Impact of COVID-19 outbreak on mental health and perceived strain among caregivers tending children with special needs

Prevalence and correlates of depression and anxiety in caregivers of children with attention-deficit/hyperactivity disorder during the fifth wave of COVID-19 and school closure in Hong Kong

BACKGROUND

Caregivers of children with attention-deficit/hyperactivity disorder (ADHD) are vulnerable to increased psychological distress during COVID-19. However, specific pandemic- and child-related factors contributing to their poor mental health have not been fully investigated. We aimed to comprehensively examine prevalence and correlates of depression and anxiety among caregivers of ADHD children in Hong-Kong during the peak of fifth pandemic wave with territory-wide school closure.

METHOD

One-hundred-ninety-nine caregivers of ADHD children were assessed with self-rated questionnaires between 29 March-14 April, 2022. Questionnaires encompassed socio-demographics, pre-existing physical/psychiatric morbidity, COVID-19 related factors, children's ADHD and other psychiatric symptoms. Caregivers' psychological distress was quantified by Patient Health Questionnaire-9 (PHQ-9) and Generalized Anxiety Disorder Scale-7 (GAD-7). Caregivers who scored ≥ 10 in PHQ-9 and GAD-7 were classified as having probable depression and probable anxiety, respectively. Univariate and multivariate logistic regression analyses were conducted to identify correlates associated with caregivers' probable depression and anxiety status.

RESULTS

Forty-four (22.4%) and 33 (16.9%) caregivers had probable depression and anxiety, respectively. Multivariate regression analyses revealed that caregivers' pre-existing mental disorder, greater COVID-19 stressor burden, and more severe emotional symptoms and insomnia of ADHD children were independently associated with both caregivers' depression and anxiety status.

CONCLUSION

A significant proportion of caregivers of ADHD children experienced clinically-significant depressive and anxiety symptoms during the peak of fifth pandemic wave and school closure. Findings suggest that optimizing management of caregivers' pre-existing mental health conditions, addressing emotional and sleep symptoms in ADHD children, and implementing strategies to alleviate pandemic-related stressors may reduce caregivers' psychological distress.

Investigation of psychological resilience and care burden of parents caring for children with special healthcare needs in Turkey: A cross-sectional study

AIM

The study was planned to investigate the resilience and care burden of caregiving parents in Turkey.

METHODS

Demographic and descriptive characteristics were recorded. Psychological resilience was assessed using the Brief Resilience Scale (BRS) and caregiving burden was assessed using the Zarit Caregiving Burden Scale (ZCBS). Independent Sample t-test and ANOVA Mann-Whitney U and Kruskall Wallis tests were used to analyze the data.Multivariate variance analysis was performed with post-hoc tests to determine the differences between the groups. Significance p < 0.05 was accepted.

RESULTS

A total of 112 caregivers, 97 of whom were women, with a mean age of 39.84 ± 10.73 years, participated in the study. The mean age of with children with special healthcare needs was 10.83 ± 8.56 years, 61.6 % were male, and 42.9 % had both physical and mental disabilities. In children with special health needs, 41.1 % had mobility limitations, 43.8 % had communication problems, 44.6 % had learning problems and 31.3 % had nutritional problems. The level of mobility limitation, communication, learning and nutrition problems in children with special healthcare needs and the presence of chronic disease or musculoskeletal system problems in caregivers were found to be associated with care burden (p < 0.05). Psychological resilience of caregivers of those with moderate care burden was lower than those with mild care burden (p < 0.05). There was a negative, moderately significant relationship between caregivers' psychological resilience and care burden (r = -0.356; p < 0.001).

CONCLUSION

New strategies should be developed to increase psychological resilience and reduce the burden of care in caregivers of complex children with special healthcare needs.

IMPLICATIONS TO PRACTICE

The lived experience of caregivers who support children with special healthcare needs can be improved with psychological and practical care support from health professionals.

Telenursing on primary family caregivers and children with disabilities: a scoping review

Introduction

Despite the need for continued support for children with disabilities and their families, COVID-19 has made the support difficult. Telenursing can monitor daily life and support from a remote location, continuously and at a low cost. However, there are few practical reports on its use in children with disabilities.

Objective

This scoping review aims to summarize the published literature on telenursing for children with disabilities in home care settings.

Methods

We included studies involving children (0-18 years of age) with disabilities and their families and specified telecommunication assessment, monitoring, and intervention such as tele-education, teleconsultation and telementoring involving nurses via information communication technologies. We included studies that used any design written in English or Japanese. A comprehensive search was conducted on March 14, 2021 using six databases: MEDLINE via PubMed, Cumulative Index to Nursing & Allied Health Literature, Cochrane Central Register of Controlled Trials, Embase, PsycINFO, and Ichushi Web. Two or more reviewers individually screened eligible studies according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses flow diagram. Data on the characteristics of the included studies, telecommunications technology interventions, and children with disabilities were mapped in tables.

Results

Eleven studies, published between 2003 and 2020, met the inclusion criteria. Only one study used the term "telenursing," while others used "telehealth" and other terms, which involved multidisciplinary support such as physicians and social workers in addition to nurses. Although there were various types of telecommunications technology interventions, they were categorized as consultation, healthcare provision, monitoring, and education. Most studies have examined telecommunication technology interventions by healthcare professionals, including nurses. Five studies focused on children with medical complexities, and two focused on children with neurodevelopmental disabilities, including developmental delays. There is insufficient information on telecommunications technology interventions, especially assessment tools, trigger points, and the status of the target population.

Conclusion

This scoping review aimed to map the published literature on telenursing for children with disabilities and their families in home care settings. Available evidence indicates a lack of research focusing on the implementation of telecommunications for children with disabilities and their families. Further research is required to assess the effects of telecommunications technology interventions. Additionally, they should provide information for implementing telecommunication technology safety.

Scoping Review Registration

Figshare (https://doi.org/10.6084/m9.figshare.21747047.v1).

Impact of CoVID-19 pandemic on multidisciplinary follow-up and clinical outcomes among pediatric spina bifida patients

BACKGROUND

The longitudinal, multidisciplinary care of children with spina bifida was disrupted during the CoVID-19 pandemic with unclear effect.

OBJECTIVE

To compare outpatient care utilization and outcomes among children with spina bifida before and during the CoVID-19 pandemic.

STUDY DESIGN

A pre-post analysis (2018-2020 vs 2020-2022) comparing outpatient care utilization and clinical outcomes was performed using the onset of the CoVID-19 pandemic as a hinge point. Clinical visits and clinically significant events - ED visits, admissions, UTIs, shunt malfunctions - were tabulated from chart review, and patients not seen in the last two years were called for follow up. Differences between visits and outcomes for individuals during pre- and intra-pandemic periods were calculated, and relationships between demographic variables and care utilization as well as clinical visits and clinical outcomes were evaluated via linear regression.

RESULTS

A total of 216 patients were included, 39 (18%) of whom were lost to follow up intra-pandemic. Mean in-person visits decreased from 3.7 (SD 2.8) pre-pandemic to 2.5 (SD 2.3, p < 0.00) intra-pandemic. Only six patients (0.03%) had virtual visits pre-pandemic vs 95 (44%) intra-pandemic; virtual visits did not equalize mean total visits with those pre-pandemic (3.3 [2.9], p = 0.02). Recent surgery was significantly associated with difference in clinic visits between periods (p < 0.00). Admissions (44 vs 29%, p < 0.00), ED visits (55 vs 43.5%, p < 0.00), and shunt malfunctions (21 vs 12.6%, p = 0.01) were significantly higher pre-pandemic; UTI incidence was similar (34 vs 31%, p = 0.41). Clinic visits were significantly positively associated with ED visits (p = 0.02), admissions (p < 0.00), and shunt malfunctions (p = 0.04). Nearly half (40.5%) of patients lost to follow up were contacted; 30% of patients reported difficulty accessing appointments and 17% accessing supplies during the pandemic.

DISCUSSION

Despite an increase in telehealth visits during the pandemic, there was a decrease in mean total clinic visits compared to pre-pandemic. Adverse events did not increase during the pandemic period as expected; incidence of all evaluated outcomes was higher pre-pandemic. Additionally, outpatient care utilization during the pandemic was positively associated with ED presentation and shunt malfunction and did not appear to protect against other outcomes.

CONCLUSION

Though clinical follow-up for pediatric spina bifida patients decreased during the COVID-19 pandemic, clinical outcomes did not acutely worsen. Clinic visits were supplemented but not entirely replaced by telemedicine in this period and were associated with poorer clinical outcomes, possibly reflecting an increase in patients' and families' threshold to engage in outpatient care during the pandemic.

