This large cross-sectional study examined the impact of COVID-19 emergency measures on child/adolescent mental health for children/adolescents with and without pre-existing psychiatric diagnoses. Using adapted measures from the CRISIS questionnaire, parents of children aged 6–18 (N = 1013; 56% male; 62% pre-existing psychiatric diagnosis) and self-reporting children/adolescents aged 10–18 (N = 385) indicated changes in mental health across six domains: depression, anxiety, irritability, attention, hyperactivity, and obsessions/compulsions. Changes in anxiety, irritability, and hyperactivity were calculated for children aged 2–5 years using the Strengths and Difficulties Questionnaire. COVID-19 exposure, compliance with emergency measures, COVID-19 economic concerns, and stress from social isolation were measured with the CRISIS questionnaire. Prevalence of change in mental health status was estimated for each domain; multinomial logistic regression was used to determine variables associated with mental health status change in each domain. Depending on the age group, 67–70% of children/adolescents experienced deterioration in at least one mental health domain; however, 19–31% of children/adolescents experienced improvement in at least one domain. Children/adolescents without and with psychiatric diagnoses tended to experience deterioration during the first wave of COVID-19. Rates of deterioration were higher in those with a pre-exiting diagnosis. The rate of deterioration was variable across different age groups and pre-existing psychiatric diagnostic groups: depression 37–56%, anxiety 31–50%, irritability 40–66%, attention 40–56%, hyperactivity 23–56%, obsessions/compulsions 13–30%. Greater stress from social isolation was associated with deterioration in all mental health domains (all ORs 11.12–55.24). The impact of pre-existing psychiatric diagnosis was heterogenous, associated with deterioration in depression, irritability, hyperactivity, obsession/compulsions for some children (ORs 1.96–2.23) but also with improvement in depression, anxiety, and irritability for other children (ORs 2.13–3.12). Economic concerns were associated with improvement in anxiety, attention, and obsessions/compulsions (ORs 3.97–5.57). Children/adolescents with and without pre-existing psychiatric diagnoses reported deterioration. Deterioration was associated with increased stress from social isolation. Enhancing social interactions for children/adolescents will be an important mitigation strategy for current and future COVID-19 waves.

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Mostly worse, occasionally better: impact of COVID-19 pandemic on the mental health of Canadian children and adolescents.

Caregivers and families of autistic people have experienced stress and increase in demands due to the COVID-19 pandemic that may have long-term negative consequences for both their own and their children's mental health. A scoping review was conducted to identify pandemic related demands experienced by caregivers and families of autistic children and youth. The review also consolidated information on coping strategies and parenting-related guidelines that have emerged to help parents meet these demands. Search strategies were approved by a research librarian and were conducted in peer-reviewed and gray literature databases between May 2020 and February 2021. Additional resources were solicited through author networks and social media. All articles were published between December 2019 and February 2021. Article summaries were charted, and a thematic analysis was conducted with confirmation of findings with our knowledge users. Twenty-three published articles and 14 pieces of gray literature were included in the review. The majority of articles characterized and highlighted the increase in demands on caregivers of autistic children and youth during the pandemic globally. Both quantitative and qualitative studies suggest that parents have experienced an increase in stress and mental health-related symptoms during lockdown measures. Findings suggest that families are employing coping strategies, but there no evidence-based supports were identified. The review highlighted the potential long-term impact of prolonged exposure to increasing demands on the mental health and wellbeing of caregivers and families of autistic people, and pointed to a need for the rapid development and evaluation of flexible and timely support programs. LAY SUMMARY: Caregivers and families of autistic children and youth have faced increased demands due to pandemic-related lockdown measures. We reviewed the literature to outline sources of stress, links to their influence on caregiver mental health, and if support programs have emerged to help them. Our findings suggest a number of demands have increased caregivers' risk to mental health challenges, and their potential impact on family wellbeing. Ongoing development of evidence-based supports of all families of autistic children and youth are needed.

The impact of COVID-19 on the mental health and wellbeing of caregivers of autistic children and youth: A scoping review.

