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Aims: Children and adolescents were affected in various ways by the measures due to COVID-19 pandemic. The aims of this study were to investigate and compare the effects on mental health across age, to identify latent class trajectories of emotional and behavioural problems over 12-months and to examine the association of classes of trajectories with baseline demographic and clinical predictors. Method(s): Children (n = 1854) and adolescents (n = 1243) from the general population were assessed baseline, at 6-, 9-, and 12-month follow-up. They were eligible if they were residents in Austria, Germany, or Switzerland, were parents/caregivers of a child aged between 7 and 10 years or adolescents >=11 years, had sufficient German language skills and provided informed consent. Results and Conclusion(s): Significant age-effects were found regarding type and frequency of problems. While children had the largest increase in aggressive behaviours, adolescents reported the largest increase in emotional problems. Sociodemographic variables, exposure to and appraisal of COVID-19, psychotherapy before COVID-19 and parental mental health significantly predicted change in problemscores (F >= 3.69, p <= .001). Using growth mixture modelling, a oneclass solution was detected for the trajectory of aggressive behaviours and a two- and three-class solution for withdrawn/depression and anxiety/depression. A substantial proportion of children and adolescents experienced age-related mental health problems during the different stages of the COVID-19 pandemic. These results suggest that psychological problems of specific sub-groups should be monitored over the longer-term and interventions to improve communication, emotion regulation, and appraisal style should be offered to risk groups.
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As the COVID-19 pandemic further unfolds, it becomes a key theoretical and practical question to identify trajectories of child psychological well-being and to explore risk and resilience factors for developmental adjustment. The current study addressed this research gap by means of an ecological design: A (lockdown)-B (relaxation)-B (relaxation)-A (lockdown). We collected parental reports via online questionnaires over four measurement occasions during the COVID-19 pandemic in Germany (non-probabilistic sample): from the first lockdown (T1-spring 2020, N = 1769) to the following period of relaxation (T2-summer 2020, n = 873; T3-fall 2020, n = 729) on to the second lockdown (T4-winter 2020/21, n = 748). Key measures at T1-T4 were child emotional and behavioral problems as well as hyperactivity, child emotional and family-related well-being, parental strain, and parent-child relationship quality. We found evidence for quadratic growth models. While child problem behaviors (b = 0.32, p < 0.001) and emotional well-being (b = - 0.33, p < 0.001) improved after the first lockdown during subsequent periods of relaxation before worsening again in the second lockdown, child family-related well-being steadily decreased over all four measurement points (T1-T2: p < 0.001; T2-T3: p = 0.045; T3-T4: p = 0.030). Importantly, parental stress emerged as a strong risk factor (ps < 0.11) and the parent-child relationship quality constituted a resilience factor (p = 0.049) for child psychological well-being. These findings have major implications for policies aiming to further child health during the COVID-19 pandemic.
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Background: The children and adolescents with ASD around the world have experienced a major disruption of their everyday lives due to the COVID-19 pandemic. Social isolation has inflicted a negative impact on the psychological well-being of these children and adolescents. Aim(s): To investigate the impact of COVID-19 pandemic in children and adolescents with ASD in terms of comprehension and adherence to implemented measures and changes in their behavioural problem. Methodology: A retrospective cross-sectional (descriptive) study was done involving 16 ASD children and adolescents attending OPD of a tertiary care institute within a time period of 12 months for various behavioural problems using ISAA scale and Nisonger CBRF. Each subject was assessed on a single occasion for 3 different timelines-Pre-COVID (before March 2020), during full Lockdown (March-May 2020) and Post-Lockdown (January 2021-January 2022). Result(s): The ISAA scoring revealed significant increase in ASDrelated behaviours (i.e. inappropriate emotional response, difficulty in communication etc.) from before pandemic to during pandemic and Post-Lockdown (p value<0.05).The Nisonger Child Behaviour Rating Form revealed deterioration in Positive Social behaviour (p value<0.05).Significant increase in problem behaviour was seen in all the six domains (Conduct problem, Insecure/Anxious, Hyperactive, Self-injury/Stereotype, Self-isolated/Ritualistic and Overtly Sensitive) (p value<0.05). Conclusion(s): Disruption of daily routine and social distancing have led to increase in problem behaviours of the children and adolescents with ASD as well as an increase in deficits of positive behaviours.
