Impact of the COVID-19 pandemic on the well-being of children with neurodevelopmental disabilities and their parents

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.

Quality of life and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders attending public hospitals in Addis Ababa, Ethiopia: a cross-sectional study

BACKGROUND

Neurodevelopmental disorders are a set of disorders that negatively affect the acquisition of skills in a variety of developmental domains, including motor function, learning, socialization, language and cognition. However, there is no information available on the standard of living of Ethiopian primary caregivers of children and adolescents with neurodevelopmental disorders. Therefore, this study aimed to assess the quality of life (QOL) and associated factors among primary caregivers of children and adolescents with neurodevelopmental disorders in Addis Ababa, Ethiopia.

METHODS

A cross-sectional study was conducted during 1-30 May 2022. Systematic random sampling was used to obtain 352 samples. QOL was measured using the WHO Quality of Life Brief. The gathered information was coded, entered into EpiData 4.6.0.2 and analyzed with SPSS version 26. Multiple linear regression analysis was used to identify the correlates of QOL and the strength of the correlation was measured by β coefficient with 95% CI.

RESULTS

The mean score of the overall QOL was 62.61 with a SD of 5.17. The mean (±SD) scores for the physical health, psychological, environmental and social relationship domains of primary caregivers were 57.36±9.98, 66.98±9.39, 66.06±12.91 and 60.02±9.14, respectively. Age was significantly associated with physical domain (β=-0.25, 95% CI -0.43 to -0.07) and with environmental domain (β=-4.57, 95% CI -9.06 to -0.09). Being divorced/widowed was negatively associated with psychological health (β=-2.99, 95% CI -5.82 to -0.17) and social health (β=-0.62, 95% CI -1.33 to -0.10). The presence of medical illness was negatively associated with the physical health domain (β=-4.32, 95% CI -7.64 to -2.91) and the environmental domain (β=-3.11, 95% CI -5.71 to -0.51). Poor social support was negatively associated with psychological health (β=-3.25, 95% CI -5.89 to -0.61) and the social health domain (β=-3.39, 95% CI -11.3 to 4.6), and moderate social support (β=8.62, 95% CI 3.15 to 14.09) was positively associated with physical health. Depression (β=-6.32, 95% CI -11.96 to -0.67) and anxiety (β =-3.07, 95% CI -5.80 to -0.34) were negatively associated with physical health and the psychological health domain, respectively.

CONCLUSIONS

The findings from this study indicate that all dimensions of QOL of primary caregivers of children and adolescents with neurodevelopmental disorders in this study setting were compromised. Being divorced or widowed, lack of formal education, age, average monthly income, poor social support, depression, anxiety and the presence of medical illness were factors associated with QOL in all domains. This requires integrating a bio-psychosocial perspective, a positive mental health strategy and pharmaceutical therapies to enhance QOL for caregivers of children and adolescents with neurodevelopmental disorders.

Following 4 months of social distancing during COVID-19 Pandemic in Brazil did not change aspects of functioning in children and adolescents with developmental disabilities: A longitudinal study

The COVID-19 pandemic and its demands of social distancing have created challenges in the lives of children/adolescents with developmental disabilities and their families, which would change aspects of children's functioning. The objetive of this study was to evaluate changes in some components of functioning of children/adolescents with disabilities following 4 months of social distancing during a period of high contamination rate in the year 2020 in Brazil. Participated 81 mothers of children/adolescents with disabilities, 3-17 years, most of them (80%) diagnosed with Down syndrome, cerebral palsy and autism spectrum disorder. Remote assessments of functioning' aspects including IPAQ, YC-PEM/ PEM-C, Social Support Scale and PedsQL V.4.0. Wilcoxon tests compared the measures, with significance level <0.05. No significant changes in participant's functioning were identified. Social adjustments required to facing the pandemic during two points in time in the midst of the pandemic did not change the evaluated aspects of functioning in our sample of Brazilian.

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.

Impact of COVID-19 pandemic on prescription stimulant use among children and youth: a population-based study

COVID-19 associated public health measures and school closures exacerbated symptoms in some children and youth with attention-deficit hyperactivity disorder (ADHD). Less well understood is how the pandemic influenced patterns of prescription stimulant use. We conducted a population-based study of stimulant dispensing to children and youth ≤ 24 years old between January 1, 2013, and June 30, 2022. We used structural break analyses to identify the pandemic month(s) when changes in the dispensing of stimulants occurred. We used interrupted time series models to quantify changes in dispensing following the structural break and compare observed and expected stimulant use. Our main outcome was the change in the monthly rate of stimulant use per 100,000 children and youth. Following an initial immediate decline of 60.1 individuals per 100,000 (95% confidence interval [CI] - 99.0 to - 21.2), the monthly rate of stimulant dispensing increased by 11.8 individuals per 100,000 (95% CI 10.0-13.6), with the greatest increases in trend observed among females, individuals in the highest income neighbourhoods, and those aged 20 to 24. Observed rates were between 3.9% (95% CI 1.7-6.2%) and 36.9% (95% CI 34.3-39.5%) higher than predicted among females from June 2020 onward and between 7.1% (95% CI 4.2-10.0%) and 50.7% (95% CI 47.0-54.4%) higher than expected among individuals aged 20-24 from May 2020 onward. Additional research is needed to ascertain the appropriateness of stimulant use and to develop strategies supporting children and youth with ADHD during future periods of long-term stressors.

The experiences of families of children with cerebral palsy and complex disability after three years accessing the National Disability Insurance Scheme

INTRODUCTION

In Australia, children with cerebral palsy and complex disability receive funded supports through the National Disability Insurance Scheme (NDIS). This individualised funding scheme requires parents to navigate and advocate on behalf of their child, supported by expert reports, recommendations, and allied health services. Supports aim to enable participation in all areas of daily life, which may be otherwise largely inaccessible to children with complex disability and their families. This study aimed to explore the experiences of families of children with complex disability after 3 years accessing the NDIS.

METHODS

A qualitative research design with a demographic questionnaire and in-depth interview was undertaken. Purposive sampling was used to recruit participants from one organisation providing occupational therapy and other allied health services. Data analysis implemented Braun and Clarke's thematic approach to examine the experiences of participants.

CONSUMER AND COMMUNITY INVOLVEMENT

This research was conducted with a registered National Disability Insurance Scheme provider to give voice to parent consumers who raise children with complex disability.

FINDINGS

Seven mothers and one father (N = 8) of children with complex disability were interviewed. Most parents reported increased success and satisfaction navigating the scheme. Five overall themes were generated from the data: pivotal roles of families, parental empowerment, life-changing equipment, the fallibility of the scheme, and a critical scheme.

CONCLUSION

Parents reported reliance on the scheme for their child's basic daily care and a more enriched life for their child and family. Parents were grateful for the scheme but experienced inconsistencies, navigation difficulties, and variable choice and control. Most parents had fears about the sustainability of the scheme, translating into uncertainty about their child's future. Allied health professionals, including occupational therapists, are key advocates for children with complex disability and their families. Collaboration through sharing knowledge and skills to support children, their families, and carers is key to empowering parents to navigate the NDIS.

