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Parent-Reported Behavioural Changes in Children With Autism Spectrum Disorder During the COVID-19 Lockdown in Italy

Authors:
  • Institute of Ortophonology
  • Instutute of Ortophonology
  • Institute of Ortophonology, Rome, Italy
  • Institute of Ortophonology

Abstract and Figures

Autism Spectrum Disorders (ASD) are characterized by impairments in social interaction and reciprocal communication. During a pandemic, when social distancing becomes mandatory for all, both parents and children are not supported in-person by their therapists and cannot participate in usual therapies. This study reports the main clinical changes experienced by parents of children with during the first month of lockdown during the COVID-19 pandemic in Italy. Using standardized questionnaires, the families of 63 ASD children were interviewed in February and April 2020. Findings showed an increase in restricted and repetitive behaviours in about 30% of the sample; also, motor restlessness and sleep disturbances increased, with greater irritability and mood dysregulation. On the other hand, no changes emerged in personal self-care autonomies, in taste/smell sensitivity, and in auto or other-directed aggression. Despite the undeniable negative impact that lockdown can have on the psychosocial well-being of children, having maintained a continuity in supporting families, parental counselling (even if online and not in-person) helped families to redefine the meanings of behavioural changes of their children and to understand their adaptive functionality.
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Di Renzo, M. D., et al. (2020). Parent-Reported Behavioural Changes in Children With
Autism Spectrum Disorder During the COVID-19 Lockdown in Italy.
Continuity in
Education
,
1(1), pp. 117–125. DOI: https://doi.org/10.5334/cie.20
BRIEF REPORT
Parent-Reported Behavioural Changes in Children
With Autism Spectrum Disorder During the
COVID-19 Lockdown in Italy
Magda Di Renzo, Federico Bianchi Di Castelbianco, Elena Vanadia, Massimiliano
Petrillo, Simona D’Errico, Lidia Racinaro and Monica Rea
Institute of Ortofonologia, IT
Corresponding author: Magda Di Renzo (m.direnzo@ortofonologia.it)
Autism Spectrum Disorders (ASD) are characterized by impairments in social interaction and
reciprocal communication. During a pandemic, when social distancing becomes mandatory for
all, both parents and children are not supported in-person by their therapists and cannot
participate in usual therapies. This study reports the main clinical changes experienced by
parents of children with during the rst month of lockdown during the COVID-19 pandemic in
Italy. Using standardized questionnaires, the families of 63 ASD children were interviewed in
February and April 2020. Findings showed an increase in restricted and repetitive behaviours
in about 30% of the sample; also, motor restlessness and sleep disturbances increased, with
greater irritability and mood dysregulation. On the other hand, no changes emerged in personal
self-care autonomies, in taste/smell sensitivity, and in auto or other-directed aggression.
Despite the undeniable negative impact that lockdown can have on the psychosocial well-being
of children, having maintained a continuity in supporting families, parental counselling (even if
online and not in-person) helped families to redene the meanings of behavioural changes of
their children and to understand their adaptive functionality.
Keywords: Autism Spectrum Disorder; COVID-19; quarantine; parents; clinical symptoms
Children With Autism During the Coronavirus Lockdown
The coronavirus COVID-19 pandemic in 2020 led to many governments mandating restrictive measures to
be taken in order to prevent its wider spread. For parents and children, staying at home was one of those
measures, including families with a child with Autism Spectrum Disorder (ASD). Before the pandemic in Italy,
most children with ASD were included in more or less intensive rehabilitation programmes at home and
in dedicated hospitals or institutions. During the pandemic, due to the social distancing, both families and
ASD children were not supported in-person by their therapists and were not able to participate in external
therapies (Narzisi, 2020). In fact, in Italy health facilities were told to provide only “emergency” medical care
and, as a result, people with other health problems, including mental health disorders, have had to wait
until the end of the emergency period to seek help, probably until October 2020. That is, because they are
not considered to be in an “emergency” condition, patients with chronic mental health problems who need
constant medical care have not been able to access proper care.
Cassidy et al. (2020), based on a roundtable discussion, published “An Expert Discussion on Autism in
the COVID-19 Pandemic,” which, among other things, summarizes the main international ASD-related
organizations that are working on creating guidelines in their respective countries (e.g., the National
Autistic Society in the UK, The Autism Society of America in the USA). Everyone agrees that dealing with
uncertainty, changes in routine, loss of long-standing coping mechanisms, increased social isolation, and
lack of connectedness are important risk factors caused by physical distancing. Added to this are the possible
increases or flare-ups in co-occurring mental health issues, such as anxiety. Experts also fear that “rationing
of health care resources may discriminate against people with disabilities by confusing measures of frailty
with disability-related functional challenges” (Cassidy et al., 2020, p. 116).
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In Italy, regardless of the type of therapeutic treatment, the rehabilitation programmes for children with
ASD are usually also focused on parental support in order to better manage typical symptoms of autism and
stimulate the child’s social and communication skills. Home quarantine as well as the closure of day care
facilities are likely to have a negative impact on clinical outcomes, with a risk of aggravation of symptoms
and even a relapse. Having to stay home not only slows progress in developing social skills, but also reduces
self-reliance and self-confidence (Chaturvedi, 2020).
