COVID-19 pandemic effects in people with Autism Spectrum Disorder and their caregivers: Evaluation of social distancing and lockdown impact on mental health and general status

Effects of COVID-19 on Autism Spectrum Disorder in Qatar

Introduction

The unprecedented impact of the coronavirus pandemic (COVID-19) has had profound implications on the ASD community, including disrupting daily life, increasing stress and emotional dysregulation in autistic children, and worsening individual and family well-being.

Methods

This study used quantitative and qualitative survey data from parents in Qatar (n=271), to understand the impact of the COVID-19 pandemic on autistic children and their families in Qatar. The questionnaire was a combination of open-ended (qualitative) and closed-ended (quantitative) questions to explore patterns in the experiences of the different families, as well as to contrive themes. The survey was created in a way to evaluate the psychological, academic/intervention, economic, and other impacts of the pandemic related measures on a sample of multicultural families residing in the State of Qatar during the peak period of confinement and physical distancing in 2020. Data acquisition involved the utilization of Google Forms. Subsequent quantitative analysis employed the SPSS software and chi-square analysis for numerical examination, enabling the characterization of the studied population and exploration of associations between parental stress levels and variables such as employment status, therapy accessibility, presence of hired assistance, and alterations in their childs skills. Concurrently, qualitative data from written responses underwent thorough categorization, encompassing themes such as emotional isolation, mental or financial challenges, and difficulties in obtaining support.

Results

Parents expressed distress and disturbance in their daily lives, including profound disruptions to their childrens access to treatment, education, and activities. Most parents reported deteriorations in their childrens sleep (69.4%), behavioral regulation (52.8%), and acquired skills across multiple domains (54.2%). Parents also reported decreased access to family and social support networks, as well as decreased quality of clinical and community support. Qualitative analysis of parental responses revealed that child developmental regression was an important source of parental stress.

Discussion and conclusion

The greater impact of the pandemic on autistic children and their families emphasizes the need for accessible and affordable health, education, and family services to manage their special needs.

Emotions and behaviours of child and adolescent psychiatric patients during the COVID-19 pandemic

BACKGROUND

Previous pandemics have had negative effects on mental health, but there are few data on children and adolescents who were receiving ongoing psychiatric treatment.

AIMS

To study changes in emotions and clinical state, and their predictors, during the COVID-19 pandemic in France.

METHOD

We administered (by interview) the baseline Youth Self-Report version of the CoRonavIruS Health Impact Survey v0.3 (CRISIS, French translation) to 123 adolescent patients and the Parent/Caregiver version to evaluate 99 child patients before and during the first 'lockdown'. For 139 of these patients who received ongoing treatment in our centre, treating physicians retrospectively completed longitudinal global ratings for five time periods, masked to CRISIS ratings.

RESULTS

The main outcome measure was the sum of eight mood state items, which formed a single factor in each age group. Overall, this score improved for each age group during the first lockdown. Clinician ratings modestly supported this result in patients without intellectual disability or autism spectrum disorder. Improvement of mood states was significantly associated with perceived improvement in family relationships in both age groups.

CONCLUSIONS

Consistent with previous studies of clinical cohorts, our patients had diverse responses during the pandemic. Several factors may have contributed to the finding of improvement in some individuals during the first lockdown, including the degree of family support or conflict, stress reduction owing to isolation, limitations of the outcome measures and/or possible selection bias. Ongoing treatment may have had a protective effect. Clinically, during crises additional support may be needed by families who experience increased conflict or who care for children with intellectual disability.

Mapping autism's research landscape: trends in autism screening and its alignment with sustainable development goals

Introduction

Autism Spectrum Disorder is a complex neurodevelopmental syndrome that profoundly affects social interactions, communication, and sensory perception. The research traced the evolution of autism research from 2011-2022, specifically focusing on the screening and diagnosis of children and students.

Methods

Through an analysis of 12,262 publications using the PRISMA framework, bibliographic coupling, science mapping, and citation analysis, this study illuminates the growth trajectory of ASD research and significant disparities in diagnosis and services.

Results

The study indicates an increasing trend in autism research, with a strong representation of female authorship. Open Access journals show a higher average citation impact compared to their closed counterparts. A keyword co-occurrence analysis revealed four central research themes: Child Development and Support Systems, Early Identification and Intervention, Prevalence and Etiology, and Mental Health. The pandemic's onset has prioritized research areas like mental health, telehealth, and service accessibility.

Discussion

Recommendations on a global level stress the importance of developing timely biological markers for ASD, amplifying Disability Inclusion research, and personalizing mental health services to bridge these critical service gaps. These strategies, underpinned by interdisciplinary collaboration and telehealth innovation, particularly in low-resource settings, can offer a roadmap for inclusive, context-sensitive interventions at local levels that directly support SDG3's aim for health and well-being for all.

Locked down-locked in: experiences of families of young children with autism spectrum disorders in Delhi, India

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.

The psychological impact of the COVID-19 pandemic on children/adolescents with ASD and their family environment: a systematic review

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.

A narrative systematic review of changes in mental health symptoms from before to during the COVID-19 pandemic

The onset of the COVID-19 pandemic raised concerns regarding population-wide impacts on mental health. Existing work on the psychological impacts of disaster has identified the potential for multiple response trajectories, with resilience as likely as the development of chronic psychopathology. Early reviews of mental health during the pandemic suggested elevated prevalence rates of multiple forms of psychopathology, but were limited by largely cross-sectional approaches. We conducted a systematic review of studies that prospectively assessed pre- to peri-pandemic changes in symptoms of psychopathology to investigate potential mental health changes associated with the onset of the pandemic (PROSPERO #CRD42021255042). A total of 97 studies were included, covering symptom clusters including obsessive-compulsive disorder (OCD), post-traumatic stress disorder (PTSD), fear, anxiety, depression, and general distress. Changes in psychopathology symptoms varied by symptom dimension and sample characteristics. OCD, anxiety, depression, and general distress symptoms tended to increase from pre- to peri-pandemic. An increase in fear was limited to medically vulnerable participants, and findings for PTSD were mixed. Pre-existing mental health diagnoses unexpectedly were not associated with symptom exacerbation, except in the case of OCD. Young people generally showed the most marked symptom increases, although this pattern was reversed in some samples. Women in middle adulthood in particular demonstrated a considerable increase in anxiety and depression. We conclude that mental health responding during the pandemic varied as a function of both symptom cluster and sample characteristics. Variability in responding should therefore be a key consideration guiding future research and intervention.