PLAIN LANGUAGE SUMMARY

The National Disability Insurance Scheme (NDIS) provides funding for people with permanent and significant disability. Children with cerebral palsy (and other complex disability) are lifetime users of the NDIS. For children with complex disability, their families are crucial to ensuring that their daily needs are being met, including providing medication. Previous research indicated that parents rely on the NDIS to support their children; however, there have been various challenges such as long wait times for equipment and difficulty understanding how to use the scheme. This study explored the experiences of families of children with complex disability, after more than 3 years of being an NDIS participant. Eight parents from one therapy service provider completed a short questionnaire about themselves, their child, and their family, followed by an interview with the first author. Four authors (occupational therapists) worked together to design and implement this study. The findings highlighted several key points: the important role of parents as caregivers; parents became more knowledgeable and confident to navigate the NDIS with time; equipment funded by the NDIS was life-changing; the NDIS has ongoing issues; and the crucial nature of the NDIS. Occupational therapists can be extremely important to families, including with supporting families to navigate the NDIS and advocating for them. Occupational therapists must stay current with their knowledge of the NDIS as they provide lifetime support, including prescribing equipment, technology, and home modifications.

Immigrant Origin and Disability Increase Risk for Anxiety Among Youth During COVID-19: The Role of Unmet Needs for Support in Distance Learning and Family Conflicts

PURPOSE

Shifting to distance learning due to COVID-19 may decrease teacher support and increase family conflicts, potentially increasing anxiety. Nevertheless, there is scarce information on this topic among disability and/or immigrant-origin groups. Thus, we investigated whether these minority groups reported more anxiety than the reference group-Finnish-origin youth without disabilities-and whether unmet needs for support in distance learning and family conflicts mediated differences in anxiety during the pandemic. Differences in these mediators were also investigated.

METHODS

Population-based data of 165,033 youth aged 12 to 29 from the cross-sectional Finnish School Health Promotion study were obtained in 2021 using total population sampling. Logistic regressions with Stata were used to investigate the differences between the target (youth with disabilities, immigrant backgrounds, or both of these characteristics) and reference groups. The Karlson-Holm-Breen method was used to test for mediation.

RESULTS

The groups with disabilities (odds ratio [OR] = 4.14 [95% confidence interval (CI): 4.02-4.27]), immigrant backgrounds (OR = 1.15 [95% CI: 1.06-1.25]), or both of these characteristics (OR = 5.03 [95% CI: 4.59-5.52]) reported anxiety more often than the reference group. The difference between the minority and reference groups in unmet needs in distance learning and family conflicts were significant. Immigrant-origin youth with disabilities were most vulnerable to family conflicts, and the groups with disabilities were more prone to unmet needs. Unmet needs and family conflicts accounted for 28% of the association between immigrant-origin youth without disabilities and anxiety, whereas the mediating percentage was smaller for immigrant-origin youth with disabilities (13%) and Finnish-origin youth with disabilities (11%).

DISCUSSION

Immigrant-origin youth with disabilities need targeted support to prevent anxiety. Alleviating family conflicts and unmet needs in distance learning during crises could help decrease anxiety. Support for distance learning should be provided to youth with disabilities, regardless of their immigrant backgrounds.

Scoping review: longitudinal effects of the COVID-19 pandemic on child and adolescent mental health

The COVID-19 pandemic and associated containment measures have massively changed the daily lives of billions of children and adolescents worldwide. To investigate the global longitudinal effects on various mental health outcomes over a period of 1.5 years, we conducted a scoping review in accordance with the guidelines of the Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR). We included the peer-reviewed articles from PubMed, Web of Science, and APA PsycInfo that were published between December 2019 and December 2021, followed a longitudinal or repeated cross-sectional design, and quantitatively assessed with clinical questionnaires the effect of the COVID-19 pandemic or a related stressor on mental health indicators in community samples of children and adolescents.The results of our qualitative analysis of 69 studies indicate a general trend of less psychological well-being and more mental health problems, such as heightened stress, and depressive and anxiety symptoms during the pandemic. Data suggest that both protection measure intensity and infection dynamics were positively associated with severity of the psychopathology. The most reported influencing factors were age, gender, socio-economic status, previous state of mental and physical health, self-regulation abilities, parental mental health, parenting quality, family functioning, social support, isolation and loneliness, health-related worries, and consistent routines and structure. Our results demonstrate that children and adolescents worldwide have experienced more mental health problems due to the COVID-19 pandemic. They call for improved access to child and adolescent mental health care and prioritisation of child and adolescent welfare in political decision making.

Positive parenting practices support children at neurological risk during COVID-19: a call for accessible parenting interventions

Children and youth with neurological and/or neurodevelopmental conditions were at high risk for behavioral and mental health challenges during the COVID-19 pandemic. Positive and responsive parenting practices may be one way to prevent and manage potential difficulties in families. We aimed to identify whether positive parenting practices were associated with reduced behavioral concerns in children at neurological risk during the late stages and aftermath of the COVID-19 pandemic. In addition, we examined whether ongoing parental stress, anxiety, and depression impacted parenting practices during this time period. Families (N = 179) with children 4 to 15 years old (M = 7.11y, SD = 2.02) diagnosed with neurological (84.3%), neurodevelopmental (54.8%) or comorbid neurological and/or neurodevelopmental conditions (21.2%) were contacted to complete online questionnaires regarding demographics, parent stress, child behavior, COVID-19 conditions, and parenting practices. Multivariable linear regression (MLR) analyses examined the association between positive parenting practices and parenting competency measures with child behavioral outcomes, controlling for relevant covariates, including COVID-19 related stress. MLR were also run to determine whether parental mental health impacted parenting practices. More positive parenting practices predicted fewer child problem behaviors and lower intensity of problem behaviors. Similarly, a higher sense of satisfaction with parenting competence also predicted fewer child problem behaviors and lower intensity of problem behaviors. In addition, higher reported parental depression, anxiety, and stress significantly predicted fewer reported positive parenting practices. Findings points to the promising application of positive parenting interventions to support vulnerable families, as well as the need for parental mental health intervention to support parenting practices.

What supports and services post COVID-19 do children with disabilities and their parents need and want, now and into the future?

Introduction

Children and youth with disabilities and special healthcare needs, and their families, have been uniquely affected by the COVID-19 pandemic. However, the voices of children themselves are still not well represented in the existing literature.

Methods

This qualitative descriptive study used a combination of visual methods and interviews to learn about the experiences of Canadian children with disabilities (n=18) and their parents (n=14) during the COVID pandemic and into the post-pandemic period. Data collection was carried out between January and July 2023. The aim was to identify the supports and services children and families need at present and moving forward.

Results

Families' pandemic experiences were complex and nuanced. For many, the pandemic complicated and disrupted everyday activities and supports. These disruptions were largely buffered by parents. However, some families also identified unexpected benefits. Key themes pertaining to present and future needs included the need for services that are flexible; consistent; conducive to relationship-building; comprehensive; coordinated across sectors; and designed to support the needs of the whole family.

Discussion

Implications for policy and practice are outlined.

Tasks performed by parents to enable telepractice for children with communication disorders: an interview study with clinicians and parents

PURPOSE

Current service models in childhood rehabilitation promote the active participation of parents/caregivers in their children's therapies. The existing literature provides a limited understanding of the tasks and responsibilities parents undertake in their children's therapies, especially over telepractice. This study describes the tasks undertaken by parents in their children's speech therapy delivered virtually during the COVID-19 pandemic.

METHODS

A qualitative descriptive study was conducted with parents and speech-language pathologists, using open-ended interviews. Interviews were analyzed using a combination qualitative content analysis and thematic analysis.