Stress and Self-Efficacy in Parents/Caregivers and Oral Health of Individuals with Down Syndrome During the COVID-19 Pandemic: A Cross-Sectional Study

The family of individuals living with Down Syndrome (DS) often demonstrate high levels of stress associated with the demand for care and difficulties experienced in everyday life. The aim of this cross-sectional study was to assess perceived stress by parents/caregivers of individuals with DS and its association with general perceived self-efficacy and dental outcomes, considering the COVID-19 pandemic's impacts on family's daily activities and finances. A sample of 257 parents/caregivers answered a questionnaire with socioeconomic, dental, and behavioral variables and the short version of the Perceived Stress Scale and the General Perceived Self-Efficacy Scale. The sample was divided into three groups based on perceived stress levels. Associated variables were evaluated using multinomial logistic regression (level of significance 5%), adjusting for socioeconomic factors. The mean perceived stress score was 17.84 ± 5.75 (0-39). Medium stress (second tertile) was associated with finger/nail biting in individuals with DS (OR = 2.05; 95%CI 1.04-4.03; p = 0.038), difficulty in performing oral hygiene (OR = 2.39; 95%CI 1.23-4.65; p = 0.011) and medium and high self-efficacy (OR = 0.12; 95%CI 0.05-0.31; p < 0.001 and OR = 0.38; 95%CI 0.15-0.98; p = 0.046, respectively); high stress (third tertile) was associated with medium and high self-efficacy (OR = 0.25; 95%CI 0.09-0.67; p = 0.006 and OR = 0.05; 95%CI 0.02-0.15; p < 0.001, respectively) and negative impact of COVID-19 in family finances (OR = 3.00; 95%CI 1.39-6.44; p = 0.005). It was concluded that parents/caregivers' perceived stress was averaged and associated with self-efficacy, finger/nail biting, oral hygiene demands, and the financial impact of COVID-19.

The impact of the COVID-19 pandemic on stress and coping in parents of children with Autism Spectrum Disorder

INTRODUCTION

Autism Spectrum Disorder (ASD) is a neurodevelopmental disorder characterized by impairments in communication, social interaction, and repetitive behavior. The declaration of the COVID-19 pandemic in March 2020 resulted in significant changes in daily life due to restrictive measures. This period posed particular challenges for families with children living with autism, given the limitations in medical care and social services.

OBJECTIVE

This study aimed to understand how families with autistic children perceive stress during the pandemic and the coping strategies employed in unexpected situations.

METHOD

A total of 44 families with children with ASD and 300 control families, including 44 control families in a matched subsample, were included in the study. To assess stress and parental coping with COVID-19-related stress, the Responses to Stress Questionnaire (Adult Self-Report RSQ-COVID-19) was utilized.

RESULTS

Caregivers of autistic children experienced significantly higher stress levels (p = .027, d = 0.479) during the pandemic, with notable stressors such as limited access to medical care and challenges associated with remote work. Despite expectations, coping strategy differences were not statistically significant.

CONCLUSION

Families and supporters of children with autism naturally encounter various experiences and challenges stemming from their additional needs. Our study's results highlight an accentuation of stress during challenging situations. As these situations may recur in the future, there is a need to design and implement support plans for these families, appropriate intervention programs, and preparations for the utilization of telemedicine tools.

Caregivers' Perceptions of COVID-19 Educational Disruptions on Children With Developmental Language Disorder and Typically Developing Peers

PURPOSE

Understanding the experiences of families of children with developmental language disorder (DLD) during COVID-19 educational disruptions is essential for designing responsive supports during pandemic recovery efforts and beyond. This qualitative study describes the experiences of families of first- and second-grade children with DLD during the pandemic as compared to the experiences of families of typically developing (TD) peers.

METHOD

A conventional content analysis approach was used to analyze caregivers' written responses to open-ended questions regarding their perceptions of COVID-19 educational disruptions. Responses were analyzed separately by group: caregivers of children with DLD (n = 23) and caregivers of TD children (n = 22).

RESULTS

Four categories of caregiver responses were generated for each group: impacts on children, remote learning challenges, impacts on caregivers, and protective factors. For both groups, concerns about the child's well-being and literacy learning were most prevalent and prevailed over concerns about oral language. Most caregivers in each group described negative impacts of educational disruptions on their cdhildren. As compared to caregivers of TD children, caregivers of children with DLD reported higher rates of remote learning challenges and more negative impacts on literacy learning, speech and/or language, and education in general. DLD caregivers also shared fewer positive comments and remarks related to protective factors.

CONCLUSIONS

Results indicate that families of children with DLD may have experienced more challenges during COVID-19 educational disruptions as compared to families of TD peers. Thus, responsive research and supports for these families is essential.

Exploring Psychosocial Distress in Caregivers of Children and Youth With Special Health Care Needs

PURPOSE

Caring for a child or youth with special health care needs (CYSHCN) can be overwhelming. Parents and caregivers may experience psychosocial distress, such as depression, frustration, and hopelessness. The purpose of the current study was to gain further insight into families' perspectives on the psychosocial impacts of caring for CYSHCN to identify gaps in health care systems and strengthen systems of support.

METHOD

A qualitative descriptive design was used in 16 parents and caregivers. Colaizzi's method of analysis and semi-structured interviews were used.

RESULTS

Six themes emerged from this study: (1) Stigma and Isolation, (2) Religion as a Coping Mechanism, (3) Financial Challenges, (4) Bearing the Burden, (5) Familial Denial, and (6) System-Related Concerns.

CONCLUSION

Psychiatric-mental health nurses (PMHNs) are in a pivotal position to use their knowledge, skills, and experiences to guide families. PMHNs can also engage communities and enhance mental health promotion to break the stigma associated with having a CYSHCN. [Journal of Psychosocial Nursing and Mental Health Services, 62(9), 37-46.].

Factors Associated with Intention to Use Telerehabilitation for Children with Special Needs: A Cross-Sectional Study

Background: Children with special health care needs (CSHCN) require long-term and ongoing rehabilitation interventions supporting their development. Telerehabilitation can provide continuous rehabilitation services for CSHCN. However, few studies have explored the intention of CSHCN and their caregivers to use telerehabilitation and its impact on them. Objective: The objective of this study was to identify factors that influence the intention to use telerehabilitation among CSHCN and their caregivers. Methods: This study was a cross-sectional study. Based on the unified theory of acceptance and use of technology, extended with additional predictors (trust and perceived risk [PR]), this study developed a research model and proposed 10 hypotheses. A structured questionnaire was distributed to 176 caregivers. Data were analyzed and research hypotheses were tested using partial least squares structural equation modeling to better understand the factors influencing the use of telerehabilitation. Results: A total of 164 valid questionnaires were collected. CSHCN and their caregivers were overall satisfied with this telerehabilitation medical service. The results of the structural model analysis indicated that social influence (SI), facilitating conditions (FC), and trust had significant effects on behavioral intention (BI) to use telerehabilitation, while the paths between performance expectancy (PE), effort expectancy (EE), and PR and BI were not significant. PE, EE, and SI had a significant effect on trust. Moreover, EE and SI had indirect effects on BI, with trust as the mediator. Conclusions: The results indicated that SI, FC, and trust are significant factors influencing CSHCN and their caregivers' use of telerehabilitation. Trust is also an important mediator for the intention and highly influenced by PE, EE, and SI.

Burden Experienced by Primary Caregivers of Children With Psychotic Disorders and at Clinical High Risk for Psychosis

BACKGROUND

Despite the existing research exploring caregiver burden in adult psychosis, few studies have examined the experience of providing care to children diagnosed with psychotic disorders (PDs) and those identified as having clinical high risk for psychosis (CHR-P).

AIM

This study measured the level of burden in caregivers of children with PD and CHR-P and examined associated risk factors, including social support, caregiver-child relationship, severity of illness, and frequency of psychiatric hospitalizations.

METHODS

A total of 56 caregivers completed validated measures and provided demographic information. Measures included the Zarit Burden Interview, the Multidimensional Scale of Perceived Social Support, the Behavior Assessment System for Children, Third Edition, Parenting Relationship Questionnaire-Child and Adolescent Form (BASC-3 PRQ-CA), and the Clinical Global Impression-Severity scale.

RESULTS

The majority of caregivers were women (86%), mothers (84%), White (63%), married (66%), working full-time (50%), college-educated (79%), and whose mean age was 45.7 years (SD = 8.09). Nearly half of the caregivers (45%) reported a high level of caregiver burden, 39% rated their burden in the mild to moderate range, and 16% reported little to no burden. There was no significant difference in mean burden between PD and CHR-P groups. Higher caregiver burden was associated with lower levels of social support (r = -.408, p = .002), lower levels of parenting confidence (r = -.514, p < .001), higher levels of relational frustration (r = .612, p < .001), and higher severity of illness (r = .316 p = .025).

CONCLUSIONS

These findings underscore the critical unmet need for support for caregivers of children with PD and CHR-P. Applications to clinical practice are discussed.

