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1.
Br J Psychiatry ; 218(1): 7-9, 2021 01.
Article in English | MEDLINE | ID: covidwho-1556719

ABSTRACT

Children and adults with neurodevelopmental disorders make up an estimated 10% of the population. Addressing health inequalities and poorer life outcomes is essential to deliver better quality care. Two parent-carers working in national roles in England suggest ways to increase understanding and work together in coproduction to achieve this.


Subject(s)
Neurodevelopmental Disorders , Psychiatry , Adult , Caregivers , Child , England , Humans , Neurodevelopmental Disorders/therapy , Quality of Health Care
2.
Pediatrics ; 146(1)2020 07.
Article in English | MEDLINE | ID: covidwho-1456130

ABSTRACT

CONTEXT: More than 4 decades of research indicate that parenting interventions are effective at preventing and treating mental, emotional, and behavioral disorders in children and adolescents. Pediatric primary care is a viable setting for delivery of these interventions. OBJECTIVE: Previous meta-analyses have shown that behavioral interventions in primary care can improve clinical outcomes, but few reviews have been focused specifically on the implementation of parenting interventions in primary care. We aimed to fill this gap. DATA SOURCES: We reviewed 6532 unique peer-reviewed articles published in PubMed, the Cumulative Index to Nursing and Allied Health Literature, and PsycInfo. STUDY SELECTION: Articles were included if at least part of the intervention was delivered in or through primary care; parenting was targeted; and child-specific mental, emotional, and behavioral health outcomes were reported. DATA EXTRACTION: Articles were reviewed in Covidence by 2 trained coders, with a third coder arbitrating discrepancies. RESULTS: In our review of 40 studies, most studies were coded as a primary. Few researchers collected implementation outcomes, particularly those at the service delivery system level. LIMITATIONS: Including only published articles could have resulted in underrepresentation of implementation-related data. CONCLUSIONS: Parenting interventions delivered and implemented with fidelity in pediatric primary care could result in positive and equitable impacts on mental, emotional, and behavioral health outcomes for both parents and their children. Future research on the implementation strategies that can support adoption and sustained delivery of parenting interventions in primary care is needed if the field is to achieve population-level impact.


Subject(s)
Neurodevelopmental Disorders/therapy , Parenting , Parents/psychology , Primary Health Care/organization & administration , Child , Humans , Neurodevelopmental Disorders/psychology
3.
Medicine (Baltimore) ; 99(1): e18611, 2020 Jan.
Article in English | MEDLINE | ID: covidwho-1455400

ABSTRACT

BACKGROUND: This systematic review protocol aims to examine the evidence of effectiveness and cost-effectiveness of interventions for children and adolescents with, or at risk of developing mental disorders in low- and middle-income countries (LAMICs). METHODS: We will search Medline Ovid, EMBASE Ovid, PsycINFO Ovid, CINAHL, LILACS, BDENF and IBECS. We will include randomised and non-randomised controlled trials, economic modelling studies and economic evaluations. Participants are 6 to 18 year-old children and adolescents who live in a LAMIC and who present with, or are at high risk of developing, one or more of the conditions: depression, anxiety, behavioural disorders, eating disorders, psychosis, substance abuse, autism and intellectual disabilities as defined by the DSM-V. Interventions which address suicide, self-harm will also be included, if identified during the extraction process. We will include in person or e-health interventions which have some evidence of effectiveness (in relation to clinical and/or functional outcomes) and which have been delivered to young people in LAMICs. We will consider a wide range of delivery channels (e.g., in person, web-based or virtual, phone), different practitioners (healthcare practitioners, teachers, lay health care providers) and sectors (i.e., primary, secondary and tertiary health care, education, guardianship councils). In the pilot of screening procedures, 5% of all references will be screened by two reviewers. Divergences will be resolved by one expert in mental health research. Reviewers will be retrained afterwards to ensure reliability. The remaining 95% will be screened by one reviewer. Covidence web-based tool will be used to perform screening of references and full text paper, and data extraction. RESULTS: The protocol of this systematic review will be disseminated in a peer-reviewed journal and presented at relevant conferences. The results will be presented descriptively and, if possible, meta-analysis will be conducted. Ethical approval is not needed for anonymised secondary data. CONCLUSION: the systematic review could help health specialists and other professionals to identify evidence-based strategies to deal with child and adolescents with mental health conditions.