RESULTS

Parents performed many tasks to enable telepractice. These tasks happened before (e.g., setting up both physical and virtual space for therapy), during (e.g., managing child's behavior), and after the virtual therapy session (e.g., carrying out home practice). While parents were willing to perform these tasks in order to help their children, some expressed the toll that it can take on them.

CONCLUSIONS

Compared to what is known from in-person visits, some of these tasks were novel and unique to telepractice. We recommend that clinicians and parents collaboratively decide on tasks and responsibilities to avoid burdening parents, and that they weigh the costs associated with performing these tasks against the benefits of teletherapy.IMPLICATIONS FOR REHABILITATIONParents perform many tasks to support their children's therapies, both during and outside of therapy sessionsTherapies delivered virtually require parents to assume additional tasks to support their childrenFor services to be Family-Centered, tasks and responsibilities need to be decided collaboratively between parents and clinicians.

Strength and resilience of developing brain circuits predict adolescent emotional and stress responses during the COVID-19 pandemic

The COVID-19 pandemic has had profound but incompletely understood adverse effects on youth. To elucidate the role of brain circuits in how adolescents responded to the pandemic's stressors, we investigated their prepandemic organization as a predictor of mental/emotional health in the first ~15 months of the pandemic. We analyzed resting-state networks from n = 2,641 adolescents [median age (interquartile range) = 144.0 (13.0) months, 47.7% females] in the Adolescent Brain Cognitive Development study, and longitudinal assessments of mental health, stress, sadness, and positive affect, collected every 2 to 3 months from May 2020 to May 2021. Topological resilience and/or network strength predicted overall mental health, stress and sadness (but not positive affect), at multiple time points, but primarily in December 2020 and May 2021. Higher resilience of the salience network predicted better mental health in December 2020 (β = 0.19, 95% CI = [0.06, 0.31], P = 0.01). Lower connectivity of left salience, reward, limbic, and prefrontal cortex and its thalamic, striatal, amygdala connections, predicted higher stress (β = -0.46 to -0.20, CI = [-0.72, -0.07], P < 0.03). Lower bilateral robustness (higher fragility) and/or connectivity of these networks predicted higher sadness in December 2020 and May 2021 (β = -0.514 to -0.19, CI = [-0.81, -0.05], P < 0.04). These findings suggest that the organization of brain circuits may have played a critical role in adolescent stress and mental/emotional health during the pandemic.

Physical Therapy Services During COVID-19 Pandemic: Perception of Families of Brazilian Children With Physical Disabilities

PURPOSE

To describe the perspective of caregivers about physical therapy (PT) during the COVID-19 pandemic and the effect of social distancing on the health of children with physical disabilities.

METHODS

This survey research used a remote questionnaire to identify the perceptions of caregivers about the effect of the COVID-19 pandemic on the health of children and adolescents with physical disabilities and on PT services. Data were analyzed using the frequency of responses; open-ended questions were analyzed through a hybrid approach to thematic analysis.

RESULTS

Caregivers of 47 children with cerebral palsy were included. Although most received regular PT services during the pandemic, worsened children's physical conditions and anxiety were prevalent. Caregivers believed that they lacked technical skills.

CONCLUSIONS

Social distancing impacted the health of children with physical disabilities, especially their physical conditions. Identifying facilitators and barriers for PT services can be helpful in future similar scenarios.Video abstract Supplemental Digital Content available at:http://links.lww.com/PPT/A503.

Alignment of Canada's COVID-19 policy response with barriers and facilitators for coping reported by caregivers of youth with developmental delays, disorders, and disabilities

Introduction

The UNICEF-WHO Global Report on Developmental Delays, Disorders, and Disabilities is an ongoing initiative aimed at increasing awareness, compiling data, providing guidance on strengthening health systems, and engaging country-level partners. Data from its caregiver survey assessing impacts of the COVID-19 pandemic showed that half of youths with developmental delays and disabilities (DDDs) and their caregivers struggled to cope, with a significant portion reporting a lack of supports and difficulty managing the worsening of the child's symptoms in isolation. Governments created service strategies supporting vulnerable groups. Little is known about the alignment between COVID-19 policies for persons with disabilities and their lived experiences. Contextualizing caregivers' experiences can promote the development of tailored public supports for these families following a public health crisis.

Methods

Online survey data were collected from June-July 2020, leading to a convenience sample of caregivers of youth with DDDs across Canada. Respondents answered two open-ended questions regarding challenges and coping strategies during the pandemic. We conducted a thematic analysis of responses using inductive coding on NVivo software. Overarching codes derived from the dataset were contextualized using an analysis of provincial policies published during the pandemic. Parallels with these policies supported the exploration of families' and youths' experiences during the same period.

Results

Five hundred and seventy-six (N = 576) participants answered open-ended questions. Barriers to coping included family mental health issues, concerns about the youths' regression, challenges in online schooling, limited play spaces, and managing physical health during quarantine. Environmental barriers encompassed deteriorating family finances, loss of public services, and a lack of accessible information and supports. In contrast, caregivers reported coping facilitators, such as family time, outdoor activities, and their child's resilience. Environmental facilitators included community resources, public financial supports, and access to telehealth services. Few COVID-19 policies effectively addressed caregiver-identified barriers, while some restrictions hindered access to facilitators.

Conclusion

Prioritizing needs of families of youths with DDDs during public health emergencies can significantly impact their experiences and mental health. Enhancing financial benefits, providing telehealth services, and creating inclusive public play spaces are priority areas as we navigate the post-pandemic landscape.

Remote Delivery of Allied and Behavioral Healthcare During COVID-19 for Children With Developmental Disabilities

Objective

Many children with autism spectrum disorder (ASD) and other developmental disabilities (DD) transitioned to telehealth services due to the COVID-19 pandemic. Our objectives were to describe reductions in allied and behavioral healthcare services and receipt of caregiver training to deliver services at home because of COVID-19 for children with ASD and other DD, and factors associated with worse response to remote delivery of services for children with ASD.

Method

Prior to the pandemic, children 2 to 5 years of age were enrolled in a multi-site case-control study and completed a developmental assessment. Caregivers completed questionnaires on child behavior problems and ASD symptoms. Children were classified as having ASD vs another DD based on standardized diagnostic measures. Subsequently, caregivers completed a survey during January to June 2021 to assess how COVID-19 affected children and families.

Results

Caregivers reported that most children with ASD and other DD had a decrease in service hours (50.0%-76.9% by service type) during the COVID-19 pandemic. Children with ASD were significantly more likely to experience reduced speech/language therapy than children with other DD. Receipt of caregiver training to deliver services at home ranged from 38.1% to 57.4% by service type. Among children with ASD, pre-pandemic problems with internalizing behaviors and social communication/interaction were associated with worse response to behavioral telehealth but no other common therapies.

Conclusion

Our study demonstrates the caregiver-reported impacts of COVID-19 on remote delivery of allied and behavioral healthcare services for children with ASD and other DD. Considerations for caregiver support and remote delivery of services are provided.

Child and family health-related quality of life and participation outcomes and goals after acquired brain injury: a cross-sectional survey

OBJECTIVE

To explore longer-term health-related quality of life (HRQoL) and participation outcomes and goals of children and young people (CYP) with acquired brain injuries (ABI) and their families in a region of the UK and the impact of the COVID-19 pandemic.

METHODS

Cross-sectional survey of (5-18 CYP) and their parent-carers 12-43 months following ABI. Included measures of HRQoL, participation, family function and parental wellbeing and demographic and free text questions.

