Economic impacts of the COVID-19 pandemic on families of children with autism and other developmental disabilities

Background

To control the spread of the coronavirus disease (COVID-19), many jurisdictions throughout the world enacted public health measures that had vast socio-economic implications. In emergency situations, families of children with developmental disabilities (DDs), including autism, may experience increased difficulty accessing therapies, economic hardship, and caregiver stress, with the potential to exacerbate autism symptoms. Yet, limited research exists on the economic impacts of the COVID-19 pandemic on families of children with autism or another DD compared to families of children from the general population.

Objectives

To assess impact of the COVID-19 pandemic related to parental employment and economic difficulties in families of children with autism, another DD, and in the general population, considering potential modification by socioeconomic disadvantage before the pandemic and levels of child behavioral and emotional problems.

Methods

The Study to Explore Early Development (SEED) is a multi-site, multi-phase, case-control study of young children with autism or another DD as compared to a population comparison group (POP). During January-July 2021, a COVID-19 Impact Assessment Questionnaire was sent to eligible participants (n=1,789) who had enrolled in SEED Phase 3 from September 2017-March 2020. Parents completed a questionnaire on impacts of the pandemic in 2020 and completed the Child Behavior Checklist (CBCL) to measure behavioral and emotional health of their child during this time. Multiple logistic regression models were built for employment reduction, increased remote work, difficulty paying bills, or fear of losing their home. Covariates include group status (autism, DD, POP), household income at enrollment, child's race and ethnicity, and binary CBCL Total Problems T-score (<60 vs. ≥60). Unadjusted and adjusted odds ratios (aOR) and 95% confidence intervals (CI) were calculated.

Results

The study included 274 children with autism, 368 children with another DD, and 385 POP children. The mean age of 6.1 years (standard deviation, 0.8) at the COVID-19 Impact Assessment did not differ between study groups. Parents of children with autism were less likely to transition to remote work (aOR [95% CI] = 0.6 [0.4, 1.0]) and more likely to report difficulty paying bills during the pandemic (1.8 [1.2, 2.9]) relative to parents of POP children. Lower income was associated with greater employment reduction, difficulty paying bills, and fear of losing their home, but inversely associated with transitioning to remote work. Parents of non-Hispanic (NH) Black children experienced greater employment reduction compared to parents of NH White children (1.9 [1.1, 3.0]). Parents from racial and ethnic minority groups were more likely to experience difficulty paying bills and fear losing their home, relative to NH White parents. Caregivers of children with CBCL scores in the clinical range were more likely to fear losing their home (2.1 [1.3, 3.4]).

Conclusion

These findings suggest that families of children with autism, families of lower socio-economic status, and families of racial and ethnic minority groups experienced fewer work flexibilities and greater financial distress during the pandemic. Future research can be used to assess if these impacts are sustained over time.

Risk factors and clinical correlates of sensory dysfunction in preschool children with and without autism spectrum disorder

Sensory dysfunction is a common feature of autism spectrum disorder (ASD). The objectives of this analysis were to examine risk factors and clinical correlates of sensory dysfunction in preschool children with and without ASD. Children aged 2-5 years were enrolled in a multi-site case-control study. Data were collected in eight areas across the United States in three phases. Caregivers completed an interview with questions on assisted delivery, maternal alcohol use, maternal anxiety during pregnancy, pregnancy weight gain, neonatal jaundice, preterm birth, and child sensory diagnosis given by a healthcare provider. Caregivers also completed an interview and questionnaires on sensory symptoms and clinical correlates of sensory dysfunction in their child. There were 2059 children classified as ASD, 3139 as other developmental delay or disability (DD), and 3249 as population comparison (POP). Caregivers reported significantly more sensory diagnoses and sensory symptoms in children classified as ASD than DD or POP (23.7%, 8.6%, and 0.8%, respectively, for a sensory diagnosis and up to 78.7% [ASD] vs. 49.6% [DD] for sensory symptoms). Maternal anxiety during pregnancy and neonatal jaundice were significantly associated with a sensory diagnosis and certain sensory symptoms in children with ASD and DD. Children's anxiety, attention deficits/hyperactivity, and sleep problems were significantly albeit subtly correlated with both a sensory diagnosis and sensory symptoms in children with ASD and DD. These findings support sensory dysfunction as a distinguishing symptom of ASD in preschool children and identify risk factors and clinical correlates to inform screening and treatment efforts in those with atypical development.

Report of an Innovative Research Program for Baccalaureate Nursing Students

In summary, an innovative low-cost way to teach undergraduate students about research and to socialize students into attending research conferences has been developed. It is not perfect yet, but with time, critical students, and responsive research-productive faculty, each program should improve. It is not surprising that sophomore students do not achieve the objectives at the same level as older students. As students move closer to the "real" world of nursing practice and develop increasing sophistication about nursing in general and research in particular, they are, hopefully, more knowledgeable consumers of nursing research. What is particularly satisfying to the planners of those Research Days is that through the experience of attending Undergraduate Research Day at various points in their educational progress, students are socialized into discussing research. Additionally, they seemed to develop some degree of comfort with this aspect of their future nursing role. The RN and former student panel participants normalized research involvement for the student attendees. Panel member stories about their mistakes and successes made students realize that nursing investigations need not be the sole property of those with doctoral degrees. A serendipitous outcome of these programs was an increased awareness by students of the specific research project in which their teachers were engaged. Students informally reported a feeling of pride and reflected accomplishment. The importance of timing in offering such programs should not have been a surprise at this urban commuter university. Unwittingly, in scheduling the Friday afternoon program the planners ignored the initial consideration that the program not impose financial hardship on students.(ABSTRACT TRUNCATED AT 250 WORDS)

Mothering behavior and maternal role attainment during the postpartum period

Relationships among subjective and behavioral components of maternal role attainment were investigated separately for 64 primiparous and 60 multiparous mothers. The influence of contextual variables on maternal behavior was also examined. Subjects were medically low risk with normal infants. Attitudes toward themselves and their infants and feelings of self-confidence were measured at 1 to 2 days and 4 to 6 weeks after delivery. At 4 to 6 weeks mothers were also videotaped performing an infant feeding at home. Tapes were rated for maternal sensitivity and responsivity. For primiparas, self-confidence was related to maternal feeding behavior as were maternal age, education, and socioeconomic class. For multiparas, only initial attitude toward self was related to maternal behavior; however, maternal age and infant size were contextual factors related to behavior. Distinctions proposed among subjective and behavioral components are in part supported by the findings of the study.

Maternal role attainment and identity in the postpartum period: stability and change

Stability and change in maternal identity and maternal role attainment were examined in 64 medically normal, middle-class primiparous and 58 multiparous women. Using two semantic differential scales, "Myself as Mother" and "My Baby", for maternal identity and the Pharis (1978) Self-Confidence Scale for role attainment, subjects were tested at 1 to 3 days and 4 to 6 weeks postpartum. Main effects for parity and testing occasions were found for both semantic differential scales. While mothers' attitudes toward themselves became more positive over time, those toward their babies became less positive. Self-confidence showed main effects for both time of testing and parity as well as interaction effects. Although attitudes and self-confidence were stable across testing occasions, self-confidence was less related to indicators of maternal identity for multiparas than for primiparas. Sociodemographic variables demonstrated only low correlations with indicators of maternal identity and role attainment. Testing the relationship of maternal identity and role attainment to actual parenting behaviors is needed to determine the empirical and practical import of these two concepts in nursing practice.