Caring for the Most Vulnerable: A Model for Managing Maladaptive Behavior in Children with Mental Special Needs During the COVID-19 Pandemic.

Background: This article presents the results of a comprehensive national model developed for managing maladaptive behaviors (MBs) in children with mental special needs (CMSNs) during the coronavirus disease 2019 (COVID-19) pandemic that combines telehealth-based Applied Behavioral Analyses, psychiatric interventions, and support from local psychosocial teams. This study aims to determine the effectiveness of a system that combined telehealth applications with local psychosocial support teams, allowing services from video calls to emergency interventions. Materials and Methods: The system combines the telehealth applications with the services from local psychosocial intervention teams. In addition to system records covering sociodemographic variables and initial complaints, a telephone survey questioning the effectiveness and satisfaction of the system was used as the main outcome. Results: In total, 347 individuals used the system with mothers constituting the majority of applicants (88.7%, n = 332). The overall satisfaction of the system was 8.8/10. In terms of effectiveness, 63.3% (n = 237) of caregivers reported an improvement in the reason of application. Counselors decided on a need for follow-up visits for 36.6% (n = 137) of applications. A referral to a psychiatrist was asked for 40 patients (10.6%). Discussion: To our best knowledge, this is the first study presenting a model for managing MBs of CMSNs during the COVID-19 outbreak. In general, therefore, it seems that there is a need for unique systems to handle behavioral problems of CMSNs. Conclusions: The findings of this study suggest that it is possible to establish an integrative multistep multidisciplinary telehealth-based approach in a short while.

Exacerbation of obsessive compulsive disorder symptoms in children and adolescents during COVID-19 pandemic.

OBJECTIVE: To investigate the effects of COVID-19 pandemic and related home confinement on symptom profile, symptom severity and exacerbation of obsessive compulsive disorder (OCD) symptoms and related factors among young subjects with OCD. METHOD: Young subjects who have been followed up with a primary diagnosis of OCD in a university hospital were reached by telephone or online programs to assess symptom profile, symptom severity and exacerbation during pandemic. Children's Yale-Brown Obsessive Compulsive (CY-BOCS) and Clinical Global Impression- Severity (CGI-S) Scales were used to rate symptom profile and severity before pandemic and during pandemic periods. RESULTS: There was a significant increase in the frequency of contamination obsessions (p=0.008) and cleaning/washing compulsions (p=0.039) during pandemic period. CY-BOCS obsessions (p<0.001), compulsions subscales (p<0.001) and total scores (p<0.001), and CGI-S scores (p<0.001) during pandemic period were statistically higher than before pandemic period. There was a significant relationship between the change in CY-BOCS scores with talking/searching in the social environment about COVID-19, daily preoccupation about COVID-19, duration of OCD diagnosis and diagnosis of COVID-19 in someone familiar. CONCLUSIONS: Young subjects with OCD may develop additional symptoms and worsen already existing symptoms of OCD during COVID-19 pandemic.