RESULTS

Ninety-five responses (30% response) were received. 67% of CYP were at risk of impaired HRQoL, 72% had severely impaired participation. 53% of parent-carers reported reduced HRQoL and family functioning, 37% of parent-carers screened positive for anxiety/depression. Relationships exist between CYP participation and HRQoL and parental HRQoL and family functioning. Goals were overwhelmingly activity and participation focused. Participants described the global impact of an ABI on the CYP and family as well as the additional impact of the COVID-19 pandemic on CYP and family wellbeing.

CONCLUSION

ABI significantly impacts CYP participation and both CYP and parent-carer wellbeing in the long-term, potentially further impacted by the COVID-19 pandemic. Rehabilitation interventions should address both participation and the psychological wellbeing of CYP with ABI and their parent-carers.

The Relationship Between Nutrition-Physical Activity Behaviors of Autistic Children with Their Families and Children's Obesity Levels During Covid Pandemic

The family has a key role in the obesity management of children with autism. This study examines the relationship between the nutrition-physical activity behaviors of autistic children with their families and children's obesity levels during covid-19 pandemic. The descriptive and cross-sectional study involved 80 parents of autistic children. A positive correlation was found between children's mean BMI values before and during the pandemic(p = 0.000). Family Nutrition and Physical Activity Scale(FNPAS) and Brief Autism Mealtime Behavior Inventory(BAMBI) score were 55.18 ± 7.86 and 31.76 ± 8.79, respectively. In addition, it was found that 32.5% of the children ate more than before the pandemic, 50.0% engaged in less physical activity, and 16.3% didn't do any physical activity. The study results suggesting the risk of obesity.

Sleep Problems Before and During the COVID-19 Pandemic in Children with Autism Spectrum Disorder, Down Syndrome, and Typical Development

Sleep problems are common in children and adolescents, particularly those with Neurodevelopmental Disorders. With the changes in daily habits resulting from the COVID-19 pandemic, we have analyzed sleep characteristics, during social isolation, in Brazilian children and adolescents aged between 4 and 12 years with Autism Spectrum Disorder (N = 267), Down Syndrome (N = 74), and typical development (N = 312). The ASD group presented with worse indicators of sleep habits in the Children's Sleep Habits Questionnaire (CSHQ-BR) and fell asleep later during the pandemic. The entire group started fall asleep and waking up later during the pandemic - as well as waking up more often during the night. These results may contribute to parental guidance and sleep habit-related interventions during and after the COVID-19 pandemic.

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.

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.

Population-level changes in anxiety and depression and the unmet need for support at school among adolescents with and without disabilities, 2017-2021: The effects of the COVID-19 pandemic

BACKGROUND

Adolescents' mental health problems increased during the COVID-19 pandemic, but little information is available on how adolescents with disabilities were affected.

OBJECTIVE

We investigated the population-level changes in depression and anxiety and the unmet need for support at school from social workers/psychologists, doctors/nurses, and teachers among adolescents with specific disabilities and those without disabilities before (2017-2019) and during (2021) the pandemic.

METHODS

We analyzed population-based cross-sectional data from the Finnish School Health Promotion study of lower secondary school students obtained in 2017 (n = 73,678), 2019 (n = 87,215), and 2021 (n = 91,560). Students with disabilities were classified into four groups based on self-reporting: disabilities only in mobility, cognition, sensory, or two or more domains. Regression models were applied to investigate population-level changes.

RESULTS

From 2017-2019 to 2021, anxiety and depression increased at the population level among all adolescents. The interaction analysis revealed that the increase was higher among adolescents with cognitive and mobility disabilities and lower among those with sensory disabilities compared to adolescents without disabilities. The increase in the prevalence of the unmet need for support was similar for those with and without disabilities, except for support from social workers/psychologists, where the unmet need was higher among those with mobility disabilities.

CONCLUSION

The COVID-19 pandemic had more detrimental effects on the mental health of adolescents with mobility and cognitive disabilities than those without disabilities. There is an urgent need for resources and targeted support to prevent anxiety and depression among adolescents with mobility and cognitive disabilities during crises.

Participation of Children With Autism During COVID-19: The Role of Maternal Participation

BACKGROUND

Little is known about participation during adverse times.

OBJECTIVES

This study described participation of children with autism aged 6 to 13 during COVID-19 pandemic and examined the extent to which child factors, mother's own participation, and environmental barriers/supports explain child participation in home and community.

METHOD

A total of 130 mothers completed the Participation and Environment Measure for Children and Youth, the Health Promoting Activities Scale, functional issues checklist, and sociodemographic questionnaire.

RESULTS

Children's participation frequency and involvement were significantly higher at home than in the community. In both settings, mothers desired change in 71% of activities. Multiple regression models indicated that child's age and mother's participation frequency significantly explained child's home involvement (R2 = 21%), where mother's participation (frequency) had a unique contribution (ΔR2 = 10.4%) at home but not in the community.

CONCLUSION

Findings imply the importance of maternal participation to child's participation at home and suggest redirecting attention for enhancing family participation as a whole.

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.

"It's already stressful being a foster parent": A qualitative inquiry into foster parenting stress during COVID-19

BACKGROUND

Emerging literature suggests parents were under increased stress as a result of the COVID-19 pandemic; however, fewer studies to date have examined the wellbeing of foster parents in this season. Miller et al.'s (2020) quantitative study recommended in-depth, qualitative study of the stressors faced by foster parents during COVID-19.

OBJECTIVE

Accordingly, this qualitative study sought to fill a gap in the literature regarding foster parents' lived experiences of foster parenting stress during the COVID-19 pandemic.

PARTICIPANTS AND SETTING

Virtual, semi-structured interviews were conducted with n = 20 foster parents from across one Southern U.S. state between April and July 2021.

METHODS

Verbatim transcripts were analyzed utilizing Braun and Clarke's (2006) thematic analysis.

RESULTS

Five themes emerged in the analysis: (1) Varied Descriptions of Fostering in a Pandemic; (2) Nowhere to Go; (3) COVID-Consciousness; (4) The Virtual Reality; and (5) Stress Relief. Eight total additional subthemes were recorded. All themes and subthemes were described with representative direct quotations from the data.

CONCLUSIONS

Findings from this study demonstrated foster parents experienced both shared and unique parenting challenges during COVID-19. Three areas for further consideration and development in practice included improving online service delivery, strengthening guidance for online parent-child visitation, and enhancing support for foster parents of children with special needs. Developing social support and self-care practices should continue to be ongoing priorities for foster parents and foster parent-serving agencies.

The impact of COVID-19 on children and adolescents attending Child and Youth Mental Health Services in Queensland, Australia

OBJECTIVE

This explorative study aims to provide insight into impacts of the COVID-19 pandemic and associated restrictions, on mental health of children and adolescents treated at Child and Youth Mental Health Services, and their parents.

METHOD

The COVID-19 Mental Health Survey was disseminated to parents of children and adolescents under treatment at community Child and Youth Mental Health Services (Brisbane, Australia) between July-November 2020 throughout different stages of COVID-19 related restrictions. Parents of 110 children participated.