Changes in Psychiatric Medication Use During the COVID-19 Pandemic in a Pediatric Long-Term Care Facility

Background: Coronavirus disease 2019 (COVID-19) caused a global pandemic that dramatically altered infection control procedures in long-term care facilities. Mental health decline among residents of geriatric facilities during the pandemic has been described (Ferro Uriguen et al., 2022). Our study aims to evaluate psychological effects of the pandemic on residents of a pediatric long-term care facility, a population comprised of medically complex children. To characterize this, we compared patterns of psychotropic medication use during the COVID-19 pandemic to those of the prepandemic period among residents of a 76-bed pediatric long-term care facility. Methods: We conducted a retrospective study of psychotropic medication use from January 2019 to August 2022 using de-identified monthly facility medication refill data. Linear multivariable regression models were used to estimate the level and trends in the monthly rates of medication refills per 10,000 bed days among resident children before and after the pandemic onset. Six classes of psychotropic medications were analyzed including antipsychotics, antidepressants and anxiety medications, trazodone, clonidine, mood stabilizers, and gabapentin. Results: The pandemic onset was associated with a significant increase in the monthly prescribing rates of antidepressant and anxiety medications (20.83; 95% CI, 3.96-37.71; p = 0.017), mood stabilizers (10.44; 95% CI, 5.79-15.09; p < 0.001), and trazodone (-27.66; 95% CI, -40.44 to 14.88; p < 0.001) above those expected by prepandemic trends. The trend in trazodone use changed significantly during the pandemic from decreasing prepandemic to increasing (2.21; 95% CI, 1.28-3.14; p < 0.001). Antidepressant, anxiety medication, and gabapentin use increased throughout the study. Antidepressant and anxiety medication use surged early in the pandemic, but then continued growth at their prior rates of use. Discussion: Increased use of antidepressant and anxiety medications and trazodone suggests a possible impact of the COVID-19 pandemic on rates of anxiety, depression, sleep disturbance, and agitation among children with severe intellectual and developmental disabilities living in long-term care.

Adapting a quality of life scale for children and young people with Down syndrome in Chile

In Chile, there are no validated instruments for the evaluation of quality of life (QoL) of people with Down syndrome (DS). To analyze construct validity and reliability of the KidsLife-Down scale in Chile to measure QoL in people with DS aged from 4 to 21 years. Families of boys, girls, and young people with DS between 4 and 21 years were invited to participate. The scale was answered by relatives or caregivers. To assess the internal consistency, reliability tests were performed using Cronbach's alpha coefficient. A confirmatory factor analysis was performed. The scale was answered by 531 relatives or caregivers. Cronbach's coefficient was greater than 0.7 in all the items. The confirmatory factor analysis of the scale allowed its validation for clinical use in the Chilean population. "Kids Life Down-Chile" scale has adequate psychometric properties to be used in clinical practice and to help us improve QoL with better support strategies.

Reflections of the COVID-19 pandemic on health problems of children with special needs

OBJECTIVE

This research aimed to examine changes caused by the COVID-19 pandemic in activities of daily living and health status of children with special needs.

METHOD

The current descriptive and comparative study was carried out with 82 students studying at a special education practice school that provided daytime education to children with special needs before and during the COVID-19 pandemic. The Personal Information Form, the Katz Index of Independence in Activities of Daily Living, and the Omaha System Problem Classification Scheme were employed as data collection tools in the research.

RESULTS

The 10 most common problems during the COVID-19 pandemic were stated as cognition (86.6%), mental health (75.6%), speech and language (85.4%), interpersonal relationships (79.3%), personal care (79.3%), social contact (64.6%), growth and development (63.4%), neighborhood/workplace safety (58.5%), communication with community resources (57.3%), and caretaking/parenting (n = 47, 57.3%). The incidence of "cognition," "speech and language," "neighborhood/workplace safety," "communication with community resources," and "caretaking/parenting" problems of children with special needs was significantly higher during the pandemic than before the pandemic (p < 0.05; p < 0.001).

CONCLUSION

The current research emphasized the significant impacts on the health of children with physical and mental disabilities and loss of opportunity, as their education was considerably interrupted during the quarantine. During a pandemic, the regular evaluation of health benefits/risks is essential to ensure the continuity of medical follow-up, rehabilitation, education, and support mechanisms for children with disabilities.

Impact of the COVID-19 pandemic on perceived changes in responsibilities for adult caregivers who support children and youth in Ontario, Canada

BACKGROUND

The COVID-19 pandemic has created long-lasting changes in caregiving responsibilities, including but not limited to increased demands, loss of support, worsening mental and physical health, and increased financial worries. There is currently limited evidence regarding factors associated with perceived changes in caregiving responsibilities.

AIMS

This observational study aimed to investigate factors (sociodemographic characteristics of caregivers and mental health and/or addiction concerns of the caregiver and their youth) that predict perceived negative changes in caregiving responsibilities among adult caregivers (aged 18+ years) of children and youth (aged 0-25 years) in Ontario, Canada, during the COVID-19 pandemic.

METHOD

Data were collected from 1381 caregivers of children and youth between January and March of 2022 through a representative cross-sectional survey completed online. Logistic regression was conducted to determine predictors contributing to perceived negative changes in caregiving responsibilities.

RESULTS

Among the sociodemographic characteristics, only ethnicity significantly predicted outcome. Higher caregiver strain (odds ratio [OR] = 10.567, 95% CI = 6.614-16.882, P < 0.001), worsened personal mental health (OR = 1.945, 95% CI = 1.474-2.567, P < 0.001), a greater number of children/youth cared for per caregiver (OR = 1.368, 95% CI = 1.180-1.587, P < 0.001), dissatisfaction with the availability of social supports (OR = 1.768, 95% CI = 1.297-2.409, P < 0.001) and negative changes in mental well-being in at least one child/youth (OR = 2.277, 95% CI = 1.660-3.123, P < 0.001) predicted negative changes in caregiving responsibilities.

CONCLUSION

These results support further exploration of the implications of negative perceptions of caregiving responsibilities and what processes might be implemented to improve these perceptions and the outcomes.

Who cares about the carers? A call to action on behalf of mothers of disabled children

This 'perspective' article is an urgent call to action on behalf of mothers (and indeed fathers) of disabled children in the wake of the COVID-19 pandemic. In doing so draws attention to the 'perfect storm' experienced by United Kingdom-based parents of reduced support and increased stress, coupled with the effects of isolation. It also illuminates some of the impact of actions taken, and not taken, during and after the pandemic and the enduring effects for working parent-carers. In doing so I argue that, despite facing these extreme challenges, these parents have been a neglected group from both a policy and research perspective. The call to action therefore extends to society, employers, and to the research community.

Caregiving Stress Experienced by Parents of Adult Children with Intellectual Disabilities During COVID-19 in Korea

Many of community supports and resources were shattered in the COVID-19 pandemic, leaving parents to navigate caring for their adult child with intellectual disabilities with little support. This study explored caregiving stress experienced by parents of adult children with intellectual disabilities during the COVID-19 pandemic in Korea. In-depth interviews were conducted with 19 parents of an adult child with intellectual disabilities. Thematic analysis yielded two themes: caregiving burden and deteriorating health. Parents bore the brunt of the caregiving burden, spending much of their time helping their adult child with daily activities and managing their challenging behaviors, leaving the caregivers struggling physically and mentally. The heightened caregiver burden and associated deteriorating health among these parents raise serious concerns, indicating a need for immediate support to alleviate these issues and help parents navigate caring for their adult child with intellectual disabilities during the COVID-19 pandemic.

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.

"Tremendous burdens often unveil enormous gifts": The experiences of South African caregivers implementing speech and language teletherapy for children with cerebral palsy during COVID-19

PURPOSE

In accordance with South Africa's restrictions to mitigate the spread of COVID-19, some speech-language pathologists (SLPs) attempted to engage in novice teletherapy regimes to ensure continuity of care for children with cerebral palsy (CP). This study aimed to explore the experiences of caregivers of children with CP implementing SLP teletherapy during COVID-19 in South Africa. The goal was to shed light on how these families can be better supported and how teletherapy practices can be adjusted for this population.

METHODS

This study employed a qualitative phenomenological research design using in-person and virtual semi-structured interviews with 18 purposively sampled participants with children with CP who received speech and language teletherapy during COVID-19. The data was evaluated using an inductive thematic analysis approach whereby themes elicited from the caregivers' narratives were analyzed.

RESULTS

Interviews (n = 18) unveiled the significant understanding caregivers gained by becoming integral and active stakeholders in the provision of teletherapy. Caregivers were able to meaningfully communicate and bond with their children with CP. However, caregivers also assumed the burden that teletherapy placed on them, as they had to renegotiate their role during the pandemic in order to provide routine teletherapy.

