Impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders: Emotional/Behavioral Symptoms and Parental Stress
Abstract
:1. Introduction
2. Materials and Methods
2.1. Participants
2.2. Telephone Interview
- -
- In your opinion, family management during the lockdown period worsened, was unchanged or improved?
- -
- If family management has worsened, what are the principal reasons that led to difficulties in management?
- -
- In your opinion, did the symptoms related to your child’s medical condition worsen during the lockdown period?
- -
- In your opinion, is your child having sleep problems that were not present before?
- -
- In your opinion, is your child having eating problems that were not present before?
- -
- On a scale of 1 to 10, how concerned are you about the general pandemic situation?
- -
- What are your main reasons for concern?
- -
- Are you benefiting or have you benefited from online psychological support provided for the COVID-19 emergency?
- -
- What are the reasons why you did not benefit from online psychological support?
2.3. Child Behavior CheckList
2.4. Parental Stress Index
2.5. Statistical Analysis
3. Results
3.1. Background
- -
- Obligation for everybody to remain in their home;
- -
- Limitation of the free circulation of people (only allowed to deal with necessary situations, after filling a self-certification form);
- -
- Mandatory use of a mask to cover nose and mouth outside one’s own home;
- -
- Prohibition on gatherings, with an obligation to respect the safety distances between one individual and another (at least 1 m);
- -
- Cancellation of all face-to-face teaching activities (including exams) from kindergartens to universities and the beginning of distance learning;
- -
- Closure of non-residential rehabilitation centers;
- -
- The ceasing of all productive activities not considered indispensable;
- -
- Promotion of working from home;
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- Closure of restaurants and shops, an exception made for those that trade essential goods such as food, pharmacies, newsagents, tobacco shops, electronics stores, hardware stores, opticians, laundries and funeral homes;
- -
- Closing of beauty centers, hairdressers, barbers etc.; only services guaranteed were those of banks, post offices and insurance companies;
- -
- Closure of all recreational and sporting activities (cinemas, theatres, museums, gyms, etc.);
- -
- Suspension of religious celebrations.
3.2. Sample Characteristics
3.3. Comparison of Mean Scores at PSI and CBCL before–during COVID-19 Pandemic
3.4. Correlation Analysis between PSI and CBCL Subscales
4. Discussion
Author Contributions
Funding
Institutional Review Board Statement
Informed Consent Statement
Data Availability Statement
Acknowledgments
Conflicts of Interest
References
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Participants n = 383 | |
child age (mean ± SD) | 9.89 ± 4.42 |
sex | |
male | 233 (61%) |
female | 150 (39%) |
father age (mean ± SD) | 43.87 ± 7.05 |
mother age (mean ± SD) | 40.82 ± 6.34 |
maternal education level (mean ± SD) * | 14.07 ± 3.89 |
paternal education level (mean ± SD) * | 14.07 ± 3.71 |
Families who refused to participate in the study n = 15 | |
child age (mean ± SD) | 10.73 ± 4.48 |
sex | |
male | 9/15(%) |
female | 6/15(%) |