Further, some children with severe autistic symptoms may not understand what is going on, why their
school is no longer accessible, why their routines are interrupted. Hence, it is possible that some of them
will have difficulty adapting to changes in their environment. Thus, the intrinsic characteristics of autism
(impairments in social communication and interaction, restricted and repetitive behaviours, interests, or
activities) and the frequent co-existence of neurological, psychiatric, and medical co-morbidities (Christensen
et al., 2018) make individuals with autism a more vulnerable population that needs maximum attention
in the context of the prevention and control strategies of the COVID-19 epidemic (Istituto Superiore di
Sanità [ISS], 2020). The National Institute of Health (ISS, 2020) issued important recommendations for
describing the measures currently in place (e.g., social distancing) and even the most negative ongoing
events (symptomatic parent at home or hospitalization) to children with ASD through the use of concrete
terminology, avoidance of abstract sentences or metaphors, and/or use of augmentative and alternative
communication interventions (Logan, Iacono, & Trembath, 2017). Some children may find it difficult to
articulate how they feel about unexpected changes. For others, communication impairments may be
associated with problems of receptive and expressive communication, limited verbal, or nonverbal skills,
and perspective and/or social communication deficits.
Fear, frustration, and worry can be expressed through behaviours such as changes in sleep/wake rhythms
or eating patterns, an increase in repetitive behaviours, excessive rumination, an increase in agitation or
irritability, or a decrease in self-care (Hume et al., 2020). Further, many individuals with ASD use electronic
devices (such as television, tablet, smartphone) more often and for longer periods of the day, making it
difficult to stop using them or to switch from one activity to another. The rigidity and inflexibility of some
individuals with autism can make these transitions particularly problematic (ISS, 2020).
The objective of this study was to investigate the main changes perceived by parents in their child’s autistic
symptomatology during the first month of home quarantine imposed by Italian governmental decrees to
deal with COVID-19. We specifically wanted to (a) to verify the presence of improvements or worsening of
the typical symptoms of autism (e.g. restricted and repetitive behaviours, mannerisms and stereotypes);
(b) investigate changes in children’s self-care skills; and (c) verify changes in arousal (hyperactivity, fears
induced by new situations, and problems with sleeping), in aggressiveness (aggressiveness and irritability),
and the sensory profile (olfactory and gustatory sensitivity).
Method
Participants
The study included 63 families and their children with ASD; eight females and 55 males aged between
2.7 and 9.4 years old (see Table 1). Of the children, 36.5% had a mild level of diagnostic severity; 38.1% a
moderate level, and 25.4% a severe level. With reference to stages of language development, 28.6% had no
language, 22.2% had holophrastic speech, 20.6% had telegraphic speech, 28.6% had a complete phrasal
structure. Further, 92% were of Italian origin; the families of the remaining 8% were from Afghanistan,
Cameroon, Philippines, Peru, and Romania. A total of 33% of the children were only children, 57% had a
brother/sister, 8% had two siblings, and 2% had four siblings.
All the children followed a therapeutic approach (DERBBI model) for ASD (Di Renzo et al., 2020).
DERBBI – Developmental, Emotional Regulation and Body-Based Intervention – is focused on constructing
Table 1: Characteristics of the Study Sample.
Mean (SD)Range
Child age, years 5.9 (1.7) 2.7–9.4
Child age when beginning rherapy, months 34 (7.8) 21–55
Treatment duration, months 38.9 (20.1) 4–82
Child intelligence quotient 84.3 (16.3) 44–112
Di Renzo et al: Parent-Reported Behavioural Changes in Children With Autism Spectrum
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communicative interaction with children; it is mediated by a therapist and the caregiver, who help the child
to regulate his or her own reactions when confronted with external or internal stimuli that may be perceived
as disturbing or harmful. The specific characteristic of the intervention is the use of the therapist’s body
as a communication tool, in order to enrich an emotional exchange in the dyad (for further details, see Di
Renzo et al., 2020). All children ceased therapy March 10, 2020, because of government regulations related
to minimize the spread of COVID-19.
Procedure
The parents of children with ASD were involved in this study. At the time of the study, the children
had been participating in the Institute of Ortofonologia (Rome) rehabilitation projects for about
three years after receiving a diagnosis of ASD in accredited private centres or public programs in
Rome (Italy). From March to April 2020, the children had to cease attending the rehabilitation
programme; instead, their parents conducted weekly telephone and Skype counselling meetings with
psychologists.
For the study, the parents were contacted by phone, and a subsequent 40-minute telephone appointment
was scheduled. Psychologists made the calls between April 10 and 14, 2020 (T1). They explained to the
parents the aims of the research and that during the calls they would discuss the general well-being of their
children through a series of questionnaires that had been presented to them in February 2020 (T0) during
periodic follow-up meetings. No parent refused to participate in the research; all telephone interviews were
conducted with mothers.
Instruments
ABAS-II. The Adaptive Behaviour Assessment System-II provides an individualized measure of adaptive
behaviour. The parent report of the ABAS-II (Harrison & Oakland, 2003) used in this study addresses nine
adaptive skill areas (M = 10; SD = 3). In this study, the parents were given the Self-Care subscale in the form
of a structured interview.
ASDBI. The ASD Behaviour Inventory (Cohen & Sudhalter, 2005) is a standardized rating scale for parents;
it was designed to include separate subscales that independently address different types of maladaptive or
adaptive behaviours. In this study, the following maladaptive subscales (higher scores indicative of more
behaviour problems) were administered: (a) Arousal Problems, assessing hyperactivity, fears induced by
new situations and problems with sleeping; and (b) Aggressiveness, assessing both self and other-directed
aggression, along with general moodiness and irritability.