Deletion of TRPC6, an Autism Risk Gene, Induces Hyperexcitability in Cortical Neurons Derived from Human Pluripotent Stem Cells

Autism spectrum disorder (ASD) is a complex and heterogeneous neurodevelopmental disorder linked to numerous rare, inherited, and arising de novo genetic variants. ASD often co-occurs with attention-deficit hyperactivity disorder and epilepsy, which are associated with hyperexcitability of neurons. However, the physiological and molecular mechanisms underlying hyperexcitability in ASD remain poorly understood. Transient receptor potential canonical-6 (TRPC6) is a Ca2+-permeable cation channel that regulates store-operated calcium entry (SOCE) and is a candidate risk gene for ASD. Using human pluripotent stem cell (hPSC)-derived cortical neurons, single-cell calcium imaging, and electrophysiological recording, we show that TRPC6 knockout (KO) reduces SOCE signaling and leads to hyperexcitability of neurons by increasing action potential frequency and network burst frequency. Our data provide evidence that reduction of SOCE by TRPC6 KO results in neuronal hyperexcitability, which we hypothesize is an important contributor to the cellular pathophysiology underlying hyperactivity in some ASD.

Content Analysis of Abstracts Published in Autism Journals in 2021: The year in Review

PURPOSE

Ever since Leo Kanner first described autism in 1943, the research in this field has grown immensely. In 2021 alone, 5837 SCOPUS indexed documents were published with a title that contained the words: "autism", "autistic", or "ASD". The purpose of this study was to examine the most common topics of autism research in 2021 and present a geographical contribution to this research.

METHODS

We performed a content analysis of 1102 abstracts from the articles published in 11 Autism journals in 2021. The following journals, indexed by the SCOPUS database, were included: Autism, Autism Research, Molecular Autism, Journal of Autism and Developmental Disorders, Research in Autism Spectrum Disorders, Focus on Autism and Other Developmental Disabilities, Education and Training in Autism and Developmental Disabilities, Review Journal of Autism and Developmental Disorders, Advances in Autism, Autism and Developmental Language Impairments, and Autism in Adulthood.

RESULTS

According to the analysis, the main research topics were: mental health, social communication, social skills, quality of life, parenting stress, ADHD, Covid-19, self-efficacy, special education, and theory of mind. In relation to geographic distribution, most studies came from the USA, followed by the UK, Australia, and Canada.

CONCLUSION

Research topics were aligned with the priorities set by stakeholders in autism, most notably persons with autism themselves and their family members. There is a big gap in research production between developed countries and developing countries.

Psychosocial Outcomes in Autistic Children Before and During the COVID-19 Pandemic

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.

The Covid-19 pandemic had polarizing effects on trait scores depending on a person's resilience and predispositions: A longitudinal prospective study

While Covid-19 is, first and foremost, a pernicious physical illness, its highly contagious nature has led to significant disruption in social life and psychological stress, occasionally resulting in dire mental health consequences that are still not fully understood. To address this issue, a prospective longitudinal design study was conducted by administering standard self-reporting questionnaires covering the NEO-five factor inventory (NEO-FFI), shyness, alexithymia, autism quotient, anxiety, depression, and sensory processing sensitivity (SPS). A total of 114 participants (of which 71.93% were females) with an average age of 30.29 (standard deviation = 11.04) completed the survey before and a few months after the pandemic. Results revealed the distribution of population scores to become more extreme in either positive or negative trait directions despite the stability of average trait scores across the population. Higher resilience was found to be positively correlated with improved trait scores post-pandemic but corona anxiety score was not correlated with trait score changes. In addition, in the subjects with moderate negative trait scores, agreeableness and autism scores and in subjects with high negative trait scores, openness, SPS and shyness scores were significantly correlated with trait scores changes post-pandemic. These results reveal the nuanced effects of the pandemic on the people's psychological well-being and highlight vulnerabilities for certain groups despite the overall stability of population that needs to be taken into account for mental health policies going forward.

Trajectories of internalizing symptoms among autistic and nonautistic youth during the COVID-19 pandemic

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.

Autism spectrum disorder, parent coping, and parent concerns during the COVID-19 pandemic

The COVID-19 outbreak beginning in 2019 has created a challenging period for families who have children with autism spectrum disorder (ASD). The purpose of this study was to examine parents' perceptions about the consequences of the pandemic on their child who has ASD and parents' concerns and resources during the pandemic. Data was collected between July to November 2020 from U.S. parents who have at least one child with ASD between 3 and 21 years old. An online survey, consisting of 88 items, was developed and distributed online in newsletters and Twitter pages of several ASD organizations, and various caregiving support groups on Facebook. Descriptive analysis showed that during the data collection time (N = 57), 79% of the children had immediate access to electronic devices to utilize online services. Many of the children used remote learning services for less than 2 h (74%) per day. Many children had difficulties following social distance rules. They spent more time in passive activities than active activities. Twenty-five percent of parents reported that they drank alcohol more often during the pandemic. However, parents who participated in support groups consumed less alcohol. Also, child symptom severity was associated with parents taking less times for themselves. These results can assist practitioners in identifying specific difficulties that parents and children with ASD experienced during the pandemic. This work also underlines the parents' needs for community supports and mental health services.

Emotional and Behavioral Problems of Children with ASD-The Lessons That We Learned from the Pandemic

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.

The impact of COVID-19 on sleep for autistic children: A systematic review

BACKGROUND

Up to 80% of children with autism experience behavioural sleep problems, predominantly relating to bedtime resistance, sleep anxiety, sleep dysregulation, and shorter duration, which are associated with increased autistic symptom expression and emotional and behavioural difficulties. Researchers predicted the COVID-19 pandemic would worsen sleep and behavioural difficulties for autistic children, due to their need for routine and certainty. This systematic review is the first to focus on delineating the role of sleep disturbance in exacerbating autistic symptoms and internalising and externalising behaviours during the pandemic.

METHOD

In this PROSPERO registered systematic review, we aggregated and synthesised findings from empirical studies from 2020 onwards that included children with autism and examined sleep outcomes, using narrative and framework synthesis due to the variety of methods and designs employed. We identified additional relevant themes through inductive thematic analysis.

RESULTS

Seventy-one studies met the search criteria, and we selected seventeen for review following screening and quality assessment. These studies reported mixed findings; with strongest support for worsening of sleep problems typically experienced by autistic children, including difficulties with sleep regulation and shorter sleep duration. Further, sleep problems were associated with increased expression of autistic characteristics.

