COVID-19 Pandemic Impacts on Children with Developmental Disabilities: Service Disruption, Transition to Telehealth, and Child Wellbeing
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Instruments
2.3. Data Analysis
3. Results
4. Discussion
4.1. Service Disruption and Transition
4.2. Telehealth and In-Person Comparison
4.3. Deteriorations in Child Wellbeing and Related Factors
5. Conclusions
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Conflicts of Interest
References
- Bauer, L.; Broady, K.; Edelberg, W.; Donnell, J.O. Ten Facts about COVID-19 and the U.S. Economy; Brookings: Washington, DC, USA, 2020. [Google Scholar]
- López-Bueno, R.; López-Sánchez, G.F.; Casajús, J.A.; Calatayud, J.; Tully, M.A.; Smith, L. Potential Health-Related Behaviors for Pre-School and School-Aged Children during COVID-19 Lockdown: A Narrative Review. Prev. Med. 2021, 143, 106349. [Google Scholar] [CrossRef]
- López-Bueno, R.; López-Sánchez, G.F.; Gil-Salmerón, A.; Grabovac, I.; Tully, M.A.; Casaña, J.; Smith, L. COVID-19 Confinement and Sexual Activity in Spain: A Cross-Sectional Study. Int. J. Environ. Res. Public Health 2021, 18, 2559. [Google Scholar] [CrossRef]
- Gil-Salmerón, A.; López-Sánchez, G.F.; López-Bueno, R.; Pardhan, S.; Grabovac, I.; Smith, L. Association between Anxious and Depressive Symptomatology and Sexual Activity in Spain: A Cross-Sectional Study during the COVID-19 Quarantine. Int. J. Environ. Res. Public Health 2022, 19, 147. [Google Scholar] [CrossRef]
- Zhang, S.; Liu, M.; Li, Y.; Chung, J.E. Teens’ Social Media Engagement during the COVID-19 Pandemic: A Time Series Examination of Posting and Emotion on Reddit. Int. J. Environ. Res. Public Health 2021, 18, 10079. [Google Scholar] [CrossRef]
- Bentenuto, A.; Mazzoni, N.; Giannotti, M.; Venuti, P.; de Falco, S. Psychological Impact of Covid-19 Pandemic in Italian Families of Children with Neurodevelopmental Disorders. Res. Dev. Disabil. 2021, 109, 103840. [Google Scholar] [CrossRef]
- Brown, J.D.; Moraes, S.; Mayhew, J. Service Needs of Foster Families with Children Who Have Disabilities. J. Child Fam. Stud. 2005, 14, 417–429. [Google Scholar] [CrossRef]
- Eshraghi, A.; Li, C.; Alessandri, M.; Messinger, D.; Eshraghi, R.; Mittal, R.; Armstrong, F.D. COVID-19: Overcoming the Challenges Faced by Individuals with Autism and Their Families. Lancet Psychiatry 2020, 7, 481–483. [Google Scholar] [CrossRef]
- Tohidast, S.A.; Mansuri, B.; Bagheri, R.; Azimi, H. Provision of Speech-Language Pathology Services for the Treatment of Speech and Language Disorders in Children during the COVID-19 Pandemic: Problems, Concerns, and Solutions. Int. J. Pediatr. Otorhinolaryngol. 2020, 138, e110262. [Google Scholar] [CrossRef]
- Sylvan, L.; Goldstein, E.; Crandall, M. Capturing a Moment in Time: A Survey of School-Based Speech-Language Pathologists’ Experiences in the Immediate Aftermath of the Covid-19 Public Health Emergency. Perspect. ASHA Spec. Interest Groups 2020, 5, 1735–1749. [Google Scholar] [CrossRef]
- Zablotsky, B.; Black, L.I.; Maenner, M.J.; Schieve, L.A.; Danielson, M.L.; Bitsko, R.H.; Blumberg, S.J.; Kogan, M.D.; Boyle, C.A. Prevalence and Trends of Developmental Disabilities among Children in the United States: 2009–2017. Pediatrics 2019, 144, e20190811. [Google Scholar] [CrossRef]
- Centers for Disease Control and Prevention (CDC). Facts about Developmental Disabilities. Available online: https://www.cdc.gov/ncbddd/developmentaldisabilities/facts.html (accessed on 3 March 2021).