SSP. The Short Sensory Profile (McIntosh, Miller, & Shyu, 1999) assesses sensory symptoms in seven
domains with 38 items to determine how the child modulates sensory inputs through the sensory
systems and which behavioural and emotional responses are associated with sensory processing.
In this study only the Taste/Smell Sensitivity subscale was administered. Parents were asked to
indicate how often their child showed sensory behaviours. Scores are assigned on a five-point Likert
scale ranging from “always” = 0 to “never” = 4. Low scores are indicative of frequent dysfunctional
behaviours.
Statistical Analyses
In order to evaluate variations in children’s scores between T0 (February 2020) and T1 (April 2020), analyses
of unifactorial (ANOVA) and multivariate (MANOVA) variance for repeated measurements were conducted.
Effect size was calculated using the partial eta squared, whereby η2 = 0.02 is considered a small effect, 0.13
a medium effect, and 0.23 a large effect (Pierce, Block, & Aguinis, 2004). In order to analyse changes over
time of the measures based on categorical variables, an analysis of the chi-square was also carried out. The
level of significance was set at p < 0.05. All statistical analyses were performed using the software version
21.0 of SPSS.
Results
Changes in Autistic Symptoms
The first goal of the study was to verify the presence of improvements or worsening of the typical symptoms
of autism. Here 33.6% of parents (21 out of 63) reported intensification of autistic typical symptoms in the
last month; 14% (9 out of 63) reported an increase in restricted and repetitive behaviours, 1.6% (1 out of
63) an increase in mannerisms, 14% (9 out of 63) an increase in motor stereotypies, and 3.2% (2 out of 63)
an increase in vocal stereotypes.
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Changes in Self-Care Autonomies
The second aim was to verify changes in self-care skills (ABAS-II subscale). Parents did not report any changes
in the autonomies related to the use of the toilet, in washing or dressing in the last month (F = 3.169;
p = .08) (see Table 2).
Maladaptive and Sensory Problems
The third aim was to verify changes in maladaptive problems. As shown in Table 2, the scores at the ASDBI
subscales significantly increased, thus indicating a worsening in Arousal Problems, specifically in Hyperactive
Behaviours, such as motor restlessness, agitation, moving back and forth in the room (F = 49.00; p < .01;
η2 = .44), in Fears induced by new situations (F = 11.698; p < .01; η2 = .16), and in Sleep Regulation Problems,
such as difficulty falling asleep, nocturnal awakenings, and difficulty in waking up (F = 15.645; p < .01; η2 = .20).
Data analysis also revealed significant worsening in Aggressiveness, specifically in Moodiness (the child
gets scared for no apparent reason, gets angry or cries suddenly, changes his mood quickly) (F = 11.737;
p < .01; η2 = .16), in Irritability (the child has a tantrum, is hard to please) (F = 26.481; p < .01; η2 = .30). In
contrast, no significant changes were found in the Self- and Other-Directed Aggression subscales (hitting,
scratching, biting themselves or others). Finally, parents did not perceive significant changes in their children
in the Taste/Smell Sensitivity subscale of the Short Sensory Profile (see Table 2).
The variables “age of the child” (p = .82), “severity of autistic symptomatology” (p = .53), and “intelligence
quotient” (p = .52) were included as covariates, but none of these was significant, indicating that the
variations detected over time were independent from these variables.
Qualitative Responses
From the analysis of the frequency distribution of individual items, it emerges that in the Hyperactive
subscale, the percentage of children who “often” showed problems significantly increased on all four items
included in the subscale (see Table 3). Even in the Fears induced by new situations and Sleep Regulation
Problems, the percentage of children who “often” showed difficulties, both in falling asleep and awakening
phase, increased significantly.
Finally, in the Moodiness and Irritability areas, the percentage of children who “often” showed difficulty
significantly increased, especially with respect to becoming fearful for no reason and significantly changing
one’s mood.
In addition, qualitative data from interviews with parents into the possible psychosocial impact of
the pandemic on their children highlighted that 19 parents (about 30% of the total sample) reported
improvements in the communicative-relational domain; parents of five children (out of 42 who had more
than one child) reported improvements in the quality of relationships and play between siblings.
Further progress observed by parents during this period included both verbal communication, such as the
appearance of single new words or initial verbalizations, and nonverbal communications, such as greater
Table 2: Difference Between the Averages of the Scores on the ABAS-II Self-Care Subscale, the ASDBI
Subscales, and the SSP.
Test Subscale T0 T1 F P η2
ABAS-II Self-Care 2.1 2.2 3.169 .08 /
ASDBI Hyperactivity 1.0 1.4 49.00 <.01 .44
Fear of New situations 0.7 0.9 11.698 <.01 .16
Sleep Regulation Problems 0.4 0.8 15.645 <.01 .20
Moodiness 0.4 0.6 11.737 <.01 .16
Irritability 0.9 1.3 26.481 <.01 .30
Self-Directed Aggression 1.6 1.7 0.219 .64 /
Other-Directed Aggression 0.4 0.5 3.189 .08 /
SSP Taste/Smell Sensitivity 3.6 3.5 3.253 .08 /
Note: ABAS-II: Adaptive Behavior Assessment System, Second Edition. ASDBI: Autism Spectrum Disorder Behavior
Inventory; SSP: Short Sensory Profile. T0 = February 2020; T1 = April 2020.
