COVID-19 and behaviors in children with autism spectrum disorder: Disparities by income and food security status

The Economic Impacts of COVID-19 on Autistic Children and Their Families

PURPOSE

We used data from the National Survey of Children's Health to (1) examine differences in economic hardship and safety net program use after the implementation of federal relief efforts, and (2) assess whether the COVID-19 pandemic exacerbated autism-based disparities in hardship and program use.

METHODS

We examined five dimensions of economic hardship (poverty, food insecurity, medical hardship, medical costs, and foregone work) and four safety net programs (cash assistance, Supplemental Nutrition Assistance Program (SNAP), Special Supplemental Nutrition Program for Women, Infants and Children (WIC), and free or reduced-cost meals). First, we calculated adjusted prevalence and odds ratios to compare pre-COVID (2018-2019) and during COVID (2021) outcomes by autism status. Next, we calculated the adjusted odds of each outcome among autistic children compared to those of children with and without other special healthcare needs at both time points.

RESULTS

COVID-19 exacerbated autism-based disparities in food insecurity, SNAP, and public health insurance, but alleviated inequities in medical hardship, foregone work, and cash assistance. Autistic children did not experience declines in food insecurity or increases in SNAP like other children; medical hardship and foregone work decreased more for autistic children; and the magnitude of autism-based differences in public coverage significantly increased during the pandemic.

CONCLUSION

Federal relief efforts likely improved economic outcomes of children; however, these effects varied according to type of hardship and by disability group. Efforts to promote economic well-being among autistic populations should be tailored to the financial challenges most salient to low-income autistic children, like food insecurity.

Impact of Climate Change, Food Insecurity, and COVID-19 on the Health of Neonates and Children: A Narrative Review

Climate change, food insecurity, and epidemics affect all population sub-groups. This article reviews the current evidence on the relationships between climate change, food insecurity, and the COVID-19 pandemic in the context of newborn and child health. The authors searched Medline, PsycINFO, Cumulative Index to Nursing and Allied Health Literature (CINAHL), and Scopus databases using a structured approach. Food insecurity, particularly from the lack of food access and affordability, increased amidst the COVID-19 pandemic. Factors such as nationwide lockdowns, increased unemployment and financial instability, and school closures precipitated food insecurity. Children born to immigrant parents, belonging to racial and ethnic minority groupsor low-income families, and those who were Autistic were highly vulnerable. Climate change also contributes to food insecurity, with increased susceptibility among neonates and children compared to adults. There is a need for further research on the relationships between climate-linked exposures and COVID-19 transmission. Multisectoral collaborations and multilevel interventions are necessary to mobilize local and national resources for mitigating and preventing the synergistic effects of the three concurrent crises. The evidence-informed discourse on this topic can help in improved preparedness and response for future outbreaks and epidemics. The policy interventions for newborn and child survival need to factor in climate change, food insecurity, and emerging diseases.

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.

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.

Efficacy of coping mechanisms used during COVID-19 as reported by parents of children with autism

The COVID-19 pandemic's alterations to daily life have been especially challenging for families with Autism Spectrum Disorder (ASD), worsening the core features of ASD and overall mental health. With the increased need for effective coping, the current retrospective study used data from a survey regarding parent reports of how often their child with ASD used certain coping strategies (frequency), as well as the extent to which they felt their child benefitted from their use (efficacy) in mitigating stress during the pandemic. This retrospective study Repeated measures ANOVAs were conducted to evaluate whether there were significant differences in both frequency and efficacy ratings for each coping strategy, for the entire sample as well as for three children's age groups. Using Spearman's rank-order correlations, correlation coefficients between the frequency and efficacy of each coping strategy were explored. Results revealed that maladaptive strategies were used more frequently than adaptive strategies, while parent routine as the most frequently used and efficacious for all age groups. Additionally, for adaptive strategies, humor and focusing on the positive had the strongest correlations between frequency and efficacy ratings amongst all age groups. Of the maladaptive strategies, repetitive behaviors, rumination, and isolation had the strongest correlations for the youngest, middle, and oldest age groups, respectively. Further, for each age group, the adaptive coping strategies had stronger correlations between frequency and efficacy than the maladaptive ones. It is our hope that the results of this study will lay the foundation for developing adaptive coping strategies to alleviate stress in children with ASD. Further investigations using a larger cohort are warranted to determine effective coping strategies for individuals with ASD across a range of situations, including acute stressors (such as future public health emergencies and natural disasters), as well as common daily stressors.

