Virtual educational therapy: A case study of clinical supports and advocacy

A case study is a research approach that is used to generate an in-depth, multifaceted understanding of a complex issue in its real-life context. It is both time- and space-bound and is useful to explore, describe, and explain phenomena. It is an established research design that is used extensively in a wide variety of disciplines, particularly in the social sciences, including education. Many master's programs employ the case study methodology as the basis for the culminating project. The case study methodology is especially relevant to advancing "younger disciplines" such as educational therapy. Many do not understand the training and difference in approaches between an Educational Therapist and a tutor, so publishing case studies is crucial. This book presents a board-certified educational therapist's year-long case study of clinical supports and advocacy for a student with learning disabilities who is attending school remotely during the COVID-19 pandemic. With online and blended learning, now the norm in K-12 education, educational therapists need new models of intervention, treatment, and relationship-building for their child-age clients. The book offers detailed single-case research focused on a middle-school student who is learning virtually while challenged with attention-deficit/hyperactivity disorder as well as visual and verbal memory issues, but who is nonetheless found ineligible for special education services. Across eight chapters, the book describes the neuropsychological principles, research-based techniques, personal interactions, clinical approaches, and advocacy efforts that led to a vulnerable student's significant gains in academic skills and outcomes. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

Long-Term Neurologic Sequelae Among Patients with Varying COVID-19 Severity: An Administrative Claims Database Analysis

Objectives: Examine the long-term incident neurologic sequelae post COVID recovery and assess relationship with COVID severity using real-world data. Method(s): This retrospective cohort study was conducted using Optum Research Database between 01July2019 to 30Sep2022. Patients included were >=18 years with COVID diagnosis (index date) between 01Jan2020 and 31Oct2020, with continuous enrollment 6 months before and >=12 months after index date, known demographics, not pregnant, and with no baseline neurologic conditions. Patients were stratified into COVID severity cohorts as mild (index diagnosis), moderate (inpatient visit within 15 days of index), or severe (evidence of acute respiratory distress) and followed for a minimum of 12-months post-index. Neurologic sequelae examined were persistent headache, migraine, anosmia, sleep disturbance, cognitive dysfunction, post-traumatic stress disorder, suicidality, anxiety, depression, attention deficit hyperactivity disorder, cerebrovascular disease (CVD), fatigue/myalgia and tremors. Descriptive statistics and incidence rate ratios (IRR) were calculated to assess outcomes. Result(s): Of 534,843 patients, 107,656 (Mild 96,637;Moderate 3,371;Severe 7,648) met the study inclusion criteria. Median follow up time was 750, 774 and 768 days in the mild, moderate and severe cohorts, respectively. About 20% of patients in the mild, 32% in moderate and 35% in the severe cohort experienced >=3 neurologic sequelae during the follow-up period. A significantly higher incidence of any neurologic sequelae was observed in moderate and severe cohorts compared with the mild cohort (IRR 3.1 and 3.0, respectively;p<0.001). Cognitive dysfunction (moderate IRR 5.4, severe IRR 5.7;p<0.001), and CVD (moderate IRR 4.8, severe IRR 4.0;p<0.001) were the most commonly occurring manifestations in moderate and severe cohorts compared with the mild cohort. Conclusion(s): These results highlight the need for long-term monitoring and preventative strategies for neurologic conditions post COVID recovery that might impair quality of life and increase overall healthcare burden in the U.S.Copyright © 2023

Patient Centricity: Design and Conduct of Clinical Trials in Orphan Diseases: Third of Three Sets of Expanded Proceedings from the 2020 ISCTM Autumn Conference on Pediatric Drug Development

This article expands on a session, titled "Patient Centricity: Design and Conduct of Clinical Trials in Orphan Diseases," that was presented as part of a two-day meeting on Pediatric Drug Development at the International Society for Central Nervous System (CNS) Clinical Trials and Methodology (ISCTM) Autumn Conference in Boston, Massachusetts, in October 2020. Speakers from various areas of pediatric drug development addressed a variety of implications of including children in drug development programs, including implications for rare/orphan diseases. The speakers have written summaries of their talks. The session's lead Chair was Dr. Joan Busner, who wrote introductory and closing comments. Dr. Simon Day, regulatory consultant, outlined some of the past mistakes that have plagued trials that did not consult with patient groups in the early design phase. Dr. Atul Mahableshwarkar provided an industry perspective of a recent trial that benefited from the inclusion of patient input. Drs. Lucas Kempf and Maria Sheean provided regulatory input from the perspectives of the United States (US) Food and Drug Administration (FDA) and European Medicines Agency (EMA), respectively. Dr. Judith Dunn outlined a novel approach for assessing and rank ordering patient and clinician clinical meaningfulness and the disconnect that may occur. Dr. Busner provided closing comments, tied together the presented issues, and provided a synopsis of the lively discussion that followed the session. In addition to the speakers above, the discussion included two representatives from patient advocacy groups, as well as an additional speaker who described the challenges of conducting a pediatric trial in the US and European Union (EU), given the often competing regulatory requirements. This article should serve as an expert-informed reference to those interested and involved in CNS drug development programs that are aimed at children and rare diseases and seek to ensure a patient-centric approach.Copyright © 2023, Matrix Medical Communications. All rights reserved.