CONCLUSIONS

Preliminary findings of worsening sleep and increased autistic characteristics for autistic children throughout the COVID-19 pandemic highlight the need for ongoing, accessible and flexible service provision during exposure to environmental stressors. We propose that behavioural sleep interventions are well suited to telehealth adaptation and play an important role in supporting families when in-person treatment for sleep problems is not possible.

Artificial intelligence evaluation of COVID-19 restrictions and speech therapy effects on the autistic children's behavior

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.

Sleep in Children With Neurodevelopmental Disabilities During COVID-19: An Integrative Review

INTRODUCTION

Sleep issues occur at higher rates in children with neurodevelopmental disorders than in the typical population. Little is known about the impact of COVID-19 on sleep issues in this population METHOD: This integrative review aimed to characterize studies during the COVID-19 pandemic (2020-2022) addressing the prevalence and management of sleep issues in children and youth with neurodevelopmental disorders.Comprehensive database searches were used to identify articles, and 31 studies were considered suitable for this review.

RESULTS

Most studies reported worsening sleep disturbances during COVID-19 restrictions. All studies were conducted when clinics were closed; only two studies addressed treatment options such as music therapy and sleep hygiene education and found improvement in sleep issues.

DISCUSSION

Future research needs to concentrate on developing interventions to assist families remotely and empower families with a toolkit of preparedness in times of crisis.

COVID-19 Induced Environments, Health-Related Quality of Life Outcomes and Problematic Behaviors: Evidence from Children with Syndromic Autism Spectrum Disorders

Between July 2020 and January 2021, 230 principal caregivers completed a questionnaire to measure proxy-assessed health-related quality of life outcomes (HRQoL), behavioral outcomes in children with syndromic autism spectrum disorders and COVID-19 induced changes to lifestyle and environments. HRQoL and behavioral outcomes reported earlier during the pandemic were generally worse compared to those reported later. COVID-19 induced reduction to a caregiver's mental health appointments, and hours spent watching TV were associated with decreases in HRQoL and increased the likelihood of problematic behaviors. Increasing time outdoors and time away from digital devices were positively associated with HRQoL and behaviors and might protect children from COVID-19 induced restrictions.

Perceived Anxiety in Family Caregivers of Individuals with Autism Spectrum Disorder, Down Syndrome and Williams Syndrome during the Lockdown of the First COVID-19 Wave in Spain

The lockdown during the first wave of COV- ID-19 in Spain has been related to higher levels of anxiety in the general population. However, the emotional impact on Spanish caregivers of individuals with neurodevelopmental disorders (NDD) has not been studied so far.

Access to Care After Autism Diagnosis During the COVID-19 Pandemic: A Quality Improvement Project

OBJECTIVE

The aim of this study was to identify barriers and improve access to services for children diagnosed with autism spectrum disorder (ASD) during the COVID-19 pandemic.

METHODS

Sixty-two patients diagnosed with ASD between March 23 and June 30, 2020, at a large urban safety net hospital were identified by chart review. Patients were called from January to March 2021 and queried regarding access to services. Brief interventions were provided as part of a modified Plan-Do-Study-Act approach. A second chart review was conducted between April and May 2021 to determine whether families accessed any additional services.

RESULTS

At the time of initial evaluation, 12 patients (19%) had been able to access all recommended services, 32 (52%) had been able to access some recommended services, and 9 (15%) were not able to access any services. Service levels for 9 families (15%) were undetermined. Sixteen patients (26%) lacked any follow-up with their developmental behavioral pediatrician since their initial evaluation. Thirty patients (48%) reported changes to their individualized educational program or early intervention services, and 17 patients (27%) were receiving in-home applied behavior analysis. After the brief intervention, 13 patients had accessed new services, and 9 patients previously lost to follow-up had completed an appointment.

CONCLUSION

Patients diagnosed with ASD in the spring of 2020 had significant difficulty accessing community services. The transition to telemedicine exacerbated this hospital's difficulty contacting patients for follow-up. Additional research is needed to fully characterize the disruptions to services experienced by patients diagnosed with ASD during the pandemic and to increase accessibility and equity of care.

Mental Health Impact of Early Stages of the COVID-19 Pandemic on Individuals with Pre-Existing Mental Disorders: A Systematic Review of Longitudinal Research

In view of disease-related threats, containment measures, and disrupted healthcare, individuals with pre-existing mental illness might be vulnerable to adverse effects of the COVID-19 pandemic. Previous reviews indicated increased mental distress, with limited information on peri-pandemic changes. In this systematic review, we aimed to identify longitudinal research investigating pre- to peri-pandemic and/or peri-pandemic changes of mental health in patients, focusing on the early phase and considering specific diagnoses. PsycINFO, Web of Science, the WHO Global literature on coronavirus disease database, and the Cochrane COVID-19 Study Register weresearched through 31 May 2021. Studies were synthesized using vote counting based on effect direction. We included 40 studies mostly from Western, high-income countries. Findings were heterogeneous, with improving and deteriorating mental health observed compared to pre-pandemic data, partly depending on underlying diagnoses. For peri-pandemic changes, evidence was limited, with some suggestion of recovery of mental distress. Study quality was heterogeneous; only few studies investigated potential moderators (e.g., chronicity of mental illness). Mental health effects on people with pre-existing conditions are heterogeneous within and across diagnoses for pre- to peri-pandemic and peri-pandemic comparisons. To improve mental health services amid future global crises, forthcoming research should understand medium- and long-term effects, controlling for containment measures.

Examining Adolescents' Mental Health Before and During the COVID-19 Pandemic

The current study characterized the impact of the COVID-19 pandemic and stay-at-home orders on adolescents' internalizing symptoms and assessed predictors of adolescents' internalizing symptoms during the pandemic. Seventy-nine adolescents (18 autistic, 61 nonautistic) and their parents who participated in a previous study and were at least 10 years old (M = 13.8, SD = 1.7) were invited to participate in three online follow-up surveys post-stay-at-home order (May through November 2020). Measures of children's anxiety and depressive symptoms, parenting practices, family togetherness, conflict, financial problems, and parental mental health during the pandemic were collected. Nonautistic adolescents experienced a significant decrease in anxiety symptoms across the beginning of the pandemic and a significant increase in depressive symptoms from pre- to post-stay-at-home order. Permissive parenting and financial problems predicted adolescents' depressive symptoms. Parental mental health difficulties and permissive parenting predicted adolescents' anxiety symptoms. Results underscore the need to support parents and youth.

