Mental Health of Most Kids With Autism Declined in Pandemic

Kate Johnson

May 20, 2022

More than half of children and youth with autism experienced pandemic-related declines in mental health between May and December 2020, according to a large Canadian cohort study.

The study, based on surveys with parents of 230 children and youth with autism, showed that 141 (61%) of these children had mental health deterioration, and 37 (14%) accessed acute mental health services. The researchers identified a range of risk factors for both outcomes.

"We found that some factors inherent to the child predicted poorer mental health during the pandemic: specifically, preexisting concerns related to anxiety and depression," senior author Evdokia Anagnostou, MD, child neurologist and professor of pediatrics, the University of Toronto, Ontario, told Medscape Medical News. "However, we also found that family and community factors impact the mental health of autistic kids and are good targets for intervention."

The findings were published online May 5 in Paediatrics & Child Health.

Disrupted Routines

Observations have indicated that school closures and lockdowns during the first year of the pandemic affected children's mental health. Children have had increased stress and exhibited more internalizing and externalizing behaviors.

Children with preexisting mental health conditions or neurodevelopmental disorders have been particularly vulnerable to decreases in mental health under these circumstances. Changes in routine and disrupted access to educational and health services have increased stress among children with autism and their parents. Greater stress and mental health problems among parents are recognized as risk factors for mental health difficulties among children.

The investigators sought to identify subgroups of children with autism who are most at risk of poor mental health outcomes during the pandemic. They used survey data from a large Canadian collaboration involving two clinically referred cohorts and one community cohort in Ontario.

In addition to reporting their own mental health status using the Patient Health Questionnaire, parents also reported changes in the following six measures of their children's mental health during lockdown: depression, anxiety, obsessive-compulsive disorder, irritability, inattention, and hyperactivity. The first three measures were considered internal­izing symptoms, and the latter three externalizing symptoms.

COVID-related stress and material deprivation were assessed in questions adapted from the CRISIS_AFAR question­naire. The researchers also examined access to academic and health services during lockdown.

Loss of Services

The children's mean age was 10.89 years, and 76% of them were boys. The population's mean IQ was 89.08. A plurality of households (36.6%) had incomes of CAD $100,000 or more.

Predictors of a child's mental health deterioration included greater severity of their pre-pandemic internalizing symptoms, parents' current depression and anxiety, and COVID-related stress, including material deprivation.

Decline in mental health was associated with the loss of academic and medical services. "A total of 61.3% of children who did not re­ceive pre-pandemic academic services and 70.0% of children who lost these services during the pandemic showed mental health deterior­ation," noted the researchers. In addition, 70.1% of children who lost access to their doctor were in the group with mental health deterioration.

Among children who accessed mental health services, predictors of need for these services were older age, lower family income, greater material deprivation, and loss of access to academic services. The investigators observed a trend toward girls being more likely to access services. When the researchers corrected the data for multiple comparisons, however, these associations did not persist.

"Given that these symptoms increase with age generally and are more prevalent in girls than boys, it's not surprising that we found age and sex effects," said Anagnostou, who also is assistant director of the Holland Bloorview Research Institute, Toronto. "This suggests that clinicians should be particularly astute and anticipate the needs for additional supports for this group of children," she said, adding that supporting parental mental health may be as important. "And lastly, in our advocacy roles, assuring financial supports, considering supporting marginalized groups, and keeping school open will go a long way in protecting kids' mental health."

Anagnostou said that other recent work by her group has shown that while most children suffered mental health setbacks during the pandemic, children with autism were particularly affected. "Generally, outside of the pandemic, autistic children have higher rates of mental health concerns than the general population," she said. She recommended that clinicians "anticipate that children with preexisting anxiety or depression symptoms may be particularly vulnerable" in future lockdowns.

Uneven Risk Distribution

Commenting on the findings for Medscape Medical News, Melanie Dirks, PhD, professor of psychology at McGill University in Montreal, Quebec, and expert in the social and emotional development of children and youth, said "the take-home from this study is that it is consistent with a growing body of work documenting that the risks of the pandemic for children's mental health and well-being were not evenly distributed across the population. Families with fewer resources are at greater risk, and we need to determine how best we can support those families, as well as to ensure continuity of services."

The study was funded by the Canadian Institutes for Health Research; Centre for Brain and Mental Health; Hospital for Sick Children; Leong Centre for Healthy Children, SickKids; Miner's Lamp Innovation Fund in Prevention and Early Detection of Severe Mental Illness at the University of Toronto; Ontario Brain Institute; and the Ontario Ministry of Health. Anagnostou has served as a consultant to Roche and Quadrant Therapeutics. She has received in-kind support from AMO pharma and CRA, grant funding from Roche, royalties from APPI and Springer, and editorial honoraria from Wiley. She also holds a patent for the Anxiety Meter device. Dirks has disclosed no relevant financial relationships.

Paediatr Child Health. Published online May 5, 2022. Full text

Kate Johnson is a Montreal-based freelance medical journalist who has been writing for more than 30 years about all areas of medicine.

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