The challenges of screen time in children with typical development and children with developmental disorders during COVID-19 pandemic.

Background: The significant lifestyle changes that occurred during the lockdown period associated with the COVID-19 pandemic may have had many potential adverse effects on children, in particular, sedentary screen exposure among children, including those with developmental disorders. We conducted a cross-sectional study to investigate and compare the screen time and outdoor activity time of children with typically development (TD) and those with developmental disorders during and before the emergence of COVID-19, and identified the risk factors related to screen time during the COVID-19 pandemic. Methods: A total of 496 children were surveyed via online questionnaires. Parents or/and children filled in the online questionnaire, including basic characteristics, screen time, outdoor activity time, and other related factors. The Statistical Product and Service Solutions software was used to analyze all data. Results: Children spent less time outdoors (t=14.774, P<0.001) and more time on electronic screens (t=-14.069, P<0.001) during the lockdown period of COVID-19, compared to the periods before COVID-19. Age (P=0.037), pre-COVID-19 screen time (P=0.005), screen time used for learning/education (P<0.001), screen time of siblings (P=0.007), and use of screen devices as electronic babysitters (P=0.005) were risk factors for screen time during the COVID-19 pandemic, while restrictive use of electronic devices by parents (P<0.05) was a protective factor. The screen time of children with autism spectrum disorder (ASD) or attention deficit hyperactivity disorder (ADHD) was significantly longer than children with TD before COVID-19 pandemic, but there is no statistical difference during the COVID-19 pandemic. Conclusions: During the COVID-19 pandemic, children's screen exposure time increased, and outdoor activities decreased significantly. This represents a significant challenge, and we should focus our efforts on managing children's screen time and promoting healthier lifestyles, including children with typical development, as well as those with developmental disorders.

Randomized Trial of A Healthy Weight Intervention for Youth with Mental Illness: The Champion Trial

Introduction: Overweight and obesity in youth with serious emotional disturbance (SED) is exceedingly common. In 2015 the AHA called attention to mental illnesses in youth as important risk conditions for early CVD and the need for transformational change in management of overweight and obesity in this group. Our objective was to test a 12-month, innovative healthy weight intervention in youth with SED.Hypothesis: The active intervention is more effective than control in decreasing BMI Z-score compared at 12 m. Method(s): We conducted a two-arm randomized trial in 2 outpatient pediatric mental health settings in 112 youth, ages 8-18 yrs. The active intervention group was offered 12m of in-person and virtual individual weight management sessions led by health coaches who provided guidance on improving diet and increasing physical activity, and engaged parents. Result(s): At baseline, mean (SD) age was 13.0 (2.7) yrs with 46% ages 8-12 and 54% 13-18;55% were male, 46% Black, 39% had household income less than $50K/yr and 31% lived in a single-parent household. Primary diagnoses were ADHD (41%), major depression (23%), and anxiety (23%). Mean BMI Z-score (SD) was 2.0(0.4), BMI 30.4 (6.4) kg/m2.Mean(SD) psychotropic medications were 2.1(1.4).At 12m, 111 (99%) had a follow-up weight;42 were collected after the onset of the COVID pandemic). The intervention group compared to the control group had 0.15 decrease in BMI Z-Score (95% CI 0.26 to 0.04), p<0.007) between baseline and 12 m (Figure) and a 1.43 kg/m2 decrease in BMI (95% CI 2.43, 0.42, p<0.006). Estimated net effect on BMI Z-score for intervention vs. control was enhanced during the pandemic but not statistically different from net effects pre-pandemic (p=0.06). Conclusion(s): A weight control intervention designed for children with SED decreased BMI Z-score substantially over 12 months, including during the COVID-19 pandemic. These results provide empirical evidence in support of weight control programs in a population at high risk for early development of CVD risk factors.