Subject(s)
Developing Countries , Neurodevelopmental Disorders/therapy , Child , Humans , Neurodevelopmental Disorders/economics , Systematic Reviews as Topic
4.
J Child Neurol ; 36(9): 760-767, 2021 08.
Article in English | MEDLINE | ID: covidwho-1172813

ABSTRACT

Because of the COVID-19 pandemic, in-person services for individuals with neurodevelopmental disabilities were disrupted globally, resulting in a transition to remote delivery of services and therapies. For individuals with neurogenetic conditions, reliance on nonclinical caregivers to facilitate all therapies and care was unprecedented. The study aimed to (1) describe caregivers' reported impact on their dependent's services, therapies, medical needs, and impact on themselves as a result of the COVID-19 pandemic and (2) assess the relationship between the extent of disruption of services and the degree of self-reported caregiver burden. Two online questionnaires were completed by caregivers participating in Simons Searchlight in April and May 2020. Surveys were completed by caregivers of children or dependent adults with neurodevelopmental genetic conditions in Simons Searchlight. Caregivers reported that the impact of the COVID-19 pandemic moderately or severely disrupted services, therapies, or medical supports. The majority of caregivers were responsible for providing some aspect of therapy. Caregivers reported "feeling stressed but able to deal with problems as they arise," and reported lower anxiety at follow-up. Caregivers reported that telehealth services were not meeting the needs of those with complex medical needs. Future surveys will assess if and how medical systems, educational programs, therapists, and caregivers adapt to the challenges arising during the COVID-19 pandemic.


Subject(s)
COVID-19/psychology , Caregiver Burden/psychology , Caregivers/psychology , Health Care Surveys/methods , Health Services Accessibility/statistics & numerical data , Neurodevelopmental Disorders/therapy , Adolescent , Adult , Caregivers/statistics & numerical data , Child , Child, Preschool , Female , Health Care Surveys/statistics & numerical data , Humans , Male , Needs Assessment , Pandemics , SARS-CoV-2 , Surveys and Questionnaires
5.
Br J Psychiatry ; 218(6): 302-304, 2021 06.
Article in English | MEDLINE | ID: covidwho-1112458

ABSTRACT

We explore whether the needs of individuals with neurodevelopment disorders have been overlooked during the coronavirus disease 2019 (COVID-19) pandemic and set out the issues that need to be considered in response to future health crises and pandemics.


Subject(s)
COVID-19 , Influenza, Human , Neurodevelopmental Disorders , Humans , Influenza, Human/epidemiology , Neurodevelopmental Disorders/epidemiology , Neurodevelopmental Disorders/therapy , Pandemics , SARS-CoV-2
6.
J Am Acad Child Adolesc Psychiatry ; 60(1): 2-6, 2021 01.
Article in English | MEDLINE | ID: covidwho-1065243

ABSTRACT

Families of children with neurodevelopmental disorders are especially vulnerable during the COVID-19 pandemic. Physical distancing requirements and closure of schools and services in the context of the COVID-19 pandemic are likely challenging to everyone but may be particularly impactful for families with children with neurodevelopmental disorders ([NDDs], eg, intellectual disability, attention-deficit/hyperactivity disorder [ADHD], autism spectrum disorder [ASD]). Although a small number of children may experience less stress or anxiety due to reduced social and academic expectations,1 for many children with NDDs, and particularly those with ASD, carefully developed behavioral and environmental supports, and consistent and predictable routines and expectations, are vital for their mental well-being.2 Consequently, abrupt discontinuation of these supports during quarantine and prolonged isolation creates a real risk for behavioral exacerbations in this vulnerable population.3-6 Possible consequences for family members include physical and mental strain,7 whereas for the child with an NDD, increased emotional distress and challenging behavior may create safety concerns and the need for hospitalization.4,6 Children with NDDs may be at increased risk for COVID and COVID-related complications,8 emphasizing the need for preventive and/or crisis behavioral health care availability outside of emergency and hospital settings.


Subject(s)
COVID-19/prevention & control , Neurodevelopmental Disorders/therapy , Telemedicine/methods , Adaptation, Psychological , Adolescent , COVID-19/complications , COVID-19/epidemiology , COVID-19/psychology , Caregivers/psychology , Child , Child, Preschool , Female , Humans , Male , Neurodevelopmental Disorders/complications , Neurodevelopmental Disorders/psychology , Ontario/epidemiology , Pandemics , Parents/psychology , Program Evaluation , Stress, Psychological/etiology , Stress, Psychological/therapy
7.
J Med Internet Res ; 23(1): e22619, 2021 01 20.
Article in English | MEDLINE | ID: covidwho-1040099

