: 10.3389/fpsyt.2023.1134396] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/30/2022] [Accepted: 02/06/2023] [Indexed: 02/26/2023] Open
Abstract
Introduction The COVID-19 pandemic outbreak have caused increased levels of emotional and behavioral problems, particularly among people with pre-existing mental health conditions. Young individuals with autism spectrum disorders (ASD) and developmental delay (DD) are particularly at risk due to their vulnerability. The purpose of this study was to look into the different effects of the COVID-19 pandemic on 1-6-year-old children with ASD and DD. Methods Parents and guardians of children with ASD completed an online survey that included questions about their children's socio-demographics characteristics, the effects of the COVID-19 outbreak on their health, and what they needed in order to deal with the conditions of the pandemic. Results This study compared 4,138 children with ASD to 711 children with DD. Children with ASD had a higher risk of having more emotional and behavioral problems than children with DD (OR 1.38, 95% CI 1.12-1.70). Compared to parent-oriented rehabilitation at home, discontinuing rehabilitation had a higher likelihood of negative emotional and behavioral change (OR 1.67, 95% CI 1.41-1.98). Having teachers' online support had a higher likelihood of negative emotional and behavioral change for ASD children (OR 1.26, 95% CI 1.03-1.54). Conclusions This article provided evidence that children with developmental disabilities, particularly ASD, were at risk for a variety of challenges to their emotional functioning during the COVID-19 period, and that online support was not an ideal way for children with ASD to receive effective educational intervention in China.
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Affiliation(s)
- Yanan Zhao
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- China Center for Health Development Studies, Peking University, Beijing, China
- Asia-Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
| | - Yanan Luo
- Department of Global Health, School of Public Health, Peking University, Beijing, China
| | - Rong Zhang
- Neuroscience Research Institute, Peking University, Beijing, China
- Key Laboratory for Neuroscience of the Ministry of Education, Key Laboratory for Neuroscience of the Ministry of National Health Commission, Department of Neurobiology, School of Basic Medical Sciences, Peking University Health Science Center, Beijing, China
- Autism Research Centre, Peking University Health Science Centre, Beijing, China
| | - Xiaoying Zheng
- School of Population Medicine and Public Health, Chinese Academy of Medical Sciences/Peking Union Medical College, Beijing, China
- Asia-Pacific Economic Cooperation Health Sciences Academy, Peking University, Beijing, China
- Autism Research Centre, Peking University Health Science Centre, Beijing, China
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29
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Vibert B, Segura P, Gallagher L, Georgiades S, Pervanidou P, Thurm A, Alexander L, Anagnostou E, Aoki Y, Birken CS, Bishop SL, Boi J, Bravaccio C, Brentani H, Canevini P, Carta A, Charach A, Costantino A, Cost KT, Cravo EA, Crosbie J, Davico C, Donno F, Fujino J, Gabellone A, Geyer CT, Hirota T, Kanne S, Kawashima M, Kelley E, Kim H, Kim YS, Kim SH, Korczak DJ, Lai MC, Margari L, Marzulli L, Masi G, Mazzone L, McGrath J, Monga S, Morosini P, Nakajima S, Narzisi A, Nicolson R, Nikolaidis A, Noda Y, Nowell K, Polizzi M, Portolese J, Riccio MP, Saito M, Schwartz I, Simhal AK, Siracusano M, Sotgiu S, Stroud J, Sumiya F, Tachibana Y, Takahashi N, Takahashi R, Tamon H, Tancredi R, Vitiello B, Zuddas A, Leventhal B, Merikangas K, Milham MP, Di Martino A. CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions. Mol Autism 2023; 14:7. [PMID: 36788583 PMCID: PMC9928142 DOI: 10.1186/s13229-022-00536-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/26/2022] [Accepted: 12/26/2022] [Indexed: 02/16/2023] Open
Abstract
BACKGROUND Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. METHODS Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. RESULTS Clustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. LIMITATIONS Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. CONCLUSIONS Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.
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Affiliation(s)
- Bethany Vibert
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Patricia Segura
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Louise Gallagher
- grid.8217.c0000 0004 1936 9705Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Stelios Georgiades
- grid.25073.330000 0004 1936 8227Department of Psychiatry and Behavioural Neurosciences, McMaster University, Hamilton, ON Canada
| | - Panagiota Pervanidou
- Unit of Developmental and Behavioral Pediatrics, First Department of Pediatrics, School of Medicine, National & Kapodistrian University of Athens, “Aghia Sophia” Children’s Hospital, Athens, Greece
| | - Audrey Thurm
- grid.416868.50000 0004 0464 0574Neurodevelopmental and Behavioral Phenotyping Service, National Institute of Mental Health, Bethesda, MD USA
| | - Lindsay Alexander
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA
| | - Evdokia Anagnostou
- grid.414294.e0000 0004 0572 4702Autism Research Centre, Bloorview Research Institute, Holland Bloorview Kids Rehabilitation Hospital, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Paediatrics, University of Toronto, Toronto, ON Canada
| | - Yuta Aoki
- grid.410714.70000 0000 8864 3422Medical Institute of Developmental Disabilities Research, Showa University, Tokyo, Japan
| | - Catherine S. Birken
- grid.17063.330000 0001 2157 2938Department of Pediatrics, School of Medicine, University of Toronto, Toronto, ON Canada ,grid.42327.300000 0004 0473 9646Division of Paediatric Medicine, Hospital for Sick Children, Toronto, ON Canada
| | - Somer L. Bishop
- grid.266102.10000 0001 2297 6811Department of Psychiatry and Behavioral Sciences and Weill Institute for Neurosciences, University of California, San Francisco, CA USA