RESULTS

Most reported child's symptoms were sadness (46%), anxiety (60%), lack of focus (61%), lack of joy in their usual activities (38%) and reduction in sleep (42%). Parental emotions were significantly correlated with their child's emotions. Parent's lack of enjoyment of usual activities had the overall strongest average correlation (0.27) but this was no longer significant once other variables were controlled for. Children who attended school remotely for some of the days had a significantly (p < .05) higher risk of having more reported symptoms. Interestingly, in later stages of the lockdown with further easing of restrictions, symptoms also tended to be more severe.

CONCLUSION

Cross-sectional data on children and adolescents in Queensland, Australia with pre-existing mental health issues suggests mental health continued to deteriorate through the pandemic even as restrictions eased. Changes in schooling seem to be an especially important risk factor.

Impact of COVID-19 on Utilisation of Funds by People With Disabilities: Lessons Drawn From the Australian National Disability Insurance Scheme

BACKGROUND

COVID-19 pandemic has affected everyone, especially people with disabilities (PwD). While there has been qualitative research on the impact of the pandemic on PwD in Australia, little quantitative evidence has been produced on the magnitude of this impact.

METHODS

A range of descriptive analytic methods are employed on the data merged from the National Disability Insurance Scheme (NDIS) and COVID-19 data on national, state, and regional levels to compare the expenditure of the NDIS participants who are in pandemic-affected regions and time periods with those that are not. Regression analysis is also performed to estimate the participants' utilisation of funds using explanatory variables drawn from the NDIS, COVID-19, and lockdown policy information.

RESULTS

Our analysis reveals that: (1) the pandemic reduced expenditure of the NDIS participants by approximately A$ 31.2 million, equal to 8.85% of the total expenditure over five quarters for the state of Victoria (VIC) alone; (2) the contractions in expenditure lasted for up to two quarters during the pandemic; (3) the reductions in expenditure were largely associated with the limited mobility imposed via lockdowns compared to the impaired access to services; and (4) the spread of COVID-19 that led to restrictions on mobility of people had a bearing on utilisation of funds by NDIS participants in the subsequent quarter.

CONCLUSION

COVID-19 has affected the expenditure of the PwD in Australia. We overlaid the NDIS data on the COVID-19 outbreaks to estimate the impact of the pandemic on expenditure and utilisation rate of the funds allocated to the NDIS participants. Our findings point to potential policy interventions to mitigate some of the adverse consequences of similar nationwide emergencies.

Uncertainty, Sensory Processing, and Stress in Autistic Children During the COVID-19 Pandemic

BACKGROUND

COVID-19 increased uncertainty for most and was especially disruptive to autistic people and their families, due in part to tendencies toward intolerance for uncertainty across this population. As such, COVID presented a natural experiment of uncertainty and its correlates in autism. Previous reports have shown associations between intolerance of uncertainty, sensory difficulty, and stress.

AIMS

We investigated changes in sensory difficulties and stress associated with COVID-related increases in uncertainty.

METHODS AND PROCEDURES

Primary caregivers of 47 autistic children (ages 6-15) completed online surveys containing questions about demographics, experiences, and supports received during the pandemic. Additionally, caregivers filled out measures of intolerance of uncertainty and sensory processing for both pre- and during-COVID conditions.

OUTCOMES AND RESULTS

Eighty nine percent of children had significant sensory difficulties before the pandemic. This group showed significant increases in sensory difficulties and intolerance of uncertainty during the pandemic. These changes were significantly correlated with each other, suggesting that as uncertainty increased so did sensory difficulties. Disruption to routine was also significantly correlated with sensory differences and child, household, and parent stress.

CONCLUSIONS AND IMPLICATIONS

Our findings add to fundamental understanding of the relationship between uncertainty, sensory processing, and stress by leveraging a natural experiment in increased uncertainty. These results have the potential to contribute to improved supports for autistic individuals in clinical, educational, home, and other settings.

A nationwide study of COVID-19 impact on mental health-related presentations among children and adolescents to primary care practices in Australia

This study explored the impacts of COVID-19 on the mental health (MH)-related visits to general practices (GPs) among children and young people (CYP) up to 18 years of age in Australia. This study analysed national-level data captured by the NPS MedicineWise program on monthly CYP MH-related visits per 10,000 visits to GPs from January 2014 to September 2021. We considered the pre-COVID-19 period (January 2014-February 2020) and the COVID-19 period (March 2020-September 2021). We used a Bayesian structural time series (BSTS) model to estimate the impact of COVID-19 on MH-related GP visits per 10,000 visits. A total of 103,813 out of 7,690,874 visits to GP (i.e., about 135 per 10,000 visits) were related to MH during study period. The BSTS model showed a significant increase in the overall MH-related visits during COVID-19 period (33%, 95% Credible Interval (Crl) 8.5%-56%), particularly, visits related to depressive disorders (61%, 95% Crl 29%-91%). The greatest increase was observed among females (39%, 95% Crl 12%-64%) and those living in socioeconomically least disadvantaged areas (36%, 95% Crl 1.2-71%). Our findings highlight the need for resources to be directed towards at-risk CYP to improve MH outcomes and reduce health system burden.

Experiences of parents of children with rare neurogenetic conditions during the COVID-19 pandemic: an interpretative phenomenological analysis

BACKGROUND

The Coronavirus disease 2019 (COVID-19) pandemic has impacted parental and child mental health and wellbeing in the UK. This study aimed to explore the experiences of parents of children with rare neurological and neurodevelopmental conditions with a known or suspected genetic cause (neurogenetic) across the first year of the pandemic in the UK.

METHODS

Semi-structured interviews were conducted with 11 parents of children with rare neurogenetic conditions. Parents were recruited via opportunity sampling from the CoIN Study, a longitudinal quantitative study exploring the impact of the pandemic on the mental health and wellbeing of families with rare neurogenetic conditions. Interviews were analysed using Interpretative Phenomenological Analysis.

RESULTS

Four main themes were identified: (1) "A varied impact on child wellbeing: from detrimental to 'no big drama'"; (2) "Parental mental health and wellbeing: impact, changes, and coping"; (3) "'The world had shut its doors and that was that': care and social services during the pandemic"; and (4) "Time and luck: abstract concepts central to parents' perspectives of how they coped during the pandemic". The majority of parents described experiencing an exacerbation of pre-pandemic challenges due to increased uncertainty and a lack of support, with a minority reporting positive effects of the pandemic on family wellbeing.

CONCLUSIONS

These findings offer a unique insight into the experiences parents of children with rare neurogenetic conditions across the first year of the pandemic in the UK. They highlight that the experiences of parents were not pandemic-specific, and will continue to be highly relevant in a non-pandemic context. Future support should to be tailored to the needs of families and implemented across diverse future scenarios to promote coping and positive wellbeing.

Codesigning a social prescribing pathway to address the social determinant of health concerns of children with cerebral palsy and their families in Australia: a protocol for a mixed-methods formative research study

INTRODUCTION

Social determinants of health (SDH) are contributors to health inequities experienced by some children with cerebral palsy and pose barriers to families engaging with complex and fragmented healthcare systems. There is emerging evidence to support 'social prescribing' interventions that systematically identify SDH concerns and refer patients to non-medical social care support and services to address their needs. To date, social prescribing has not been trialled specifically for children with neurodevelopmental disabilities, including cerebral palsy, in Australia. This study aims to codesign a social prescribing programme to address SDH concerns of children with cerebral palsy and their families who attend one of the three tertiary paediatric rehabilitation services in New South Wales, Australia.