ABSTRACT

BACKGROUND: In response to COVID-19, there has been increasing momentum in telehealth development and delivery. To assess the anticipated exponential growth in telehealth, it is important to accurately capture how telehealth has been used in specific mental health fields prior to the pandemic. OBJECTIVE: This systematic review aimed to highlight how telehealth has been used with clinical samples in the neurodevelopmental field, including patients with neurodevelopmental disorders (NDDs), their families, and health care professionals. To identify which technologies show the greatest potential for implementation into health services, we evaluated technologies for effectiveness, economic impact, and readiness for clinical adoption. METHODS: A systematic search of literature was undertaken in April 2018 and updated until December 2019, by using the Medline, Web of Science, Scopus, CINAHL Plus, EMBASE, and PsycInfo databases. Extracted data included the type of technology, how the technology was used (ie, assessment, treatment, and monitoring), participant characteristics, reported outcomes and authors' views on clinical effectiveness, user impact (ie, feasibility and acceptability), economic impact, and readiness for clinic adoption. A quality review of the research was performed in accordance with the Oxford Centre for Evidence-Based Medicine Levels of Evidence. RESULTS: A total of 42 studies met the inclusion criteria. These studies included participants and family members with autism spectrum disorders (21/42, 50%), attention deficit hyperactivity disorders (8/42, 19%), attention deficit hyperactivity or autism spectrum disorders (3/42, 7%), communication disorders (7/42, 17%), and tic disorders (2/42, 5%). The focus of most studies (33/42, 79%) was on treatment, rather than assessment (4/42, 10%) or monitoring (5/42, 12%). Telehealth services demonstrated promise for being clinically effective, predominantly in relation to diagnosing and monitoring NDDs. In terms of NDD treatment, telehealth services were usually equivalent to control groups. There was some evidence of positive user and economic impacts, including increased service delivery efficiency (eg, increased treatment availability and decreased waiting times). However, these factors were not widely recorded across the studies. Telehealth was demonstrated to be cost-effective in the few studies that considered cost-effectiveness. Study quality varied, as many studies had small sample sizes and inadequate control groups. Of the 42 studies, only 11 (26%) were randomized controlled trials, 12 (29%) were case studies or case series, 6 (14%) were qualitative studies, and 5 (12%) were noncomparative trials. CONCLUSIONS: Telehealth has the potential to increase treatment availability, decrease diagnosis waiting times, and aid in NDD monitoring. Further research with more robust and adequately powered study designs that consider cost-effectiveness and increased efficiency is needed. This systematic review highlights the extent of telehealth technology use prior to the COVID-19 pandemic and the movement for investing in remote access to treatments. TRIAL REGISTRATION: PROSPERO International Prospective Register of Systematic Reviews CRD42018091156; https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42018091156.


Subject(s)
Monitoring, Physiologic/methods , Neurodevelopmental Disorders/therapy , Telemedicine/methods , Female , Humans , Male , Neurodevelopmental Disorders/epidemiology , Qualitative Research
9.
Res Dev Disabil ; 107: 103786, 2020 Dec.
Article in English | MEDLINE | ID: covidwho-811818

ABSTRACT

BACKGROUND: In Italy, due to the COVID-19 emergency, hospitals and health services were required to undergo rapid changes in organization and assistance delivery in order to control the epidemic outbreak. The confinement of the population and the outbreak impact on health care systems disrupted the routine care for non COVID-19 patients. Particular challenges have been faced for services working with neurodevelopmental disabilities and pediatric neurological disorders. We present the adaptation of our Child Neurology and Developmental Neuropsychology Service at the Developmental Neurology Unit, which is responsible for cognitive and behavioral assessment of children with neurodevelopmental disorders and neurological diseases, on an inpatient/outpatient basis, to the epidemic outbreak. In particular, we describe the introduction of telehealth in clinical practice and provide qualitative and quantitative data regarding the feasibility of the telemedicine protocol and the level of satisfaction experienced by families. OUTCOMES: Patients admitted on an inpatient basis are limited to non-deferrable cases; all patients do pre-admission screening to exclude COVID-19 infection. Child neurologists and psychologists have switched the out-patient visits to telemedicine sessions, despite they had little to no previous experience in telemedicine. Families' response to the proposal of video-sessions has been positive with 93 % of families accepting it, preparing appropriate devices and conditions to participate at home. Main barriers to tele-sessions access were socio-economic and linguistic disadvantage, together with familiar health issues. The Telemedicine Satisfaction Questionnaire revealed high level of agreementi between expected care and actual care received by patients and caregivers. CONCLUSIONS: The experience of our Service confirms the importance of an inclusive response to emergency with respect to people with disabilities, ensuring the quality and continuity of care in times of population quarantine. Our experience could be useful worldwide to evaluate the feasibility of the Italian emergency response applied to the assistance of children with neurodevelopmental disabilities.


Subject(s)
Ambulatory Care/methods , Neurodevelopmental Disorders/therapy , Neurology , Parents , Patient Satisfaction , Psychology, Child , Telemedicine/methods , COVID-19 , Child, Preschool , Delivery of Health Care , Feasibility Studies , Hospitalization , Humans , Italy , Neuropsychology
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