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Table 3: Difference Between Response Rates to the ASDBI Subscales.
Subscale Item Answer T0 (%) T1 (%) Chi square P
Hyperactivity Restless N/A 61.9 38.1 20.71 .001
S/t 36.5 25.4
Oft. 1.6 36.5
Fidgets N/A 63.5 34.9 11.64 .01
S/t 36.5 34.9
Oft. 0.0 30.2
Climbs on furniture N/A 71.4 66.7 78.19 .001
S/t 17. 5 14.3
Oft. 11.1 19.0
Wanders around room N/A 60.3 49.2 53.54 .001
S/t 34.9 27.0
Oft. 4.8 23.8
Fear of New
Situations
Becomes upset when things don’t occur at
their usual times
N/A 88.9 826 32.41 .001
S/t 9.5 11.1
Oft. 1.6 6.3
Resists changing from one activity to another N/A 57.2 46.1 60.39 .001
S/t 36.5 34.9
Oft. 6.3 19
Becomes upset when own schedule or order
of the routine is changed
N/A 79.3 68.3 61.50 .001
S/t 15.9 20.6
Oft. 4.8 11.1
Resists changing own location in room N/A 81 69.9 63.91 .001
S/t 12.7 19
Oft. 6.3 11.1
Sleep
Regulation
Problems
Difficulty falling asleep N/A 88.9 68.2 19.70 .001
S/t 9.5 14.3
Oft. 1.6 17.5
Awakens one or more times at night N/A 81.0 68.2 50.77 .001
S/t 12.7 15.9
Oft. 6.3 15.9
Awakens unusually early and stays awake the
rest of the day
N/A 87.3 76.2 62.26 .001
S/t 7.9 12.7
Oft. 4.8 11.1
Difficulty awakening at morning N/A 96.8 87.3 11.28 .01
S/t 3.2 7.9
Oft. 0 4.8
(Contd.)
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responsiveness in comprehension or the emergence of communicative gestures, a more present visual
engagement, and greater attention to and engagement in activities such as homework, drawing, or playing.
Discussion and Conclusion
In the period, March-April 2020, during the coronavirus (COVID-19) pandemic, physical distancing measures
were implemented in Italy, thereby disrupting routines and reducing access to services for families and
children with ASD. One month after the beginning of the restrictive measures announced by the Italian
government, our findings showed an increase of restricted, repetitive behaviours, mannerisms, and
stereotypes in about 33% of the children in the sample. This finding is similar to that reported by Sprang
and Silman (2013), who found that 30% of isolated or quarantined children showed signs of post-traumatic
stress disorder during the 2009 H1-N1 pandemic in the United States. On the other hand, the increase in
stereotyped behaviours could also be interpreted as a sign of the children’s need to anchor themselves to a
known pattern of behaviour (though apparently not functional), which could have a soothing value when
daily routines were abruptly interrupted and the children had to adjust to a new and sudden adaptation,
both external (social isolation and full-time coexistence with parents) and internal (managing emotions,
such as anger or sadness).
As Tribulato (2014) argued, “ritual repetition is an effective tool for reducing anxiety … Through stereotypies,
children with ASD try to reduce and counteract the anxieties, fears and internal conflicts … In fact, when
the child’s anxiety and suffering decrease, this type of symptoms is greatly attenuated …. For this reason, it
Subscale Item Answer T0 (%) T1 (%) Chi square P
Moodiness Becomes fearful for no reason N/A 90.5 84.1 38.68 .001
S/t 9.5 11.1
Oft. 0 4.8
Cries for no reason N/A 98.4 93.6 / ns
S/t 1.6 4.8
Oft. 0 1.6
Angry for no reason N/A 87.3 85.8 / ns
S/t 7.9 6.3
Oft. 4.8 7.9
Shift in mood quick N/A 76.2 66.7 56.10 .001
S/t 19 19
Oft. 4.8 14.3
Irritability Cranky N/A 63.5 38.1 34.21 .001
S/t 30.2 36.5
Oft. 6.3 25.4
Difficult to please N/A 79.3 69.8 53.00 .001
S/t 15.9 15.9
Oft. 4.8 14.3
Takes a long time to calm down when upset N/A 77.8 71.4 67.02 .001
S/t 15.9 15.9
Oft. 6.3 12.7
Easily frustrated N/A 65 50.8 32.61 .001
S/t 30.2 28.6
Oft. 4.8 20.6
Note: ASDBI: Autism Spectrum Disorder Behavior Inventory; T0: February 2020; T1: April 2020; N/A: Never/Almost
Never; S/t: Sometimes; Oft.: Often.
Di Renzo et al: Parent-Reported Behavioural Changes in Children With Autism Spectrum
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is absolutely useless and counterproductive to struggle to limit or try to extinguish these signs of suffering,
through reproaches or negative reinforcements. It is much better to commit to offering the child a more
peaceful, joyful and dialoguing environment” (pp. 50–51).
In the present study, parents perceived a significant increase in their children’s difficulty in the areas
of Hyperactivity and Fear toward new situations, expressed in terms of sensory-motor agitation and
restlessness. This could be related to the absence of planned routines; in fact, according to parents’ reports,
in the months preceding the lockdown, routine activities (school, therapy, extracurricular activities) had
helped them contain and manage the conduct of their children.