Psychological distress and related factors among caregivers of children with attention-deficit/hyperactivity disorder during the COVID-19 pandemic.

The present study examined the relationships of caregiver factors (including caregivers' age, sex and educational year), child-family interactions (caregivers' difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, children's conflict with elders and siblings, and parenting styles), and children's factors (attention-deficit/hyperactivity disorder [ADHD] and oppositional defiant disorder [ODD] symptoms) with psychological distress of the caregivers of children with ADHD in the COVID-19 pandemic. This study recruited 252 caregivers of children with ADHD to participate and complete a questionnaire collecting their psychological distress in the COVID-19 pandemic, demographics, difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, and parenting styles as well as children's conflict with elders and siblings, and the ADHD and ODD symptoms. Hierarchical regression models were constructed to examine the factors related to psychological distress among caregivers. Factors across caregiver, child, and child-family interaction dimensions, including children's conflict levels with elders and siblings, inattention symptoms, and caregivers' difficulties in managing children's protective behaviors against COVID-19, learning and daily performance, female sex, and younger age were significantly associated with psychological distress among caregivers in various hierarchical regression models. Health professionals should take the relevant factors identified in this study when developing an intervention to relieve caregivers' psychological distress in the COVID-19 pandemic.

Prevalence and trends of common mental disorders from 2007-2009 to 2019-2022: results from the Netherlands Mental Health Survey and Incidence Studies (NEMESIS), including comparison of prevalence rates before vs. during the COVID-19 pandemic.

Up-to-date information on the prevalence and trends of common mental disorders is relevant to health care policy and planning, owing to the high burden associated with these disorders. In the first wave of the third Netherlands Mental Health Survey and Incidence Study (NEMESIS-3), a nationally representative sample was interviewed face-to-face from November 2019 to March 2022 (6,194 subjects; 1,576 interviewed before and 4,618 during the COVID-19 pandemic; age range: 18-75 years). A slightly modified version of the Composite International Diagnostic Interview 3.0 was used to assess DSM-IV and DSM-5 diagnoses. Trends in 12-month prevalence rates of DSM-IV mental disorders were examined by comparing these rates between NEMESIS-3 and NEMESIS-2 (6,646 subjects; age range: 18-64 years; interviewed from November 2007 to July 2009). Lifetime DSM-5 prevalence estimates in NEMESIS-3 were 28.6% for anxiety disorders, 27.6% for mood disorders, 16.7% for substance use disorders, and 3.6% for attention-deficit/hyperactivity disorder. Over the last 12 months, prevalence rates were 15.2%, 9.8%, 7.1%, and 3.2%, respectively. No differences in 12-month prevalence rates before vs. during the COVID-19 pandemic were found (26.7% pre-pandemic vs. 25.7% during the pandemic), even after controlling for differences in socio-demographic characteristics of the respondents interviewed in these two periods. This was the case for all four disorder categories. From 2007-2009 to 2019-2022, the 12-month prevalence rate of any DSM-IV disorder significantly increased from 17.4% to 26.1%. A stronger increase in prevalence was found for students, younger adults (18-34 years) and city dwellers. These data suggest that the prevalence of mental disorders has increased in the past decade, but this is not explained by the COVID-19 pandemic. The already high mental disorder risk of young adults has particularly further increased in recent years.

An Emotional Bias Modification for Children With Attention-Deficit/Hyperactivity Disorder: Co-design Study.

BACKGROUND: Attention-deficit/hyperactivity disorder (ADHD) is one of the common neurodevelopment disorders. Children with ADHD typically have difficulties with emotional regulation. Previous studies have investigated the assessment for underlying emotional biases using the visual probe task. However, one of the significant limitations of the visual probe task is that it is demanding and repetitive over time. Previous studies have examined the use of gamification methods in addressing the limitations of the emotional bias visual probe task. There has also been increased recognition of the potential of participatory action research methods and how it could help to make the conceptualized interventions more relevant. OBJECTIVE: The primary aim of this study was to collate health care professionals' perspectives on the limitations of the existing visual probe task and to determine if gamification elements were viable to be incorporated into an emotional bias modification task. METHODS: A co-design workshop was conducted. Health care professionals from the Department of Development Psychiatry, Institute of Mental Health, Singapore, were invited to participate. Considering the COVID-19 pandemic and the restrictions, a web-based workshop was conducted. There were 3 main phases in the workshops. First, participants were asked to identify limitations and suggest potential methods to overcome some of the identified limitations. Second, participants were shown examples of existing gaming interventions in published literature and commercial stores. They were also asked to comment on the advantages and limitations of these interventions. Finally, participants were asked if gamification techniques would be appropriate. RESULTS: Overall, 4 health care professionals consented and participated. Several limitations were identified regarding the conventional emotional bias intervention. These included the nature of the task parameters, included stimulus set, and factors that could have an impact on the accuracy of responding to the task. After examining the existing ADHD games, participants raised concerns about the evidence base of some of the apps. They articulated that any developed ADHD game ought to identify the specific skill set that was targeted clearly. Regarding gamification strategies, participants preferred economic and performance-based gamification approaches. CONCLUSIONS: This study has managed to elucidate health care professionals' perspectives toward refining a conventional emotional bias intervention for children with ADHD. In view of the repetitiveness of the conventional task, the suggested gamification techniques might help in influencing task adherence and reduce the attrition rates.

