Changes in sleep duration and disturbances during Covid-19 lockdown and internalizing-externalizing behaviors in children with attention deficit hyperactivity disorders.

OBJECTIVE: To examine how changes in sleep patterns and sleep problems occurring between the pre-pandemic and the Covid-19 lockdown period influenced mood-behavioral functioning of children with Attention Deficit Hyperactivity Disorder (ADHD). METHODS: Parents of 992 children with ADHD (85.4% boys, mean age: 11.52 years, SD = 3.17), recruited from the Italian ADHD family association, completed a modified version of the Sleep Disturbance Scale for Children and filled out 11 emotional behavioral items selected from the Child Behavior Checklist (CBCL) 6-18 questionnaire. Subgroups identified based on sleep duration changes ("maintained", "increased", "reduced") and of sleep problems during lockdown ("onset", "remission", "maintained", "no sleep problem") were analyzed to evaluate the association with internalizing and externalizing scores. RESULTS: Sleep duration showed no or low influence on internalizing and externalizing behaviors after control for age, sex, and socioeconomic status. Patients with ADHD with "no sleep problem" showed significant lower scores in internalizing and externalizing behaviors than those who "maintained" or had "onset" of different sleep problems. The effect sizes were higher for internalizing than externalizing behaviors. Lower internalizing scores were found in those who remitted difficulty in falling asleep, daytime sleepiness, nightmares, vs. the "maintained" or "onset" groups and those who remitted hypnic jerks vs. the "onset" group. Children with ADHD who "maintained" sleep terrors reported higher internalizing and mainly externalizing scores than the other groups. CONCLUSION: Sleep problems negatively influence daytime functioning of patients with ADHD. but mood and behavioral domains show different susceptibility to the changes of sleep problems, and different vulnerability to specific sleep problems.

The effect of laboratory-verified smoking on SARS-CoV-2 infection: results from the Troina sero-epidemiological survey.

Previous research yielded conflicting results on the association between cigarette smoking and risk of SARS-CoV-2 infection. Since the prevalence of smoking is high globally, the study of its impact on COVID-19 pandemic may have considerable implications for public health. This study is the first to investigate the association between the SARS-CoV-2 antibody sero-positivity and biochemically verified smoking status, to refine current estimates on this association. SARS-CoV-2-specific IgG and serum cotinine levels (a well-known marker of tobacco exposure) were assessed in a large sero-epidemiological survey conducted in the town of Troina (Sicily, Italy). A propensity score matching was carried out to reduce the effect of possible factors on SARS-CoV-2 infection risk among study participants. Of the 1785 subjects included in our study, one-third was classified as current smokers, based on serum cotinine levels. The overall proportion of subjects with positive serology for SARS-CoV-2 IgG was 5.4%. The prevalence of SARS-CoV-2 antibody positivity and previous COVID-19 diagnosis were reduced in smokers. This reduced prevalence persisted after adjusting for possible confounders (such as sex, age, previous infection, chronic conditions, and risk group) at regression analyses, and the point estimates based on the PS-matched models resulted consistent with those for the unmatched population. This study found a lower proportion of positive SARS-CoV-2 serology among current smokers, using direct laboratory measures of tobacco exposure and thus avoiding possible bias associated with self-reported smoking status. Results may also serve as a reference for future clinical research on potential pharmaceutical role of nicotine or nicotinic-cholinergic agonists against COVID-19.

Post-stroke aphasia at the time of COVID-19 pandemic: a telerehabilitation perspective.

