Coronavirus disease 2019 (COVID-19) is an infectious disease that was declared a global pandemic on March 11, 2019, by the World Health Organization. The COVID-19 pandemic has made very rapid and profound changes in our daily lives and society (1). This pandemic will have irreversible effects on children with neurodevelopmental disorders. Neurodevelopmental disorders are a group of disorders that begin in the period of development. These disorders’ symptoms usually appear early in a child’s development and often before entering school, leading to impairments in personal, academic, occupational, and social functioning. The fifth edition of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5) classifies the following disorders as neurodevelopmental disorders: Autism Spectrum Disorder (ASD), Intellectual Disabilities (ID), Attention-Deficit/Hyperactivity Disorder (ADHD), motor disorders, Specific Learning Disorder (SLD), communication disorders, and other neurodevelopmental disorders (2).
To prevent the spread of the COVID-19, many governments have enacted restrictive laws and regulations, and one of the main actions of parents and children is to stay at home. In these situations, it is very difficult for families and caregivers to care for children with neurodevelopmental disorders who have special needs. The spread of this virus can lead to severe psychological distress in people who have previous mental health problems (3,4). Children with neurodevelopmental disorders are at risk due to increased vulnerability to complex and unpredictable changes. This disease increases stress and anxiety in children with neurodevelopmental disorders and their families. The daily routine of children with neurodevelopmental disorders is affected by the frequent observance of health tips and advice, as well as social isolation and distancing, and causes them discomfort (5).
It is clear that in certain critical situations like this pandemic, the mental health of children with neurodevelopmental disorders will also be affected. More common changes in their mental health include insomnia, belligerence, screaming, aggression, and irritability. In fact, compared to people without such disorders, they are much more likely to develop symptoms of stress, anxiety, Post-Traumatic Stress Disorder (PTSD), and depression. As mentioned, in addition to the children themselves, the mental health of their families is also undergoing devastating changes (6,7). Finally, despite insufficient research on children with neurodevelopmental disorders and their families during the COVID-19 pandemic, many experts report that many of these parents have low mood and high anxiety, which can have a wide range of effects on their children’s adjustment (8).
The following recommendations can help improve
the mental health status of children with neurodevelopmental disorders and families during the COVID-19 pandemic:
The role of parents
1. Children with neurodevelopmental disorders need more attention from their parents. These children need their parents’ physical presence, and parents need to accompany them more in play-related activities at home. Parents should take the time to provide positive attention and reassurance to the child.
2. To increase children’s awareness of the pandemic, parents should use simple terms about COVID-19 to communicate with children appropriate to their age. Children should be given factual and accurate information with the help of health protocols and videos provided by government sources or authorized international organizations such as UNICEF and WHO.
3. It is quite possible for parents to notice changes in their children’s behavior during an outbreak. If these children’s behavioral problems are minor and not harmful to others, parents should ignore them, which may reduce the frequency of their misbehavior.
The role of school teachers
1. Teachers should spend some time teaching about COVID-19 and preventive health behaviors, depending on the students’ level of understanding and using the guidelines of international organizations. They can model and implement preventive measures by following health protocols through their behavior.
2. Teachers are involved in promoting students’ mental health. They can help teach simple exercises such as muscle relaxation, deep breathing, and positive self-talk. They can also teach students the right behaviors by using more practical examples by holding virtual workshops on “life skills” and “coping with stress”.
3. With the support of school principals, teachers should make it possible for reading materials related to education and life skills to be made available to underprivileged children who do not have access to the Internet.
The role of pediatricians
1. They should be equipped and able to use telecounseling as much as possible. They should generously provide telephone or online counseling to parents during the pandemic.
2. They need to educate parents about the needs of children at different stages of development. They should also help parents by providing simple and specific information about promoting mental health online or through booklets for parents.
3. Mental health assessments should be performed using standard screening tools that can easily assess various mental health problems in children, including ASD, ADHD, anxiety disorders, and depression.
The role of mental health staff
1. Instead of face-to-face assessments and interventions, there is a need for “adaptation to telemental health”. The provision of mental health care services should be aimed at providing public access to these services.
2. Special content related to this pandemic should be provided to promote mental health and manage behavioral problems in special schools and provide psychological first aid for students with neurodevelopmental disorders.
3. Clinical psychologists should design and implement short-term remote or face-to-face behavioral interventions to manage situations in children such as ADHD, ASD, and ID that are primarily parent-centered. The pathological consequences of a crisis such as PTSD and depression in children should also be considered in similar lines. There is a need for creative solutions, often on a case-by-case basis.
Future research is expected to provide sufficient evidence to provide educational, therapeutic, and rehabilitation services to children with neurodevelopmental disorders and their families during the outbreak of the COVID-19 pandemic, and also, by implementing thoughtful measures, improve their mental health and ultimately their quality of life.
Conflict of Interest
There is no conflict of interest.