Educators' experiences and reflections on the implementation of evidence-based practices for autistic students in public schools during the COVID-19 pandemic

Introduction

In 2020, the COVID-19 pandemic forced many schools to close their doors and transition to remote learning, disrupting how autistic students received school-based services and support. While school structure changes were challenging for all students, autistic students were uniquely affected, considering their reliance on predictability and routine; moreover, education settings are where most autistic children receive services. Much has been studied regarding the use of evidence-based practices (EBPs) for autistic students in traditional school settings, yet little is known about how educators use EBPs in remote learning environments in the wake of the COVID-19 pandemic.

Method

In this study, we explore educators' experiences with EBP implementation at the height of the pandemic and educators' reflections of its impact on autistic students and their school systems. Qualitative data were collected from 81 educators (general educators, special educators, and paraeducators) in semi-structured interviews regarding EBP use at the onset of the pandemic.

Results

Four themes emerged from interviews: (1) pandemic and remote learning environment challenges to inclusion and EBP use; (2) EBP use adaptations for remote learning environments; (3) pandemic and remote learning environment benefits for EBP use; and (4) considerations for EBP use beyond the pandemic.

Conclusion

These findings elucidate educators' experiences using EBPs during the COVID-19 pandemic and highlight important areas of consideration for autism-focused EBP implementation as remote instruction continues to be a learning format. More research is needed to understand how to best implement EBPs for autistic students in this emerging instruction context.

A longitudinal study of the mental health of autistic children and adolescents and their parents during COVID-19: Part 1, quantitative findings

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.

Resilience, and positive parenting in parents of children with syndromic autism and intellectual disability. Evidence from the impact of the COVID-19 pandemic on family's quality of life and parent-child relationships

Family quality of life (FQoL) outcomes collected during the first year of COVID-19 has been combined with 2018 data to estimate the outbreak's impact on parental outcomes on a sample of 230 families with syndromic autistic children and those with intellectual disabilities (IDs). Despite challenges imposed by the COVID-19 outbreak, our study found that FQoL outcomes reported by participating parents during the first year of COVID-19 appears to be similar to ratings from a prepandemic study of families with the same conditions. Parents of children in our sample generally displayed a stable functioning trajectory as measured by the validated FQoL instrument. Across syndromic autistic groups considered, families reported that their relationships with their children were positive. Our findings provide evidence of families' resilience which might explain the presence of positive parent-child interactions during COVID-19. Exploring mechanisms which would explain how families with autistic and ID children confront, manage disruptive experiences, and buffer COVID-19 induced stress is a fruitful direction for future research.

Measures of tonic and phasic activity of the locus coeruleus-norepinephrine system in children with autism spectrum disorder: An event-related potential and pupillometry study

A growing body of research suggests that locus coeruleus-norepinephrine (LC-NE) system may function differently in individuals with autism spectrum disorder (ASD). Understanding the dynamics of both tonic (resting pupil diameter) and phasic (pupil dilation response [PDR] and event-related potential [ERP]) indices may provide meaningful insights about the nature of LC-NE function in ASD. Twenty-four children with ASD and 27 age- and nonverbal-IQ matched typically developing (TD) children completed two experiments: (1) a resting eye-tracking task to measure tonic pupil diameter, and (2) a three-stimulus oddball paradigm to measure phasic responsivity using PDR and ERP. Consistent with prior reports, our results indicate that children with ASD exhibit increased tonic (resting pupil diameter) and reduced phasic (PDR and ERP) activity of the LC-NE system compared to their TD peers. For both groups, decreased phasic responsivity was associated with increased resting pupil diameter. Lastly, tonic and phasic LC-NE indices were primarily related to measures of attention-deficit/hyperactivity disorder (ADHD), and not ASD, symptomatology. These findings expand our understanding of neurophysiological differences present in ASD and demonstrate that aberrant LC-NE activation may be associated with atypical arousal and decreased responsivity to behaviorally-relevant information in ASD.

Adolescents with Neuropsychiatric Disorders during the COVID-19 Pandemic: Focus on Emotional Well-Being and Parental Stress

(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.

COVID-19 Pandemic and Autism Spectrum Disorder, Consequences to Children and Adolescents - a Systematic Review

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.

[Autism Spectrum Disorders: What the COVID-19 Pandemic Has Taught Us]

The article is devoted to the consequences of the pandemic caused by SARS-CoV-2 and more particularly, of the preventive measures adopted during this period on people with autism spectrum disorders (ASD). These people are more at risk (especially in cases of comorbidity with intellectual disability) of being infected and hospitalized longer. This increased risk is explained by the presence of biological risk factors (increased cytokines, decreased melatonin) and by psychological factors related to the clinical picture of ASD. Hesitancy concerning COVID vaccinations is discussed in relation to the erroneously purported link between vaccination and the onset of autism. As expected, the pandemic has had negative effects on the clinical picture of children, adolescents, and adults with ASD: sleep disorders, increased behavioural disorders, more stereotypies, parental distress. Unexpectedly, researchers and clinicians have also highlighted the positive effects of the pandemic, described as the "paradoxical‿ effects (improved communication and relationships, decreased anxiety, being happier because of being more in control over their schedule). The explanation for these effects was related to non-attendance at school and, thus, no bullying, decreased sensory and social overload, increased time spent at home, and solidarity with the autistic community and with the entire community. Finally, the question of the transfer of certain conditions that contributed to the above-mentioned improvements to the post-pandemic period is addressed.

COVID-19 and Perceived Changes to Quality of Life, Anxiety, Depression, and Loneliness in Autistic and Other Neurodivergent U.K. Adults

Background

In the United Kingdom, we have experienced many changes to our daily lives as a result of COVID-19. Autistic and other neurodivergent (ND, e.g., those with attention-deficit hyperactivity disorder) adults may be more vulnerable to negative effects of the pandemic due to pre-existing mental health disparities and unmet support needs. Furthermore, there is little research, either pandemic related or otherwise, which considers how the experiences of autistic adults with additional intersecting ND identities might differ from those without.

Methods

We collected data from an online survey during June 2020 to September 2020 to explore the psychological impact of the coronavirus pandemic on U.K. adults (N = 286, age 18-72 years). Participants included neurotypical (NT) adults (N = 98), autistic adults (N = 73), other ND adults (N = 53), as well as autistic adults with an additional intersecting ND identity (N = 63). We measured and compared levels of quality of life (QoL), depression, anxiety, and loneliness across groups as well as perceived change in these as a result of the pandemic.

Results

Autistic adults, with and without additional ND identities, had consistently low QoL and high anxiety, depression, and loneliness compared with NT adults. We found no differences in these areas between autistic adults with and without additional intersecting ND identities. In some areas, non-autistic ND participants were also doing poorly compared with their NT peers. Many participants felt that their QoL, mental health, and loneliness had worsened due to the pandemic, and this was largely similar across groups.