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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.
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The potential impact of the COVID-19 pandemic on young people's mental and physical health is of increasing concern. We examined the levels of internalizing and externalizing problem behavior and physical complaints before and during the COVID-19 pandemic in Germany. Data came from a repeated cross-sectional study on child and youth health in schools in Germany. Assessments took place from November to February each year. Two data collections were conducted before the COVID-19 pandemic in 2018-2019 and in 2019-2020. Collections during the pandemic took place in 2020-2021 and 2021-2022. A total of 63,249 data observations were included in the analyses. Multilevel analyses were used to examine temporal trends in mean emotional problems (e.g., often unhappy, downhearted), hyperactivity-inattention (e.g., constantly fidgeting or squirming), conduct problems (e.g., fights with other children), and physical complaints. Models were adjusted for age, gender, school type, socioeconomic status, and sensation seeking. During the COVID-19 pandemic, children and adolescents in Germany experienced an increase in emotional problems from the pre-pandemic cohort 2019-2020 to the pandemic cohort 2021-2022 (ß = 0.56, 95% CI (0.51-0.62)) and, over the course of the pandemic, reported elevated levels of physical complaints (ß = 0.19, 95% CI (0.16-0.21)). Findings of increased emotional problems and physical complaints after the two years of the pandemic support the ongoing demand for low-threshold health promotion and prevention and the need for further monitoring of young people's health in Germany.
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COVID-19 , Mental Disorders , Humans , Child , Adolescent , Mental Health , Cross-Sectional Studies , Pandemics , Mental Disorders/epidemiologyABSTRACT
Purpose: Adolescence (ages 10-19) is a sensitive developmental period for the emergence of mental and behavioral health problems, but there is a lack of multi-country qualitative studies that explore how adolescents themselves understand these critical challenges. As part of UNICEF's 2021 State of the World's Children Report, the Global Early Adolescent Study collaborated with organizations in 13 countries to hold a series of focus group discussions (FGDs) with adolescents focused on mental health. These FGDs aimed to (1) understand adolescents' perspectives on significant mental health challenges in their age group, (2) understand adolescents' perspectives on the key risk and protective factors driving these challenges, and (3) understand the ways in which adolescents cope with these challenges, including barriers and facilitators to help-seeking. Methods: A total of 71 FGDs were conducted across 13 countries between February and June of 2021. Countries were selected to ensure geographic, economic, and cultural diversity, and included: Belgium, Chile, China, the Democratic Republic of Congo, Egypt, Indonesia, Jamaica, Jordan, Kenya, Malawi, Sweden, Switzerland, and the United States. Within each country, FGDs were stratified by sex and age such that there were at least two younger (ages 10-14) and two older (ages 15-19) focus groups. Depending on the COVID-19 restrictions at the time, FGDs were either held in-person or online. All FGDs were held in local languages and lasted between 60 and 90 minutes. FGDs were recorded, transcribed verbatim, and translated into English when necessary. These English translations were then coded and analyzed using an inductive thematic analysis approach. Results: Across diverse cross-cultural settings, a number of consistent findings emerged from the voices of adolescents. In particular, adolescents around the world emphasized the many contexts that drive mental health challenges, including family adversity, community violence, unsupportive school environments, poverty, social media culture, and restrictive gender norms. They also discussed significant barriers to seeking help for mental health challenges, such as community stigma, lack of social support, and fears of invalidation. These barriers frequently resulted in adolescents coping with these challenges without support, often using maladaptive strategies. Importantly, adolescents generally described and understood mental health in terms of distress (e.g., sadness, loneliness, shame, anger) rather than disorder (e.g., depression, anxiety). Conclusions: Above all, it was clear that adolescents around the world need much better formal and informal supports to adequately address mental and behavioral health problems, and that these responses must take into account the many contexts that contribute to these problems. Further, the non-clinical terminology frequently used by adolescents suggests that taking a purely diagnostic approach in addressing mental health challenges may exclude many adolescents in need of assistance. Sources of Support: Wellcome Trust.