This study aimed to reveal how the COVID-19 stay-at-home period has affected the quality of life (QOL) of children with neurodevelopmental disorders and their parents and to identify possible factors that enabled them to maintain their QOL. We enrolled 136 school-aged children (intellectual quotient ≥ 50) and their parents and administered QOL questionnaires to assess the maladaptive behavior of the children; depression, anxiety, and stress of the parents; and activities of their daily lives. The relationship between their QOL and clinical features was examined. The decrease in QOL of children and parents was associated with the mother's limited job flexibility. Decreased QOL was also associated with changes in the sleep rhythms of the children. Maladaptive behaviors in children were associated with parental stress. However, maintained QOL of some families who faced these same conditions of job stress and sleep disorders was associated with less parental stress, less parental depression and anxiety, and milder maladaptive behavior in children. Both mothers with limited job flexibility and changes in the sleep rhythm of children were associated with reduced QOL of children and their parents. Low parental stress was associated with decreased maladaptive behavior in children and with maintained QOL of the family.

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The quality of life of children with neurodevelopmental disorders and their parents during the Coronavirus disease 19 emergency in Japan.

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

Background: For the first time in a century, the world society is faced with the pandemic which is the coronavirus disease 2019 (COVID-19) There is a lack of i

The Serbian experience of challenges of parenting children with autism spectrum disorders during the COVID-19 pandemic and the state of emergency with lockdown.

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Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic

We evaluated factors affecting psychological ill-effects and resilience of caregivers of children with developmental disabilities during the coronavirus pandemic. Depression, Anxiety, and Stress Scales (DASS-21) and Connor-Davidson Resilience Scale 25-item were administered. Logistic regression was used to identify factors associated with psychological ill-effects and resilience. DASS-21 depression, anxiety and stress scores were high; these were associated with difficulties with infection control measures, autism diagnosis, and need for early intervention services. For caregivers of children with ASD, our DASS-21 scores were significantly higher than non-pandemic scores locally and in other Asian sites. Resilience scores correlated inversely with DASS-21 scores. Targeted support to selected at-risk caregivers and improving resilience can help their coping.

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Factors Contributing to Psychological Ill-Effects and Resilience of Caregivers of Children with Developmental Disabilities During a Nation-wide Lockdown During the COVID-19 Pandemic.

The Coronavirus Disease 2019 pandemic by virtue of its sudden, unprecedented and widespread nature, has led to a multitude of psychological effects on individuals across societies. This includes anxiety which has important implications on the daily functioning, physical and mental health of individuals. Children are a vulnerable group of the population who can experience anxiety which potentially can lead to long-lasting implications on their health for years to come. It is thus important that their caregivers, including parents and healthcare professionals be aware of strategies that can help with anxiety in children. This article discusses anxiety in children in the context of the COVID-19 pandemic and outlines strategies that may be helpful.

/pdf/managing-children-s-anxiety-during-covid-19-pandemic-39xkhp5jr0.pdf

Managing Children's Anxiety During COVID-19 Pandemic: Strategies for Providers and Caregivers.