Conclusions

These results highlight that COVID-19 may have led to increased need and demand for mental health services across the U.K. adult population. Both autistic and ND adults may be in particular need of increased (and improved) mental health and well-being support. This is likely because of pre-existing differences in mental health and well-being as well as individuals facing further difficulties as a result of the pandemic.

Impact of Belgian COVID-19 lockdown restrictions on autistic individuals’ socio-communicative behaviors and their parents’ quality of life

Background

In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals’ and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals’ behavior and their parents’ or caregivers’ quality of life; we also sought to identify individual characteristics that may influence such changes.

Methods

We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families’ quality of life and in autistic individuals’ behavior, as well as factors likely to influence the extent and direction of these changes.

Results

We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families’ quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors.

Conclusion

COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.

The impact of COVID-19 on individuals with ASD in the US: Parent perspectives on social and support concerns

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.

The experience of the COVID-19 pandemic by persons with ASD: Social aspects

While causing a variety of social restrictions, the COVID-19 pandemic has also precipitated the digitalisation of public services and official procedures, reducing many, until recently necessary, immediate social interactions. This study has been conducted to investigate their perception of the COVID-19 pandemic and its impact on their current and future social interactions. To this end, semi-structured narrative interviews were conducted. Ten adults on the autism spectrum participated in the study. The phenomenological analysis of the narratives focused on categories related to the social functioning of the study participants. The interpretation of the narratives has shown that autistic people can experience a sense of loss due to the lack of direct contact. On the other hand, we also talked to the participants who expressed their satisfaction with the situation of obligatory social distance. The respondents also discussed the subject of changing the form of interaction in some areas of public life to one that is more adjusted to the needs of people with their condition. The study concludes with a suggestion that autistic people might benefit from technological progress in institutions and the availability of the option to prefer online contact for interactions that are not strictly necessary.

Psychosocial and Behavioral Effects of the COVID-19 Pandemic on Children and Adolescents with Autism and Their Families: Overview of the Literature and Initial Data from a Multinational Online Survey

Since COVID-19 has become a pandemic, everyday life has seen dramatic changes affecting individuals, families, and children with and without autism. Among other things, these changes entail more time at home, digital forms of communication, school closures, and reduced support and intervention. Here, we assess the effects of the pandemic on quality of life for school-age autistic and neurotypical children and adolescents. First, we provide a comprehensive review of the current relevant literature. Next, we report original data from a survey conducted in several countries, assessing activities, well-being, and social life in families with autism, and their changes over time. We focus on differences between children with and without autism from within the same families, and on different outcomes for children with high- or low-functioning autism. While individuals with autism scored lower in emotional and social functioning than their neurotypical siblings, both groups of children showed comparable decreases in well-being and increases in anxiety, compared to before the pandemic. By contrast, decreases in adaptability were significantly more pronounced in autistic children and adolescents compared to neurotypical children and adolescents. Overall, although individual families reported some positive effects of pandemic restrictions, our data provide no evidence that these generalize across children and adolescents with autism, or even just to individuals with high-functioning autism. We discuss the increased challenges that need to be addressed to protect children and adolescents’ well-being under pandemic conditions, but also point out potentials in the present situation that could be used towards social participation and success in older children and young adults with autism.

Effects of the Early Phase of COVID-19 on the Autistic Community in Sweden: A Qualitative Multi-Informant Study Linking to ICF

While the COVID-19 pandemic is ongoing, early outcome studies indicate severe and pervasive global effects of the pandemic and associated measures to prevent the spread of the virus. General population studies, as well as insight into the outcomes for particular groups, will be necessary in order to mitigate potentially long-term effects as well as to prepare for future epidemics or pandemics. The pandemic conditions have been marked by rapid and abrupt changes and unpredictability which are circumstances that leave the autistic population particularly vulnerable to adverse outcomes following the distinctive features of the diagnosis. Studies are only beginning to delineate the outcomes of the global autism community and the present study adds to these findings by providing a local, multi-perspective, qualitative analysis of the lived experiences of the Swedish autism community. In this study, autistic youth and adults, caregivers of autistic individuals, as well as representatives of Swedish interest organizations were interviewed. Thematic analysis was performed on the population as a whole and patterns of results were formalized according to the International Classification of Function, Disability and Health (ICF-CY). Participants report wide-ranging adverse outcomes of the pandemic relating to mental health and access to support, participation in daily activities and socialization, education, and work as well as parental resources. However, participants also report positive outcomes relating to a reduction in specific social and everyday demands, and normalization of lived experiences. Additionally, interviews outlined some strategies used to cope during pandemic conditions. Implications of these findings are discussed.

Parent observations about the impact of COVID-19 on children with autism spectrum disorder in Turkey

Objectives: The Covid-19 pandemic has shown that people with disabilities are the most vulnerable, neglected and discriminated individuals at times of emergency. National and international studies are needed to understand the extent to which the general well-being, quality of life, and positive and negative behaviors of children with ASD are affected during the pandemic. Methods: This study explores the impact of Covid-19 on the typical behaviors of children with Autism Spectrum Disorder (ASD) by focusing on quantitative observation findings obtained from their parents and caregivers. In order to explore the effects of three months of pandemic restrictions during the initial period, 103 parents and caregivers were asked to describe significant behavior changes in their children with ASD comparing before and during the pandemic period. Results: The results showed that children were negatively affected in 21 of 32 typical ASD traits. However, a significant number of participants also reported positive changes in several of their children's social and communicative behaviors as shared family time increased during the pandemic. This finding alone was not statistically supported. However, when it was coupled with the variable of access to online education assistance, it was concluded that the two variables together reduced the negative impact on children. Additionally, we found a sex difference in the impact of Covid-19 on children with ASD. The test results and mean scores show that girls were affected either more negatively or more positively than boys. Conclusions: Our results indicate that the negative effects of a natural disaster such as Covid-19 may be decreased when family members cooperatively share their responsibilities, spend more time with their children with ASD, and use distance education support services.Keywords: Autism spectrum disorder, Covid-19, pandemic, parents, sex difference, social distancing.