| | - Jessica Boi
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Carmela Bravaccio
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Helena Brentani
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Paola Canevini
- grid.4708.b0000 0004 1757 2822Department of Health Sciences, Università Degli Studi Di Milano, Milan, Italy ,grid.415093.a0000 0004 1793 3800Epilepsy Center - Sleep Medicine Center, Childhood and Adolescence Neuropsychiatry Unit, ASST SS. Paolo E Carlo, San Paolo Hospital, Milan, Italy
| | - Alessandra Carta
- Department of Medical, Surgical and Pharmacy, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Italy
| | - Alice Charach
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Antonella Costantino
- grid.414818.00000 0004 1757 8749Child and Adolescent Neuropsychiatric Unit, Foundation IRCCS Ca’ Granda Ospedale Maggiore Policlinico, Milan, Italy
| | - Katherine T. Cost
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada
| | - Elaine A Cravo
- grid.20736.300000 0001 1941 472XUFPR - Federal University of Paraná, Paraná, Brazil
| | - Jennifer Crosbie
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Chiara Davico
- grid.7605.40000 0001 2336 6580Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Federica Donno
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy
| | - Junya Fujino
- grid.265073.50000 0001 1014 9130Department of Psychiatry and Behavioral Sciences, Graduate School of Medical and Dental Sciences, Tokyo Medical and Dental University, Tokyo, Japan
| | - Alessandra Gabellone
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Cristiane T Geyer
- grid.20736.300000 0001 1941 472XUFPR - Federal University of Paraná, Paraná, Brazil
| | - Tomoya Hirota
- grid.266102.10000 0001 2297 6811Department of Psychiatry and Behavioral Sciences, University of California San Francisco, San Francisco, CA USA ,grid.257016.70000 0001 0673 6172Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan
| | - Stephen Kanne
- grid.5386.8000000041936877XDepartment of Psychiatry, Weill Cornell Medical College, Center for Autism and the Developing Brain, New York, NY USA
| | | | - Elizabeth Kelley
- grid.410356.50000 0004 1936 8331Department of Psychology, Queens University, Kingston, ON Canada
| | - Hosanna Kim
- grid.266102.10000 0001 2297 6811The UCSF Center for ASD & NDDs, University of California San Francisco, San Francisco, CA USA
| | - Young Shin Kim
- grid.266102.10000 0001 2297 6811The UCSF Center for ASD & NDDs, University of California San Francisco, San Francisco, CA USA
| | - So Hyun Kim
- grid.222754.40000 0001 0840 2678School of Psychology and Psychiatry, Korea University, Seoul, South Korea
| | - Daphne J. Korczak
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Meng-Chuan Lai
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada ,grid.5335.00000000121885934Autism Research Centre, Department of Psychiatry, University of Cambridge, Cambridge, UK ,grid.155956.b0000 0000 8793 5925Centre for Addiction and Mental Health, Toronto, ON Canada ,grid.412094.a0000 0004 0572 7815Department of Psychiatry, National Taiwan University Hospital and College of Medicine, Taipei, Taiwan
| | - Lucia Margari
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Lucia Marzulli
- grid.7644.10000 0001 0120 3326Department of Precision and Regenerative Medicine and Ionian Area, (DiMePRe-J), University of Bari “Aldo Moro”, Bari, Italy
| | - Gabriele Masi
- IRCCS Stella Maris Foundation, Calambrone-Pisa, Italy
| | - Luigi Mazzone
- grid.6530.00000 0001 2300 0941Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Jane McGrath
- grid.8217.c0000 0004 1936 9705Department of Psychiatry, School of Medicine, Trinity College Dublin, Dublin, Ireland ,39ADMiRE, Linn Dara Child and Adolescent Mental Health Services, Cherry Orchard Hospital, Ballyfermot, Dublin, Ireland
| | - Suneeta Monga
- grid.42327.300000 0004 0473 9646Department of Psychiatry, Hospital for Sick Children, Peter Gilgan Centre for Research and Learning, Toronto, ON Canada ,grid.17063.330000 0001 2157 2938Department of Psychiatry, Temerty Faculty of Medicine, University of Toronto, Toronto, ON Canada
| | - Paola Morosini
- Unita’ Operativa di Neuropsichiatria dell’ Infanzia e dell’ adolescenza, Lodi, Italy
| | - Shinichiro Nakajima
- grid.26091.3c0000 0004 1936 9959Keio University School of Medicine, Tokyo, Japan
| | | | - Rob Nicolson
- grid.39381.300000 0004 1936 8884Department of Psychiatry, University of Western Ontario, London, ON Canada
| | - Aki Nikolaidis
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA
| | - Yoshihiro Noda
- grid.26091.3c0000 0004 1936 9959Keio University School of Medicine, Tokyo, Japan
| | - Kerri Nowell
- grid.134936.a0000 0001 2162 3504Thompson Center of Neurodevelopmental Disorders, University of Missouri, Columbia, MO USA
| | - Miriam Polizzi
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Joana Portolese
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Maria Pia Riccio
- grid.4691.a0000 0001 0790 385XUOSD di Neuropsichiatria Infantile - Dipartimento di Scienze Mediche Traslazionali, Università Federico II di Napoli, Naples, Italy
| | - Manabu Saito
- grid.257016.70000 0001 0673 6172Department of Neuropsychiatry, Graduate School of Medicine, Hirosaki University, Hirosaki, Aomori, Japan ,grid.257016.70000 0001 0673 6172Research Center for Child Mental Development, Graduate School of Medicine, Hirosaki University, Hirosaki, Japan ,grid.257016.70000 0001 0673 6172Department of Clinical Psychological Science, Comprehensive Rehabilitation Science, Graduate School of Health Sciences, Hirosaki University, Hirosaki, Aomori, Japan
| | - Ida Schwartz
- grid.8532.c0000 0001 2200 7498Genetics Department/UFRGS, Medical Genetics Service/HCPA, Porto Alegre, Brazil
| | - Anish K. Simhal
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA ,grid.51462.340000 0001 2171 9952Medical Physics, Memorial Sloan Kettering Cancer Center, New York, USA
| | - Martina Siracusano
- grid.6530.00000 0001 2300 0941Child Neurology and Psychiatry Unit, Systems Medicine Department, University of Rome Tor Vergata, Rome, Italy