father age (mean ± SD) | 43.40 ± 2.64 |
mother age (mean ± SD) | 39.67 ± 2.06 |
maternal education level (mean ± SD) * | 14.27 ± 3.15 |
paternal education level (mean ± SD) * | 13.73 ± 3.24 |
Diagnosis | Autism Spectrum Disorder = 4 Epilepsy = 3 Specific Learning Disorder = 2 Intellectual Disability =3 |
Principal Diagnosis * | Age (Years) | Sex | Father Age (Years) | Mother Age (Years) | Characteristics of the Principal Disease | Neuro-Psychiatric Comorbidities | Other Clinical Conditions | Drug Therapy |
---|---|---|---|---|---|---|---|---|
autism spectrum disorder n = 114 | 8.1 ± 4.24 | male = 79 (69%) | 45.18 ± 6.74 | 41.81 ± 6.32 | level 1 = 44 (39%) level 2 = 43 (38%) level 3 = 27 (24%) | 35 (30%) | 29 (25%) | 22 (19%) |
epilepsy n = 93 | 13.50 ± 7.78 | male = 53 (57%) | 42.50 ± 10.61 | 37.50 ± 10.61 | focal = 51 generalized = 31 unknown = 11 | 26 (28%) | 17 (18%) | 82 (88%) |
specific learning disorders n = 41 | 10.50 ± 2.11 | male = 22 (54%) | 39.72 ± 4.51 | 38.00 ± 3.49 | mixed = 28 (68%) dyslexia + dysorthography = 10 (27%) only dyscalculia = 3 (7%) | 7 (17%) | 7 (17%) | 0 (0%) |
intellectual disability n = 34 | 9.00 ± 4.93 | male = 18 (53%) | 43.42 ± 6.21 | 40.41 ± 6.33 | mild = 21 (62%) moderate = 9 (29) severe = 4 (12%) | 13 (38%) | 14 (41%) | 7 (21%) |
communication disorders n = 32 | 5.09 ± 1.44 | male = 20 (63%) | 38.23 ± 7.17 | 35.56 ± 5.03 | language disorder = 20 (63%) speech sound disorder = 10 (31%) stuttering = 2 (6%) | 4 (13%) | 5 (15%) | 0 (0%) |
attention deficit/hyperactivity disorder n = 21 | 10.76 ± 3.51 | male = 15 (71%) | 44.33 ± 8.12 | 40.52 ± 6.48 | combined = 15 (71%) inattentive = 3 (19) hyperactive/impulsive = 2 (10%) | 5 (24%) | 3 (14%) | 12 (57%) |
behavioral disorders n = 16 | 11.67 ± 2.58 | male = 12 (75%) | 42.50 ± 4.52 | 40.13 ± 4.40 | oppositional-defiant disorder = 13 (81%) conduct disorder = 3 (19%) | 12 (75%) | 2 (13%) | 7 (44%) |
anxiety disorders n = 16 | 11.34 ± 3.45 | male = 7 (44%) | 44.44 ± 7.74 | 43.00 ± 5.59 | generalized anxiety = 9 (56%) school phobia = 5 (31%) social anxiety disorder = 3 (19%) | 12 (75%) | 2 (13%) | 12 (75%) |
mood disorders n = 16 | 12.50 ± 2.79 | male = 7 (44%) | 43.00 ± 6.70 | 40.06 ± 4.92 | depressive disorder = 11 (69%) bipolar disorder = 5 (31%) | 12 (75%) | 2 (13%) | 14 (88%) |
Total sample n = 383 | 9.89 ± 4.42 | male = 233 (61%) | 43.87 ± 7.05 | 40.82 ± 6.34 | - | 126 (33%) | 81 (21%) | 156 (41%) |
Questions | |
---|---|
In your opinion, the family management during this lockdown period is: | |
worse | 275/383 (71.80%) |
unchanged | 89/383 (23.23%) |
improved | 19/383 (4.96%) |
If the family management has worsened, what are the principal reasons that led to difficulties in management? (more than one answer can be provided) | |
changes in daily routine | 195/275 (70.90%) |
home confining | 185/275 (67.27%) |
distance learning | 178/275 (64.72%) |
discontinuation of rehabilitative therapy | 146/275 (53.09%) |
decrease in social relationships | 113/275 (41.09%) |
emotional impact linked to the perception of danger | 98/275 (35.63%) |
Smart-working | 71/275 (25.81%) |
In your opinion, the symptoms related to your child’s medical condition worsened during the lockdown period. | |
yes | 168/383 (43.86%) |
no | 215/383 (56.14%) |
In your opinion, is your child having sleep problems that were not present before? | |