CONCLUSION

Findings indicated the need for person-centered SLP teletherapy interventions that utilize contextually and culturally responsive techniques and resources.

Impact of Child and Family Factors on Caregivers' Mental Health and Psychological Distress during the COVID-19 Pandemic in Greece

Although primary caregivers of children with developmental disabilities (DDs) experience higher levels of distress than primary caregivers of typically developing children do, this problem has received limited attention in Greece. Therefore, this study examined mental health and associated factors among primary caregivers of children with and without DDs in Greece during the COVID-19 pandemic. This cross-sectional study included 156 participants. Primary caregivers completed a self-report survey on sociodemographic characteristics, the Depression, Anxiety, and Stress Scale-21 items, and the 12-item General Health Questionnaire. Primary caregivers of children with DDs, particularly mothers, reported more mental health problems and higher levels of psychological distress than the control group. Among families parenting a child with disabilities, caregivers' psychological distress was significantly related to having a child with autism spectrum disorder and the severity of the child's behavioral difficulties. Significant predictors of caregivers' distress were the parent being female, the child being male, a single-parent family, a lower income, and higher depressive symptoms. Caregivers raising children with DDs face unique challenges in terms of care, necessitating the development of family-based interventions to improve the social-emotional well-being and overall quality of life for both parents and children.

Experiences of UK and Irish family carers of people with profound and multiple intellectual disabilities during the COVID-19 pandemic

BACKGROUND

People with profound and multiple intellectual disabilities (PMID) have high and intensive support needs that ordinarily place significant strain on family carers. This was further heightened by the removal of many external supports during the COVID-19 pandemic. We sought to explore the experiences of family carers of people with PMID during the COVID-19 pandemic and understand what the longer-term impact might be on their lives.

METHODS

Focus group interviews (n = 32) were conducted with family carers (n = 126) from the four countries of the UK and the Republic of Ireland. Participants were asked questions relating to their experiences of the COVID-19 pandemic, coping strategies, and challenges faced. All focus groups were conducted using the online platform, Zoom. These were audio recorded, transcribed verbatim and analysed employing inductive thematic analysis.

FINDINGS

Three main themes were generated from the data including (1.0) COVID-19 as a double-edged sword (2.0), The struggle for support (3.0), Constant nature of caring. These included 11 subthemes. (1.1) 'COVID-19 as a catalyst for change', (1.2) 'Challenges during COVID-19: dealing with change', (1.3) 'Challenges during COVID-19: fear of COVID-19', (1.4); 'The online environment: the new normal' (2.1) 'Invisibility of male carers', (2.2) 'Carers supporting carers', (2.3) 'The only service you get is lip service: non-existent services', (2.4); 'Knowing your rights' (3.1) 'Emotional response to the caring role: Feeling devalued', (3.2) 'Emotional response to the caring role: Desperation of caring', (3.3) 'Multiple demands of the caring role.'

CONCLUSIONS

The COVID-19 pandemic presented immense challenges to family carers of people with PMID but also provided some opportunities. Families had already struggled to receive many of the supports and services to which they were entitled to only to have these removed at the onset of the pandemic. The experiences of male carers have been largely absent from the literature with this research showing they want to be included in decision making and require tailored support services. Service providers should see the end of the COVID-19 pandemic as providing opportunity to re-examine current provision and design services with family carers. As the direct threat from COVID-19 diminishes and the experiences of those who lived through this period come to the fore, there is a need to re-examine current models and provision of support to family carers to better meet their needs.

Prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders during the COVID-19 pandemic: A meta-analysis and systematic review

BACKGROUND

The COVID-19 pandemic impacted children and adolescents with neurodevelopmental disorders, which caused difficulties and increased caregivers' burden.

AIM

The objective of this study was to assess the prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders. Methods and procedures We searched the PubMed, Embase and Web of Science databases for relevant studies published from December 2019 to March 2023. Random effects models were used to calculate the pooled prevalence of psychological problems among caregivers. Subgroup analyses were used to detect potential heterogeneity and sensitivity analyses were performed to evaluate the robustness of the included studies. Egger's and Begg's tests were used to examine publication bias. Outcomes and results Twenty studies involving 14,743 participants were included in this systematic review and meta-analysis. The main psychological problems among caregivers were anxiety (36.6%, 95% confidence interval [CI] 19.6-53.7%), depression (41.1%, 95%CI 35.4-46.8%), and stress (58.9%, 95%CI 45.1-72.7%). There were differences in prevalence by study year, national economic level, continent, and sample size. Conclusions and implications Our study showed that caregivers of children and adolescents with neurodevelopmental disorders had a high prevalence of anxiety, depression, and stress during the COVID-19 pandemic. Therefore, the psychological problems of these caregivers should not be overlooked. We recommend that the government should provide caregivers with more medical and financial assistance. What this paper adds? The current study is the first systematic review and meta-analysis focusing on parents whose children have neurodevelopmental disorders during the COVID-19 pandemic. The results show that the prevalence of psychological problems among caregivers of children with neurodevelopmental disorders is particularly prevalent, which suggests that we should attach importance to the parenting pressure and mental health of this special group.

Parental anxiety and depression are associated with adverse mental health in children with special needs during the COVID-19 pandemic

Introduction

The coronavirus disease 2019 (COVID-19) pandemic has led to restrictions in various areas of life, including social life, work, leisure, health, and education. Vulnerable groups, such as children with special needs and their parents, may be at increased risk of experiencing exacerbated mental health problems during stressful periods such as the COVID-19 lockdowns.

Materials and methods

Telephone interviews were conducted with 954 parents of children with special needs. We assessed parental levels of generalized anxiety and depression using the validated GAD-7 and PHQ-8 scales. Parents were asked to rate family burden and their worry about the COVID-19 crisis, as well as their children's adverse mental health symptoms and health behaviors. Parents also reported their children's worries about the COVID-19 crisis. We conducted regressions to examine the relationship between parents' mental health problems and their children's adverse mental health symptoms and health behaviors. Qualitative data from open-ended questions were coded thematically and major themes of parental worry about the COVID-19 crisis were identified.

Results

Parental anxiety and depression symptoms predicted adverse mental health symptoms and behaviors in children with special needs. Criteria for current depression were met by 7.9% of parents of children with special needs, whereas 4.7% of the general population in Vorarlberg met the criteria for current depression according to data from the Austrian Health Interview Survey in 2019. Parental self-ratings of both depression and anxiety were highly correlated. The majority of parents reported being burdened (79.1%) or worried (67.8%) about the COVID-19 crisis. The main themes of parental worry about the COVID-19 crisis included COVID-19 infection (40.6%), economic situation (13.1%), uncertainty (8.4%), lack of social contact with family and friends (8.1%), family health status (7.5%), and school life (7.5%).

Discussion

Mental health symptoms in parents of children with special needs were strongly associated with increased adverse mental health symptoms and health behaviors in their children. Parents of children with special needs were more likely to be depressed during the COVID-19 pandemic than adults in 2019. We call for additional mental health support to reduce the mental health burden in families with children with special needs.

Deepening Depression in Women Balancing Work-Life Responsibilities and Caregiving during the COVID-19 Pandemic: Findings from Gender-Specific Face-to-Face Street Interviews Conducted in Italy

PURPOSE

This study investigated the impact of the COVID-19 pandemic on mental health, quality of life, and family functioning in a sample of the general female population, exploring difficulties encountered in managing family and work responsibilities and burden of care when taking care of a loved one. This study was, moreover, aimed at investigating factors capable of influencing severe depressive symptomatology in the context of socio-demographics, traumatic events, individual vulnerability, and family functioning.

METHOD

The sampling method used in this research was non-probability sampling. The survey took place during a Hospital Open Weekend (8-10 October 2021) organized by the National Gender Observatory on Women's Health "Fondazione Onda" on the occasion of the World Mental Health Day.

RESULTS

A total of 211 women were interviewed (mean age = 35.6, 53% living alone, more than 15% with financial difficulties, 47% exposed to the 2009 L'Aquila earthquake). More than 50% of the sample reported a higher complexity in managing their lives during the COVID-19 pandemic compared to their previous routine, with no statistically significant differences between working women and non-workers, although the latter obtained higher scores for depressive symptomatology and poorer quality of life. Compared to non-caregivers, female caregivers (22.3%) in charge of the care of loved ones affected by physical (10.9%) or psychiatric disabilities (11.4%) complained of a poorer quality of life, especially in general health perception (p = 0.002), physical function (p = 0.011), role limitations related to physical problems (p = 0.017), bodily pain (p = 0.015), mental health (p = 0.004), and social functioning (p = 0.007). Women caring for people affected by mental disorders seemed to experience a more significant worsening in vitality (p = 0.003) and social functioning (p = 0.005). Approximately 20% of the total sample reported severe depressive symptomatology. Previous access to mental health services (O.R. 10.923; p = 0.000), a low level of education (O.R. 5.410; p = 0.021), and difficulties in management of everyday lives during the COVID-19 pandemic (O.R. 3.598; p = 0.045) were found to be the main variables predictive of severe depressive psychopathology. Old age, good problem-solving skills, and ability to pursue personal goals were identified as protective factors.