Parents' personality, parenting stress, and problem behaviors of children with special needs in China before and during the COVID-19 pandemic

The positive predictive effect of children's problem behaviors on parenting stress has been verified to some extent, but research on parents of children with special needs remains insufficient. Moreover, the role of parental personality traits in the relationship between children's problem behaviors and parenting stress, and whether it differs from before the COVID-19 pandemic, remains unclear. Accordingly, in this study, online questionnaires were used to survey parents of children with autism and intellectual disabilities in China - 337 parents before and 604 during the COVID-19 pandemic - to explore the relationship between problem behaviors in the children and parenting stress as well as the moderating effect of parents' personality. The results showed that problem behaviors of children with autism and intellectual disabilities had a positive predictive effect on parenting stress. However, there was no significant difference in this effect before and during the pandemic. In addition, the relationship between children's problem behaviors and parenting stress was moderated by the Agreeableness and Neuroticism of the parents, but only during COVID-19 pandemic. The research results suggest that, during the pandemic when facing problem behaviors of children with autism or intellectual disabilities, positive personality characteristics such as Agreeableness have a protective effect on parenting stress. By contrast, negative personality characteristics such as Neuroticism are risk factors. The study results provide evidence from special groups regarding the role of parents' personalities in the parent - child interaction and the parenting stress models.

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.

Psychosocial Functioning and the Educational Experiences of Students with ASD during the COVID-19 Pandemic in Poland

Due to their individual developmental and learning needs, adolescents with autism spectrum disorder (ASD) benefit from a variety of educational, medical, and therapeutic services. During the COVID-19 pandemic, these services were discontinued or significantly reduced, which may have resulted in increased difficulties in coping with various areas of life. The purpose of this study was to explore how the pandemic affected the psychosocial and educational functioning of students with ASD. A qualitative, problem-focused interview method was used. The obtained material was subjected to interpretive phenomenological analysis. The study involved 10 secondary school students diagnosed with ASD. The assessment of the effects of the pandemic on the functioning of people with ASD is inconclusive. The respondents noted both negative and positive effects of lockdown. On the positive side, they were able to spend time with their family, isolate themselves from difficult social relationships and feel better. Among the negative effects, adolescents point to difficulties in emotional functioning—increased levels of stress and anxiety, as well as increased feelings of loneliness and difficulties with online education. The study showed the varied experiences of young people with autism during the pandemic, highlighting the significant need to support some of them in terms of their emotional, social and educational functioning.

A Pediatrician's Guide to Working with Children on the Autism Spectrum in Coronavirus Disease 2019 and Beyond: Retrospect and Prospect

The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with developmental disabilities, while simultaneously catalyzing innovation. Children are vulnerable to the impacts of COVID-19, resulting in increased stress, anxiety, isolation, and health challenges, further amplified in autistic children and children with other neurodevelopmental disabilities. These children are uniquely vulnerable due to communication impairments, comorbid medical disorders, reduced adaptability, and reliance on therapeutic interventions. Abrupt reduction in services and access to care during the pandemic compromised physical and mental health and led to missed intervention opportunities at critical times. It is important to examine the effects that the pandemic triggered, address deficiencies, and recognize new opportunities to improve systems of care to prepare for unforeseen futures.

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.