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Objective: Coronavirus disease 2019 (COVID-19) pandemic has led to emergence of new developmental risk factors. Developmental risk factors for young children with inherited metabolic disorders have not been studied based on a comprehensive framework. We aimed to determine the developmental risk factors of young children with inherited metabolic disorders during COVID-19 pandemic based on bioecological theory. Material(s) and Method(s): In a cross-sectional design, children aged 0-42 months that who had appointments at Ankara University School of Medicine Department of Pediatrics (AUDP) Pediatric Metabolism Division with the diagnoses of inherited metabolic disorders were recruited between October 1st, 2020 to January 1st, 2021. Developmental risk factors were assessed with a semi-structured interview based on questions of the Expanded Guide for Monitoring Child Development revised for the pandemic at AUDP Developmental Pediatrics Division. Result(s): The sample consisted of 95 children with inherited metabolic disorders (median age:25, IQR: 17-35 months, 57.9% boys). Most children (54 children, 56.8%) had amino-acid metabolism disorders. Child-related developmental risk factors included new behavioral problems in most of the sample (53 children, 55.8%) and increased screen time in 26 children (27.3%). As family-related developmental risk factors, 40 children (42.1%) were living with a family member diagnosed with major depression. In environment-related developmental risk factors;41 families (43.2%) experienced a decrease in their household income and 21 (22.1%) loss of job during the pandemic, 17 (17.9%) delay in health care follow up visits, 8 of 28 (28.6%) discontinuity of intervention and rehabilitation services. Participation in life was severely limited in 42 (44.2%) children with inherited metabolic disorders. Conclusion(s): Apart from life threatening medical problems, children and their families in Turkey and potentially in other low- and middle-income countries face multiple developmental risk factors. Preventable or reducible risk factors should be addressed to support these children's development in this pandemic and beyond. Copyright © 2022 Ankara Pediatric Hematology Oncology Training and Research Hospital. All rights reserved.
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The mental health of children and adolescents has been significantly affected by the COVID-19 pandemic, and recent data suggests there had been an upsurge of psychiatric morbidity in this subgroup of population. Nonpharmacological behavioral intervention in the form of play therapy has been regarded as one of the best treatment strategies in children with emotional disorders. During lockdown, we attempted a play therapy via telemedicine. In this case report, we describe the case of a four-year-old girl who had sudden-onset behavioral problems following an unplanned hair cut during the lockdown, which was managed with teleplay therapy. Copyright © 2022, Matrix Medical Communications. All rights reserved.
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Introduction: Problematic gaming, social media, and pornography use have all been conceptualized as potential behavioral addictions, sharing similar etiological and neurological mechanisms. Nevertheless, majority of the research to date has investigated these behaviors separately or explored their co-occurrence. The present study aimed to investigate how an identical set of predictors relates to each problematic behavior, exploring the similarities and differences between them. Methods: Data was collected during the first wave of the COVID-19 pandemic with an online survey among a convenience sample of Hungarians. Three linear regression models with the three different problematic behaviors as outcomes were conducted (problematic social media use/pornography use/gaming N = 332/396/217;gender = 62.2/66.0/69.9% males;mean age = 38.6/39.9/37.6 years;SD = 10.7/11.0/10.0). Results: Findings revealed that depression symptoms were significantly and positively related to all three problem behaviors. Problematic pornography use was associated with male gender, while problematic social media use was associated with female gender. Time spent on each activity was positively correlated with the problematic use of the same activity. Remarkably, playing time was also positively associated with problematic social media use and problematic pornography use. Moreover, loneliness was significantly and positively associated with problematic pornography use. Conclusion: The results indicate that problematic gamers, social media, and pornography users all may experience depression symptoms and that excessive use may result in adverse consequences in all these activities. The current findings extend the knowledge regarding the psychological features of problematic use of games, pornography, and social media, highlighting the need to focus on their common underlying etiological processes.