CONCLUSIONS

The COVID-19 pandemic underlined the need for support amongst emotionally vulnerable women with pre-existing mental health conditions, partly reflecting the cumulative effects of traumas.

Changes in caregiver mental health and pediatric asthma control during COVID-19

OBJECTIVE

This study evaluated caregivers' stress and depressive symptoms, and children's asthma control, before COVID-19 began and after its onset among families in the RVA Breathes program.

METHODS

The RVA Breathes intervention, which took place in an urban city in the United States, includes asthma education delivered by a community health worker (CHW), a home assessment, and school nurse components. Participants included 125 children (5-11 years) with asthma and their caregivers (48% household income <$25,000) enrolled prior to the pandemic. Families were randomized to an active intervention arm (full intervention or intervention without school nurse component) or the control group. Caregivers completed the Center for Epidemiological Studies Depression Scale (CES-D) and the Perceived Stress Scale (PSS); children and caregivers completed the Childhood Asthma Control Test (cACT). Assessments pre-COVID-19 were compared to those completed after the pandemic's onset.

RESULTS

Children in both intervention groups had better cACT scores after the start of COVID-19 compared to before (t(55) = -2.131, p = .019; t(28) = -2.893, p = .004). Caregivers in the intervention groups had lower PSS scores after the start of COVID-19 compared to pre-COVID-19 (t(53) = 3.928, p < .001; t(28) = 2.568, p = .008). Furthermore, CES-D scores improved among caregivers in the full intervention (t(48) = 1.789, p = .040). Caregivers in the control condition did not report significant changes in stress or depressive symptoms.

CONCLUSIONS

Findings suggest that support from interventionists, including CHWs, might have alleviated stress and depressive symptoms during COVID-19, as well as improved asthma control during the pandemic.

Psychological impact of six weeks of strict home confinement in Spanish families having school-aged children with attention-deficit/hyperactivity disorder

After the COVID-19 outbreak, early publications reported worsening symptoms and increased caregiver burden in families having children with Attention-Deficit/Hyperactivity Disorder (ADHD). In the present study, we launched an online survey to examine the psychological impact of the 41 days of strict home confinement implemented in Spain in families having children with ADHD compared to families having children with typical development (TD). We achieved a representative sample of 190 school-aged children (NADHD =100 and NTD=90) from 181 families. Respondents were mainly mothers (≈96%). We found that mother reports of hyperactive-impulsive symptoms significantly increased during home confinement regardless of ADHD diagnosis. During the lockdown, we also found that perceived stress significantly increased in mothers of ADHD and TD children, but, unexpectedly, this increase was much more noticeable for the latter group. Moreover, our study suggests that children having parents working in frontline jobs or living in families with higher household conflicts might display increased ADHD symptoms during the lockdown, irrespective of ADHD diagnosis. Our results highlight the need to provide psychological support to families most exposed to the pandemic and target household problems and mothers' well-being at intervention processes, in both ADHD and TD families.

Impacts of the COVID-19 pandemic on access to healthcare among people with disabilities: evidence from six low- and middle-income countries

BACKGROUND

The pandemic has placed considerable strain on health systems, especially in low- and middle-income countries (LMICs), leading to reductions in the availability of routine health services. Emerging evidence suggests that people with disabilities have encountered marked challenges in accessing healthcare services and supports in the context of the pandemic. Further research is needed to explore specific barriers to accessing healthcare during the pandemic, and any strategies that promoted continued access to health services in LMICs where the vast majority of people with disabilities live.

METHODS

Qualitative in-depth interviews were conducted with persons with disabilities in Ghana, Zimbabwe, Viet Nam, Türkiye (Syrian refugees), Bangladesh, and India as part of a larger project exploring the experiences of people with disabilities during the COVID-19 pandemic and their inclusion in government response activities. Data were analysed using thematic analysis.

RESULTS

This research found that people with disabilities in six countries - representing a diverse geographic spread, with different health systems and COVID-19 responses - all experienced additional difficulties accessing healthcare during the pandemic. Key barriers to accessing healthcare during the pandemic included changes in availability of services due to systems restructuring, difficulty affording care due to the economic impacts of the pandemic, fear of contracting coronavirus, and a lack of human support to enable care-seeking.

CONCLUSION

These barriers ultimately led to decreased utilisation of services which, in turn, negatively impacted their health and wellbeing. However, we also found that certain factors, including active and engaged Organisations of Persons with Disabilities (OPDs) and Non-Governmental Organizations (NGOs) played a role in reducing some of the impact of pandemic-related healthcare access barriers.

The Relationship Between COVID-19 and the Development of Depression: Implications on Mental Health

Initially, Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2), the virus responsible for coronavirus disease-2019 (COVID-19), was predominantly considered to primarily affect the respiratory system. However, later studies revealed that it also affects brain function through its ability to bind to the angiotensin-converting enzyme type 2 (ACE2) receptors expressed on neural cells. Our study involved a comprehensive review of literature aiming to investigate the relationship between COVID-19 and the development of depression. Our analysis shows a connection between these 2 conditions, as a consequence of the inflammatory response in the nervous system to the COVID-19 virus and the psychophysiological effects of the pandemic. In COVID-19 patients, depression can arise either due to the direct viral infection of the brain or as a result of an indirect immune response triggering neuroinflammation after a cytokine storm. The resulting depression can be treated with non-pharmacological therapies such as psychotherapy, antidepressant medications, or a combination of these treatments depending on the severity of the symptoms.

Impact of COVID-19 on Mothers Raising Children with Special Needs: Insights from a Survey Study

Home confinement during the COVID-19 outbreak had psychological effects that continue to be explored by researchers. This study investigated factors influencing the mental health of mothers caring for special needs children in Italy's first lockdown. Specifically, we investigated the relationships between emotional states of depression, anxiety, stress, perceived distress related to home confinement, coping strategies, and other contextual variables (such as opportunities for distance learning and remote working) in a group of 68 mothers of children with special needs and 68 matched mothers of typically developing children. Data from an online survey showed no significant difference between the two groups. However, the research revealed that being a remote worker was a significant predictor of reduced stress in mothers of children with special needs, while distance learning was a significant predictor of reduced stress in mothers of typically developing children. In addition, the study found that hyperarousal symptoms were predictive of stress in mothers of children with special needs, while intrusive thoughts and avoidance coping were predictive of stress in mothers of typically developing children. In conclusion, further research is needed to develop effective support and intervention strategies for families with children with special needs and to deeply investigate the impact of flexible work arrangements and social aid on the mental health of mothers in non-emergency settings.

Comparing Anxiety Levels during the COVID-19 Pandemic among Mothers of Children with and without Neurodevelopmental Disorders

The COVID-19 pandemic undoubtedly burdened families, perhaps even more for parents of children with neurodevelopmental disabilities. This research aims to determine the anxiety levels in mothers of children with neurodevelopmental disorders (autism spectrum disorder and specific language impairment) and mothers of typically developed children. The cross-sectional study comprised 280 mothers from the period of the COVID-19 pandemic in Serbia. A confidential survey included main demographic data and the State-Trait Anxiety Inventory (STAI). Results revealed that the mean levels of STAI-S and STAI-T are elevated in the observed sample of mothers in the first pandemic wave; the STAI-S level is in the high category (STAI-S mean = 46.69), while STAI-T is in the intermediate category near the cut-off value for the high level (STAI-T mean = 43.04). A statistically significant strong positive correlation between STAI-S and STAI-T is seen (r = 0.802, p = 0.001). GLMM analysis revealed that interactions, rather than independent variables, significantly impact anxiety, implying a complex relationship between the observed variables and STAI. Compared with the results from the pre-pandemic study, our findings reveal that COVID-19 affects mothers of children with and without neurodevelopmental disorders in a complex manner, imposing a need for psychological support, which may positively affect mothers' mental health and the development of their offspring.

Healthcare and Behavior Changes for Adults With Down Syndrome 1-Year Into COVID-19

Individuals with Down syndrome (DS) have been disproportionately harmed by the COVID-19 pandemic and may have been more likely to have sacrificed opportunity and activity to avoid potential exposures. Our objective was to describe the experience one to one and half years into the COVID-19 pandemic for adults with DS, as reported by their caregivers in an online survey conducted between April 2021 and September of 2021. In our sample of 438 adults with DS, caregivers reported that adults with DS lost activities, struggled with employment, had negative behavioral changes, lost skills, and developed more mental health conditions. For adults with DS, one in five caregivers reported less healthcare usage, one in four reported delayed routine care, and 86.5% reported lost activities. As the pandemic continues, targeted support for adults with DS is needed to prevent further skill loss and mental health conditions.