We report on our remote speech therapy experience in post-stroke aphasia. The aim was to test the feasibility and utility of telerehabilitation to support future randomized controlled trials. Post-stroke aphasia is a common and disabling speech disorder, which significantly affects patients' and caregivers' health and quality of life. Due to COVID-19 pandemic, most of the conventional speech therapy approaches had to stop or "switch" into telerehabilitation procedures to ensure the safety of patients and operators but, concomitantly, the best rehabilitation level possible. Here, we planned a 5-month telespeech therapy programme, twice per week, of a patient with non-fluent aphasia following an intracerebral haemorrhage. Overall, treatment adherence based on the operator's assessments was high, and incomplete adherence for technical problems occurred very rarely. In line with the patient's feedback, acceptability was also positive, since he was constantly motivated during the sessions and the exercises performed autonomously, as confirmed by the speech therapist and caregiver, respectively. Moreover, despite the sequelae from the cerebrovascular event, evident in some writing tests due to the motor deficits in his right arm and the disadvantages typical of all telepractices, more relevant results were achieved during the telerehabilitation period compared to those of the "face-to-face" therapy before the COVID-19 outbreak. The telespeech therapy performed can be considered successful and the patient was able to return to work. Concluding, we support it as a feasible approach offering patients and their families the opportunity to continue the speech and language rehabilitation pathway, even at the time of pandemic.

Seroepidemiological Survey on the Impact of Smoking on SARS-CoV-2 Infection and COVID-19 Outcomes: Protocol for the Troina Study.

BACKGROUND: After the global spread of SARS-CoV-2, research has highlighted several aspects of the pandemic, focusing on clinical features and risk factors associated with infection and disease severity. However, emerging results on the role of smoking in SARS-CoV-2 infection susceptibility or COVID-19 outcomes are conflicting, and their robustness remains uncertain. OBJECTIVE: In this context, this study aims at quantifying the proportion of SARS-CoV-2 antibody seroprevalence, studying the changes in antibody levels over time, and analyzing the association between the biochemically verified smoking status and SARS-CoV-2 infection. METHODS: The research design involves a 6-month prospective cohort study with a serial sampling of the same individuals. Each participant will be surveyed about their demographics and COVID-19-related information, and blood sampling will be collected upon recruitment and at specified follow-up time points (ie, after 8 and 24 weeks). Blood samples will be screened for the presence of SARS-CoV-2-specific antibodies and serum cotinine, being the latter of the principal metabolite of nicotine, which will be used to assess participants' smoking status. RESULTS: The study is ongoing. It aims to find a higher antibody prevalence in individuals at high risk for viral exposure (ie, health care personnel) and to refine current estimates on the association between smoking status and SARS-CoV-2/COVID-19. CONCLUSIONS: The added value of this research is that the current smoking status of the population to be studied will be biochemically verified to avoid the bias associated with self-reported smoking status. As such, the results from this survey may provide an actionable metric to study the role of smoking in SARS-CoV-2 infection and COVID-19 outcomes, and therefore to implement the most appropriate public health measures to control the pandemic. Results may also serve as a reference for future clinical research, and the methodology could be exploited in public health sectors and policies. INTERNATIONAL REGISTERED REPORT IDENTIFIER (IRRID): DERR1-10.2196/32285.

Impact of COVID-19 pandemic on the neuropsychiatric status of Wilson's disease.

We have read with interest the Letter to the Editor by Drs. Zhuang and Zhong, who presented the clinical data of 68 patients with Wilson's disease (WD) who were admitted to the hospital before and during the coronavirus disease 2019 (COVID-19) pandemic, and appreciated their findings on hepatic and some extrahepatic manifestations. Nevertheless, given the strong impact of the pandemic on patients with neurological and psychiatric disorders, we would have expected a worsening of the psychiatric and/or neurological impairments in these patients. In contrast, according to the authors, these manifestations remained, somewhat unexpectedly, unchanged. This finding is in contrast with most of the current literature that highlights not only an increased incidence of mental health disorders in the general population but also an exacerbation of neurological and psychiatric symptoms in patients with chronic diseases, especially in those with pre-existing neuropsychiatric disorders, such as WD. Although the study was mainly focused on the hepatic features of WD patients taking anti-copper treatment, a generic and cumulative definition of neurological and psychiatric manifestations, as in this study, does not allow for further considerations. Future studies during and after the pandemic are necessary to clarify the real impact, either direct or indirect, of the COVID-19 pandemic on the neurological and psychiatric symptoms of WD patients.