| | - Stefano Sotgiu
- Department of Medical, Surgical and Pharmacy, Unit of Child Neuropsychiatry, University Hospital of Sassari, Sassari, Italy
| | - Jacob Stroud
- grid.428122.f0000 0004 7592 9033Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY USA
| | - Fernando Sumiya
- grid.11899.380000 0004 1937 0722Department of Psychiatry, Hospital das Clinicas HCFMUSP, Faculty of Medicine, University of São Paulo (USP), São Paulo, Brazil
| | - Yoshiyuki Tachibana
- grid.63906.3a0000 0004 0377 2305Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | - Nicole Takahashi
- grid.134936.a0000 0001 2162 3504Thompson Center of Neurodevelopmental Disorders, University of Missouri, Columbia, MO USA
| | | | - Hiroki Tamon
- grid.63906.3a0000 0004 0377 2305Division of Infant and Toddler Mental Health, Department of Psychosocial Medicine, National Center for Child Health and Development, Tokyo, Japan
| | | | - Benedetto Vitiello
- grid.7605.40000 0001 2336 6580Department of Public Health and Pediatric Sciences, Section of Child and Adolescent Neuropsychiatry, University of Turin, Turin, Italy
| | - Alessandro Zuddas
- grid.7763.50000 0004 1755 3242Department of Biomedical Sciences, Section of Neuroscience & Clinical Pharmacology, University of Cagliari, Cagliari, Italy ,Child & Adolescent Neuropsychiatry Unit, “A.Cao” Paediatric Hospital, Cagliari, Italy
| | - Bennett Leventhal
- grid.170205.10000 0004 1936 7822University of Chicago, Chicago, IL USA
| | - Kathleen Merikangas
- grid.416868.50000 0004 0464 0574Genetic Epidemiology Research Branch, Intramural Research Program, National Institute of Mental Health, Bethesda, USA
| | - Michael P. Milham
- grid.428122.f0000 0004 7592 9033Center for the Developing Brain, Child Mind Institute, New York, NY USA ,grid.250263.00000 0001 2189 4777Nathan S. Kline Institute for Psychiatric Research, Orangeburg, NY USA
| | - Adriana Di Martino
- Autism Center, Child Mind Institute, 101 E 56Th Street, Third Floor, New York, NY, USA.
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30
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Tremolada M, Rosa M, Incardona RM, Taverna L, Guidi M. Impact of the COVID-19 Pandemic on Psychosocial Well-being and Adaptation in Children and Adolescents with Asperger's Syndrome. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:2132. [PMID: 36767499 PMCID: PMC9915274 DOI: 10.3390/ijerph20032132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/31/2022] [Revised: 01/20/2023] [Accepted: 01/22/2023] [Indexed: 06/18/2023]
Abstract
Mental health could worsen in children and adolescents with autism spectrum disorder during the COVID-19 pandemic. In addition, their parents could be more at risk for an increase in anxiety and depression symptomatology. This study aims to understand the adaptation and the psychosocial well-being in a sample of 16 males aged 10-21 years old with Asperger's syndrome after the quarantine for COVID-19 when they return to school and partially to their activities in September 2020. The adopted approach is multi-informant with a battery of questionnaires on psychological health and adaptation given by a secure online web data Qualtrics both to adolescents and also to their parents. Paralleling matched peers with typical developments were assessed by adopting the same methodology. The results evidenced several difficulties in psychological health in population with Asperger's syndrome, especially in anxiety and socialization. Adaptation is put in crisis, even if they reported a good comprehension and adoption of the right behaviors anti-COVID-19. Parents of children with Asperger's syndrome reported similar psychological difficulties and general health to those of the group of children typically developing. Some clinical indications could be discussed for psychologists who follow children and adolescents with Asperger's syndrome.
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Affiliation(s)
- Marta Tremolada
- Department of Developmental and Social Psychology, University of Padua, 35131 Padua, Italy
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Mariangela Rosa
- Cooperativa Progetto Insieme, Via Cappello 44, Noventa Padovana, 35027 Padua, Italy
| | - Roberta Maria Incardona
- Pediatric Hematology, Oncology and Stem Cell Transplant Center, Department of Woman’s and Child’s Health, University of Padua, 35128 Padua, Italy
| | - Livia Taverna
- Faculty of Education, Free University of Bolzano-Bozen, 39100 Bolzano, Italy
| | - Michele Guidi
- Cooperativa Progetto Insieme, Via Cappello 44, Noventa Padovana, 35027 Padua, Italy
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How to Make the Unpredictable Foreseeable? Effective Forms of Assistance for Children with Autism Spectrum Disorder (ASD) during the COVID-19 Pandemic. Diagnostics (Basel) 2023; 13:diagnostics13030407. [PMID: 36766512 PMCID: PMC9914931 DOI: 10.3390/diagnostics13030407] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/16/2022] [Revised: 01/18/2023] [Accepted: 01/21/2023] [Indexed: 01/24/2023] Open
Abstract
Symptomatology in patients with the diagnosis of autism spectrum disorder (ASD) is very heterogeneous. The symptoms they present include communication difficulties, behavior problems, upbringing problems from their parents, and comorbidities (e.g., epilepsy, intellectual disability). A predictable and stable environment and the continuity of therapeutic interactions are crucial in this population. The COVID-19 pandemic has created much concern, and the need for home isolation to limit the spread of the virus has disrupted the functioning routine of children/adolescents with ASD. Are there effective diagnostic and therapeutic alternatives to limit the consequences of disturbing the daily routine of young patients during the unpredictable times of the pandemic? Modern technology and telemedicine have come to the rescue. This narrative review aims to present a change in the impact profile in the era of isolation and assess the directions of changes that specialists may choose when dealing with patients with ASD.