The Psychological Impact of the COVID-19 Lockdown: A Comparison between Caregivers of Autistic and Non-Autistic Individuals in Italy

The COVID-19 outbreak has disrupted the daily routine of the population worldwide, including autistic people and their caregivers, with severe consequences on mental health. On one hand, the reduced social contacts and the interruption of outpatient and daycare services during the lockdown have represented a real challenge for autistic people and their caregivers. On the other hand, confinement has allowed individuals to spend more time pursuing their interests and stay home with their family members without feeling the pressure of social expectations. The present study aimed to compare the levels of personal wellbeing, family distress, insomnia, and resilience between caregivers of autistic people and caregivers of people with other neurodevelopmental, psychiatric, or relational disabilities. A web survey was completed by 383 participants, of which 141 were primary caregivers of autistic people. We did not find any significant difference between caregivers of autistic and non-autistic people in any of the considered psychological variables. Lower age of the autistic family member and lower resilience levels were significantly associated with higher individual distress in the group of caregivers of autistic people. Our findings do not corroborate the hypothesis that caregivers of autistic individuals have had more severe consequences than other caregivers during the lockdown. However, they confirm the importance of promoting resilient coping strategies in autistic people and their caregivers.

Feeding and Swallowing Issues in Autism Spectrum Disorders

Children with autism spectrum disorder (ASD) often experience difficulties related to communication and behaviour. However, their feeding issues are most distressing to their families and healthcare professionals as they impact on the children's adaptive function and health. In comparison to typically developing children, those with ASD experience significantly more feeding difficulties. Children with ASD may display distinctive feeding difficulties and atypical feeding behaviours that include picky eating, limited independent feeding, need for increased feeding times, and a highly restrictive food repertoire. Many of these feeding difficulties continue into childhood, persist in adolescence, and even spill over into adulthood. This proves to be a formidable challenge, as feeding is an essential component for healthy nutrition, growth, and development. This article will highlight how particular food items that are eaten and preferred by affected children may be contributing to their exhibited feeding difficulties. Next, it will be shown how the children's restrictive diets supplant more healthy food options. When this is combined with the children's noted reduced physical activity, the consequences are especially serious, as they include not only malnutrition but also give rise to childhood obesity. In sum, it will be demonstrated that feeding difficulties in young children with ASD are not well understood nor managed. The dearth of knowledge about feeding issues in this population affects both assessment choices and, specifically, management practices - aspects that will be elaborated on in this article. Conclusions will include suggested future directions for enhancing and complementing knowledge of these issues for stakeholders.

Repercusiones de la pandemia de COVID-19 para las personas con autismo y sus familias: revisión de alcance

Resumen Objetivo: mapear la evidencia científica disponible sobre las repercusiones de la pandemia de COVID-19 para las personas con Trastorno del Espectro Autista y sus familiares. Método: revisión de alcance realizada en las siguientes bases de datos: MEDLINE, CINAHL, SciELO, SCOPUS, EMBASE, Wiley Online Library, en agosto/septiembre de 2021. El protocolo de esta revisión fue registrado en Open Science Framework bajo DOI 10.17605/OSF.IO/JYTVD. Los datos fueron analizados y sintetizados en forma narrativa. Resultados: 46 publicaciones identificadas indican que el período de pandemia trajo numerosas repercusiones para la población con autismo y sus familiares al experimentar serias dificultades en los cambios o irregularidades en las rutinas programadas; acceso limitado a educación, terapias y apoyo social. Conclusión: la evidencia sugiere que la pandemia de COVID-19 agudizó las desigualdades que ya experimentaban las personas con autismo y sus familias, tuvo consecuencias negativas en los aspectos emocionales, psicológicos, comportamentales y sociales, que afectaron la calidad de vida y salud mental de esta población. Es fundamental que se realicen estudios futuros sobre personas con autismo y sus familias durante períodos de crisis de salud pública para planificar intervenciones psiquiátricas, psicosociales y educativas.

Repercussões da pandemia da COVID-19 para pessoas com autismo e aos seus familiares: revisão de escopo

Resumo Objetivo: mapear as evidências científicas disponíveis sobre as repercussões da pandemia da COVID-19 para as pessoas com Transtorno do Espectro Autista e seus familiares. Método: revisão de escopo realizada nas bases de dados: MEDLINE, CINAHL, SciELO, SCOPUS, EMBASE, Wiley Online Library, nos meses de agosto/setembro de 2021. O protocolo desta revisão foi registrado em Open Science Framework sob o DOI 10.17605/OSF.IO/JYTVD. Os dados foram analisados e sintetizados de forma narrativa. Resultados: 46 publicações identificadas sinalizam que o período pandêmico trouxe inúmeras repercussões para a população com autismo e seus familiares ao vivenciarem sérias dificuldades nas mudanças ou irregularidades das rotinas programadas; limitação no acesso à educação, às terapias e apoio social. Conclusão: as evidências sugerem que a pandemia da COVID-19 exacerbou as desigualdades já vivenciadas por pessoas com autismo e seus familiares, com consequências negativas nos aspectos emocionais, psicológicos, comportamentais e sociais, interferindo na qualidade de vida e saúde mental desta população. Estudos futuros sobre indivíduos com autismo e suas famílias durante períodos de crise de saúde coletiva são de fundamental importância para o planejamento de intervenções psiquiátricas, psicossociais e educacionais.

Repercussions of the COVID-19 pandemic for people with autism and their family members: A scoping review

OBJECTIVE

to map the diverse scientific evidence available about the repercussions of the COVID-19 pandemic for people with Autism Spectrum Disorder and their family members.

METHOD

a scoping review conducted in the following databases: MEDLINE, CINAHL, SciELO, SCOPUS, EMBASE and Wiley Online Library, in August and September 2021. The protocol of this review was registered at the Open Science Framework under DOI 10.17605/OSF.IO/JYTVD. The data were analyzed and synthesized in a narrative way.

RESULTS

a total of 46 publications identified indicate that the pandemic period brought about countless repercussions for the population with autism and their family members when experiencing serious difficulties in the changes or irregularities of the scheduled routines and limited access to education, therapies and social support.

CONCLUSION

the diverse evidence suggests that the COVID-19 pandemic intensified the inequalities already experienced by individuals with autism and their family members, with negative consequences in the emotional, psychological, behavioral and social aspects, interfering with the quality of life and mental health of this population segment. Future studies on individuals with autism and their families during public health crisis periods are of fundamental importance for planning psychiatric, psychosocial and educational interventions.

A bibliometrics analysis and visualization of autism spectrum disorder

BACKGROUND

The prevalence of autism spectrum disorder (ASD) increased rapidly in the last 20 years. Although related research has developed rapidly, little is known about its etiology, diagnostic marker, or drug treatment, which forces researchers to review and summarize its development process and look for the future development direction.