Changes in Sleep Patterns and Disorders in Children and Adolescents with Attention Deficit Hyperactivity Disorders and Autism Spectrum Disorders during the COVID-19 Lockdown.

BACKGROUND: The COVID-19 lockdown determined important changes in the sleep of a large percentage of the world population. We assessed the modifications of reported sleep patterns and disturbances in Italian children and adolescents with autism spectrum disorders (ASD) or attention deficit hyperactivity disorders (ADHD), compared to control children, before and during the COVID-19 lockdown in Italy. METHODS: Parents of 100 ASD, 236 ADHD patients, and 340 healthy children filled out an anonymous online survey and a modified version of the Sleep Disturbance Scale for Children (SDSC), advertised via social media, to evaluate sleep patterns and disturbances of their children before and during the lockdown. RESULTS: Before the lockdown, bedtime and risetime were not different between the three groups. During the lockdown, ADHD children tended to have a later bedtime and risetime than ASD and controls, while ASD children tended to maintain similar bedtime and risetime. Overall, during the lockdown, a reduced sleep duration significantly differentiated clinical groups from controls. Anxiety at bedtime, difficulties in falling asleep, and daytime sleepiness increased in all groups during the lockdown. Hypnic jerks, rhythmic movement disorders, night awakenings, restless sleep, sleepwalking, and daytime sleepiness increased in ASD and ADHD patients, in particular. CONCLUSIONS: This is the first study comparing sleep habits and disorders in ASD and ADHD during the lockdown showing specific differences consistent with the core characteristics of two neurodevelopmental disorders.

The impact of COVID-19 confinement on the neurobehavioral manifestations of people with Major Neurocognitive Disorder and on the level of burden of their caregivers

The long-term consequences of confinement at home due to the COVID-19 pandemic are not yet known;however, an exacerbation of the neurobehavioral symptoms of patients with dementia and an increase in their caregiver burden are conceivable. The aims of this study were to investigate any changes in the neuropsychiatric symptoms of patients with Major Neurocognitive Disorder as well as in the levels of burden and distress of their caregivers due to COVID-19 confinement, and to detect any relationship between the changes in patients and their caregivers. A "pre-post" study was carried out by means of a semi-structured telephone interview, which was administered to 128 caregivers of patients with dementia. The interview included patient and caregiver demographic information, the Neuropsychiatric Inventory-Questionnaire (NPI-Q) and the Caregiver Burden Inventory (CBI). Results showed an increased risk for burning out of caregivers by about 10%. Statistically significant differences were found between the conditions prior to lockdown (pre-lockdown) and during lockdown in both the CBI and the NPI-Q distress scale. Neuropsychiatric symptoms in patients with dementia significantly increased as well. Results have a practical implication for the organization of public and private support services. (PsycInfo Database Record (c) 2021 APA, all rights reserved)

Impact of COVID-19 lockdown on sleep in children with autism spectrum disorders.

STUDY OBJECTIVES: The impact of the COVID-19 outbreak on sleep of participants with autism spectrum disorder (ASD) was assessed. METHODS: Parents of 111 children and adolescents with ASD filled out an anonymous online survey shared via social media, investigating the sleep patterns and disturbances before and during the lockdown. RESULTS: The lockdown changed significantly the bedtime on weekdays in 57.8% of participants with ASD (56.9% delayed; 0.9% advanced) and the rise time in 69.2% (61.7% delayed and 7.5% advanced). Sleep duration varied on weekdays in 49.1% (24.1% increased; 25% decreased). During the lockdown, participants with ASD showed a significant increase of sleep disturbances, compared to the preceding period, especially falling asleep (35.1% vs 22.5%), anxiety at bedtime (22.5% vs 10.8%), sleep terrors (5.4% vs 0%), and daytime sleepiness (14.4% vs 3.6%). CONCLUSIONS: Lockdown affected sleep of patients with ASD, showing an increase of difficulty in falling asleep, anxiety at bedtime, sleep terrors, and daytime sleepiness. The outbreak of COVID-19 significantly worsened sleep disturbances of children with ASD. CITATION: Bruni O, Melegari MG, Breda M, et al. Impact of COVID-19 lockdown on sleep in children with autism spectrum disorders. J Clin Sleep Med. 2022;18(1):137-143.