The effects of the COVID-19 pandemic on the well-being of children with autism spectrum disorder: Parents' perspectives

The COVID-19-related lockdown interrupted children's learning progress and discontinued social learning and regular activities that children with autism spectrum disorder (ASD) rely on socially and physically. Negative consequences for children with ASD were reported far and wide. To investigate this problem in Kazakhstan, we conducted a mixed-methods study that drew on data from an online survey with 97 parents and semi-structured interviews with 14 parents. While parent-report quantitative results suggest that children were likely to experience negative impacts of the pandemic due to disrupted educational and therapeutic services, qualitative findings confirm that they have experienced an elevated mental health and behavioral challenges during the lockdown. Remote educational and therapeutic services were not helpful as families coped with pandemic-caused problems on their own. We highlight that continued support and care during and after a crisis is vital not only for children with ASD but also for the families under-resourced mentally and socially.

The Role of Occupational Therapy in Managing Food Selectivity of Children with Autism Spectrum Disorder: A Scoping Review

Food selectivity is common in children with autism spectrum disorder (ASD). It can be defined as the unwillingness to eat common or new foods, resulting in a lack of variety in the diet or limited food consumption for multiple reasons, such as inflexibility or sensory alterations. We conducted a peer scoping review to describe the interventions that are carried out from occupational therapy (OT) in children with ASD with food selectivity. Two authors independently searched the databases PubMed, Scopus, Web of Science, and EMBASE, as well as the OT journals indexed in Journal Citation Reports. Articles exploring OT interventions in children (≤12 years) with ASD and food selectivity, published in Spanish or English, with experimental design, and with full text available were included. Of the 1445 articles identified, 8 articles met the inclusion criteria. Three main intervention categories were identified: sensory–behavioral, family focused, and other interventions. Most of the interventions from OT were aimed at treating sensory–behavioral aspects. Only three articles described interventions led exclusively by occupational therapists, and the rest were led by a multidisciplinary team. Finally, although these interventions are not exclusive to OT, occupational therapists can participate together with other professionals as an essential component in the treatment of food selectivity in children with ASD.

COVID-19 and Food-Related Outcomes in Children with Autism Spectrum Disorder: Disparities by Income and Food Security Status

BACKGROUND

Limited research suggests increased adverse behavioral outcomes, such as distractibility and hyperactivity, among children with autism spectrum disorder (ASD) as a result of coronavirus 2019 (COVID-19); however, little is known about how the pandemic has impacted food-related behaviors among children with ASD.

OBJECTIVE

This study characterizes the impact of the pandemic on access to preferred foods and eating behaviors among children with ASD.

METHODS

Caregiver proxies (n = 200) participated in a cross-sectional, online survey investigating the impact of COVID-19 on reported food and eating behaviors of children, ages 2-17 y. Logistic regression models were used to assess the magnitude of association of a change in the child's eating behaviors and in food availability, overall and by household income and food security status.

RESULTS

A majority of respondents reported a moderate-to-large impact on their child's eating behaviors (57%) since the onset of COVID-19, and 65% reported unavailability of their child's preferred foods. Increased risk of a moderate-to-large impact on children's eating behaviors was associated with shelter regulations compared with no regulations (OR: 2.30; 95% CI: 1.12, 4.72), food insecurity compared with security status (OR: 2.60; 95% CI: 1.45, 4.67), and household income of <$50,000 compared with ≥$100,000 (OR: 2.33; 95% CI: 1.02, 5.29). The pandemic also amplified the risk of food unavailability by household food security status (food insecure vs. secure; OR: 4.13; 95% CI: 2.12, 7.69) and across income levels (<$50,000 vs. ≥$100,000; OR: 3.48; 95% CI: 1.42, 8.55; and $50,000 to <$100,000 vs. ≥$100,000; OR: 4.00; 95% CI: 1.71, 9.34). Reported frequencies of consumption of meat, seafood, vegetables, and 100% fruit juice significantly decreased among the children post-onset of COVID-19, while frequency of consumption of sweets increased.

CONCLUSIONS

A large proportion of caregivers reported substantial COVID-19 impacts on food availability and eating behaviors of children with ASD, especially among low-resource dyads. This study highlights the added burden of existing disparities due to the pandemic on children living with ASD.