- Aishworiya, R.; Kang, Y.Q. Including Children with Developmental Disabilities in the Equation During This COVID-19 Pandemic. J. Autism Dev. Disord. 2021, 51, 2155–2158. [Google Scholar] [CrossRef] [PubMed]
- Chadd, K.; Moyse, K.; Enderby, P. Impact of COVID-19 on the Speech and Language Therapy Profession and Their Patients. Front. Neurol. 2021, 12, 629190. [Google Scholar] [CrossRef]
- White, S.W.; Stoppelbein, L.; Scott, H.; Spain, D. It Took a Pandemic: Perspectives on Impact, Stress, and Telehealth from Caregivers of People with Autism. Res. Dev. Disabil. 2021, 113, 103938. [Google Scholar] [CrossRef] [PubMed]
- Jeste, S.; Hyde, C.; Distefano, C.; Halladay, A.; Ray, S.; Porath, M.; Wilson, R.B.; Thurm, A. Changes in Access to Educational and Healthcare Services for Individuals with Intellectual and Developmental Disabilities during COVID-19 Restrictions. J. Intellect. Disabil. Res. 2020, 64, 825–833. [Google Scholar] [CrossRef] [PubMed]
- Kowanda, M.; Cartner, L.; Kentros, C.; Geltzeiler, A.R.; Singer, K.E.; Weaver, W.C.; Lehman, C.D.; Smith, S.; Smith, R.S.; Walsh, L.K.; et al. Availability of Services and Caregiver Burden: Supporting Individuals with Neurogenetic Conditions during the Covid-19 Pandemic. J. Child Neurol. 2021, 36, 760–767. [Google Scholar] [CrossRef] [PubMed]
- Camden, C.; Pratte, G.; Fallon, F.; Couture, M.; Berbari, J.; Tousignant, M. Diversity of Practices in Telerehabilitation for Children with Disabilities and Effective Intervention Characteristics: Results from a Systematic Review. Disabil. Rehabil. 2020, 42, 3424–3436. [Google Scholar] [CrossRef]
- Center for Connected Health Policy. COVID-19 Telehealth Coverage Policies. Available online: https://www.cchpca.org/ (accessed on 9 August 2021).
- Baweja, R.; Brown, S.L.; Edwards, E.M.; Murray, M.J. COVID-19 Pandemic and Impact on Patients with Autism Spectrum Disorder. J. Autism Dev. Disord. 2021, 52, 473–483. [Google Scholar] [CrossRef]
- Anaby, D.R.; Campbell, W.N.; Missiuna, C.; Shaw, S.R.; Bennett, S.; Khan, S.; Tremblay, S.; Kalubi-Lukusa, J.C.; Camden, C. Recommended Practices to Organize and Deliver School-Based Services for Children with Disabilities: A Scoping Review. Child Care Health Dev. 2019, 45, 15–27. [Google Scholar] [CrossRef]
- Ashburner, J.; Vickerstaff, S.; Beetge, J.; Copley, J. Remote versus Face-to-Face Delivery of Early Intervention Programs for Children with Autism Spectrum Disorders: Perceptions of Rural Families and Service Providers. Res. Autism Spectr. Disord. 2016, 23, 1–14. [Google Scholar] [CrossRef]
- Campbell, J.; Theodoros, D.; Russell, T.; Gillespie, N.; Hartley, N. Client, Provider and Community Referrer Perceptions of Telehealth for the Delivery of Rural Paediatric Allied Health Services. Aust. J. Rural Health 2019, 27, 419–426. [Google Scholar] [CrossRef]