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Background: Medical Legal Partnerships (MLPs) help address the social determinants of health or health-harming legal needs impacting the health and wellbeing of vulnerable pediatric patients and families. Methods: To examine the impact of COVID-19 on MLPs and the children and families they serve, we conducted 96 semi-structured interviews with 18 clients and 78 MLP staff including legal aid staff, attorneys, health and social workers, and health administrators from programs in 10 states representing 5 U.S. regions. Six of these MLPs have a children's hospital as a medical partner. Interviews were collected between March and November 2020, capturing the initial and long-term impact of COVID-19. Results: Initially, MLP partner clinics had reduced patient volumes in response to the pandemic resulting in decreased MLP referrals. Later in the pandemic, however, MLP's saw an increase in demand for assistance with employment, housing, education, food insecurity and access to healthcare. Of 81 interviews with statements related to the impact of COVID 19 on clients, over half identified employment issues due to COVID exposure and increased evictions as problems for their patient-clients. Nearly one third of the 81 interviews discussed how children's educational needs were impacted by COVID. They cited families experiencing difficulties accessing educational resources at home, trouble receiving IEP services, and behavioral problems related to the transition to non-traditional education. MLPs also noted increased food insecurity, inequities in internet access and subsequent educational outcomes, and an increased time to resolve issues due to closed schools and courts. Furthermore, several MLP sites were challenged with the shift to remote work. No longer being at the clinical site made it more difficult to coordinate referral intake and consults with medical partners and trainings had to become virtual. Programs also noted there were fewer resources available during the pandemic to help families meet their needs. A few MLPs also experience reduced funding in their own programs which sometimes resulted in a decrease in legal personnel to provide services. Conclusion: The COVID 19 pandemic exacerbated the need for civil legal services to address social determinants of health for low-income families while simultaneously creating new barriers to resolution of those legal needs and reducing access to resources for children and their families.
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Introduction: Parental burnout might take place when excessive demands overwhelm the parents' resources. Aims: To develop and validate the Hungarian version of the Parental Burnout Assessment (PBA-HUN), an instrument designed to measure parental burnout;and to determine the prevalence of parental burnout in Hungary. Methods: Data were collected via an online survey from parents with at least one child living in the household (N = 1215;82.6% mothers;Mage = 38.68 years;SDage = 6.27 years). Confirmatory factor analysis was used to investigate the factor structure of the PBA-HUN.Results: The four-factor structure of the original PBA was replicated, confirming the following factors: exhaustion in one's parental role, contrast with one's parental role, feelings of being fed up, and emotional distancing from one's children. A second-order model with a higher-order factor representing overall parental burnout also fit the data well. The internal consistency of both the subscale and total scores was excellent (α ≥ 0.84). Parental burnout had a moderately strong negative correlation with life satisfaction, and weak or moderate positive correlations with perceived stress, depression, vital exhaustion, and COVID-specific perceived stress supporting the construct validity of the PBA-HUN. The prevalence of parental burnout stood at 5.8% in this sample. The weak relationship between PBA-HUN scores and sociodemographic factors was also similar to those found in prior studies. Parental burnout correlated negatively with the number of hours spent sleeping and engaging in spare time activity, respectively. Conclusions: The PBA-HUN is a reliable and valid tool to assess parental burnout in Hungary.
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BACKGROUND: Cognitive, learning and/or behavioral disorders are common (up to 70%) complications of neurofibromatosis (NF). The first multidisciplinary-clinic for neurocutaneous-disorders was established at the Aghia Sophia Children's Hospital in Athens, Greece, in 2016. Since then, more than 200 children and adolescents with NF have been examined. SCOPE: Acknowledging and indicating awareness on the devastating life-long consequences (poor academic performance, behavioral problems, and limited career prospectives) that can result from cognitive impairment, a research collaboration with educational specialists was recently implemented to examine the neurocognitive functions of children and adolescents with NF. MATERIALS: Children and adolescents aged 7-14 years who suffer from NF type I or type II, were eligible for study entry. The third edition of the Wechsler Intelligence Scale (WISC-III) was used to measure participants' cognitive function. RESULTS: Preliminary results of this ongoing study are presented. Patients' recruitment was limited by the coronavirus disease 2019 (COVID-19) restrictions. At this stage, the research involved 10 participants suffering from NF, with mean (± SD) age of 11.55 (± 1.80) years and a male-to-female ratio of 1. The mean (± SD) full-scale intelligence quotient (IQ) was 85.50 (± 18.80), corresponding to the 0.3rd to 73th percentile range. The mean (± SD) scores of performance IQ and verbal IQ were 84.90 (± 17.43) and 89.40 (± 17.23) respectively, corresponding to the 1st to 73rd percentile range for both subscales. CONCLUSION: Significant cognitive deficits, according to the percentile scores of WISC-III, were demonstrated in the small number of children and adolescents suffering from NF (type I or type II). Cognitive assessment, as part of the multidisciplinary approach of these patients is warranted, to aid timely educational interventions and improve patient learning outcomes.