METHODS AND ANALYSIS

This is a qualitative multi-site study conducted at the three NSW paediatric hospitals' rehabilitation departments using a codesign approach. Children aged 12-18 years with cerebral palsy, parents/caregivers of children (aged 0-18 years) with cerebral palsy, and clinicians will be involved in all stages to codesign the social prescribing programme. The study will consist of three components: (1) 'what we need', (2) 'creating the pathways' and (3) 'finalising and sign off'. This project is overseen by two advisory groups: one group of young adults with cerebral palsy and one group of parents of young people with cerebral palsy. The study will be guided by the biopsychosocial ecological framework, and analysis will follow Braun and Clark's thematic approach.

ETHICS AND DISSEMINATION

The study protocol was approved by the human research ethics committee of the Sydney Children's Hospitals Network. This codesign study will inform a future pilot study of feasibility and acceptability, then if indicated, a pilot clinical trial of efficacy. We will collaborate with all project stakeholders to disseminate findings and undertake further research to build sustainable and scalable models of care.

TRIAL REGISTRATION NUMBER

ACTRN12622001459718.

Social Challenges as a Consequence of the COVID-19 Pandemic among South Florida Preschool Children with Disability and Obesity

The COVID-19 pandemic has negatively impacted the childcare industry over the past two years. This study examined how pandemic-related challenges impacted preschool-aged children by disability and obesity status. Participants were 216 children (80% Hispanic, 14% non-Hispanic Black) aged 2 to 5 years in 10 South Florida childcare centers. In November/December 2021, parents completed a COVID-19 Risk and Resiliency Questionnaire, and body mass index percentile (BMI) was collected. Multivariable logistic regression models examined the association of COVID-19 pandemic-related social challenges (transportation, employment) and child BMI and disability status. As compared to normal-weight children, those families with a child who was obese were more likely to report pandemic-related transportation (OR: 2.51, 95% CI: 1.03-6.28) challenges and food insecurity (OR: 2.56, 95% CI: 1.05-6.43). Parents of children with disabilities were less likely to report that food did not last (OR: 0.19, 95% CI: 0.07-0.48) and that they could not afford balanced meals (OR: 0.33, 95% CI: 0.13-0.85). Spanish-speaking caregivers were more likely to have a child who was obese (OR: 3.04, 95% CI: 1.19-8.52). The results suggest that COVID-19 impacts obese preschool children from Hispanic backgrounds, while disability was a protective factor.

"I'm the Family Ringmaster and Juggler": Autistic Parents' Experiences of Parenting During the COVID-19 Pandemic

Background

Little is known about autistic parenthood. The literature that exists suggests that autistic parents can find it difficult to manage the everyday demands of parenting and domestic life. While emerging research has also highlighted more positive parenting experiences, greater understanding of autistic parenthood is needed.

Objective

This study sought to understand autistic parents' parenting experiences during the initial phase of the COVID-19 pandemic.

Methods

Thirty-five Australian autistic parents (95% women) of autistic children (aged 4-25 years) took part in semi-structured interviews designed to elicit their experiences of life during lockdown. We used reflexive thematic analysis using an inductive (bottom-up) approach to identify patterned meanings within the data set.

Results

Autistic parents repeatedly spoke of how the lockdown brought some initial relief from the intensity of their usual lives caring for their children. Nevertheless, most autistic parents felt that the "cumulative stress" of trying to juggle everything during lockdown proved very challenging, which eventually took its toll on parents' mental health. Parents were aware that they needed support but found it difficult to reach out to their usual social supports (including autistic friends) for help, and formal supports were virtually nonexistent. Consequently, they felt "very much forgotten." Nevertheless, they described how their connections with their children grew stronger over lockdown as they focused on nurturing their children's "mental health ahead of everything else."

Conclusions

Our analysis shows how challenging conventional life can be for autistic parents. Parenting requires grappling with a distinctive set of demands, which are usually partially manageable through the informal supports many autistic parents draw upon. The relative absence of informal supports during the pandemic, however, left them reliant on more formal supports, which were not forthcoming. Research is urgently needed to identify the most effective formal supports for autistic parents, ideally in partnership with autistic parents themselves.

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

INTRODUCTION

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

RESULTS

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

DISCUSSION

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

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

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

Transitioning a Research Protocol for Videosomnography to Assess Sleep and Nighttime Caregiving Activities in School-Aged Children With Developmental Disabilities During the COVID-19 Pandemic

INTRODUCTION

The COVID-19 pandemic significantly affected children with developmental disabilities (DDs)' sleep. Videosomnography is a noninvasive, portable time-lapse video recording system to objectively obtain a child's sleep-wake behaviors and parents' caregiving activities in a natural environment.

METHOD

From September 2020 to February 2021, we conducted a feasibility study using actigraphy (in mothers) and videosomnography in children with DDs for seven consecutive nights to assess sleep and nighttime caregiving activities. Because of the pandemic, we developed and implemented alternative data collection strategies, such as delivering a "study package" with easy-to-follow written instructions and emailed video-recorded instructions on recording a child's sleep.

RESULTS

We aimed to enroll 10 mothers and 10 school-aged children with DDs and achieved this goal. Nine out of 10 mothers completed video recordings of their child's sleep, with only 10% missing data for videosomnography.

DISCUSSION

This paper shared adaptations to our videosomnography protocol and lessons learned.

Improving Participation among Youth with Disabilities within Their Unique Socio-Cultural Context during COVID-19 Pandemic: Initial Evaluation

BACKGROUND

Participation in meaningful activities is important for quality of life among youth with disabilities; yet participation is often restricted during adverse times. This study aimed to explore the effectiveness of the Pathways and Resources for Engagement and Participation (PREP) intervention among ultra-Orthodox Jewish Israeli youth with disabilities during the COVID-19 pandemic.

METHODS

A 20-week single-subject research design with multiple baselines measuring participation goals/activities was employed with two youths (15 and 19 years old) combining quantitative and qualitative descriptive data. Changes in participation levels were measured biweekly using the Canadian Occupational Performance Measure; COPM; participation patterns were measured using the Participation and Environment Measure-Children and Youth; PEM-CY pre- and post-intervention; parents' satisfaction was measured using the Client Satisfaction Questionnaire, CSQ-8. Semi-structured interviews were conducted post-intervention.

RESULTS

Both participants significantly improved participation in all selected goals and participation patterns, and were highly satisfied with the intervention. The interviews revealed additional information on personal and environmental barriers, factors supporting intervention, and intervention effects.

CONCLUSIONS

The results indicated that an environment-centered and family-centered approach can potentially improve the participation of youths with disabilities within their unique socio-cultural context, during adverse times. Flexibility, creativity, and collaboration with others also contributed to intervention success.

CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions

BACKGROUND

Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services.

METHODS

Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups.

RESULTS

Clustering revealed four subgroups. One subgroup-broad symptom worsening only (20%)-included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup.

LIMITATIONS

Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic.

CONCLUSIONS

Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis.

The roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by Japan's public health nurses

Background

Public Health Nurses (PHNs) collaborate with community volunteer welfare commissioners to support children with developmental disorders and their families lead a life without isolation.

Objective

This study aims to clarify the roles and competencies that PHNs expect of welfare commissioners in supporting children with developmental disorders and their families.