NEI Congress 2023

The proceedings contain 53 papers. The topics discussed include: clinical study of lurasidone combined with nutritional intervention strategy in the treatment of chronic schizophrenia;analysis of clinical medication scheme and nursing measures of acute stress disorder complicated with delirium under the COVID-19;a study on the mental state of prisoners near the end of their sentence caused by a psychological anxiety case;a clinical study on the effect of peperidone combined with cognitive behavioral therapy on symptoms of schizophrenia;the clinical effect of feedforward control nursing combined with methylphenidate sustained-release tablets on children with attention deficit hyperactivity disorder;study on the effect of community legal consciousness health management on cognitive function of senile patients;effects of special sports training on autonomic nervous regulation;a study of positive intervention of music therapy and neurofeedback on negative emotions and attention in college students;and alleviating effect of the geriatric care system integrating physical and psychological on the common mental problems of the elderly.

Mental health of caregivers of children with neurodevelopmental disorders during the pandemic.

Caregivers are especially likely to be more psychologically affected during the social and health care system constraints generated by the COVID-19 pandemic. Caregivers of children with neurodevelopmental disorders (i.e., autism, intellectual disability, attention deficit, hyperactivity, motor disability) have a more essential role than caregivers of healthy children. A quantitative cross-sectional study was designed, using descriptive, comparative and correlational statistical techniques to analyze health-related quality of life, emotional distress and overload in four subgroups of caregivers, classified according to the child's diagnosis. A total of 132 caregivers (86.4% women) were included. In group 1 (cognitive disability), 28 caregivers participated;in group 2 (ADHD), 51 were included;in group 3 (autism spectrum disorder), 33 caregivers participated, and in group 4 (motor disability), 20 were included. The main findings of this study were: i) alterations in physical role, bodily pain, general health and vitality;ii) very low percentages of depression, anxiety, stress and overload symptomatology;iii) differences in social functioning between the motor disability and ADHD groups;and in stress and overload between the autism and motor disability groups;and iv) moderate correlations between the dimensions of bodily pain and emotional role and depression, anxiety, stress and overload. It was concluded that there is more impairment in variables associated with physical health than with mental health.Copyright © 2023

Discrepancies in Studies on ADHD and COVID-19 Raise Concerns Regarding the Risks of Stimulant Treatments During an Active Pandemic

Two publications by Merzon and colleagues in the Journal of Attention Disorders (JAD) suggest that attention-deficit hyperactivity disorder (ADHD) increases the risk of COVID-19 infections (2020) and severe outcomes (2021). Adherence to stimulant treatments was recommended to attenuate the spread of the pandemic (2020). The conclusions of these timely studies attracted considerable attention, probably due to their wide-scope implications for the public health. But how valid are they? Furthering our earlier critique published in this journal, the current article outlines seven severe gaps in these publications, including inconsistencies in the definitions and rates of ADHD, inadequate definition for ADHD medications, omissions of crucial information, unsuitable analyses, and unmet declarations regarding conflicts of interests and data availability. In fact, the latter, which constitutes a repeated avoidance of data sharing (up to this day, March 28, 2023), seems to have led the editor-in-chief of JAD to propose the write-up of the current article (which he then judged, after the peer review process, as "worthy of publication," but also that JAD is "not the best placement" of its publication—despite its specific focus on several JAD articles). To complete the picture regarding this burning public health issue, this article also provides a glimpse into the problematic happenings that took place behind the scenes, which included a personal defamation and various stalling tactics, along with an elaborated and fully-referenced response that was sent by the authors of the current article to the reviewers and the editor-in-chief of JAD in real time (Appendix). Together, the discrepancies and problematic ethical conducts that are exposed in the current article suggest that the speculation regarding the link between a neurodevelopmental diagnosis (ADHD) and a respiratory virus (COVID-19) has not been subjected to adequate scientific inquiry. On the contrary, the lack of transparency, the observed gaps, and the existing extensive literature on stimulant-related cardiovascular risks, including the recently published guidelines for starting ADHD medications by one of the authors of the 2021 study, raise concerns regarding the potentially dangerous implications of stimulant use during a global epidemic. [ FROM AUTHOR] Copyright of Ethical Human Psychology & Psychiatry is the property of Springer Publishing Company, Inc. and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full . (Copyright applies to all s.)