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The COVID-19 pandemic is affecting families and children worldwide. Experiencing the pandemic leads to stress in families resulting from fear of infection and social isolation derived from social distancing. For families raising preschoolers, the prolonged closure of childcare centers puts additional childcare burden on family members, especially mothers. Due to the limited research exploring the impact of COVID-19 on preschool children's problem behaviors, this study examines the association between stress due to COVID-19 and preschool children's internalizing and externalizing problem behaviors related to mother's depression and parenting behavior. The study sample included data collected from 316 South Korean mothers raising preschool-aged children aged 3 to 5. The study findings suggest that mother's COVID-19 stress was indirectly associated with preschool children's internalizing and externalizing problem behaviors resulting from the mother's depression and parenting behaviors, although the direct effect of COVID-19 stress on preschool children's outcomes was not statistically significant. Increase in mother's COVID-19 stress was associated with increase in depression, and sequentially decreased positive parenting behaviors, which in turn resulted in preschool children's internalizing and externalizing problem behaviors. The study findings highlight the need to focus on enhancing mental health of mothers and preschool children's adjustment by implementing supportive interventions to reduce the adverse impacts of the prolonged COVID-19 pandemic.
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Introduction: A 19-year-old non-verbal male with history of CHARGE syndrome, severe autism, intellectual disability, coloboma with blindness OD and severely imparied vision OS, deafness, self-injurious and aggressive behavior, Tetralogy of Fallot status post repair, pulmonary valve replacement, hypertension, hypothyroidism, megacolon, gastrostomy tube dependence, eosinophilic esophagitis and chronic kidney disease with an irregular sleep cycle who has failed multiple medications for insomnia has shown treatment success with suvorexant. Report of Cases: This patient's sleep schedule ranges from 1.5 to 5 hour segments at various times of day or night including naps at school with occasional longer periods of sleep up to 10 hours and longer periods of wakefulness up to 22 hours who has been treated with the following medications: trazodone, clonidine, hydroxyzine, diphenhydramine, quetiapine, gabapentin, mirtazapine, eszopiclone, melatonin and ramelteon. His behavioral problems have been treated with olanzapine. He continued to be aggressive and difficult to direct. His parents reported exhaustion. Then, suvorexant 5mg was added at bedtime while the following sleep medications were continued: gabapentin total daily dose of 1500mg (300mg in morning and 3pm;900mg at bedtime, 300mg one hour later if still awake), ramelteon 8mg, mirtazapine 7.5mg and olanzapine 10mg at bedtime and bid prn aggressive behavior. He also takes the following daily medications: bisacodyl, polyethylene glycol, simethicone, hyoscyamine, cholecalciferol, aspirin, levothyroxine, hypoallergenic nutritional formula, starch and albuterol prn. With the addition of suvorexant 5mg, he had been able to get 9.5 hours of consolidated sleep at night with improvement in his behavior until he contracted Covid-19 and regressed. The suvorexant dose was increased to 10mg which again improved his insomnia and behavior. Conclusion: Various medications have either not worked at all or have worked suboptimally for insomnia in this medically complex patient who has an irregular Circadian rhythm disorder. Adding an orexin receptor antagonist as a novel mechanism to his regimen has shown promise. At this time, this patient has been stable for one month with suvorexant 10mg at bedtime after regression on the 5mg dose that coincided with a Covid-19 infection. We are proceeding with cautious optimism.