yes | 114/383 (29.77%) |
no | 269/383 (70.23%) |
In your opinion, is your child having eating problems that were not present before? | |
yes | 108/383 (28.20%) |
no | 275/383 (71.80%) |
On a scale of 1 to 10, how concerned are you about the general pandemic situation? | 7.6 ± 2.13 (mean ± standard deviation) |
What are your main reasons for concern? (more than one answer can be provided) | |
fear of COVID contagion | 182/383 (47.51%) |
worsening of the child’s clinical symptoms | 118/383 (30.80%) |
difficulty in obtaining medical assistance | 84/383 (21.93%) |
difficulties in family routine and management | 78/383 (20.36%) |
emergence or worsening of emotional/behavioral problems in the child | 58/383 (15.14%) |
Are you benefiting or have you benefitedfrom online psychological support providedduring the COVID-19 emergency? | |
yes | 8/383 (2.08%) |
no | 375/383 (97.91%) |
What are the reasons why you did not benefitfrom online psychological support? | |
I was not aware of the online psychological support service | 178/375 (47.46%) |
I didn’t consider online psychological support necessary | 129/375 (34.40%) |
Online psychological support was not provided in my municipality | 39/375 (10.41%) |
Other | 29/375 (7.73%) |
Standardized Neuropsychological Test | Time 0 (Mean ± SD) | Time 1 (Mean ± SD) | Statistic (Wilcoxon Test) | p Value | Ꞃ2 | DCohen |
---|---|---|---|---|---|---|
Parental Stress Index (PSI) n = 383 | ||||||
Parental Distress (PD) | 60.29 ± 27.27 | 72.38 ± 28.04 | Z = −10.540 | p< 0.001 | 0.290 | 1.278 |
Parent–Child Difficult Interaction (p-CDI) | 63.61 ± 24.29 | 76.82 ± 24.65 | Z = −11.318 | p< 0.001 | 0.334 | 1.418 |
Difficult Child (DC) | 63.84 ± 26.57 | 75.99 ± 26.47 | Z = −10.379 | p < 0.001 | 0.281 | 1.251 |
Total Stress (TS | 63.45 ± 24.63 | 76.87 ± 25.94 | Z = −12.281 | p< 0.001 | 0.394 | 1.612 |
Child Behavior CheckList (CBCL) 6–18 years n = 315 | ||||||
Anxiety/Depression | 59.36 ± 7.53 | 68.76 ± 13.18 | Z = −11.773 | p< 0.001 | 0.440 | 1.773 |
Withdrawal/Depression | 61.55 ± 8.49 | 69.44 ± 12.73 | Z = −10.652 | p< 0.001 | 0.360 | 1.501 |
Somatic complaints | 58.52 ± 7.97 | 68.59 ± 13.43 | Z = −10.879 | p< 0.001 | 0.376 | 1.552 |
Socialization | 62.20 ± 8.74 | 69.77 ± 12.92 | Z = −10.206 | p< 0.001 | 0.331 | 1.406 |
Thought problems | 61.40 ± 9.87 | 66.06 ± 11.96 | Z = −7.993 | p < 0.001 | 0.203 | 1.009 |
Attention problems | 62.75 ± 9.40 | 68.88 ± 11.48 | Z = −10.109 | p< 0.001 | 0.324 | 1.386 |
Rule-breaking behavior | 58.16 ± 7.02 | 65.28 ± 12.59 | Z = −10.396 | p< 0.001 | 0.343 | 1.445 |
Aggressive behavior | 60.80 ± 10.40 | 67.13 ± 13.26 | Z = −10.110 | p< 0.001 | 0.324 | 1.386 |
Affective problems | 61.87 ± 8.14 | 68.71 ± 11.92 | Z = −11.132 | p< 0.001 | 0.326 | 1.391 |
Anxiety problems | 61.64 ± 7.58 | 69.26 ± 11.95 | Z = −10.989 | p< 0.001 | 0.383 | 1.577 |
Somatic Problems | 57.11 ± 8.12 | 64.39 ± 11.54 | Z = −9.823 | p < 0.001 | 0.306 | 1.329 |
ADHD | 60.52 ± 7.36 | 66.23 ± 10.07 | Z = −9.959 | p < 0.001 | 0.315 | 1.356 |
Oppositional-defiantproblems | 58.01 ± 7.46 | 64.02 ± 10.93 | Z = −9.950 | p < 0.001 | 0.314 | 1.354 |
Conduct problems | 57.05 ± 7.03 | 62.92 ± 10.67 | Z = −10.769 | p< 0.001 | 0.368 | 1.527 |
Internalizing problems | 59.86 ± 9.95 | 68.37 ± 13.37 | Z = −11.227 | p< 0.001 | 0.400 | 1.633 |