- Wales, D.; Skinner, L.; Hayman, M. The Efficacy of Telehealth-Delivered Speech and Language Intervention for Primary School-Age Children: A Systematic Review. Int. J. Telerehabil. 2017, 9, 55–70. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hao, Y.; Franco, J.H.; Sundarrajan, M.; Chen, Y. A Pilot Study Comparing Tele-Therapy and in-Person Therapy: Perspectives from Parent-Mediated Intervention for Children with Autism Spectrum Disorders. J. Autism Dev. Disord. 2021, 51, 129–143. [Google Scholar] [CrossRef] [PubMed]
- McCarthy, M.; Leigh, G.; Arthur-Kelly, M. Practitioners’ Self-Assessment of Family-Centered Practice in Telepractice versus in-Person Early Intervention. J. Deaf Stud. Deaf Educ. 2020, 26, 46–57. [Google Scholar] [CrossRef] [PubMed]
- Hao, Y.; Zhang, S.; Conner, A.; Lee, N. The Evolution of Telepractice Use during the COVID-19 Pandemic: Perspectives of Pediatric Speech-Language Pathologists Academic Editors: Rubén. Int. J. Environ. Res. Public Health 2021, 18, 12197. [Google Scholar] [CrossRef] [PubMed]
- Brooks, S.K.; Smith, L.E.; Webster, R.K.; Weston, D.; Woodland, L.; Hall, I.; Rubin, G.J. The Impact of Unplanned School Closure on Children’s Social Contact: Rapid Evidence Review. Eurosurveillance 2020, 25, 2000188. [Google Scholar] [CrossRef] [Green Version]
- Loades, M.E.; Chatburn, E.; Higson-Sweeney, N.; Reynolds, S.; Shafran, R.; Brigden, A.; Linney, C.; McManus, M.N.; Borwick, C.; Crawley, E. Rapid Systematic Review: The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19. J. Am. Acad. Child Adolesc. Psychiatry 2020, 59, 1218–1239.e3. [Google Scholar] [CrossRef]
- Lee, S.J.; Ward, K.P.; Chang, O.D.; Downing, K.M. Parenting Activities and the Transition to Home-Based Education during the COVID-19 Pandemic. Child. Youth Serv. Rev. 2021, 122, 105585. [Google Scholar] [CrossRef]
- Nonweiler, J.; Rattray, F.; Baulcomb, J.; Happé, F.; Absoud, M. Prevalence and Associated Factors of Emotional and Behavioural Difficulties during COVID-19 Pandemic in Children with Neurodevelopmental Disorders. Children 2020, 7, 128. [Google Scholar] [CrossRef]
- Wong, C.A.; Ming, D.; Maslow, G.; Gifford, E.J. Mitigating the Impacts of the Covid-19 Pandemic Response on at-Risk Children. Pediatrics 2020, 146, e20200973. [Google Scholar] [CrossRef] [Green Version]
- Chandler, J.; Shapiro, D. Conducting Clinical Research Using Crowdsourced Convenience Samples. Annu. Rev. Clin. Psychol. 2016, 12, 53–81. [Google Scholar] [CrossRef] [Green Version]
- Butwicka, A.; Långström, N.; Larsson, H.; Lundström, S.; Serlachius, E.; Almqvist, C.; Frisén, L.; Lichtenstein, P. Increased Risk for Substance Use-Related Problems in Autism Spectrum Disorders: A Population-Based Cohort Study. J. Autism Dev. Disord. 2017, 47, 80–89. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Hauser-Cram, P.; Woodman, A.C. Trajectories of Internalizing and Externalizing Behavior Problems in Children with Developmental Disabilities. J. Abnorm. Child Psychol. 2016, 44, 811–821. [Google Scholar] [CrossRef] [PubMed]