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Introduction: The COVID-19 pandemic continues to evolve internationally, increasing levels of psychological stress in adolescents around the world, and thereby increasing their risk for emotional disorders associated with chronic stress. This ongoing threat to adolescents mental health requires that we identify factors that contribute to their ability to cope with situations shown to carry significant risks, such as the COVID-19 pandemic (i.e., their resiliency).Negative emotions are associated with chronic stress, and factors that reduce levels of negative emotions are associated with improved resiliency. Healthier sleep is associated with lower levels of negative emotions. Cognitive reappraisal (changing the way one thinks about potentially emotioneliciting events) is an emotional regulation strategy that downregulates negative emotions. However, there is little information about the associations between sleep quality, emotional regulation, and resiliency in adolescents. The present study sought to fill this gap by examining the associations between adolescents sleep quality and disturbances, emotional regulation strategies and adolescents resiliency during the COVID-19 pandemic. Methods: Forty-five adolescents (M=13.47, SD=1.7 years) participated in the study during the first wave of the COVID-19 pandemic in Canada (May 15 to June 30, 2020). The Pittsburgh Sleep Quality Index was used to assess adolescents self-reported sleep quality and disturbances. The Emotion Regulation Questionnaire was used to assess respondents' tendencies to regulate their emotions using cognitive reappraisal or expressive suppression. The Connor-Davidson Resilience Scale was used to measure resilience. Behavioral/emotional problems were assessed before the pandemic using the Youth Self Report (YSR). Results: Hierarchical multiple linear regression analyses revealed that lower levels of sleep disturbances and frequent use of cognitive reappraisal to regulate emotions were associated with a higher level of resiliency during the COVID-19 pandemic, above and beyond the contributions of gender or pre-pandemic emotional or behavioral problems. Conclusion: Better sleep quality and the habitual use of an emotional regulation strategy that is effective in downregulating negative emotions are associated with higher resiliency in adolescents facing the COVID-19 pandemic. The cross-sectional nature of the study does not allow the inference of causation.
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Introduction: The COVID-19 pandemic has affected millions of parent in the United States by creating physical health-related stress, changes to work and parenting demands, and the possibility of losing a job or not being able to pay bills (Brooks et al., 2020). Such stressors have the potential to disrupt parents' basic, essential needs, such as sleep (e.g., Sadeh et al., 2004). Although ample re -search suggests that disturbances to parents' sleep can have diverse, negative repercussions on their own behavior and functioning (e.g., Grandner et al., 2020), there remains relatively little evidence linking parents' sleep problems to potentially disrupt parenting processes and children's behaviors. Given the emerging and established links between these diverse constructs, the proposed study -spectively influence children's behavior via parents' sleep quality and subsequent parenting practices. Methods: The sample is comprised of 1003 parents of school-aged (5-18 years old) children who completed an initial online survey (from March 27th to April 30th of 2020) followed by up to 8 weekly on-three forms of COVID-related stress: health-related stress, stress as-sociated with work/parenting demands, and finance-related stress. In the follow-ups, parents completed measures of sleep (i.e., PROMIS sleep disturbance questionnaire), parenting (e.g., Alabama Parenting Questionnaire), and child behavioral problems (i.e., CBCL). Results: Multi-level modeling results, at the between-person level, suggested that the influence of COVID-related financial stress on disturbance and angry/hostile parenting behaviors. At the within-person level, weekly spikes in parental sleep disturbance were asso-ciated with corresponding spikes in angry/hostile parenting, which, in turn, were associated with subsequent spikes in children's be- havior problems. Conclusion: Our results highlight the longitudinal impact of par-ental sleep disturbance as a mechanism linking COVID-19-related stressors, parenting, and child functioning.