Externalizing problems | 57.69 ± 9.72 | 65.83 ± 14.03 | Z = −10.614 | p< 0.001 | 0.358 | 1.492 |
Total Problem | 60.41 ± 9.53 | 68.77 ± 13.71 | Z = −11.757 | p< 0.001 | 0.439 | 1.769 |
Child Behavior CheckList (CBCL) 1.5–5 years n = 68 | ||||||
Emotional response | 54.54 ± 11.71 | 66.40 ± 13.63 | Z = −4.518 | p< 0.001 | 0.300 | 1.310 |
Anxiety/Depression | 55.69 ± 8.56 | 64.21 ± 12.73 | Z = −5.026 | p< 0.001 | 0.371 | 1.538 |
Somatic complaints | 55.03 ± 7.08 | 63.29 ± 12.47 | Z = −4.680 | p< 0.001 | 0.322 | 1.379 |
Withdrawal | 63.62 ± 12.94 | 68.56 ± 14.42 | Z = −2.743 | p= 0.006 | 0.111 | 0.705 |
Sleep problems | 56.91 ± 11.10 | 59.49 ± 11.49 | Z = −3.201 | p= 0.001 | 0.151 | 0.842 |
Attention problems | 61.93 ± 10.63 | 65.00 ± 12.35 | Z = −2.436 | p= 0.015 | 0.087 | 0.618 |
Aggressive behavior | 56.22 ± 9.32 | 66.34 ± 15.30 | Z = −5.078 | p< 0.001 | 0.379 | 1.563 |
Affective problems | 56.63 ± 9.00 | 63.19 ± 12.50 | Z = −4.063 | p< 0.001 | 0.243 | 1.132 |
Anxiety problems | 56.54 ± 8.32 | 63.69 ± 12.12 | Z = −4.337 | p< 0.001 | 0.277 | 1.237 |
Pervasive Problems | 63.74 ± 12.16 | 66.29 ± 12.54 | Z = −2.008 | p= 0.045 | 0.059 | 0.502 |
ADHD | 59.26 ± 8.39 | 62.94 ± 9.11 | Z = −3.313 | p= 0.001 | 0.161 | 0.877 |
Oppositional-defiant problems | 59.09 ± 7.24 | 59.96 ± 9.76 | Z = −4.186 | p< 0.001 | 0.258 | 1.178 |
Internalizing problems | 56.71 ± 12.50 | 64.44 ± 15.86 | Z = −4.308 | p< 0.001 | 0.273 | 1.225 |
Externalizing problems | 56.04 ± 12.11 | 65.66 ± 17.03 | Z = −4.508 | p< 0.001 | 0.299 | 1.306 |
Total Problems | 57.69 ± 13.55 | 65.56 ± 16.92 | Z = −3.999 | p< 0.001 | 0.235 | 1.109 |
CBCL Total Problems | CBCL Externalizing Problems | CBCL Internalizing Problems | |||
---|---|---|---|---|---|
Parental stress | Parental Distress | r | 0.081 | 0.042 | 0.062 |
p value | 0.112 | 0.415 | 0.230 | ||
Parent–Child Difficult Interaction | r | 0.115 | 0.070 | 0.102 | |
p value | 0.024 | 0.172 | 0.045 | ||
Difficult Child | r | 0.089 | 0.128 | 0.092 | |
p value | 0.082 | 0.012 | 0.071 | ||
Total Stress | r | 0.107 | 0.075 | 0.103 | |
p value | 0.036 | 0.144 | 0.043 |
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Operto, F.F.; Coppola, G.; Vivenzio, V.; Scuoppo, C.; Padovano, C.; de Simone, V.; Rinaldi, R.; Belfiore, G.; Sica, G.; Morcaldi, L.; et al. Impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders: Emotional/Behavioral Symptoms and Parental Stress. Int. J. Environ. Res. Public Health 2022, 19, 3795. https://doi.org/10.3390/ijerph19073795
Operto FF, Coppola G, Vivenzio V, Scuoppo C, Padovano C, de Simone V, Rinaldi R, Belfiore G, Sica G, Morcaldi L, et al. Impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders: Emotional/Behavioral Symptoms and Parental Stress. International Journal of Environmental Research and Public Health. 2022; 19(7):3795. https://doi.org/10.3390/ijerph19073795
Chicago/Turabian StyleOperto, Francesca Felicia, Giangennaro Coppola, Valentina Vivenzio, Chiara Scuoppo, Chiara Padovano, Valeria de Simone, Rosetta Rinaldi, Gilda Belfiore, Gianpiero Sica, Lucia Morcaldi, and et al. 2022. "Impact of COVID-19 Pandemic on Children and Adolescents with Neuropsychiatric Disorders: Emotional/Behavioral Symptoms and Parental Stress" International Journal of Environmental Research and Public Health 19, no. 7: 3795. https://doi.org/10.3390/ijerph19073795