The impact of COVID-19 lockdown on child and adolescent mental health: systematic review

COVID-19 was declared a pandemic in March 2020, resulting in many countries worldwide calling for lockdowns. This study aimed to review the existing literature on the effects of the lockdown measures established as a response to the COVID-19 pandemic on the mental health of children and adolescents. Embase, Ovid, Global Health, PsycINFO, Web of Science, and pre-print databases were searched in this PRISMA-compliant systematic review (PROSPERO: CRD42021225604). We included individual studies reporting on a wide range of mental health outcomes, including risk and protective factors, conducted in children and adolescents (aged ≤ 19 years), exposed to COVID-19 lockdown. Data extraction and quality appraisal were conducted by independent researchers, and results were synthesised by core themes. 61 articles with 54,999 children and adolescents were included (mean age = 11.3 years, 49.7% female). Anxiety symptoms and depression symptoms were common in the included studies and ranged 1.8-49.5% and 2.2-63.8%, respectively. Irritability (range = 16.7-73.2%) and anger (range = 30.0-51.3%), were also frequently reported by children and adolescents. Special needs and the presence of mental disorders before the lockdown, alongside excessive media exposure, were significant risk factors for anxiety. Parent-child communication was protective for anxiety and depression. The COVID-19 lockdown has resulted in psychological distress and highlighted vulnerable groups such as those with previous or current mental health difficulties. Supporting the mental health needs of children and adolescents at risk is key. Clinical guidelines to alleviate the negative effects of COVID-19 lockdown and public health strategies to support this population need to be developed.

Adolescents with disabilities and caregivers experience of COVID-19 in rural Nepal

Introduction

Intersecting vulnerabilities of disability, low socio-economic status, marginalization, and age indicate that adolescents with disabilities in low-and middle-income countries were uniquely affected by the COVID-19 pandemic. Yet, there has been limited research about their experience. We conducted participatory research with adolescents with disabilities in rural, hilly Nepal to explore their experience of the pandemic and inform understanding about how they can be supported in future pandemics and humanitarian emergencies.

Methods

We used qualitative methods, purposively sampling adolescents with different severe impairments from two rural, hilly areas of Nepal. We collected data through semi-structured interviews with five girls and seven boys between the age of 11 and 17 years old. Interviews used inclusive, participatory, and arts-based methods to engage adolescents, support discussions and enable them to choose what they would like to discuss. We also conducted semi-structured interviews with 11 caregivers.

Results

We found that adolescents with disabilities and their families experienced social exclusion and social isolation because of COVID-19 mitigation measures, and some experienced social stigma due to misconceptions about transmission of COVID-19 and perceived increased vulnerability of adolescents with disabilities to COVID-19. Adolescents who remained connected with their peers throughout lockdown had a more positive experience of the pandemic than those who were isolated from friends. They became disconnected because they moved away from those they could communicate with, or they had moved to live with relatives who lived in a remote, rural area. We found that caregivers were particularly fearful and anxious about accessing health care if the adolescent they cared for became ill. Caregivers also worried about protecting adolescents from COVID-19 if they themselves got ill, and about the likelihood that the adolescent would be neglected if the caregiver died.

Conclusion

Contextually specific research with adolescents with disabilities to explore their experience of the pandemic is necessary to capture how intersecting vulnerabilities can adversely affect particular groups, such as those with disabilities. The participation of adolescents with disabilities and their caregivers in the development of stigma mitigation initiatives and strategies to meet their needs in future emergencies is necessary to enable an informed and inclusive response.

Mental health services and resources for children with developmental disabilities and their families: scan of local practices, gaps, and opportunities created

Background

Mental health concerns in children with disabilities are common and have a significant and negative impact. Clinicians have reported high demand for this population to receive early, targeted, and family-centred mental health interventions.

Objective

We sought to map out and describe existing pediatric mental health services/resources for children with disabilities and their families across clinical sites and local and online communities.

Methods

Using a mixed-method triangulation study design, we outreached to clinical managers at the participating clinical sites and conducted a rapid online search of local in-person, telehealth, and web-based information. The nature, access method, admission criteria, target, focus, and other pertinent information were recorded and analyzed using descriptive statistics and a narrative synthesis approach.

Results

Eighty-one (n = 81) services/resources (in-person, n = 48; telehealth, n = 10; web-based information, n = 33) were identified. Few (n = 6, 13%) in-person services had a method of care access through an online booking portal. Nearly half of in-person resources (n = 23, 47%) had admission criteria specific for children with disabilities (e.g., diagnosis, age limit), and many (n = 32, 67%) required a formal referral. A small number of in-person and telehealth services targeted the mental health concerns of the entire family (n = 23, 47%; n = 2, 20%). Very few (n = 13, 16%) services incorporated follow-up support. Important gaps emerged for certain populations (e.g., children with cerebral palsy). Practitioners' inadequate training when intervening with co-existing mental health demands of children with disabilities was noted by clinical managers.

Conclusion

Findings could be used to create a user-friendly database to easily identify suitable services and to advocate for services/resources that are lacking.

The experiences and attitudes of family caregivers of adults with intellectual and developmental disabilities at different timepoints in the COVID-19 pandemic

BACKGROUND

The COVID-19 pandemic has resulted in increased pressures for family caregivers of adults with intellectual and developmental disabilities (IDD). However, little is known about how their attitudes and perceptions have changed over the course of the pandemic.

OBJECTIVE

To compare the COVID-19 experiences and attitudes of two groups of family caregivers, reported at different timepoints in the pandemic: prior to vaccine availability and after.

METHODS

As part of a larger research study, family caregivers of adults with IDD from across Canada completed surveys on their COVID-19 experiences. Survey questions included responses about access to supports, stressors, self-efficacy, mental wellbeing, and pandemic impacts on their family member with IDD. Respondents were assigned to either of two groups based on the time of questionnaire completion: late 2020/early 2021 for Group 1 and mid 2022 for Group 2. Descriptive statistics and analysis between groups were reported.

RESULTS

Despite being surveyed at different timepoints in the pandemic, both groups indicated concerns regarding lack of professional support and resources, lack of programming, and experiences of loneliness for their family members. However, Group 2 reported greater self-efficacy dealing with COVID-19 related challenges and greater overall mental wellbeing, compared to Group 1. Group 2 caregivers, after which vaccines were widely available in Canada, were largely vaccinated (96.4%).

CONCLUSIONS

Despite the COVID-19 pandemic persisting for over two years, family caregivers of adults with IDD reported facing the same challenges as families who reported on their experiences a year prior. Notwithstanding, family caregivers surveyed later in the pandemic described a greater sense of self-efficacy and mental wellbeing.

Impact of the COVID-19 Pandemic on the Level of Anxiety and Depression in Caregivers of Children Benefiting from Neurorehabilitation Services

INTRODUCTION

At the turn of March and April 2020, due to the occurrence of COVID-19 in Poland, the first restrictions on the provision of rehabilitation services were introduced. Nevertheless, caregivers strived to ensure that their children could benefit from rehabilitation services.

AIM OF THE STUDY

To determine which of the selected data presented in the media reflecting the intensity of the COVID-19 epidemic in Poland differentiated the level of anxiety and depression in caregivers of children benefiting from neurorehabilitation services.

MATERIAL AND METHODS

The study group consisted of caregivers of children (n = 454) receiving various neurorehabilitation services in the inpatient ward of Neurological Rehabilitation of Children and Adolescents (n = 200, 44%), in the Neurorehabilitation Day Ward (n = 168, 37%), and in the Outpatient Clinic (n = 86, 19%) of the Clinical Regional Rehabilitation and Education Center in Rzeszow. The average age of the respondents was 37.23 ± 7.14 years. The Hospital Anxiety and Depression Scale (HADS) was used to measure the severity of anxiety and depression in caregivers of children. The questionnaires were distributed from June 2020 to April 2021. As a measure of the severity of the COVID-19 epidemic in Poland, the figures presented in the media were adopted. In addition, data on the COVID-19 pandemic presented in the media (Wikipedia, TVP Info, Polsat Nes, Radio Zet) on the day preceding the completion of the survey were analyzed based on statistical analysis methods.

RESULTS

73 of the surveyed caregivers (16.08%) suffered from severe anxiety disorders, and 21 (4.63%) from severe depressive disorders. The average severity of anxiety (HADS) in the subjects was 6.37 points, and the average severity of depression was 4.09 points. There was no statistically significant relationship between the data presented in the media-such as daily number of infections, total number of infections, daily number of deaths, total number of deaths, total number of recoveries, number of hospitalizations, and people under quarantine-and the level of anxiety and depression of the studied caregivers (p > 0.05).