Consequent to the coronavirus disease 2019 (COVID-19) pandemic, health care visits have heightened infectious disease protocols, including COVID-19 testing of patients with suspected or proven infections. This has resulted in additional stress and anxiety for children who have limited understanding of the rationale for these changes.1Meherali S. Punjani N. Louie-Poon S. Abdul Rahim K. Das J.K. Salam R.A. et al.Mental Health of children and adolescents amidst COVID-19 and past pandemics: a rapid systematic review.Int J Environ Res Public Health. 2021; 18: 3432Crossref PubMed Scopus (66) Google Scholar Isolation protocols, unfamiliar appearance of health care workers in personal protective equipment, and discomfort of nasopharyngeal swabs are among the many new but distressing experiences that children encounter during a health care visit nowadays. Support kits such as visual schedules and social stories are well-established interventions for children with special needs, particularly those with autism spectrum disorder.2Knight V. Sartini E. Spriggs A.D. Evaluating visual activity schedules as evidence-based practice for individuals with autism spectrum disorders.J Autism Dev Disord. 2015; 45: 157-178Crossref PubMed Scopus (73) Google Scholar Visual support kits have been used in the dental setting to help prepare children with autism for dental examination.3Marion I.W. Nelson T.M. Sheller B. McKinney C.M. Scott J.M. Dental stories for children with autism.Spec Care Dentist. 2016; 36: 181-186Crossref PubMed Scopus (20) Google Scholar Social stories have also been shown to improve outcomes in children with disruptive behavior.4Hanrahan R. Smith E. Johnson H. Constantin A. Brosnan M. A pilot randomised control trial of digitally-mediated social stories for children on the autism spectrum.J Autism Dev Disord. 2020; 50: 4243-4257Crossref PubMed Scopus (10) Google Scholar However, recent research is limited with regard to the utility of such a visual support kit in the COVID-19-related medical setting. Thus, our team created a “Special Care Kit” (https://bit.ly/specialcarekit-covid19) to provide resources to support children (both neurotypical and developmental needs) and their caregivers during their visits to health care facilities for COVID-19-related issues. The kit comprises visual schedules (Supplementary Fig. 1), social stories, pictorial boards, and animated videos to illustrate and explain the different COVID-19 processes in a developmentally appropriate manner. The kit was made available online for free. Physical copies were distributed to community clinics managing COVID-19 suspects, ambulances, and hospital emergency departments. Details of the kit were previously discussed.5Goh T.J. Lim T. Foo M. Ong SKA Aishworiya R. Nair T. et al.Supporting individuals with autism spectrum disorder in medical settings during COVID-19.Asian J Psychiatr. 2020; 54: 102441Crossref PubMed Scopus (1) Google Scholar The effectiveness of the Special Care Kit in improving the experience of children and caregivers during their COVID-19-related health care encounters was assessed through voluntary, anonymous surveys completed by parents or caregivers of children who had a COVID-19-related visit to an emergency department of a tertiary hospital from June to December 2020. Implied informed consent was taken when caregivers completed the survey, as documented in the survey sheet. All children and their accompanying caregivers were shown a relevant aspect of the kit before or during their medical encounter. Information collected included demographic data, developmental diagnosis, usual communication skills of the child, and qualitative feedback on the support kit. Descriptive statistics were used to analyze results. The National Health care Group Domain Specific Review Board provided ethical approval for the study under DSRB Domain F (Reference no. 2020/00489). A total of 46 caregivers participated in the study. The mean age of the patients was 5.1 years. Six (13.0%) patients had developmental difficulties (four had speech and language delay and two had autism spectrum disorder), of which three were still at the pre-verbal stage (such as using pictures or pointing and gestures to communicate). The remaining patients were reported to be typically developing. Nearly all (98.0%, 45/46) caregivers felt that the Special Care Kit helped their children have a better health care experience, with 39% (18/46) of them noting that their child was calmer and took the whole experience better than expected. Moreover, 61% (28/46) of the caregivers felt that their children had a better understanding of the events during the encounter, and 21% (13/46) felt that the kit helped improve the communication between the medical team and family. The majority 91% (42/46) would like to have access to other similar support kits during their child's future health care visits. The use of age-appropriate support kits in young children is potentially effective in improving their health care experience during the pandemic. The Special Care Kit may allow for better understanding of the processes, reduce the anxiety of the encounter, and improve the communication between the medical team and family. While visual support is widely used and effective in children with developmental needs, preliminary evidence from this pilot study performed during the pandemic established that they can be also helpful in typically developing children. The study is limited by the lack of data from children who did not utilize the kit. However, the psychological effect of COVID-19 on children (without using the Special Care Kit) is well established with significant difficulty during quarantine, routine change, and access to health care for those with pre-existing behavioral issues.6Panda P.K. Gupta J. Chowdhury S.R. Kumar R. Meena A.K. Madaan P. et al.Psychological and behavioral impact of lockdown and quarantine measures for COVID-19 pandemic on children, adolescents and caregivers: a systematic review and meta-analysis.J Trop Pediatr. 2021; 67: fmaa122Crossref PubMed Scopus (93) Google Scholar Children who were hospitalized for COVID-19 were also reported to have more severe depression, anxiety, and post-traumatic stress disorder symptoms than healthy controls.7Zhang A. Shi L. Yan W. Xiao H. Bao Y. Wang Z. et al.Mental Health in children in the context of COVID-19: focus on discharged children.Front Psychiatry. 2021; 12: 759449Crossref PubMed Scopus (1) Google Scholar Beyond its utility in a pandemic, caregivers would likely benefit from more age-appropriate support for their children in health care settings, as these can help reduce the stress and anxiety for the family during a new health care experience. 

http://www.pediatr-neonatol.com/article/S1875957222000651/pdf

Tammy S H Lim

Papers

Autism Spectrum Disorder and COVID-19: Helping Caregivers Navigate the Pandemic

Factors Contributing to Psychological Ill-Effects and Resilience of Caregivers of Children with Developmental Disabilities During a Nation-wide Lockdown During the COVID-19 Pandemic.

Managing Children's Anxiety During COVID-19 Pandemic: Strategies for Providers and Caregivers.

Visual supports to optimize COVID-19-related healthcare encounters for young/preschool children

Minimizing risk of infection when using developmental and psychological assessment tools: Looking beyond COVID-19.