At the same time, a worsening in the area of sleep regulation was found, showing a significant amount of
nocturnal and/or early awakenings, agitation, and difficulty in falling asleep, associated in some cases with
the need and/or desire of the children to go back to sleeping with their parents despite previously having
developed the ability to sleeping alone in their own bed. Problems related to sleep regulation were also
reported by other authors (Altena et al., 2020), who declared that potential for sleep problems to emerge or
worsen during periods like this is high. This may be particularly true for children with neurodevelopmental
conditions (including attention-deficit/hyperactivity disorder and ASD), who may be particularly vulnerable
to disturbed sleep during this time of great change and uncertainty (Becker & Gregory, 2020). In addition,
it should be emphasized that less or poor sleep may leads to greater attentional difficulties and increased
restlessness, resulting in behaviours that mimic emotional dysregulation (Golberstein, Wen, & Miller, 2020).
In our study, participating parents perceived greater variability in the moodiness and irritability of
their children, reporting an increase in apparently unmotivated fears and important difficulties in being
comforted by the caregiver. Nevertheless, a very small percentage of children showed the emergence or
intensification of self- and other-directed aggressive behaviours; this could be related to the increased
tendency to express emotions or mood changes openly, which may represent a protective factor towards
dysfunctional behaviours.
It is important to point out that the children’s self-care skill did not worsen, so that the skills acquired before
the pandemic, supported by parents, were not lost. A further noteworthy finding is the absence of a correlation
between symptomatic behaviours and intelligence quotient; that is, although the children in the present
study were very heterogeneous with respect to their IQ scores, this did not seem to have affected any changes
in symptoms during this first month of lockdown. This suggests that cognitive functions are not represented
by a single performance, as expressed in a standardized test score, but may have an adaptive meaning; in this
way, even those with a lower IQ score may be able to demonstrate coping strategies in a pandemic situation.
In light of the sudden change in habits that families and children with ASD experienced in the first month
of lockdown, the preliminary results of this study underline the importance of parental support and parents’
need to have constant contact with professional support, even online if not possible in-person. During the
counselling sessions, the psychologists found it important to redefine with parents the various meanings of
“rehabilitation,” usually involving encouraging social interactions, reducing social distances, and promoting
school inclusion.
The principal aim of therapeutic continuity in parental support was to accommodate caregivers’ previous
and emerging vulnerabilities, but above all to help them make sense of the abnormal behaviours of their
child. As one parent said, “Recently my son often got angry and cried with pain, especially when his dad
went to work at the supermarket … only thanks to the longer time spent with him and to the fact that I was
not scared at his strong reactions of anger, was I able to help my son say that he was crying because he was
afraid that his dad would meet the virus.”
Limitations
The study relied on parents’ perception of feelings and behaviours associated with a stressful experience,
and, as such, responses are potentially flawed by recall bias and social desirability. Furthermore, the parents’
subjective level of distress may have interfered with their perceptive capacities regarding their child’s
symptoms and functioning.
Also, the respondents who completed the online interview represent a self-selected group who may have
had a special interest in the topic; therefore, generalizability of the results is limited.
Ethics and Consent
Informed consent was obtained from all parents (Helsinki Declaration). This research respects the ethical
guidelines and legal requirements of the country in which it was conducted and meets the ethical standards
of the American Psychiatric Association (APA, 2013). The study was approved by the Internal Review Board
(IRB) of the Institute of Ortofonologia in Rome.
Di Renzo et al: Parent-Reported Behavioural Changes in Children With Autism Spectrum
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Acknowledgements
This manuscript is being published on a highly expedited basis as part of a series of emergency publications
related to the COVID-19 crisis. The editorial team of Continuity in Education would like to express their
gratitude to the reviewers, who generously gave their time and expertise to improve this article: Eleonora
D’Urzo, Luciana Pagano Salmi, and Mindy Elliott. The editorial processing of this article was managed by
chief editor Michele Capurso while the copyediting was carried out by Kirsten McBride.
Competing Interests
The authors have no competing interests to declare.
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Continuity in Education
,
1(1), pp. 117–125. DOI: https://doi.org/10.5334/cie.20
Submitted: 21 July 2020 Accepted: 31 August 2020 Published: 16 September 2020
Copyright: © 2020 The Author(s). This is an open-access article distributed under the terms of the Creative Commons
Attribution 4.0 International License (CC-BY 4.0), which permits unrestricted use, distribution, and reproduction in any
medium, provided the original author and source are credited. See http://creativecommons.org/licenses/by/4.0/.
Continuity in Education
is a peer-reviewed open access journal published by Ubiquity Press. OPEN ACCESS
... Seven studies report gender; male 74.7% (657/ 880) and female 25.3% (223/880). A total of 1004 subjects had ASD (Table 1) Behavior The majority of studies found significant behavioral dysregulation (Amorim et al. 2020, Colizzi et al. 2020, Di Renzo et al. 2020, Mutluer et al. 2020, Nonweiler et al. 2020, T€ urko glu et al. 2020. Children with ASD who had pre-existing behavioral problems or comorbidities (i.e. ...