- Heeramun, R.; Magnusson, C.; Gumpert, C.H.; Granath, S.; Lundberg, M.; Dalman, C.; Rai, D. Autism and Convictions for Violent Crimes: Population-Based Cohort Study in Sweden. J. Am. Acad. Child Adolesc. Psychiatry 2017, 56, 491–497.e2. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Lee, S.S.; Humphreys, K.L.; Flory, K.; Liu, R.; Glass, K. Prospective Association of Childhood Attention-Deficit/Hyperactivity Disorder (ADHD) and Substance Use and Abuse/Dependence: A Meta-Analytic Review. Clin. Psychol. Rev. 2011, 31, 328–341. [Google Scholar] [CrossRef] [PubMed] [Green Version]
- Farmer, C.A.; Aman, M.G. Aggressive Behavior in a Sample of Children with Autism Spectrum Disorders. Res. Autism Spectr. Disord. 2011, 5, 317–323. [Google Scholar] [CrossRef]
- Marquis, S.M.; Mcgrail, K.; Hayes, M.V. Mental Health Outcomes among Parents of a Child Who Has a Developmental Disability: Comparing Different Types of Developmental Disability. Disabil. Health J. 2020, 13, 100874. [Google Scholar] [CrossRef]
- Robinson-Whelen, S.; Hughes, R.B.; Taylor, H.B.; Markley, R.; Vega, J.C.; Nosek, T.M.; Nosek, M.A. Promoting Psychological Health in Women with SCI: Development of an Online Self-Esteem Intervention. Disabil. Health J. 2020, 13, 100867. [Google Scholar] [CrossRef]
Variable | Pre Pandemic Outbreak (%) | Post Pandemic Outbreak (%) | McNemar’s Test a | p-Value |
---|---|---|---|---|
Service Structure Transition | ||||
Receiving special education services | 64 | 60 | 0.73 | 0.39 |
Receiving other services | ||||
In-person treatment services | 72 | 7 | 66 | <0.001 |
Telehealth treatment services | 3 | 43 | 40 | <0.001 |
Both telehealth and in-person services | 6 | 18 | 7.2 | 0.007 |
No services | 19 | 33 | 12.25 | <0.001 |
Service Loss in Amount and Duration due to the Pandemic Outbreak | ||||
Service loss amount | % | |||
Has reduced greatly | 29 | |||
Has reduced moderately | 36 | |||
Has been similar | 28 | |||
Has increased moderately | 8 | |||
Service loss duration | ||||
No service lost | 24 | |||
Losing service less than 2 months | 27 | |||
Losing services more than 2 months | 33 | |||
No services prior to the pandemic | 17 |
Measure | Mean | Std | Min | Max |
---|---|---|---|---|
Compare with IN-PERSON services, TELE-HEALTH has more: | ||||
1. Time flexibility | 4.06 | 0.97 | 1 | 5 |
2. Transportation convenience | 4.5 | 0.81 | 1 | 5 |
3. Diagnostic accuracy | 2.54 | 0.82 | 1 | 5 |
4. Treatment effectiveness | 2.59 | 0.91 | 1 | 5 |
5. Communication clarity | 2.9 | 1.05 | 1 | 5 |
6. Ease of communication | 3.18 | 1.14 | 1 | 5 |
7. Rapport building with clinicians | 2.56 | 0.97 | 1 | 5 |
8. Comfortableness | 3.17 | 1.12 | 1 | 5 |
9. Privacy protection | 2.62 | 1.08 | 1 | 5 |
10. Acceptance | 3.22 | 0.96 | 1 | 5 |
Telehealth preference scale (items 1 to 10; Cronbach alpha = 0.84) | 2.87 | 0.63 | 1 | 5 |
11. Overall, comparing telehealth with in-person services, you would say telehealth is? | 2.51 | 0.83 | 1 | 5 |
12. How would you rate your likelihood of using telehealth in the future even if in-person services become normal? | 2.75 | 1.09 | 1 | 5 |
Measure | Mean | SD | Min | Max |
---|---|---|---|---|
Children’s behavioral and emotional changes after the pandemic outbreak: | ||||
Becoming more aggressive or rebellious | 1.75 | 0.86 | 1 | 4 |