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Warwicker S, Sant D, Richard A, Cutajar J, Bellizzi A, Micallef G, Refalo D, Camilleri L, Grech A. A Retrospective Longitudinal Analysis of Mental Health Admissions: Measuring the Fallout of the Pandemic. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:1194. [PMID: 36673950 PMCID: PMC9858631 DOI: 10.3390/ijerph20021194] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 12/05/2022] [Revised: 01/01/2023] [Accepted: 01/08/2023] [Indexed: 06/17/2023]
Abstract
BACKGROUND In this research article, we review the infrequently considered long-term impact of the pandemic on inpatient mental health, by reviewing the clinical parameters of all psychiatric admissions to Mount Carmel Hospital, our region's main psychiatric healthcare facility, from 2019-2021. METHODS 4292 patients were admitted during the research period of this retrospective longitudinal analysis. Taking 2019 as the pre-COVID reference year, we compared mean monthly admissions from 2020 and 2021, looking at patient demographics, status under the Mental Health Act, diagnosis, and self-injurious behaviour. RESULTS While the pandemic was reflected in a moderate increase in mean monthly presentations with suicidal ideation and suicidal self-injury, presentations in 2020 otherwise remained largely stable. This contrasted with a surge in presentations in 2021 with mood disorders, schizophrenia, anxiety, personality disorders, and autism spectrum disorders. Furthermore, presentations involving self-injurious behaviour continued to grow. Involuntary admissions also increased significantly in 2021. CONCLUSIONS This paper highlights the pernicious long-term impact of the pandemic on mental health presentations, demonstrated by an increase in hospital admissions and more serious presentations. These findings should be considered in the guidance for responses to any future pandemic, giving attention to the evidence of the impact of restrictive measures on mental health.
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Affiliation(s)
| | | | | | | | | | | | - Daniel Refalo
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Liberato Camilleri
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
| | - Anton Grech
- Mount Carmel Hospital, ATD 9033 H’Attard, Malta
- Department of Psychiatry, Faculty of Medicine and Surgery, University of Malta, MSD 2080 Msida, Malta
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Toseeb U, Asbury K. A longitudinal study of the mental health of autistic children and adolescents and their parents during COVID-19: Part 1, quantitative findings. AUTISM : THE INTERNATIONAL JOURNAL OF RESEARCH AND PRACTICE 2023; 27:105-116. [PMID: 35669991 PMCID: PMC9805925 DOI: 10.1177/13623613221082715] [Citation(s) in RCA: 9] [Impact Index Per Article: 9.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/05/2023]
Abstract
LAY ABSTRACT Autistic children and adolescents, and their parents/carers, tend to experience more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. The rapid change in society as a result of the COVID-19 pandemic is likely to have disproportionately affected autistic young people and their parents/carers. We investigated how the mental health of autistic young people, and their parents/carers, developed during the first lockdown in the United Kingdom and how it changed once schools fully reopened for face-to-face teaching approximately 6 months later. Parents/carers completed online standardised questionnaires about their own and their child's mental health at four time points between March 2020 and October 2020. We found that, throughout this period, autistic young people experienced more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. Anxiety levels decreased as lockdown progressed and schools reopened for face-to-face teaching but only for those with other special educational needs and disabilities. For autistic young people, both anxiety and depression symptoms remained high throughout. There were no differences in the mental health of parents/carers of autistic children compared to those with other special educational needs and disabilities. These findings suggest that the mental health of autistic children and adolescents is likely to have been disproportionately affected during and after the first lockdown in the United Kingdom. In the second part of this article (Asbury & Toseeb, 2022), we attempt to explain these trends using qualitative data provided by parents during the same period.
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Affiliation(s)
- Umar Toseeb
- Umar Toseeb, Department of Education,
University of York, York YO10 5DD, UK.
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Wang F, Memis I, Durocher JS, Furar E, Cavalcante L, Eshraghi RS, Samson AC, Van Herwegen J, Dukes D, Alessandri M, Mittal R, Eshraghi AA. Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism. PLoS One 2023; 18:e0283494. [PMID: 37053138 PMCID: PMC10101447 DOI: 10.1371/journal.pone.0283494] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Accepted: 03/11/2023] [Indexed: 04/14/2023] Open
Abstract
The COVID-19 pandemic's alterations to daily life have been especially challenging for families with Autism Spectrum Disorder (ASD), worsening the core features of ASD and overall mental health. With the increased need for effective coping, the current retrospective study used data from a survey regarding parent reports of how often their child with ASD used certain coping strategies (frequency), as well as the extent to which they felt their child benefitted from their use (efficacy) in mitigating stress during the pandemic. This retrospective study Repeated measures ANOVAs were conducted to evaluate whether there were significant differences in both frequency and efficacy ratings for each coping strategy, for the entire sample as well as for three children's age groups. Using Spearman's rank-order correlations, correlation coefficients between the frequency and efficacy of each coping strategy were explored. Results revealed that maladaptive strategies were used more frequently than adaptive strategies, while parent routine as the most frequently used and efficacious for all age groups. Additionally, for adaptive strategies, humor and focusing on the positive had the strongest correlations between frequency and efficacy ratings amongst all age groups. Of the maladaptive strategies, repetitive behaviors, rumination, and isolation had the strongest correlations for the youngest, middle, and oldest age groups, respectively. Further, for each age group, the adaptive coping strategies had stronger correlations between frequency and efficacy than the maladaptive ones. It is our hope that the results of this study will lay the foundation for developing adaptive coping strategies to alleviate stress in children with ASD. Further investigations using a larger cohort are warranted to determine effective coping strategies for individuals with ASD across a range of situations, including acute stressors (such as future public health emergencies and natural disasters), as well as common daily stressors.