... In total, 521 (51.9%) of the 1004 children with ASD who were analyzed experienced behavioral changes, which included: Anxiety, irritability, restlessness, anger, lethargy, social withdrawal, stereotyped behavior, inappropriate speech, and hyperactivity were the most common symptoms (Amorim et al. 2020, Colizzi et al. 2020, Di Renzo et al. 2020, Mutluer et al. 2020, Nonweiler et al. 2020, T€ urko glu et al. 2020. 33.6% of parents reported intensification of autistic typical symptoms in the last month, 14% reported an increase in restricted and repetitive behavior, 1.6% increase in mannerism, 14% motor stereotypies and 3.2% vocal stereotypes (Di Renzo et al. 2020). ...
... In total, 521 (51.9%) of the 1004 children with ASD who were analyzed experienced behavioral changes, which included: Anxiety, irritability, restlessness, anger, lethargy, social withdrawal, stereotyped behavior, inappropriate speech, and hyperactivity were the most common symptoms (Amorim et al. 2020, Colizzi et al. 2020, Di Renzo et al. 2020, Mutluer et al. 2020, Nonweiler et al. 2020, T€ urko glu et al. 2020. 33.6% of parents reported intensification of autistic typical symptoms in the last month, 14% reported an increase in restricted and repetitive behavior, 1.6% increase in mannerism, 14% motor stereotypies and 3.2% vocal stereotypes (Di Renzo et al. 2020). Anxiety was more prevalent in children who did not follow routines than in those who did (8.75 ± 0.96 vs. 5.36 ± 2.71, p < 0.001) (Amorim et al. 2020). ...
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Objective: This review summarizes evidence pertaining to the impact of the COVID-19 pandemic on the psychological health of children and adolescents with autism spectrum disorder (ASD). Materials and Methods: An electronic search was conducted using four major databases: PubMed, ScienceDirect, Web of Science, and Google Scholar. Using an umbrella methodology, the reference lists of relevant papers were reviewed, and citation searches were conducted. The study included articles written in English between January 2020 and March 2021 that focused on the psychological health of autistic children and adolescents. Results: All eight studies included in the final review were cross-sectional. Three of the eight studies were conducted in Italy, two in Turkey, and one study each in Portugal, Spain, and the United Kingdom, with a total of 1,407 participants. All studies used a mixture of standardized and non-standardized questionnaires to collect data. The total number of patients were 1407 at a mean age of 9.53 (SD = 2.96) years. Seven studies report gender; male 74.7% (657/880) and female 25.3% (223/880). The finding showed that behavioral issues in children and adolescents with ASD have significantly increased; 521 (51.9 percent) of the 1004 individuals with ASD presented with behavioral changes, including conduct problems, emotional problems, aggression, and hyperactivity. Some studies also found increased anxiety and difficulties managing emotions. Only one study reported clinical stabilization in children with ASD during COVID-19. Finally, 82.7% of families and caregivers of children with ASD (544 out of 658) faced challenges during COVID-19. Conclusion: Although the studies in this review suggest a general worsening of ASD children's clinical status, it remains difficult to draw definitive conclusions at this moment, with newer COVID-19 variants on the rise worldwide. During this difficult pandemic period, caregivers, families, and healthcare professionals are recommended to pay more attention to the ASD patients’ health and care needs.
... The closure of schools and in-person autism services resulted in massive disruptions of daily life for many individuals with autism and their families (Cahapay, 2022;Di Renzo et al., 2020;Garcia et al., 2020;Manning et al., 2020). Huge life disruptions for people with autism and their caregivers, such as the sudden loss of behavioral services, have the potential to increase challenging behaviors, disrupt sleep and routines, and decrease social skills and language development (degli Espinosa et al., 2020;Di Renzo et al., 2020;Garcia et al., 2020;Stenhoff et al., 2020). ...
... The closure of schools and in-person autism services resulted in massive disruptions of daily life for many individuals with autism and their families (Cahapay, 2022;Di Renzo et al., 2020;Garcia et al., 2020;Manning et al., 2020). Huge life disruptions for people with autism and their caregivers, such as the sudden loss of behavioral services, have the potential to increase challenging behaviors, disrupt sleep and routines, and decrease social skills and language development (degli Espinosa et al., 2020;Di Renzo et al., 2020;Garcia et al., 2020;Stenhoff et al., 2020). Furthermore, temporary suspension of services for individuals with autism who require intensive behavioral support may place the individual or others at risk of serious harm such as selfinjury or hurting family members (Cox et al., 2020). ...
... Individuals with autism were greatly impacted by the stay-at-home orders during the COVID-19 pandemic (Garcia et al., 2020). For example, children with autism showed an increase in repetitive behaviors, a worsening in sleep regulation, and an increase in agitation (Di Renzo et al., 2020). In addition, adolescents with autism engaged in a fewer number of days with physical activity and increased their amount of screen time (Garcia et al., 2020). ...
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Objectives The purpose of this paper is to describe a university program, Spartan Caregiver Support, that provided free on-demand telehealth services to caregivers of people with autism during the State of Michigan’s 2020 Stay-at-Home order. Method Participants (n = 17) were caregivers of people with autism residing within the State of Michigan. Participants engaged with program members over video-conference technology, where participants received specific advice to support social and behavioral needs. Results We found that caregivers reported a variety of social and behavioral concerns, including concerns related to problem behavior, social/play skills, school/academics, and daily living. Conclusions This program description provides a framework for how to deliver on-demand telehealth support to caregivers of people with autism, especially during moments of crisis or emergency.