Aggressive behavior in Italian children with ADHD in the middle of COVID-19 pandemic: Preliminary data on MAOA gene polymorphisms involvement

Attention Deficit Hyperactivity Disorder (ADHD) is characterized by oppositional, defiant, disobedient, disruptive and also aggressive behavior. Many genes are involved in its onset, particularly dopaminergic pathway genes. Moreover, genetic predisposition to aggression appears affected by the polymorphic genetic variants of the serotoninergic system, among which, functional polymorphisms in monoamine oxidase A (MAOA). The risk of contracting coronavirus infection may arouse in some people severe emotional distress characterized by symptoms of fatigue, guilt, and aggression. A survey on the psychological impact of COVID-19 pandemic in Italian families of children with neurodevelopmental disorders such as ADHD showed how children have been particularly affected by the emergency. The aim of this study was to determine whether polymorphisms at the MAOA gene are associated with increased or reduced susceptibility to develop ADHD. Therefore, the variants rs6323, rs587777457 and rs1137070 of the MAOA gene were evaluated by SBT in 35 children (mean age 10.257 range 6-16) with ADHD and 27 healthy individuals. Our analysis allowed us to identify the G/G genotype of the variant rs6323 (Arg297Arg) was significantly associated with an increased risk of ADHD (p = 0.015). Allele G indicates higher levels of the enzyme, while the T allele indicates lower levels of enzyme production. When compared in patients, the G allele was associated with higher anger (p-value = 0.01) and might cause aggressive behavior in males. Our study shows that defining a genetic profile of ADHD can provide important information on the etiopathogenesis of the disease and help identify the best therapeutic option for patients with this disorder.

Anti-fibrotic agents could be the game-changer for post-COVID-19 pulmonary fibrosis treatment

More than 220 countries and territories are globally affected by the recent pandemic COVID-19 which is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). There is possibility of third wave of this pandemic as per epidemiological and public health experts. Besides that post-COVID-19 complications are alarming matter to look upon. Post-COVID-19 complications include several symptoms like as persistent fever;cough;fatigue;headache;attention disorder;dyspnea;anosmia;ageusia;chest pain discomfort;various respiratory illness;acute respiratory distress syndrome (ARDS) etc., and here the things to worry about is the development of pulmonary fibrosis after COVID-19. In some COVID-19 patients, hyper-inflammation in the form of 'cytokine storm' along with dysregulated immune response, alveolar epithelial tissue injury and wound repair collectively cause this secondary pulmonary fibrosis. Therefore, using anti-fibrotic agents e.g. pirfenidone, nintedanib and other natural compounds could be meaningful in these circumstances although their efficacy in treating COVID-19 is subject to more detailed laboratory research works. In this review article, we have discussed the progression of pulmonary fibrosis development which is triggered by COVID-19;probable solutions with anti-fibrotic agents including anti-fibrotic drugs, some well-known natural compounds, combined anti-fibrotic therapies;and the current challenges of this field.

The Overdose Conundrum

The article discusses the impact of patients' overdose on psychiatrists. It discusses the case of a 45-year-old woman with an opioid addiction and anxiety who was enrolled in an addictions treatment program. Topics covered include how the psychiatrists cope with patient suicide or overdose, how to promote honesty about recurrence of substance use and how psychiatrists can find the right balance in setting boundaries.