METHODS

We used bibliometrics to analyze papers of ASD in the Web of Science from 1998 to 2021, to draw the network of authors, institutions, countries, and keywords in the ASD field, and visualize the results.

RESULTS

A total of 40,597 papers were included with a continually increasing trend. It turns out that the research on ASD is mainly concentrated in universities. The United States has the largest number of ASD studies, followed by England and Canada. The quality of papers related to ASD is generally high, which shows that ASD research has become a hot spot of scientific research. The keywords of ASD etiology and diagnostic markers can be classified into at least 7 aspects. The detection of keywords shows that ASD research is mostly based on its subtypes, takes children as the study population, focuses on neurodevelopmental imaging or genetics, and pays attention to individual differences. And ASD research has changed greatly under the impact of Corona Virus Disease 2019 in the past 2 years.

CONCLUSION

We consider the future development direction should be based on the improvement of case identification, accurate clinical phenotype, large-scale cohort study, the discovery of ASD etiology and diagnostic markers, drug randomized controlled trials, and telehealth.

Facial Emotion Recognition Focused on Descriptive Region Segmentation

Facial emotion recognition (FER) is useful in many different applications and could offer significant benefit as part of feedback systems to train children with Autism Spectrum Disorder (ASD) who struggle to recognize facial expressions and emotions. This project explores the potential of real time FER based on the use of local regions of interest combined with a machine learning approach. Histogram of Oriented Gradients (HOG) was implemented for feature extraction, along with 3 different classifiers, 2 based on k-Nearest Neighbor and 1 using Support Vector Machine (SVM) classification. Model performance was compared using accuracy of randomly selected validation sets after training on random training sets of the Oulu-CASIA database. Image classes were distributed evenly, and accuracies of up to 98.44% were observed with small variation depending on data distributions. The region selection methodology provided a compromise between accuracy and number of extracted features, and validated the hypothesis a focus on smaller informative regions performs just as well as the entire image.

A Systematic Review on the Impact of the Social Confinement on People with Autism Spectrum Disorder and Their Caregivers during the COVID-19 Pandemic

The COVID-19 pandemic had imposed a variety of containment measures on the general population for prolonged periods. Confinement has had, and still has, social, economic, educational, health, and psychological consequences on the entire population.

OBJECTIVE

In this article, a systematic search has been performed based on studies carried out since the beginning of the pandemic, regarding the impact of these containment measures on the autism spectrum disorder (ASD) population and their caregivers.

METHOD

We consulted six databases (i.e., PubMed, Medline, Embase, Scopus, Web of Science, and Science Direct) and selected ten studies that met the inclusion criteria. The chosen studies have been classified according to their theoretical focus, methodology, and target population.

RESULTS

We found an increase in stress and a decrease in psychological well-being among individuals diagnosed with ASD (i.e., parents and caregivers). Additionally, in studies focused on children, youth, and adults with ASD diagnosis, the results are contradictory depending on variables such as age, ASD severity, or type of family structure.

CONCLUSIONS

The results show that the consequences of quarantine and social confinement are quite contradictory and depend on variables such as age, ASD severity, and family features.

Obsessive-Compulsive Disorder During the COVID-19 Pandemic: a Systematic Review

PURPOSE OF REVIEW

This systematic review evaluated the impact of the COVID-19 pandemic on obsessive-compulsive symptoms.

RECENT FINDINGS

Most studies showed that obsessive-compulsive symptoms worsened during the early stages of the pandemic, particularly for individuals with contamination-related obsessive-compulsive disorder (OCD), though other symptoms dimensions were found to worsen as well. Many patients and individuals in the general population experienced new obsessive-compulsive-like symptoms centered on COVID-19. Self-reported rates of symptom exacerbation and COVID-19-focused symptoms were consistently lower in studies that recruited patients from specialty clinics (compared to online samples). Most studies were conducted in Spring/Summer, 2020. The COVID-19 pandemic has been an enormous stressor for individuals with OCD, especially for those with contamination symptoms. Regardless, there is strong reason to believe gold standard treatment approaches for OCD have maintained strong efficacy. Disseminating and effectively delivering evidence-based treatments for OCD is an urgent public health priority.

The association between COVID-19, personal wellbeing, depression, and suicide risk factors in Australian autistic adults

The COVID‐19 pandemic has had a significant impact on the mental health and wellbeing of the world's population, with particularly negative effects on vulnerable populations, including autistic people. Although some consensus regarding specific impact on aspects of wellbeing and mental health in autism is starting to emerge, it is unclear whether the pandemic has increased suicide risk. The goals of this study were to examine (a) potential associations between COVID‐19 impact and depression, personal wellbeing, and suicide risk factors in Australian autistic adults and (b) age and gender effects. The COVID‐19 Impact Scale (CIS), Personal Wellbeing Index, Patient Health Questionnaire, and the Suicide Behavior Questionnaire, Revised (SBQ‐R), were administered to 111 autistic adults aged 20 to 71 years during the second wave of the COVID‐19 pandemic in Australia. COVID‐19 impact showed small associations with poorer personal wellbeing (r = −0.224, p = 0.023, [−0.409, −0.016]) and higher depressive symptoms (r = 0.268, p = 0.006, [0.056, 0.445]) and was not associated with the SBQ‐R suicide risk score (r = 0.081, p = 0.418, [−0.118, 0.264). No significant effects were identified for age. Although model results were similar for women and men, the strength of the associations between personal wellbeing and depression (z = −2.16, p = 0.015), and depression and SBQ‐R suicide risk (z = 1.961, p = 0.025), were stronger in women than in men. Qualitative analysis of an open response question from the CIS suggested that the pandemic had both positive and negative impacts on participants. The COVID‐19 pandemic has had a large impact on the mental health and wellbeing of the world's population, particularly vulnerable populations such as autistic people. It is not known if these impacts on mental health and wellbeing have increased suicide risk. Our findings suggest that the impact of the COVID‐19 pandemic may be associated with poorer wellbeing and higher depression, but is not associated with suicide risk. Overall, autistic people reported both positive and negative impacts of the pandemic on their lives.