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Affiliation(s)
- Florence Wang
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Idil Memis
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Jennifer S Durocher
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
| | - Emily Furar
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Leylane Cavalcante
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Rebecca S Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Andrea C Samson
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
- Faculty of Psychology, Unidistance Suisse, Brig, Switzerland
| | - Jo Van Herwegen
- Department of Psychology and Human Development, UCL, Institute of Education, University College London, London, United Kingdom
| | - Daniel Dukes
- Institute of Special Education, University of Fribourg, Fribourg, Switzerland
- Swiss Center for Affective Sciences, University of Geneva, Geneva, Switzerland
| | - Michael Alessandri
- Department of Psychology, University of Miami, Coral Gables, Florida, United States of America
| | - Rahul Mittal
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
| | - Adrien A Eshraghi
- Hearing Research and Communication Disorders Laboratory, Department of Otolaryngology, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Neurological Surgery, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
- Department of Pediatrics, Miller School of Medicine, University of Miami, Miami, Florida, United States of America
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35
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Adolescents with Neuropsychiatric Disorders during the COVID-19 Pandemic: Focus on Emotional Well-Being and Parental Stress. Healthcare (Basel) 2022; 10:healthcare10122368. [PMID: 36553892 PMCID: PMC9778093 DOI: 10.3390/healthcare10122368] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2022] [Revised: 11/20/2022] [Accepted: 11/23/2022] [Indexed: 11/26/2022] Open
Abstract
(1) Introduction: The aim of our research was to explore emotional/behavioral changes in adolescents with neuropsychiatric conditions during the COVID-19 pandemic, and parental stress levels through a standardized assessment, comparing the data collected before and during the first months of lockdown. Moreover, an additional goal was to detect a possible relationship between emotional/behavioural symptoms of adolescents and the stress levels of their parents. (2) Methods: We enrolled 178 Italian adolescents aged between 12-18 that were referred to the Child Neuropsychiatry Unit of the University Hospital of Salerno with different neuropsychiatric diagnoses. Two standardized questionnaires were provided to all parents for the assessment of parental stress (PSI-Parenting Stress Index-Short Form) and the emotional/behavioral problems of their children (Child Behaviour Check List). The data collected from questionnaires administered during the six months preceding the pandemic, as is our usual clinical practice, were compared to those recorded during the pandemic. (3) Results: The statistical comparison of PSI and CBCL scores before/during the pandemic showed a statistically significant increase in all subscales in the total sample. The correlation analysis highlighted a significant positive relationship between Parental Stress and Internalizing/Externalizing symptoms of adolescent patients. Age and gender did not significantly affect CBCL and PSI scores, while the type of diagnosis could affect behavioral symptoms and parental stress. (4) Conclusions: our study suggests that the lockdown and the containment measures adopted during the COVID-19 pandemic could have aggravated the emotional/behavioral symptoms of adolescents with neuropsychiatric disorders and the stress of their parents. Further studies should be conducted in order to monitor the evolution of these aspects over time.
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Jones EF, Singh V, Holingue C, Errichetti CL, Myers L, Sherby MR, Gurnett C, Newland J, Kalb L. Understanding educators' perspectives and experiences of COVID-19 in schools serving children with intellectual/developmental disabilities. FRONTIERS IN EDUCATION 2022; 7:949430. [PMID: 37799289 PMCID: PMC10552794 DOI: 10.3389/feduc.2022.949430] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Indexed: 10/07/2023]
Abstract
The COVID-19 pandemic has significantly impacted educators, both personally and professionally. However, very little is known about the extent of these impacts among educators' serving children with intellectual and developmental disabilities (IDD). The present study surveyed 230 educators (teachers, staff, and administrators) to assess their wellbeing, concerns during the pandemic, and perceived importance of various COVID-19 school mitigation strategies. Data were gathered May/June of 2021 from two separate school districts, one in the Midwest and the other in the Mid-Atlantic, serving children with IDD. Nearly half of all survey respondents reported poor wellbeing. Almost all educators reported health of themselves, students, and family members was their greatest concern when compared to pandemic-related disruption of their duties or benefits (e.g., not having enough sick time). Most educators felt disinfecting routines, vaccinations, and daily health checks were the most helpful in preventing the spread of COVID-19 in schools, while in-school mask mandates and weekly testing of students and staff were perceived as less helpful. Our findings suggest that efforts are needed to support the wellbeing of educators during these challenging times. When pandemic-related policies and procedures are decided by administrators, our data suggest educators will review decisions within the framework of health and safety of themselves, their students, and families. Understanding this framework may be particularly valuable when considering implementation of COVID-19 policies, like masking and COVID-19 testing, that are less preferred.
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Affiliation(s)
- Erin F. Jones
- Information Systems Department, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Vini Singh
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Calliope Holingue
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
| | - Cheryl Lyn Errichetti
- Maryland Center for Developmental Disabilities, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Linda Myers
- Special Education, Kennedy Krieger Institute, Baltimore, MD, United States
| | - Michael R. Sherby
- Department of Neurology, Washington University in St. Louis, Baltimore, MO, United States
| | - Christina Gurnett
- Department of Neurology, Washington University in St. Louis, Baltimore, MO, United States
| | - Jason Newland
- Department of Neurology, Washington University in St. Louis, Baltimore, MO, United States
| | - Luther Kalb
- Center for Autism and Related Disorders, Kennedy Krieger Institute, Baltimore, MD, United States
- Johns Hopkins Bloomberg School of Public Health, Baltimore, MD, United States
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Alenezi S, Temsah MH, Alyahya AS, Almadani AH, Almarshedi A, Algazlan MS, Alnemary F, Bashiri FA, Alkhawashki SH, Altuwariqi MH, Alsedrani R, Alkhiri A, Alarabi M. Mental health impact of COVID-19 on Saudi families and children with special educational needs and disabilities in Saudi Arabia: A national perspective. Front Public Health 2022; 10:992658. [PMID: 36238239 PMCID: PMC9551570 DOI: 10.3389/fpubh.2022.992658] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/12/2022] [Accepted: 08/23/2022] [Indexed: 01/26/2023] Open
Abstract
Introduction The COVID-19 pandemic revealed a multidimensional impact on mental health due to health concerns, social distancing and lockdowns, job loss, and limits in institutional support. Accordingly, COVID-19 may disproportionally impact families with special educational needs and disabilities (SEND) due to the already high prevalence of mental health conditions in children with SEND and their parents. Hence, it is essential to determine the short-term impact of the pandemic on the mental health of families with SEND to identify their ongoing health, including psychological wellbeing and support needs. The current study examines the anxiety level and concerns of children with SEND and their parents living in Saudi Arabia. Methodology A cross-sectional national study design was utilized as a part of an international consortium using an online Arabic survey. Data were collected from the Ministry of Human Resources and Social Development beneficiaries from May to July 2020. The sample consisted of 1,848 parents of children with SEND aged between 1 and 18 years (mean = 9.66; SD = 4.31). A descriptive and bivariant analysis is reported. Results Parental worries on all those concerns when the pandemic started were significantly higher than before the pandemic, p < 0.050. Parental-perceived general anxiety had risen significantly across time, p < 0.001, and their perceived anxiety when the pandemic started exceeded their anxiety before the pandemic, p < 0.001. The general anxiety of children with SEND had risen significantly across time (from before the pandemic to when it had started to during the pandemic), p < 0.001. The children's general worries at the start of the pandemic had correlated significantly and positively with their anxiety, adaptive, maladaptive, and coping efficacies, and parental anxiety scores, p < 0.010 each. Conclusion Anxiety levels were high in SEND and their caregivers before and during COVID-19. At the start of the pandemic, the anxiety, adaptive, maladaptive, coping efficacies, and parental anxiety scores of children with SEND were significantly and favorably correlated. These findings support the notion of SEND-specific anxiety and patterns of coping in SEND and their caregivers. The notion also attests to the institutional support required for this specifically vulnerable population during epidemics.