Reflections on My Backyard Office

During the COVID-19 pandemic, I found Zoom to be an unsatisfying tool for treating young patients. I was able to create a backyard "office," inviting children and preteens to continue their play therapy sessions outdoors. I review how working outside changed the therapeutic frame. I noticed shifts in boundaries and treatment. Case examples, including a composite patient with attention-deficit/hyperactivity disorder (ADHD), demonstrate some of the themes that arose in the new setting.Copyright © 2022 American Psychological Association

Societal disruptions and child mental health: evidence from ADHD diagnosis during the COVID-19 pandemic

We study how the societal disruptions of the COVID-19 pandemic impacted diagnosis of a prevalent childhood mental health condition, Attention Deficit Hyperactivity Disorder (ADHD). Using both nationwide private health insurance claims and a single state's comprehensive electronic health records, we compare children exposed to the pandemic to same aged children prior to the pandemic. We find the pandemic reduced new ADHD diagnoses by 8.6% among boys and 11.0% among girls nationwide through February 2021. We further show that higher levels of in-person schooling in Fall 2020 dampened the decline for girls but had no moderating effect for boys.

Co-Occurring Physical Health Challenges in Neurodivergent Children and Young People: A Topical Review and Recommendation

Background: Neurodivergence has been established as associated with a significant number of co-occurring physical conditions, particularly for autistic individuals who are at risk for increased pain, hypermobility (including Ehlers-Danlos Syndrome) and gastrointestinal problems. However, data, so far, has been focused on adults and generally limited to discussions of condition prevalence alone. Method(s): The following article will present a topical review of the literature considering evidence for increased physical health concerns within neurodivergent populations, particularly autistic individuals, with a focus on the impact that these physical health concerns may have in an educational setting. Results and discussion: The impact of physical health concerns within neurodivergent populations in an educational setting may be concerning. Such populations may face a range of challenges in obtaining appropriate support for physical conditions. We discuss a number of said challenges including;communication challenges, misattributing physical health symptoms as a part of neurodivergence, and a history of not being believed, which limits symptomatic reporting. We further consider the potential impact these physical health concerns may have on scholastic and social development, such as impacts for attainment and attendance. Furthermore, we provide recommendations for teachers, parents/carers and other allied professionals in young people's lives, on supporting young neurodivergent people with physical health concerns.Copyright © 2023 The Author(s). Published by Informa UK Limited, trading as Taylor & Francis Group.

Supporting emotion regulation in individuals with ASD, ADHD and bipolar disorder through trauma‐informed instruction and self‐regulation strategies

Since the beginning of the COVID‐19 pandemic, students have endured drastic changes in educational routines. Such disruptions can be especially challenging for students who struggle with executive functioning, self‐regulation and emotion regulation, such as students with autism spectrum disorder (ASD), attention deficit hyperactivity disorder (ADHD) and bipolar disorder. Using a framework of trauma‐informed instruction, the authors supported classroom teachers in implementing sensory spaces for students with ASD, ADHD and bipolar disorder. The project included professional development and funding for teachers to develop, procure and offer sensory tools and strategies to assist students in recognising and managing emotions. The authors collected data on the effectiveness of the sensory supports, combining teacher surveys and student behaviour data. Results indicated increased teacher knowledge on trauma‐informed instruction and use of sensory supports to promote executive functioning and self‐regulation and decreased target behaviours in students based on structured observation and anecdotal teacher feedback.

Emerging challenges in child psychiatry practices in the post-pandemic era

Following the Covid pandemic, there are various changes in the presentation and management of childhood psychiatric disorders. The introduction of telepsychiatry for delivering therapies has its own merits and demerits. However, as a consequence of the lack of one-on-one therapy and regular consultation with a child psychiatrist which is essential for the management of neurodevelopmental disorders, detrimental effects in terms of an increase in symptoms and behavioral problems were observed. Increased identification of cases of neurodevelopmental disorders especially ADHD and autism has escalated the burden on caregivers and treating professionals. These all need to be addressed in the post-pandemic situation calling for novel approaches for better service delivery on part of the psychiatrist in advising home-based therapies rather than depending on therapy centers. Due to the disruption of routine schooling during Covid pandemic, children are facing problems in adjusting to regular school postpandemic, especially children belonging to younger age groups. Most of these children are presenting with multiple somatic complaints to avoid attending school leading to a decline in scholastic performance. Other factors such as changing schools and increased screen time have an additive role in school refusal. These are the major factors that affected most school-going children. This scenario has been increasing and has to be tackled by employing a multidisciplinary approach involving psychiatrists, psychologists, parents and school authorities. Several studies demonstrate that early identification of the problem of school refusal and an early reintroduction to school has a good prognosis. Electronic gadget usage is on the rising trend bringing about its own set of challenges including internet addiction and gaming disorders. Psychiatrists should address these problems delicately, understanding the child's point of view which may require out-of-the-box approaches.