CONCLUSIONS

It was not found that the selected data presented in the media, showing the intensity of the COVID-19 epidemic in Poland, significantly differentiated the level of anxiety and depression among caregivers of children using neurorehabilitation services. Their motivation to continue the treatment, caused by concern for their children's health, resulted in less severe symptoms of anxiety and depression during the peak period of the COVID-19 pandemic.

Perceived Social Support and Quality of Life of Children with and without Developmental Disabilities and Their Caregivers during the COVID-19 Pandemic in Brazil: A Cross-Sectional Study

BACKGROUND

Social support and Quality of life (QoL) are important aspects of life and should be explored during the specific scenario of the pandemic.

AIMS

(i) to compare the perceived social support (PSS) in caregivers and the domains of QoL of the caregiver and the child with developmental disabilities (DD) and typical development (TD); (ii) to verify the existence of the association, in each group, between the PSS, and the domain of QoL of the caregiver and the child.

METHODS AND PROCEDURES

52 caregivers of children with DD and 34 with TD participated remotely. We assessed PSS (Social Support Scale), children's QoL (PedsQL-4.0-parent proxy) and caregivers' QoL (PedsQL-Family Impact Module). The groups were compared for the outcomes using the Mann-Whitney test, and Spearman's test evaluated the correlation between the PSS and the QoL (child and caregiver) in each of the groups.

OUTCOMES AND RESULTS

There was no difference between groups for PSS. Children with DD presented lower values in PedsQL total, psychosocial health, physical health, social activities, and school activity. Caregivers of children with TD presented lower values in PedsQL family total, physical capacity, emotional aspect, social aspect, daily activities, and higher value in communication. In the DD group, we found a positive relationship between PSS with child: Psychosocial Health (r = 0.350) and Emotional Aspect (r = 0.380), and with family: Total (r = 0.562), Physical Capacity (r = 0.402), Emotional Aspect (r = 0.492), Social Aspect (r = 0.606), Communication (r = 0.535), Concern (r = 0.303), Daily Activities (r = 0.394) and Family Relationships (r = 0.369). In the TD group, we found that PSS was positively associated with Family: Social Aspect (r = 0.472) and Communication (r = 0.431).

CONCLUSIONS AND IMPLICATIONS

During the COVID-19 pandemic, despite both groups presenting similar PSS, there are important differences in QoL between them. For both groups, greater levels of perceived social support are associated with greater caregiver-reported in some domains of the child's and caregiver's QoL. These associations are more numerous, especially for the families of children with DD. This study provides a unique view into the relationships between perceived social support and QoL during the "natural experiment" of living through a pandemic.

The impact of the COVID-19 pandemic on children with disabilities and their parents or caregivers

Objectives

The study aimed to determine the impact of the pandemic on parents/caregivers and children with neurologic disabilities.

Patients and methods

This multi-center cross-sectional study was conducted with 309 parents/caregivers (57 males, 252 females) and their 309 children (198 males, 111 females) with disabilities between July 5, 2020, and August 30, 2020. The parents/caregivers were able to answer the questions and had internet access. The survey included questions on the utilization of educational and health care services (whether they could obtain medicine, orthosis, botulinum toxin injection, or rehabilitation) during the pandemic. A Likert scale was used to evaluate the effect of the specific health domains, including mobility, spasticity, contractures, speech, communication, eating, academic, and emotional status. The Fear of COVID-19 Scale was used to assess fear of COVID-19.

Results

Among the children, 247 needed to visit their physician during the pandemic; however, 94% (n=233) of them could not attend their physician appointment or therapy sessions. The restricted life during the first wave of the pandemic in Türkiye had negatively affected 75% of the children with disabilities and 62% of their parents. From the perspective of the parents/caregivers, mobility, spasticity, and joint range of motion of the children were affected. Forty-four children required repeated injections of botulinum toxin; however, 91% could not be administered. The Fear of COVID-19 Scale scores were significantly higher in the parents who could not bring their children to the routine physician visit (p=0.041).

Conclusion

During the pandemic, access to physical therapy sessions was disrupted in children with neurological disabilities, and this may have harmful consequences on the functional status of children.

Challenges of parents with children with intellectual and neurodevelopmental disorders during COVID-19: Experiences and their impact on mental health

BACKGROUND

Parents of children with intellectual and neurodevelopmental disorders are a highly burdened group that faces additional challenges during the COVID-19 pandemic.

METHODS

In this study, parents of children with intellectual and neurodevelopmental disorders (N = 600) living in Canada participated in a cross-sectional online survey.

RESULTS

More than 96% of the parents reported facing additional challenges due to the pandemic. COVID-19-related stressors correlated with poorer mental and physical health. Parents who reported a higher amount of COVID-19-related stressors also reported more post-traumatic stress disorder (PTSD) symptoms.

DISCUSSION

Resuming and implementing new services for children with intellectual and neurodevelopmental disorders and their parents will be key in alleviating the challenges for those parents.

Does caring for others affect our mental health? Evidence from the COVID-19 pandemic

Despite a growing literature about the mental health effects of COVID-19, less is known about the psychological costs of providing informal care during the pandemic. We examined longitudinal data from the UK's Understanding Society Survey, including eight COVID surveys, to estimate fixed effects difference-in-differences models combined with matching, to explore the causal effects of COVID-19 among informal carers. While matching accounts for selection on observables into caregiving, multiple period difference-in-differences specifications allow investigation of heterogeneous mental health effects of COVID-19 by timing and duration of informal care. The estimates suggest that while mental health fluctuated following the imposition of social restrictions, informal carers who started caregiving during the pandemic show the largest mental health deterioration, especially during lockdowns. Policies to mitigate the psychological burden of caregiving might be more effective if targeted at those starting to provide care for the first time.

Impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices: a global scoping review

BACKGROUND

In March 2020, the COVID-19 outbreak was declared a pandemic by the World Health Organization (WHO), generating stark economic and social repercussions that directly or indirectly affected families' wellbeing and health status.

AIMS

This review aims at mapping the existing evidence on the impact of the COVID-19 pandemic on maternal mental health, early childhood development, and parental practices, worldwide, to identify evidence gaps and better inform future delivery of care and health policy measures.

METHODS

Following the protocol defined by PRISMA-ScR, this scoping review has searched for relevant studies published between January 2020 and June 2021, selecting evidence sources based on pre-established criteria. From a total of 2,308 articles, data were extracted from 537 publications from 35 countries on all three health domains.

RESULTS

The combined stressors brought forth by the pandemic have exerted a heavy burden on the mental health of mothers and the development of young children, partly mediated by its impact on parental practices.

CONCLUSIONS

Despite remaining gaps, we have identified sufficient evidence pointing to an urgent need for more concerted global research efforts and rapid policy responses to timely address severe and pervasive negative impacts to the mental health of mothers and children at a key developmental stage.

The perceived impact of Covid-19 pandemic on the children with cerebral palsy: the parents' perspective explored within the "6-F words" framework

BACKGROUND

In 2020 the world faced the spread of the coronavirus infection disease (Covid-19). This was a general public health emergency but many people with disabilities might have been particularly affected.

OBJECTIVE

This paper aims to investigate the impact of the Covid-19 pandemic on children with Cerebral Palsy (CP) and their families.

METHODS

110 parents of children with CP (aged 2 to 19) who completed a questionnaire were included. These children were under the care of one of the Italian Children Rehabilitation Centers. Socio-demographic and clinical information about patients and their families were collected. In addition, difficulties on adopting protective measures and in respecting lockdown rules by children were explored. We adopted the ICF (International Classification of Functioning, Disability and Health) framework to create multiple choice questions. Descriptive statistics were reported and logistic regression analyses were run in order to identify the predictors of perceived impairment in motor, speech, manual and behavioral abilities.

RESULTS

Daily activities of children, as well as rehabilitation and fitness sessions, underwent a change during the pandemic. Spending more time with family due to lockdown measures, has had, in some cases a positive effect however there was a perceived decrease in rehabilitation support and school activities. The age range (between 7 and 12 years) and difficulty in respecting rules emerged as significant predictors of the perceived impairment due to Covid-19 pandemic.

CONCLUSIONS

The pandemic has had different impacts on children and their families on the basis of children's characteristics. Rehabilitation activities during a hypothetic lockdown should consider these characteristics.