... Rispetto alle criticità mostrate dalle famiglie, alcuni studi italiani hanno messo in evidenza un aumento di difficoltà da parte dei genitori di bambini con ASD di gestire attività sia più strutturate che libere, un aumento delle difficoltà di regolazione del comportamento del bambino (Colizzi, Sironi, Antonini, Ciceri, Bovo, & Zoccante, 2020a;Colizzi et al., 2020b) e un aumento dei comportamenti ristretti e ripetitivi, dei manierismi e delle stereotipie, in circa il 33% dei bambini con ASD (Di Renzo, Bianchi Di Castelbianco, Vanadia, Petrillo, DʼErrico, Racinaro, & Rea, 2020). ...
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I disturbi dello spettro autistico sono caratterizzati da difficoltà nell'interazione socio-comunicativa, dalla presenza di comportamenti e interessi ristretti e ripetitivi. In determinate circostanze, ad esempio durante un periodo di lockdown, quando l'isolamento sociale e il distanziamento diventano obbligatori per tutti, in particolare per le famiglie con un bambino con disturbo dello spettro l'interruzione delle routine quotidiane (scuola, terapia, tempo libero) rischia di minare il lavoro terapeutico e i progressi che faticosamente le famiglie avevano raggiunto fino a quel momento. In questo studio abbiamo monitorato 81 famiglie di bambini con disturbo dello spettro, valutandole prima dell'inizio della pandemia e circa 4 mesi dopo, per verificare quali comportamenti dei bambini fossero peggiorati e quali invece fossero rimasti stabili o anche migliorati. Le famiglie sono state intervistate, a febbraio e luglio 2020, attraverso rating scale standardizzate e i risultati hanno evidenziato un intensificarsi nei bambini di irrequietezza motoria, difficoltà nella regolazione del sonno, mentre non sono emersi peggioramenti nelle condotte autolesive o etero-aggressive, né nelle autonomie personali. Va considerato che tutte le famiglie coinvolte nella presente ricerca erano inserite in percorsi terapeutici e non hanno interrotto il percorso di supporto psicologico (online), con lo specifico obiettivo di sostenerli nel loro ruolo genitoriale nelle fasi più critiche vissute dai bambini, e nel renderli sempre più attivi nei processi di consolidamento delle competenze acquisite dai bambini.
... Recent studies indicate that pandemic-related upheavals severely impacted the QoL and well-being of parents of autistic children in Northern Italy [10], in Turkey [11] and in Michigan [12]; these results also emerged from a comparative study [13] and a scoping review [14]. Surveys [15][16][17], parents and clinicians' testimonies [18,19], and self-reports [20,21] further attest to the impact that lockdown had on autistic individuals. ...
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Background In the spring of 2020, Belgian authorities enforced a full lockdown period to contain the spread of the SARS-CoV-2 virus. This lockdown drastically disrupted the daily life of autistic individuals’ and that of their families. In the midst of these extraordinary circumstances, we assessed the impact of social restrictions on autistic individuals’ behavior and their parents’ or caregivers’ quality of life; we also sought to identify individual characteristics that may influence such changes. Methods We designed an online survey targeting caregivers living with an autistic child or adult. The questionnaire included 125 five-point Likert questions which targeted changes in families’ quality of life and in autistic individuals’ behavior, as well as factors likely to influence the extent and direction of these changes. Results We collected data from 209 French-speaking Belgian respondents. Respondents reported that the lockdown brought about a higher frequency of nonfunctional socio-communicative behaviors, as well as a decrease in families’ quality of life. Parents who had less access to respite care experienced a steeper decrease in their quality of life. Autistic individuals with comorbidities, and whose parents had less access to respite care and implemented fewer rules at home during lockdown were more likely to display nonfunctional socio-communicative behaviors. Conclusion COVID-19 lockdown restrictions had a negative impact on both autistic individuals and their parents.
... Some empirical studies indicated that children with ASD experienced more emotional and behavioral problems (EB-problems) during COVID-19, compared to before the pandemic (e.g., Colizzi et al., 2020;Di Renzo et al., 2020). However, other study findings revealed that children with ASD showed no changes between clinical scores (including anxiety and behavioral problems) collected at the beginning and the end of the lockdown period (Guidotti et al., 2020), although clinical scores before the pandemic were not assessed in this study. ...
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This longitudinal study assessed the impact of the COVID-19 pandemic on children with autism spectrum disorder (ASD; n = 62) by measuring emotional and behavioral problems before and during the pandemic, and by comparing this change to a matched sample of typically developing (TD) children (n = 213). Moreover, we examined whether indicators of parental well-being promoted resilience of children with ASD. Results showed that the mean change in problems did not differ between children with ASD and TD children. Importantly, some children showed an increase in problems, while others showed resilience. Parental well-being indicators were not related to resilience among children with ASD. The interindividual variability in responses, particularly among children with ASD, highlights the need for personalized support.