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Affiliation(s)
- Shuliweeh Alenezi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,*Correspondence: Shuliweeh Alenezi
| | - Mohamad-Hani Temsah
- Pediatric Department, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | - Ahmed S. Alyahya
- Department of Psychiatry, Eradah Complex for Mental Health, Riyadh, Saudi Arabia
| | - Ahmad H. Almadani
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Afnan Almarshedi
- Psychiatry Department, Prince Sultan Military Medical City, Riyadh, Saudi Arabia
| | - Maha S. Algazlan
- Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia
| | | | - Fahad A. Bashiri
- Pediatric Neurology Division, Department of Pediatrics, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Samah Hazem Alkhawashki
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | - Maram Hani Altuwariqi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
| | | | - Aqeel Alkhiri
- Department of Mental Health, Al Qunfudah General Hospital, Al Qunfudah, Saudi Arabia
| | - Mohammed Alarabi
- Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia,Department of Psychiatry, King Saud University Medical City, King Saud University, Riyadh, Saudi Arabia,SABIC Psychological Health Research and Applications Chair, Department of Psychiatry, College of Medicine, King Saud University, Riyadh, Saudi Arabia
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Dal Pai J, Wolff CG, Aranchipe CS, Kepler CK, dos Santos GA, Canton LAL, de Carvalho AB, Richter SA, Nunes ML. COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Children and Adolescents - a Systematic Review. REVIEW JOURNAL OF AUTISM AND DEVELOPMENTAL DISORDERS 2022:1-26. [PMID: 36189101 PMCID: PMC9510314 DOI: 10.1007/s40489-022-00344-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/27/2022] [Accepted: 08/27/2022] [Indexed: 11/13/2022]
Abstract
In this systematic review, we aimed to identify the impact of the COVID-19 pandemic on children/adolescents with a diagnosis of autism spectrum disorder (ASD). The protocol was registered on PROSPERO CRD42021255848. Articles were selected from PubMed, Embase, and LILACS according to these characteristics: patients from zero to 18 years old, exposed to the COVID-19 pandemic, impact on social communication/interaction and restricted/repetitive behavior domains. The Newcastle-Ottawa Scale was used to assess methodological quality and the risk of bias. Of the 351 articles initially identified, 26 were finally included with information on 8,610 patients. Although the studies were heterogeneous, they indicated that the pandemic-related issues experienced by patients with ASD were mostly manifested in their behavior and sleep patterns. Supplementary Information The online version contains supplementary material available at 10.1007/s40489-022-00344-4.
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Affiliation(s)
- Janise Dal Pai
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Cecília Gatti Wolff
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Siciliani Aranchipe
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Carolina Knorst Kepler
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Gabriele Alves dos Santos
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Luiz Augusto Leal Canton
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Antonella Brun de Carvalho
- Extension and Management of Continuing Education Activities Program, Pontifical Catholic University of Rio Grande do Sul (PEGA/PUCRS), Porto Alegre, Brazil
| | - Samanta Andresa Richter
- Brain Institute of Rio Grande Do Sul, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Porto Alegre, Brazil
| | - Magda Lahorgue Nunes
- School of Medicine, Pontifical Catholic University of Rio Grande do Sul (InsCer/PUCRS), Av Ipiranga 6690, building 63, 2nd floor, 90610-000 Porto Alegre, Brazil
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Polónyiová K, Rašková B, Ostatníková D. Changes in Mental Health during Three Waves of the COVID-19 Pandemic in Slovakia: Neurotypical Children versus Children with Autism Spectrum Disorder and Their Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:11849. [PMID: 36231151 PMCID: PMC9565628 DOI: 10.3390/ijerph191911849] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 07/26/2022] [Revised: 09/06/2022] [Accepted: 09/14/2022] [Indexed: 06/16/2023]
Abstract
The main goal of our research was to monitor changes in the mental health of Slovak families with children with autism spectrum disorder (ASD) compared to families with neurotypical children during three waves of the COVID-19 pandemic. We focused on the prevalence of depression, anxiety, stress and different stressors of parents. In children, we explored maladaptive behavior and the availability of interventions for children with ASD. The data were collected using an extensive questionnaire including the Depression, Anxiety, and Stress Scale-42 questionnaire (DASS-42) and two subscales of the Vineland Adaptive Behavior Scales (VABS-3). The research sample consisted of a total of 506 parents, 236 of whom have a child with ASD. Parents of children with ASD reported elevated anxiety during the first wave, while changes were found in parents of neurotypical children. During the second wave, the prevalence of anxiety, depression and stress experienced by parents in both groups increased, but significantly more in parents with ASD children. The internalizing maladaptive behavior of children with ASD also increased. During the third wave, no significant differences between the groups of parents were found in stress and anxiety, but parents of ASD children scored higher in depression. Externalized maladaptive behavior of neurotypical children increased, with minimal changes in children with ASD, which can be explained by the improved therapy availability for children with ASD, also observed in our study.