The impact of lockdown on sleep patterns of children and adolescents with ADHD.

STUDY OBJECTIVES: The current study examined the impact of home confinement (lockdown) because of the COVID-19 pandemic on the sleep patterns of children and adolescents with attention-deficit hyperactivity disorder (ADHD). METHODS: Nine hundred ninety-two parents of children and adolescents with ADHD filled out an anonymous online survey through the ADHD family association website. The survey investigated the sleep patterns and disturbances (using a modified version of the Sleep Disturbance Scale for Children) and screen exposure time before and during lockdown. RESULTS: During lockdown, 59.3% of children and 69.4% of adolescents with ADHD reported a change of bedtime, with a significant increase in patients with ADHD who went to sleep at 11 pm or later. Sleep duration, in contrast, resulted in 2 opposing processes with more children and adolescents sleeping either less than 6 hours/night or 10-11 hours/night. Among children and adolescents, respectively, 19.9% and 22% slept less than they did before lockdown, whereas 21.4% and 27.4% slept for more hours. Bedtime delay and decreased sleep duration were associated with an increase in screen time exposure. Moreover, patients with ADHD reported an increase in sleep disturbances when compared to their previous condition, mainly including difficulties falling asleep, anxiety at bedtime, night awakenings, nightmares, and daytime sleepiness. CONCLUSIONS: Lockdown impacted sleep-wake rhythms by strengthening the maladaptive sleep patterns reported in usual-life conditions in children and adolescents with ADHD. CITATION: Bruni O, Giallonardo M, Sacco R, Ferri R, Melegari MG. The impact of lockdown on sleep patterns of children and adolescents with ADHD. J Clin Sleep Med. 2021;17(9):1759-1765.

Telephone-Based Reality Orientation Therapy for Patients With Dementia: A Pilot Study During the COVID-19 Outbreak.

IMPORTANCE: When in-person rehabilitation is not feasible, interventions delivered in remote telephone-based sessions may be an option. OBJECTIVE: To determine whether telephone-based reality orientation therapy (T-ROT) can improve cognition, mood, and neuropsychiatric symptoms among patients with major neurocognitive disorders (NCDs) who are forced to isolate and also whether T-ROT can relieve the burden of distress among their caregivers. DESIGN: Nonrandomized interventional comparison study. SETTING: Individual telephone calls between practitioners and patients and their caregivers. PARTICIPANTS: Twenty-seven patients (14 in the experimental group, 13 in the control group) with a major NCD and their primary caregivers. INTERVENTION: Ten T-ROT sessions and a pretest-posttest neuropsychological evaluation over 4 wk. OUTCOMES AND MEASURES: Outcomes measured included cognitive and behavioral symptoms of patients with major NCDs and correlations between changes in patient clinical condition and caregiver stress. Primary outcome measures were two measures of depressive symptoms, the Neuropsychiatric Inventory Questionnaire and the Telephone Mini-Mental State Examination, administered at baseline and program discharge. RESULTS: T-ROT significantly outperformed nontreatment on all measures of depression, behavior, cognition, and caregiver burden. CONCLUSIONS AND RELEVANCE: T-ROT combined with emotional support appears to be an effective intervention for monitoring and managing the behavioral symptoms of patients with major NCDs who are forced to isolate. WHAT THIS ARTICLE ADDS: Occupational therapy practitioners can use T-ROT or similar procedures not only during a pandemic but also when it is not possible to treat patients in person at a hospital or at home. Telephone-based treatment may also represent a good practice to be integrated into traditional rehabilitation programs.