Becoming more anxious or depressed | 2.00 | 0.96 | 1 | 4 |
Becoming more restless and less concentrating | 2.40 | 0.93 | 1 | 4 |
Becoming more difficult to communicate | 1.80 | 0.89 | 1 | 4 |
Children’s behavioral and emotional scale | 1.99 | 0.76 | 1 | 4 |
Potential Causes for children’s behavioral and emotional changes: | ||||
Treatment services stopped or reduced | 2.28 | 1.09 | 1 | 4 |
Service change from in-person to online services | 2.49 | 1.23 | 1 | 4 |
Isolation from friends, extended family members, and other social networks | 2.89 | 1.07 | 1 | 4 |
Child or family stress | 2.22 | 0.93 | 1 | 4 |
Variable | Model 1 | Model 2 | Model 3 | Model 4 | ||||||||
---|---|---|---|---|---|---|---|---|---|---|---|---|
b | SE | p | b | SE | p | b | SE | p | b | SE | p | |
Intercept | 2.36 | 0.25 | <0.001 *** | 1.23 | 0.32 | <0.001 *** | 1.42 | 0.3 | <0.001 *** | 0.66 | 0.28 | 0.022 * |
Age (0 to 8) | ||||||||||||
9 to 12 | 0.2 | 0.19 | 0.298 | 0.34 | 0.17 | 0.048 * | 0.1 | 0.17 | 0.558 | 0.37 | 0.14 | 0.011 * |
13 to 17 | −0.06 | 0.19 | 0.739 | 0.04 | 0.18 | 0.841 | −0.1 | 0.18 | 0.552 | 0.04 | 0.14 | 0.791 |
Female | −0.11 | 0.17 | 0.535 | −0.02 | 0.15 | 0.901 | −0.16 | 0.15 | 0.315 | −0.15 | 0.13 | 0.238 |
Non-Hispanic White | −0.41 | 0.17 | 0.02 * | −0.28 | 0.16 | 0.083 | −0.23 | 0.16 | 0.158 | −0.17 | 0.13 | 0.195 |
Disability | ||||||||||||
ADHD | 0.15 | 0.17 | 0.386 | 0.15 | 0.15 | 0.311 | 0.11 | 0.15 | 0.47 | 0.06 | 0.12 | 0.607 |
ASD | 0.25 | 0.19 | 0.193 | 0.17 | 0.17 | 0.321 | 0.29 | 0.17 | 0.1 | 0.09 | 0.14 | 0.519 |
Family income > $50,000 | −0.29 | 0.17 | 0.1 | −0.16 | 0.16 | 0.317 | −0.18 | 0.16 | 0.254 | −0.14 | 0.13 | 0.256 |
Caregiver married | −0.07 | 0.17 | 0.688 | −0.14 | 0.15 | 0.358 | −0.22 | 0.16 | 0.172 | −0.13 | 0.13 | 0.293 |
Potential Causes | ||||||||||||
1. Service disruption | 0.22 | 0.07 | 0.001 ** | 0.12 | 0.06 | 0.028 * | ||||||
2. Service transition | 0.17 | 0.06 | 0.003 ** | 0.06 | 0.05 | 0.203 | ||||||
3. Isolation | 0.31 | 0.07 | <0.001 *** | 0.03 | 0.07 | 0.656 | ||||||
4. Stress | 0.45 | 0.07 | <0.001 *** | |||||||||
R-square | 0.12 | 0.31 | 0.28 | 0.56 |
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Zhang, S.; Hao, Y.; Feng, Y.; Lee, N.Y. COVID-19 Pandemic Impacts on Children with Developmental Disabilities: Service Disruption, Transition to Telehealth, and Child Wellbeing. Int. J. Environ. Res. Public Health 2022, 19, 3259. https://doi.org/10.3390/ijerph19063259
Zhang S, Hao Y, Feng Y, Lee NY. COVID-19 Pandemic Impacts on Children with Developmental Disabilities: Service Disruption, Transition to Telehealth, and Child Wellbeing. International Journal of Environmental Research and Public Health. 2022; 19(6):3259. https://doi.org/10.3390/ijerph19063259
Chicago/Turabian StyleZhang, Saijun, Ying Hao, Yali Feng, and Na Youn Lee. 2022. "COVID-19 Pandemic Impacts on Children with Developmental Disabilities: Service Disruption, Transition to Telehealth, and Child Wellbeing" International Journal of Environmental Research and Public Health 19, no. 6: 3259. https://doi.org/10.3390/ijerph19063259