Methods

An online survey was administered through Survey Monkey© to 220 PHNs working in Japanese municipalities using an independently developed questionnaire regarding the roles and competencies of welfare commissioners supporting children with developmental disorders and their families expected by PHNs. Exploratory Factor Analysis (EFA) was performed to simplify the data structure and enhance understanding. The reliability of the scale was confirmed using Cronbach's α. Differences due to PHN attributes (e.g., experience collaborating with welfare commissioners) were analyzed using Welch's t-test. This study was conducted between April and September 2021.

Results

The highest scoring items were, for the role, "a welfare commissioner's role is to pass on accurate information to their successor," and for competencies, "a necessary competency for a welfare commissioner is to protect the information about children with developmental disorders, and their families learned during one's work." The EFA results revealed a two-factor structure for role items: Factor 1, "Supporting children with developmental disorders and their families and preventing abuse," and Factor 2, "Connecting to social resources." Competency items were also found to have a two-factor structure: Factor 1, "Understanding the position of children with developmental disorders and their families and connecting with local residents," and Factor 2, "Understanding developmental disorders and supporting them based on assessment." A comparison of the attributes of PHNs showed no significant differences.

Conclusion

PHNs feel welfare commissioners should pass on the information and protect confidentiality when supporting children with developmental disorders and their families. Furthermore, PHNs expect welfare commissioners to connect children with developmental disorders and their families to the community, prevent abuse, and provide support based on assessment. PHNs had the same expectations regarding the roles and competencies of welfare commissioners regardless of their own attributes.

Being a Parent of Children with Disabilities during the COVID-19 Pandemic: Multi-Method Study of Health, Social Life, and Occupational Situation

Parents of children with disabilities face challenges in their daily lives, but little is known about their experience of the COVID-19 pandemic. The objective of the study was to explore the experiences of parents of children with disabilities during the COVID-19 pandemic in Quebec, Canada. Forty parents of children with disabilities from Quebec, Canada (mean [SD] age: 41.2 [6.7]; 93% women) were selected from the Ma Vie et la pandémie (MAVIPAN) study. All 40 parents completed the MAVIPAN online questionnaires including the Depression, Anxiety and Stress Scale (DASS-21), Warwick-Edinburgh Mental Wellbeing short 7-item scale (WEMWBS), Social Provisions Scale-10 item (SPS-10), and the UCLA Loneliness Scale (UCLA-LS). A multi-method analysis was used to summarize questionnaires and thematically explore parents' experiences. Parents reported deterioration in their mental (50.0%) and physical (27.5%) health, with moderate levels of depression, stress, and anxiety, yet moderately positive well-being. Additional experiences included reduction in available supports (71.4%) and feelings of social isolation (51.4%). Our results highlighted reduced mental and physical health, limited and modified access to certain services, and reduction of social supports for some parents of children with disabilities. Health professionals, policymakers, and governments should be mindful of these challenges experienced by parents of children with disabilities.

Web-Based Exercise Interventions for Children with Neurodevelopmental Disorders

Various studies have shown the effectiveness of motor interventions for children with neurodevelopmental disorders (NDDs). Web-based interventions may provide an opportunity for remote access to effective interventions with less burden on therapists. This systematic review aimed to examine the effects of web-based exercise interventions for children with NDDs. We searched PubMed for relevant articles published in English since 1994 and included intervention studies focusing on NDDs in children aged ≤18 years, who received web-based exercise interventions. We categorized the extracted information by outcome measure and intervention type and assessed the risk of bias of the included studies. We selected five articles whose subjects had autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD), and developmental coordination disorder (DCD). The exercise interventions used active video games, a Zoom-based intervention, and a WhatsApp-based intervention. Three papers showed improvements in physical activity, motor function, and executive function, whereas two papers on DCD showed no improvements in motor coordination or physical activity. Web-based exercise intervention for children with ASD and ADHD may improve their motor function, executive function, and physical activity rather than for children with NDDs. An intervention may be more effective when the content of the intervention is based on objectives and symptoms, when guidance is provided by specialists, or when sufficient explanation and support are provided to parents. However, more research is needed to statistically evaluate the effectiveness of web-based exercise interventions for children with NDDs.

Adapting the 'First 2000 Days maternal and child healthcare framework' in the aftermath of the COVID-19 pandemic: ensuring equity in the new world

The purpose of this perspective article is to emphasise the importance of the 'First 2000 Days' policy of life from conception to age five, and to propose new directions in which the policy's implementation could be extended for the benefit of children and families. The proposed approach highlights principles of responsiveness, integration, sustainability and equity, specifying initiatives that embody the kind of innovation each principle aspires to. The article also proposes innovations in data collection and linkages that would strengthen the implementation of first 2000 days policies and frameworks. This perspective proposes a framework that could improve health systems implementation of services in the first 5 years of life, by proposing a well-coordinated continuum of services with integrated physical and digital solutions. This has the potential to transform how the health system monitors and responds to children and families' needs in the critical early years of life during and beyond the current pandemic.

The effects of the SARS-CoV-2 pandemic on children and youth with special health care needs

This article seeks to review the current knowledge of the SARS-CoV-2 virus and the health effects for children and youth with special health care needs (CYSHCN). COVID-19, an infectious disease caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), became a major pandemic in 2020. Recognition of the disease could be difficult, as symptoms in children are at times different than adults and can mimic other common childhood viral infections. Children with underlying medical conditions did make up a higher proportion of those hospitalized, but also were affected in other ways including loss of nursing support, missed education and rehabilitative services, and increased stress for themselves and their families, affecting mental health in this vulnerable population. This review seeks to address what is currently known about the overall effects on CYSHCN and their families, and identify gaps in research, including the implementation of health care systems, and possible suggestions for change in the educational and community supports for this group of individuals. Ongoing analysis of large national and international data sets, as well as smaller reports based on specific congenital anomaly, genetics disease, and acquired childhood illness, and then attention to local resources and family resilience is still necessary.

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.

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

LAY ABSTRACT

Autistic children and adolescents, and their parents/carers, tend to experience more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. The rapid change in society as a result of the COVID-19 pandemic is likely to have disproportionately affected autistic young people and their parents/carers. We investigated how the mental health of autistic young people, and their parents/carers, developed during the first lockdown in the United Kingdom and how it changed once schools fully reopened for face-to-face teaching approximately 6 months later. Parents/carers completed online standardised questionnaires about their own and their child's mental health at four time points between March 2020 and October 2020. We found that, throughout this period, autistic young people experienced more symptoms of anxiety and depression compared to those with other special educational needs and disabilities. Anxiety levels decreased as lockdown progressed and schools reopened for face-to-face teaching but only for those with other special educational needs and disabilities. For autistic young people, both anxiety and depression symptoms remained high throughout. There were no differences in the mental health of parents/carers of autistic children compared to those with other special educational needs and disabilities. These findings suggest that the mental health of autistic children and adolescents is likely to have been disproportionately affected during and after the first lockdown in the United Kingdom. In the second part of this article (Asbury & Toseeb, 2022), we attempt to explain these trends using qualitative data provided by parents during the same period.

Associations Between Perceived Social Support, Perceived Competence, and Physical Activity in Hong Kong Children With Disabilities During the COVID-19 Pandemic

This study aimed to examine the associations between perceived social support, perceived competence, and physical activity in children with physical and intellectual disabilities during the COVID-19 pandemic. During the third wave of the pandemic in Hong Kong (i.e., July through December 2020), 291 participants age 6-17 years from 27 special schools were included. After controlling for demographic variables, the total variance explained by perceived social support and perceived competence was 24%, F(2, 240) = 12.42, p < .001, with perceived competence having a stronger association with physical activity (β = 0.29, p < .001) than perceived social support (β = 0.07, p = .22). This study highlights two key facilitators for shaping physical activity involvement among children with disabilities during the COVID-19 pandemic.