Changes in sleep patterns and disturbances in children and adolescents in Italy during the Covid-19 outbreak.

OBJECTIVE: To examine the impact of home confinement during the COVID-19 pandemic on the sleep patterns and sleep disturbances in Italian children and adolescents. METHODS: Participants completed an anonymous online survey, shared via social media and targeting children and adolescents aged 1-18 years, subdivided into age groups: 1-3, 4-5, 6-12, and 13-18 years. Caregivers completed a modified version of the Sleep Disturbance Scale for Children (SDSC), along with demographic information. RESULTS: The final sample consisted of 4314 subjects: 2217 males (50.4%) and 2097 females (49.6%). Age group distribution was: 1-3 years 1263 (29.3%), 4-5 years 893 (20.7%), 6-12 years 1848 (42.8%) and 13-18 years 310 (7.2%). We found a significant delay in bedtime and risetime in all age groups. School-age children and adolescents experienced the most significant delay: weekday bedtime ≥23 was reported by 28.4% of 6- to 12-year-old children during lockdown vs. 0.9% before and by 63.5% vs. 12.3% of 13- to 18-year-old adolescents. Risetime was also delayed with most subjects waking up after 8 in all age groups and sleep duration increased in all groups but not in the younger group. The screen time (excluding online lessons) boosted during the lockdown, mainly in older children but also in younger children. Sleep disorders increased in all groups but not in adolescents. Younger groups had an increased prevalence of difficulty falling asleep, anxiety at bedtime, night awakenings, nightmares and sleep terrors. CONCLUSION: Our study demonstrates that confinement due to COVID-19 determined a big delay in sleep/wake schedule of children in all age groups as well as an increase of sleep disturbances in all groups but adolescents.

Clinical management of individuals with Intellectual Disability: The outbreak of Covid-19 pandemic as experienced in a clinical and research center Research in Developmental Disabilities.

During the COVID-19 pandemic, the Oasi Research Institute of Troina (Italy) became an important hotbed for infection; in fact, 109 patients with different levels of Intellectual Disability (ID) tested positive for COVID-19. The procedures and interventions put in place at the Oasi Research Institute due to the COVID-19 pandemic are exhaustively reported in this paper. The description of the clinical procedures as well as remote/in person psychological support services provided to people with ID and their families are here divided into three different sections: Phase I (or Acute phase), Phase II (or Activity planning), and Phase III (or Activity consolidation). In each section, the main psycho-pathological characteristics of patients, the reactions of family members and the multidisciplinary interventions put in place are also described.

SARS-CoV-2 and the Nervous System: From Clinical Features to Molecular Mechanisms.

Increasing evidence suggests that Severe Acute Respiratory Syndrome-coronavirus-2 (SARS-CoV-2) can also invade the central nervous system (CNS). However, findings available on its neurological manifestations and their pathogenic mechanisms have not yet been systematically addressed. A literature search on neurological complications reported in patients with COVID-19 until June 2020 produced a total of 23 studies. Overall, these papers report that patients may exhibit a wide range of neurological manifestations, including encephalopathy, encephalitis, seizures, cerebrovascular events, acute polyneuropathy, headache, hypogeusia, and hyposmia, as well as some non-specific symptoms. Whether these features can be an indirect and unspecific consequence of the pulmonary disease or a generalized inflammatory state on the CNS remains to be determined; also, they may rather reflect direct SARS-CoV-2-related neuronal damage. Hematogenous versus transsynaptic propagation, the role of the angiotensin II converting enzyme receptor-2, the spread across the blood-brain barrier, the impact of the hyperimmune response (the so-called "cytokine storm"), and the possibility of virus persistence within some CNS resident cells are still debated. The different levels and severity of neurotropism and neurovirulence in patients with COVID-19 might be explained by a combination of viral and host factors and by their interaction.