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40
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The impact of COVID-19 on individuals with ASD in the US: Parent perspectives on social and support concerns. PLoS One 2022; 17:e0270845. [PMID: 35976958 PMCID: PMC9384980 DOI: 10.1371/journal.pone.0270845] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/08/2022] [Accepted: 06/20/2022] [Indexed: 11/19/2022] Open
Abstract
The COVID-19 pandemic’s disruptions to daily routines and services have proven especially challenging for children with autism spectrum disorder (ASD) and their families. The current retrospective study aimed to determine the impact of the COVID-19 pandemic’s social environmental changes on parental ratings of personal and child concerns about family conflict, opportunities for social interaction, and loss of institutional support (school and therapy services). Analyses of responses from families with ASD in the US determined differences in concerns across three time points which were measured simultaneously: prior to COVID-19, at the start of COVID-19, and at the time of survey completion. From our sample of 246 school-aged children, parents retrospectively reported significantly increasing levels of concern for both themselves and their children over time, with parents’ personal concern levels rated consistently higher than their ratings of their child’s level of concern. Concerns about loss of institutional support were higher for parents of children reported as having co-occurring intellectual disability. Further, parents of younger children also reported more concerns about loss of services, as well as more social concerns. For parent ratings of child concerns, children who were reportedly aware of COVID-19 were determined to have higher levels of social concerns and concerns about loss of institutional support. Meanwhile, the child’s age and gender did not impact their parent ratings of child concerns. The increased level of parental and child-perceived concerns over the course of the pandemic suggests a need for improved service delivery and support for these families. The high levels of concerns observed in the current study provide support for the need to assess families’ priorities and tailor services to best meet families’ needs. This will potentially increase the quality of life of family members, and improve ASD services across the lifespan, and improve outcomes.
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Lew-Koralewicz A. Psychosocial Functioning and the Educational Experiences of Students with ASD during the COVID-19 Pandemic in Poland. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19159468. [PMID: 35954828 PMCID: PMC9368499 DOI: 10.3390/ijerph19159468] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 06/30/2022] [Revised: 07/28/2022] [Accepted: 07/29/2022] [Indexed: 12/16/2022]
Abstract
Due to their individual developmental and learning needs, adolescents with autism spectrum disorder (ASD) benefit from a variety of educational, medical, and therapeutic services. During the COVID-19 pandemic, these services were discontinued or significantly reduced, which may have resulted in increased difficulties in coping with various areas of life. The purpose of this study was to explore how the pandemic affected the psychosocial and educational functioning of students with ASD. A qualitative, problem-focused interview method was used. The obtained material was subjected to interpretive phenomenological analysis. The study involved 10 secondary school students diagnosed with ASD. The assessment of the effects of the pandemic on the functioning of people with ASD is inconclusive. The respondents noted both negative and positive effects of lockdown. On the positive side, they were able to spend time with their family, isolate themselves from difficult social relationships and feel better. Among the negative effects, adolescents point to difficulties in emotional functioning—increased levels of stress and anxiety, as well as increased feelings of loneliness and difficulties with online education. The study showed the varied experiences of young people with autism during the pandemic, highlighting the significant need to support some of them in terms of their emotional, social and educational functioning.
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Brief Report: Covid Restrictions had Positive and Negative Impacts on Schooling for Students on the Autism Spectrum. J Autism Dev Disord 2022:10.1007/s10803-022-05451-z. [PMID: 35113328 PMCID: PMC8811594 DOI: 10.1007/s10803-022-05451-z] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 01/19/2022] [Indexed: 11/22/2022]
Abstract
The COVID-19 pandemic (2020) resulted in school closures and changes to school delivery. The aim of this study was to explore how these changes impacted on children on the autism spectrum. As part of an online survey, parents (n = 180) of school-aged children (9.3–16.5 years) on the autism spectrum in Australia were asked an open-ended question on how the COVID-19 pandemic had impacted on their child’s education experience. Nearly half (48%) of the parents reported only negative impacts, 26% only positive impacts, 12% a mix of positive and negative impacts, and 9% little or no impact. Parents identified that school restrictions impacted on more than their child’s learning. These findings highlight areas to consider when supporting autism-friendly learning.
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Sherby MR, Kalb LG, Coller RJ, DeMuri GP, Butteris S, Foxe JJ, Zand MS, Freedman EG, Dewhurst S, Newland JG, Gurnett CA. Supporting COVID-19 School Safety for Children With Disabilities and Medical Complexity. Pediatrics 2022; 149:e2021054268H. [PMID: 34737172 PMCID: PMC8926067 DOI: 10.1542/peds.2021-054268h] [Citation(s) in RCA: 7] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/20/2021] [Indexed: 02/03/2023] Open
Abstract
Children with intellectual and developmental disabilities (IDDs) and children with medical complexity (CMC) have been disproportionally impacted by the coronavirus disease 2019 pandemic, including school closures. Children with IDDs and CMC rely on schools for a vast array of educational, therapeutic, medical, and social needs. However, maintaining safe schools for children with IDDs and CMC during the coronavirus disease 2019 pandemic may be difficult because of the unique challenges of implementing prevention strategies, such as masking, social distancing, and hand hygiene in this high-risk environment. Furthermore, children with IDDs and CMC are at a higher risk of infectious complications and mortality, underscoring the need for effective mitigation strategies. The goal of this report is to describe the implementation of several screening testing models for severe acute respiratory syndrome coronavirus 2 in this high-risk population. By describing these models, we hope to identify generalizable and scalable approaches to facilitate safe school operations for children with IDDs and CMC during the current and future pandemics.