Impact of COVID-19 on physical and mental functioning in adolescents with disabilities in a sports nongovernmental organization

Abstract Objective: This study aimed to assess physical and mental health, and health-related quality of life (HRQL) parameters in adolescents with physical disabilities enrolled in a sports nongovernmental organization (NGO) versus adolescents without disabilities during coronavirus disease 2019 (COVID-19) pandemic. Methods: This cross-sectional study included 30 adolescents with disabilities and 86 adolescents without disabilities who responded to an online questionnaire with sociodemographic data and self-rated healthcare routine information during the COVID-19 quarantine. Validated self-report versions of the Strengths and Difficulties Questionnaire (SDQ), Pediatric Quality of Life Inventory 4.0 (PedsQL 4.0), Pittsburgh Sleep Quality Index (PSQI), and Pediatric Outcome Data Collection Instrument (PODCI) were also applied. Results: The median of emotional [4 (0–10) vs. 5 (0–10), p=0.018] and prosocial [7 (0–10) vs. 9 (3–10), p=0.006] problems was lower in adolescents with disabilities versus adolescents without disabilities. Adolescents with disabilities had significantly lower global function [68 (21–99) vs. 94 (67–100), p<0.001] and higher happiness scores in the PODCI scale [90 (65–100) vs. 80 (0–100), p=0.016] compared to controls. Logistic regression analysis demonstrated that physical activity/week (OR=1.03; 95%CI 1.01–1.05, p=0.002) was higher in adolescents with disabilities compared to adolescents without disabilities. However, housework activities (OR=0.14; 95%CI 0.04–0.43, p=0.001) and screen time ≥3 h/day (OR=0.09; 95%CI 0.02–0.38, p=0.001) were lower in adolescents with disabilities compared to adolescents without disabilities. Conclusion: Adolescents with disabilities attending a sports NGO were not at higher risk of adverse health-related indicators; despite showing reduced physical function, they reported more physical activity, higher happiness, and less screen time compared to adolescents without disabilities during the COVID-19 pandemic.

The impact of the COVID-19 pandemic on the mental health of families dealing with attention-deficit hyperactivity disorder

BACKGROUND

The COVID-19 pandemic uprooted regular routines forcing many children to learn from home, requiring many adults to work from home, and cutting families off from support outside the home. Public health restrictions associated with the pandemic caused widespread psychological distress including depression and anxiety, increased fear, panic, and stress. These trends are particularly concerning for families raising neuroatypical children such as those with Attention-Deficit Hyperactivity Disorder (ADHD), as these children are already more likely than their typically developing peers to experience comorbid mental health issues, and to experience greater distress when required to stay indoors. Families with children who have ADHD are also at greater risk for experiencing heightened familial stress due to the challenges associated with managing ADHD behavioural symptoms, greater parental discord and divorce, and greater financial difficulties compared to other families. The current study engaged families comprised of at least one child diagnosed with ADHD to elucidate 1) the unique ways that the COVID-19 pandemic affected their mental health and 2) the specific barriers these families faced to maintaining optimal mental wellbeing.

METHODS AND FINDINGS

A total of 33 participants (15 parent-child dyads) engaged in virtual interviews. Content analysis revealed that the most frequently identified mental health effects for families were increased child anxiety and disconnectedness, as well as deteriorating parental mental health. The most frequently identified barriers to maintaining optimal mental wellbeing were lack of routine, lack of social interaction and social supports, and uncertainty and fear.

CONCLUSIONS

Findings underscore areas of need during times of large-scale social isolation, specifically for families with children who have ADHD. This work contributes to a growing body of research aimed at creating safeguards to support mental wellbeing for vulnerable families during times of crisis.

Parenting a Child with a Neurodevelopmental Disorder during the Early Stage of the COVID-19 Pandemic: Quantitative and Qualitative Cross-Cultural Findings

Research during the COVID-19 pandemic has shown a strong relationship between child symptoms, parental stress, and mental health challenges. The pandemic has changed family routines, worsening child symptomatology and parental burden. The aim of this study was to investigate how the magnitude of the perceived changes in child externalizing behavior, parental stress, and discontinuity of therapy-from before to during the COVID-19 pandemic-affected parental mental health during the pandemic. Moreover, we sought to compare these aspects cross-culturally between European countries and the USA. To these purposes, we asked Italian, Spanish, and U.S. parents of children with neurodevelopmental disabilities (NDD) to complete an online survey. Quantitative results showed that increased parental stress may have contributed to a worsening in parental psychological distress, regardless of culture. Moreover, they suggested an indirect effect of child externalizing behaviors on parents' psychological distress via parental stress. Qualitative analyses highlighted that the lack, or discontinuity, of therapeutic activities may have been one of the key contributors to parenting burden during the COVID-19 pandemic. Finally, qualitative results highlighted resilience factors that could have decreased the risk of psychological problems during the pandemic, such as a strong sense of parental efficacy and the ability to adapt to changing family dynamics.

The psychosocial situation of families caring for children with rare diseases during the COVID-19 pandemic: results of a cross-sectional online survey

BACKGROUND

The COVID-19 pandemic is affecting many areas of life and has posed additional strains on the highly vulnerable group of caregivers of children with rare diseases (RDs). The psychosocial situation of the family caregivers deserves more attention, both in research and practice. The current study explores the distress level of caregivers of children with RDs, their psychosocial information needs, and caregiver-reported health-related quality of life (HRQoL) of children with RDs in times of the COVID-19 pandemic.

METHODS

Data from a cross-sectional online survey conducted within the German CARE-FAM-NET project (children affected by rare diseases and their families-network) between March and August 2020 were examined. The study sample included 149 family caregivers, mostly mothers (83.2%) of 167 children with RDs. The survey assessed demographic and disease-related characteristics, distress and everyday problems of caregivers (Distress Thermometer for Parents; scale 0-10), psychosocial information needs (self-developed items; scale 0-100), and caregiver-reported HRQoL of the children with RDs (DISABKIDS Chronic Generic Measure, short-form; scale 0-100). Using descriptive statistics, we analyzed the psychosocial situation of families during the COVID-19 pandemic. We further conducted correlation analysis to investigate interrelations.

RESULTS

The distress level among caregivers was high (M = 6.84, SD = 2.43); 89.6% reported clinical distress (≥ 4). Everyday problems (e.g., sleep problems, fatigue, being out of shape, fears, feeling tense or nervous, and worry) were frequent. Caregivers reported a wide range of psychosocial information needs. In about half of the children (49.5%), caregiver-reported HRQoL was low, while average HRQoL (M = 58.7, SD = 19.5) was comparable to parent-reported norm data of children with severe clinical conditions. Distress correlated positively with psychosocial information needs (r = 0.40), and negatively with the caregiver-reported HRQoL of the children (r =  - 0.46).

CONCLUSIONS

This study indicates a high psychosocial burden on family caregivers of children with RDs during the early COVID-19 pandemic, characterized by high distress levels and wide-ranging everyday problems, unmet psychosocial information needs, and reduced caregiver-reported HRQoL in children with RDs. The findings highlight the ongoing need for target group-specific, low-threshold support services (e.g., websites) during and after the pandemic.

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

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