The Impact of COVID-19 on Sleep in Autistic Adults: Longitudinal Comparisons pre and During Lockdown

Background: The longer-term impact of the pandemic on autistic adults' sleep are yet to be revealed, with studies concentrating on sleep in autistic children or mental health outcomes and coping strategies of autistic adults. Given the prevalence of sleep problems experienced by autistic adults and the changes in routine that have occurred as a result of COVID-19 societal restrictions, this study assessed the impact of the COVID-19 pandemic on sleep problems via a longitudinal subjective assessment method. Methods: Sleep data were gathered at three time points from 95 autistic adults, namely prior to the pandemic, at the start of COVID-19 and several months into COVID-19 to obtain a rich longitudinal dataset ascertaining how/if sleep patterns have changed in autistic adults over these several months. Results: In comparison to pre-lockdown, several sleep components were shown to improve during the lockdown. These improvements included reduced sleep latency (time taken to fall asleep), longer sleep duration, improved sleep efficiency, improved sleep quality, as well as improved daytime functioning. Pre-sleep cognitive arousal scores were found to decrease compared to pre-lockdown, meaning cognitive arousal improved. Approximately 65% of participants reported that they felt their sleep had been impacted since COVID-19 since Time 1, with the most common reasons reported as waking up exhausted (36.92%), not being able to get to sleep (33.85%), waking up in the night (29.23%), having a disrupted sleep pattern (27.69%), and nightmares (18.46%). Conclusions: Improvements in sleep may be related to societal changes (e.g., working from home) during the pandemic. Some of these changes are arguably beneficial for autistic adults in creating a more autism-inclusive society, for example telehealth opportunities for care. Further exploration of the associations between mental health and sleep are warranted.

Changes in Sleep Patterns and Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorders and Autism Spectrum Disorders during the COVID-19 Lockdown

BACKGROUND

The COVID-19 lockdown determined important changes in the sleep of a large percentage of the world population. We assessed the modifications of reported sleep patterns and disturbances in Italian children and adolescents with autism spectrum disorders (ASD) or attention deficit hyperactivity disorders (ADHD), compared to control children, before and during the COVID-19 lockdown in Italy.

METHODS

Parents of 100 ASD, 236 ADHD patients, and 340 healthy children filled out an anonymous online survey and a modified version of the Sleep Disturbance Scale for Children (SDSC), advertised via social media, to evaluate sleep patterns and disturbances of their children before and during the lockdown.

RESULTS

Before the lockdown, bedtime and risetime were not different between the three groups. During the lockdown, ADHD children tended to have a later bedtime and risetime than ASD and controls, while ASD children tended to maintain similar bedtime and risetime. Overall, during the lockdown, a reduced sleep duration significantly differentiated clinical groups from controls. Anxiety at bedtime, difficulties in falling asleep, and daytime sleepiness increased in all groups during the lockdown. Hypnic jerks, rhythmic movement disorders, night awakenings, restless sleep, sleepwalking, and daytime sleepiness increased in ASD and ADHD patients, in particular.

CONCLUSIONS

This is the first study comparing sleep habits and disorders in ASD and ADHD during the lockdown showing specific differences consistent with the core characteristics of two neurodevelopmental disorders.

Parental Stress and Disability in Offspring: A Snapshot during the COVID-19 Pandemic

Parenting a child with a disability, such as neurodevelopmental disorders and genetic syndromes, implies a high level of stress. During the COVID-19 outbreak—as a period implying additional challenges—few studies have specifically investigated caregivers’ distress among neurodevelopmental disabilities. The objective of the study is to investigate whether during the COVID-19 pandemic, the level of parental stress differs between four disability groups including neurodevelopmental disorders (autism spectrum disorder (ASD), attention deficit and hyperactivity disorder (ADHD)) and genetic syndromes (Rett syndrome (RTT), Sotos syndrome (SS)) in comparison to families with typical development offspring (TD). In total, 220 Italian parents of children affected by neurodevelopmental disabilities (74 ASD, 51 ADHD, 34 SS, 21 RTT, 40 TD; age M 9.4 ± SD 4.2) underwent a standardized evaluation for stress related to parenting through the self-report questionnaire, Parental Stress Index-Short Form (PSI-SF). The main findings show greater levels of parental stress—mainly linked to child behavioral characteristics rather than parental sense of competence—in parents of children affected by a disability in comparison to children with typical development. This study highlights the need to support not only individuals with special needs but also their own caregivers: core figures in the management and outcome of children disorders.

Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review

BACKGROUND

Children diagnosed with autism spectrum disorder (ASD) may have great difficulties when their routines change, and this may affect the psychological well-being of their parents. For this reason, it is important to examine studies that address the mental health of parents in order to adapt to the coronavirus disease 2019 (COVID-19) pandemic.

AIM

To determine the mental health status of parents with children diagnosed with ASD in the COVID-19 pandemic.

METHODS

The study, which is a systematic review, was conducted between December 15, 2020 and December 30, 2020 by scanning articles in English. The Scopus, Science Direct, PubMed, Cochrane, Web of Science, and Google Scholar databases were used for scanning. The keywords COVID-19 AND ("autism" OR "autistic" OR "autism spectrum disorder") AND parent AND ("mental health" OR "anxiety" OR "stress") were used in the search process. The inclusion criteria in the study were findings regarding the mental health of parents with children diagnosed with ASD in the COVID-19 pandemic, addressing their anxiety and stress situations, being a research article, and accessing the full text of the article.

RESULTS

In the study, a total of 6389 articles were reached, and the full texts of 173 articles were evaluated for eligibility. After the articles excluded by the full-text search were eliminated, 12 studies involving 7105 parents were included in the analysis. The findings obtained from the articles containing data on mental health in the COVID-19 pandemic of parents with children with autism spectrum disorder were discussed in three groups. These were findings on the experiences of parents with children with ASD in the COVID-19 pandemic regarding the areas where parents with children with ASD need support in the COVID-19 pandemic and methods of coping with the COVID-19 pandemic for parents with children with ASD. In the systematic review, it was determined that the anxiety and stress of the parents increased, they needed more support compared to the pre-pandemic period, and they had difficulty coping.

CONCLUSION

In this systematic review, it was concluded that the COVID-19 pandemic negatively affected the mental health of the parents of children with ASD.

Identification of Measures to Strengthen Resilience in Homes on the Basis of Lockdown Experience during COVID-19

The COVID-19 pandemic and the need to put population into lockdown require a reflection on the capacity of homes to adjust to a specific function for which they are not designed: ensuring the health and wellbeing of people during lockdown periods. Thus, the government in the Comunitat Valenciana promoted a study to evaluate house suitability in this Spanish region through the Valencia Institute of Building. The information was obtained by directly asking people affected through an online survey. On the basis of a series of indicators proposed in the study, the level of resilience and measures that favour house adaptation to such an extreme situation are analysed. The ultimate purpose is to offer solutions to enhance house behaviour against similar risks. The information obtained will be further useful for regional regulations of house design to be amended, currently under revision.