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Affiliation(s)
| | - Luther G. Kalb
- Kennedy Krieger Institute, Johns Hopkins Bloomberg School of Public Health, Johns Hopkins University, Baltimore, Maryland
| | | | | | | | - John J. Foxe
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Martin S. Zand
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Edward G. Freedman
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
| | - Stephen Dewhurst
- School of Medicine and Dentistry, University of Rochester, Rochester, New York
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Habilitative Teletherapy for Children with Autism Spectrum Disorder: A Survey of Parents. J Dev Behav Pediatr 2022; 43:454-460. [PMID: 35943378 PMCID: PMC9837790 DOI: 10.1097/dbp.0000000000001106] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/05/2022] [Indexed: 02/04/2023]
Abstract
OBJECTIVE The purpose of this study was to investigate whether service losses during the coronavirus disease 2019 (COVID-19) pandemic were associated with worsened parent mental health or child behavioral health among families of children with autism spectrum disorder and to identify factors associated with favorable parent appraisals of habilitative teletherapy (applied behavior analysis; speech, occupational, physical therapy) for their child. METHOD This web-based survey study was conducted from May to July 2021 with parents whose children were receiving habilitative therapy for autism from an integrated health system. A total of 322 parents responded to the survey (20% response rate). The outcome variables were pandemic-related parent mental health, pandemic-related child behavioral health, and appraisal of habilitative teletherapy. Predictors were COVID-19-related services changes in health care or child care, COVID-19 history (COVID-19 stress, testing positive for COVID-19), and child autism factors (autistic behaviors, caregiving strain). RESULTS Loss of regular child care was associated with higher odds of worsened parent mental health (odds ratio [OR] = 2.7, 95% confidence interval [CI] = 1.5-4.8); higher levels of caregiving strain were associated with worsened child behavioral health (OR = 2.3, 95% CI = 1.4-3.8). Higher levels of COVID-19 stress were associated with more favorable appraisals of telehealth (β = 0.4, p < 0.01), whereas higher caregiving strain scores were associated with less favorable appraisals of telehealth (β = -0.2, p < 0.01). CONCLUSION During COVID-19, caregiving factors were associated with worsened parent mental health and worsened child behavioral health, and telehealth is not preferred by all families. Policy interventions to support caregivers, such as affordable, high-quality child care and paid family leave, are a high priority.
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Amirova A, CohenMiller A, Sandygulova A. The effects of the COVID-19 pandemic on the well-being of children with autism spectrum disorder: Parents' perspectives. Front Psychiatry 2022; 13:913902. [PMID: 35958650 PMCID: PMC9359431 DOI: 10.3389/fpsyt.2022.913902] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/06/2022] [Accepted: 07/04/2022] [Indexed: 12/01/2022] Open
Abstract
The COVID-19-related lockdown interrupted children's learning progress and discontinued social learning and regular activities that children with autism spectrum disorder (ASD) rely on socially and physically. Negative consequences for children with ASD were reported far and wide. To investigate this problem in Kazakhstan, we conducted a mixed-methods study that drew on data from an online survey with 97 parents and semi-structured interviews with 14 parents. While parent-report quantitative results suggest that children were likely to experience negative impacts of the pandemic due to disrupted educational and therapeutic services, qualitative findings confirm that they have experienced an elevated mental health and behavioral challenges during the lockdown. Remote educational and therapeutic services were not helpful as families coped with pandemic-caused problems on their own. We highlight that continued support and care during and after a crisis is vital not only for children with ASD but also for the families under-resourced mentally and socially.
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Affiliation(s)
- Aida Amirova
- Graduate School of Education, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Anna CohenMiller
- Graduate School of Education, Nazarbayev University, Nur-Sultan, Kazakhstan
| | - Anara Sandygulova
- Department of Robotics and Mechatronics, School of Engineering and Digital Sciences, Nazarbayev University, Nur-Sultan, Kazakhstan
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Vasa RA, Singh V, Holingue C, Kalb LG, Jang Y, Keefer A. Psychiatric problems during the COVID-19 pandemic in children with autism spectrum disorder. Autism Res 2021; 14:2113-2119. [PMID: 34231323 PMCID: PMC8420610 DOI: 10.1002/aur.2574] [Citation(s) in RCA: 46] [Impact Index Per Article: 15.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/10/2021] [Revised: 06/20/2021] [Accepted: 06/21/2021] [Indexed: 01/27/2023]
Abstract
Children with autism spectrum disorder (ASD) are at elevated risk for psychiatric problems in response to the COVID-19 pandemic. This risk is due to their high rates of pre-pandemic psychiatric comorbidities and the pandemic's disruption to routines and access to necessary supports. Prior research has indicated that children with ASD may experience a worsening of specific psychiatric symptoms in response to COVID-19, though this body of work is limited in scope. The present study expands this literature by examining specific types of psychiatric problems that emerged about 2 months after the onset of the pandemic, and risk factors predicting changes in these psychiatric symptoms. Parents of children with a confirmed ASD diagnosis (N = 257), who enrolled in a clinic registry at an outpatient specialty autism center, were included in this study. All data were gathered online via customized and standardized questionnaires. Results showed that 59% of children experienced either a worsening of their pre-pandemic psychiatric diagnoses and/or the development of new psychiatric symptoms during the pandemic. Multivariable regression models indicated that risk factors for increased psychiatric problems included child understanding of COVID-19, COVID-19 illness in the family, low family income, and elevated parental depression and anxiety symptoms (all p < 0.05). Findings from this study emphasize the urgent need to provide effective and accessible psychiatric services for children with ASD and their families during and after the pandemic. LAY SUMMARY: Children with ASD are at high risk for psychiatric problems during the COVID-19 pandemic. We found that 59% of children in our clinical sample are experiencing increased psychiatric problems. The child's understanding of COVID-19, COVID-19 illness in the family, low family income, and depression and anxiety symptoms in the parent increase the risk for poor mental health during the pandemic. These findings indicate the importance of helping children with ASD access mental health treatment during COVID-19.
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Affiliation(s)
- Roma A. Vasa
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
| | - Vini Singh
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Calliope Holingue
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Luther G. Kalb
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of NeuropsychologyKennedy Krieger InstituteBaltimoreMarylandUSA
- Department of Mental HealthJohns Hopkins Bloomberg School of Public HealthBaltimoreMarylandUSA
| | - Yeon Jang
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
| | - Amy Keefer
- Kennedy Krieger InstituteCenter for Autism and Related DisordersBaltimoreMarylandUSA
- Department of Psychiatry and Behavioral SciencesJohns Hopkins University School of MedicineBaltimoreMarylandUSA
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