Salud mental de cuidadores de niños con trastornos del neurodesarrollo durante la pandemia

Los cuidadores son especialmente propensos a verse más afectados psicológicamente durante las restricciones sociales y del sistema sanitario generadas por la pandemia por COVID-19. Los cuidadores de niños con trastornos del neurodesarrollo (es decir, autismo, discapacidad intelectual, déficit de atención, hiperactividad, discapacidad motora) tienen un papel más importante que los que acompañan niños sanos. Se diseñó un estudio cuantitativo transversal, utilizando técnicas estadísticas descriptivas, comparativas y correlacionales, para analizar la calidad de vida relacionada con la salud, el malestar emocional y la sobrecarga en cuatro subgrupos de cuidadores, clasificados según el diagnóstico del niño. Se incluyeron 132 cuidadores (86,4% mujeres). En el grupo 1 (discapacidad cognitiva) participaron 28 cuidadores; en el grupo 2 (TDAH) se incluyeron 51; en el grupo 3 (trastorno del espectro autista) participaron 33 cuidadores, y en el grupo 4 (discapacidad motora) se incluyeron 20. Los principales hallazgos de este estudio fueron: 1) alteraciones en el rol físico, el dolor corporal, la salud general y la vitalidad; 2) porcentajes muy bajos de sintomatología de depresión, ansiedad, estrés y sobrecarga; 3) diferencias en el funcionamiento social entre los grupos de discapacidad motora y TDAH, y en el estrés y la sobrecarga entre los grupos de autismo y discapacidad motora, y 4) correlaciones moderadas entre las dimensiones de dolor corporal y rol emocional y la depresión, la ansiedad, el estrés y la sobrecarga. Se concluyó que hay más afectación en variables asociadas con la salud física que con las de la salud mental.

Impacts of health care service changes implemented due to COVID-19 on children and young people with long-term disability: A mapping review

AIM

To identify the research on childhood disability service adaptations and their impact on children and young people with long-term disability during the COVID-19 pandemic.

METHOD

A mapping review was undertaken. We searched the World Health Organization Global COVID-19 database using the search terms 'children', 'chronic/disabling conditions', and 'services/therapies'. Eligible papers reported service changes for children (0-19 years) with long-term disability in any geographical or clinical setting between 1st January 2020 and 26th January 2022. Papers were charted across the effective practice and organization of care taxonomy of health system interventions and were narratively synthesized; an interactive map was produced.

RESULTS

Reduction of face-to-face care and usual provision had a huge impact on children and families. Adoption of telehealth provided continuity for the care and management of some conditions. There was limited evidence of changes to mental health services, transitions of care, social care, or child-reported satisfaction or acceptability of service changes.

INTERPRETATION

The long-term impacts of service change during the pandemic need full evaluation. However, widespread disruption seems to have had a profound impact on child and carer health and well-being. Service recovery needs to be specific to the individual needs of children with a disability and their families. This should be done through coproduction to ensure that service changes meet needs and are accessible and equitable.

Virtual Training on Stress Management for the Mothers of Children with Disabilities in the United Arab Emirates

Parenting children with disabilities has consistently been reported to be associated with stress, and even more so among mothers who are primary caregivers. In non-Western contexts such as the United Arab Emirates (UAE), there is a dearth of research on maternal mental health in relation to raising children with disabilities and related mitigation strategies. During the COVID-19 pandemic (2020-2021), the Federal Government of the UAE used the Save the Child's Stress Checklist to assess the stress levels of 635 mothers who were raising children with disabilities in the northern part of the country. In the pre-test, an estimated 6% (36/635) of the mothers were found to be experiencing high levels of stress. Consequently, virtual stress management training was conducted, and 12 of the 36 mothers completed the full training. Wilcoxon's ranked test showed a reduction in their total, physical, emotional and cognitive stress at the end of the training. This study demonstrates the pressing need for ongoing training programmes to improve the mental health of mothers of children with disabilities in the UAE and similar contexts.

Parental Resources in Parents of Children with Special Needs (SNs) at the Time of COVID-19

Background. The limitations imposed by governments for containing the spread of COVID-19 have affected familial relationships, especially those of families dealing with children with special needs or chronic illness conditions. The current study aims to better understand what pathological/disability condition has impacted parental resources, sense of competence, and perception of children’s executive functioning the most. Methods. A sample of 648 parents was asked to answer a survey assessing children’s condition (typical development, specific learning disorder, autism spectrum syndrome, chronic illness), parental resources, parenting sense of competence (distinguished into parental satisfaction and self-efficacy), and parents’ perception of their children’s executive functioning. A MANOVA model was performed to assess differences in parental resources, sense of competence, and perception of the children’s executive functions according to their condition. A path analysis model was performed to examine the impact of sense of competence and children’s condition on parental resources and children’s executive functions. Results. Parents with children with specific learning disorder reported lower scores of parental resources in terms of total scores, common antecedents, and specific antecedents compared to parents with typically developed children (total scores: MD = 56.45, p < 0.001; common antecedents: MD = 22.28, p < 0.00; specific antecedents: MD = 34.17, p < 0.001), parents with autistic children (total scores: MD = 62.79, p = 0.01; common antecedents: MD = 24.03, p = 0.01; specific antecedents: MD = 38.76, p = 0.02) and parents of children with chronic illness (total scores: MD = 37.42, p = 0.04; common antecedents: MD = 16.59, p = 0.01). The path analysis model shows a direct effect of parental satisfaction (β = 0.26) and pathology/disability (β = −0.10) on parental resources that, in turn, influence parents’ perception of their children’s executive functioning (β = 0.24). Conclusion. Although no data about the prepandemic situation is available, the current study highlights that parental stress influence children’s cognition. Moreover, parents of children with special needs seemed to be challenged during COVID-19, especially parents of children with specific learning disorders, that are already stressed out by their children’s condition. Therefore, academic services should undertake preventive measures to preserve parental well-being and to provide a supportive environment for children, especially for those with atypical development.

Mental-Health Trajectories of U.S. Parents With Young Children During the COVID-19 Pandemic: A Universal Introduction of Risk

Parents of young children were a subgroup of the population identified early in the pandemic as experiencing significant mental-health symptoms. Using a longitudinal sample of 3,085 parents from across the United States who had a child or children age 0 to 5, in the present study, we identified parental mental-health trajectories from April to November 2020 predicted by pre-COVID-19 cumulative risk and COVID-19-specific risk factors. Both growth-mixture modeling and latent-growth-curve modeling were used to test the relationship between risk factors and parent mental health. Pre-COVID-19 cumulative risk and COVID-19-specific risks of financial strain, decreased employment, and increased family conflict were salient risk factors predicting poor mental-health trajectories across both modeling approaches. These finding have public-health implications because prolonged exposure to mental-health symptoms in parents constitutes a risk factor for child development.

Global COVID-19 childhood disability data coordination: A collaborative initiative of the International Alliance of Academies of Childhood Disability

PURPOSE

The International Alliance of Academies of Childhood Disability created a COVID-19 Task Force with the goal of understanding the global impact of COVID-19 on children with disabilities and their families. The aim of this paper is to synthesize existing evidence describing the impact of COVID-19 on people with disabilities, derived from surveys conducted across the globe.

METHODS

A descriptive environmental scan of surveys was conducted. From June to November 2020, a global call for surveys addressing the impact of COVID-19 on disability was launched. To identify gaps and overlaps, the content of the surveys was compared to the Convention on the Rights of the Child and the International Classification of Functioning, Disability and Health.

RESULTS

Forty-nine surveys, involving information from more than 17,230 participants around the world were collected. Overall, surveys identified that COVID-19 has negatively impacted several areas of functioning - including mental health, and human rights of people with disabilities and their families worldwide.

CONCLUSION

Globally, the surveys highlight that impact of COVID-19 on mental health of people with disabilities, caregivers, and professionals continues to be a major issue. Rapid dissemination of collected information is essential for ameliorating the impact of COVID-19 across the globe.

Impact of the coronavirus pandemic on families of patients with congenital insensitivity to pain with anhidrosis

BACKGROUND

Novel coronavirus disease (COVID-19) outbreaks have dramatically changed lifestyles, with various effects on the physical and mental health of families and children with various childhood-onset neurological diseases. A questionnaire survey was conducted to identify family-specific issues and needs of patients with congenital insensitivity to pain with anhidrosis (CIPA) during major changes in their daily lives due to the COVID-19 outbreaks.

METHODS

An anonymous questionnaire was sent to 56 families that were members of the Association of Patients and Families of CIPA in Japan between October and November 2020, the first 2 months of the third outbreak.

RESULTS

Thirty-eight families (67.2% response rate) responded to the questionnaire. The current concerns of the parents were (1) difficulty in predicting the future (19 parents, 50%), (2) household and work concerns (eight parents, 21.1%), and (3) whether they would become infected (25 parents, 65.8%). Fifteen families indicated stress due to increased time together (stress + group), and 10 families had a better understanding of each other due to increased time together. New sleep disturbances and behavioral changes were observed in approximately 20% and 50% of patients with CIPA, respectively. No single factor could explain family stress. There were also free descriptions of the importance of peer support, connections with experts, and prompt responses for resolution.

CONCLUSIONS

Each family has its own way of coping with multiple factors that contribute to the stress of the patient and family. A long-established resilience to the disease proved effective during this pandemic.