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There is a gap in literature regarding parent practices in homeschooling children with autism spectrum disorder (ASD) who demonstrate problem behaviors during instructional sessions. Research literature showed that children with ASD demonstrate problem behaviors during instructional sessions in educational environments. The problem is a gap in the literature regarding how parents who homeschool their students with ASD address the same behaviors. The conceptual framework-social learning theory. The research questions were focused on parent practices of managing problem behavior during homeschool instructional sessions and the support they received. Qualitative research was used to explore the experiences of homeschool parent practices in a specific social environment. Open-ended interview questions were used to gain understanding of the parents' perspectives regarding the management of problem behavior in homeschooled students with ASD. Thematic analysis, which emphasized patterns of meaning within qualitative data, depicted themes that developed from the interviews of the parents. Data showed that these parents experienced the same student behavioral challenges as educators in public/private schools, but often get different results using different behavior management strategies. The results of this study filled three gaps in the literature: 1) understanding the reasons behind parents' choice to homeschool, 2) understanding the practices these parents use to manage their child's behavior, and 3) the generalization of this data to practices in the discipline. Social change aspects include providing information regarding more effective instructional planning, increased student engagement, and improved behavior management for children with ASD. (PsycInfo Database Record (c) 2022 APA, all rights reserved)
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Background: Incident reporting systems are an essential element in hospital safety programs. Our objective was to describe the magnitude, evolution and characteristics of adverse events due to patient behavior reported in a high complexity reference university hospital. Methods: Cross-sectional study. Period 20162019. From the hospital registry of adverse events, the notifications of the taxonomy "Patient behavior" were obtained. They were classified according to: type of behavior, category of the reporting professional, care area, sex of the patient/companion, risk and year. The chi(2) test for the comparison of qualitative variables was used, and using a generalized linear model with Poisson distribution, prevalence ratio (PR) and 95% confidence intervals (95%CI) were estimated. Results: Patient behavior reported incidents represented the 8.2%. There was an increasing trend with a slight decrease in the last year (2016 12.4%;2017 29.5%;2018 32.5% and 2019 25.6%). The areas of neurological and psychiatric diseases, and emergencies reported 36.9% and 19.7% of the cases, respectively. Nursing was the most reporting group (73.2%). More than 60% of notifications involved male patients. The PR doubled in escapes or attempts (2.2;95%CI=1.43.5), tripling in non-compliance with hospital rules (3.0;95%CI=1.9-4.7) and aggressive or intimidating behaviors (3.4:95% CI=2.2-5.3). Conclusions: An increase in notifications related to patient behaviors is observed, with a slight decrease in the last year. This study objectively shows and characterizes a problem that is now especially relevant due to the influence of the COVID-19 pandemic on mental health, which quality and clinical safety programs must consider to minimize the associated risks.
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BACKGROUND: With more than 28 million individuals of refugee or asylum-seeking background globally, the current situation has been described as one of the largest humanitarian crises of all time. Families of refugee background have complex, multigenerational mental health and developmental needs that are not accounted for in current programming frameworks. Difficulties in resettlement have been further compounded by COVID-19-related lockdowns, straining parental mental health and placing children at an increased risk for developmental or behavioural problems. Providing appropriate support services and educational resources that address the multigenerational concerns of families of refugee background will address these challenges, allowing for improved parental mental health, family cohesion, and developmental outcomes for children. OBJECTIVES: To gather data about the experiences, resources, referral pathways and barriers that impact the experience of parents of refugee background in the Greater Toronto Area (GTA) and to develop a novel, multi-dimensional parenting program model using Community-Based Participatory Research (CBPR) principles. DESIGN/METHODS: This was a qualitative community-based participatory study using a formative research framework, in accordance with COREQ guidelines. In-depth interviews (IDIs) were conducted with parents of refugee background and care providers that work closely with this population. Data were recorded, transcribed, and coded using deductive and inductive coding methods by two independent coders. A peer debriefing strategy was used to verify the coding approach and interpretation of findings in accordance with the RATS (relevancy, appropriateness, transparency and soundness) guidelines for qualitative research. RESULTS: A total of 20 IDIs were conducted (7 parents and 13 care providers). The main topics that were identified to be incorporated into the program include features of child development, how to address resettlement issues, child advocacy, and parenting in the Canadian context. Participants felt that tackling the language barriers, addressing the overlapping responsibilities of the mothers attending the sessions, providing incentives, increasing awareness of the program, and using an anti-racist and anti-oppressive approach is key to the program's success. Participants emphasized the need for trauma-informed mental health support within the program model. CONCLUSION: This study describes the key considerations for a novel parenting program for families of refugee background, by engaging them as key stakeholders in the program design process. Future iteration of this project would involve a pilot and evaluation of the program.