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Background Individuals with neurodevelopmental disorders often have atypical emotion profiles, but little is known about how they regulate their emotions. While several studies have examined emotion regulation strategy use in autism spectrum disorder (ASD), only a few have included individuals with intellectual disability (ID) or focused on specific syndromes such as Williams syndrome (WS). Methods A parent-reported survey launched during the first months of the COVID-19 pandemic allowed to exploratorily study emotion regulation strategy use and its link to anxiety in individuals with ASD with (N=785) and without ID (N=596), WS (N=261), and Intellectual Disability not otherwise specified (N=649). Results Using multilevel analyses, besides revealing specific group differences in emotion regulation strategy use, a variety of strategies (e.g., rumination, avoiding information, repetitive behaviors) were found to be linked to elevated levels of anxiety, while focusing on the positive was linked to lower anxiety levels in all groups. Moreover, only autistic people without ID used humor more frequently while experiencing lower anxiety levels. Conclusion This study sheds light on an underexplored area of emotion regulation strategy use in different neurodevelopmental disorders. It also paves the way to further examine emotion regulation in more rigorous ways to better understand emotion regulation in different neurodevelopmental disorders as well as the impact on outcome measures such as anxiety. This exploratory study may help to develop and validate adequate measures to study a broad array of ER strategies used by individuals with neurodevelopmental disorders.
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Several studies on the impact of Covid-19 on children’s wellbeing have been published, including for those with Special Educational Needs and Disabilities. However, limited evidence is available on who these children may be, their socioeconomic background, age, gender or type of school attended. This study examines the role of socio-demographic characteristics on the experiences of Autistic Children, compared to non-Autistic children, to assess the detrimental impact of the pandemic, but also potential silver linings. Primary-school aged Autistic children were more likely to mention a silver lining (for mental health), as well as younger non-Autistic children from more affluent backgrounds. Similar effects were observed for older non-Autistic boys with special needs attending mainstream settings (regarding physical health).
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It is anticipated that the novel coronavirus disease 2019 (COVID-19) pandemic and associated societal response will have wide-ranging impacts on youth development and mental health. Sleep is crucial for child and adolescent health and well-being, and the potential for sleep problems to emerge or worsen during and following the pandemic is high. This may be particularly true for children and adolescents who are at heightened risk for the onset of sleep and mental health disturbances and for those whom developmental changes impacting sleep are rapidly occurring. Youth with pre-existing psychopathologies (including anxiety and depression) and neurodevelopmental conditions (including attention-deficit/hyperactivity disorder and autism spectrum disorder) could be especially vulnerable to disturbed sleep during this period of change and uncertainty. It is thus imperative that sleep considerations be part of research and clinical initiatives aimed at understanding and mitigating the impact of the COVID-19 pandemic in children and adolescents. This article considers ways in which the pandemic may impact sleep, including research and clinical implications.
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Problem/condition: Autism spectrum disorder (ASD). Period covered: 2012. Description of system: The Autism and Developmental Disabilities Monitoring (ADDM) Network is an active surveillance system that provides estimates of the prevalence and characteristics of ASD among children aged 8 years whose parents or guardians reside in 11 ADDM Network sites in the United States (Arkansas, Arizona, Colorado, Georgia, Maryland, Missouri, New Jersey, North Carolina, South Carolina, Utah, and Wisconsin). Surveillance to determine ASD case status is conducted in two phases. The first phase consists of screening and abstracting comprehensive evaluations performed by professional service providers in the community. Data sources identified for record review are categorized as either 1) education source type, including developmental evaluations to determine eligibility for special education services or 2) health care source type, including diagnostic and developmental evaluations. The second phase involves the review of all abstracted evaluations by trained clinicians to determine ASD surveillance case status. A child meets the surveillance case definition for ASD if one or more comprehensive evaluations of that child completed by a qualified professional describes behaviors that are consistent with the Diagnostic and Statistical Manual of Mental Disorders, Fourth Edition, Text Revision diagnostic criteria for any of the following conditions: autistic disorder, pervasive developmental disorder-not otherwise specified (including atypical autism), or Asperger disorder. This report provides ASD prevalence estimates for children aged 8 years living in catchment areas of the ADDM Network sites in 2012, overall and stratified by sex, race/ethnicity, and the type of source records (education and health records versus health records only). In addition, this report describes the proportion of children with ASD with a score consistent with intellectual disability on a standardized intellectual ability test, the age at which the earliest known comprehensive evaluation was performed, the proportion of children with a previous ASD diagnosis, the specific type of ASD diagnosis, and any special education eligibility classification. Results: For 2012, the combined estimated prevalence of ASD among the 11 ADDM Network sites was 14.5 per 1,000 (one in 69) children aged 8 years. Estimated prevalence was significantly higher among boys aged 8 years (23.4 per 1,000) than among girls aged 8 years (5.2 per 1,000). Estimated ASD prevalence was significantly higher among non-Hispanic white children aged 8 years (15.3 per 1,000) compared with non-Hispanic black children (13.1 per 1,000), and Hispanic (10.2 per 1,000) children aged 8 years. Estimated prevalence varied widely among the 11 ADDM Network sites, ranging from 8.2 per 1,000 children aged 8 years (in the area of the Maryland site where only health care records were reviewed) to 24.6 per 1,000 children aged 8 years (in New Jersey, where both education and health care records were reviewed). Estimated prevalence was higher in surveillance sites where education records and health records were reviewed compared with sites where health records only were reviewed (17.1 per 1,000 and 10.4 per 1,000 children aged 8 years, respectively; p<0.05). Among children identified with ASD by the ADDM Network, 82% had a previous ASD diagnosis or educational classification; this did not vary by sex or between non-Hispanic white and non-Hispanic black children. A lower percentage of Hispanic children (78%) had a previous ASD diagnosis or classification compared with non-Hispanic white children (82%) and with non-Hispanic black children (84%). The median age at earliest known comprehensive evaluation was 40 months, and 43% of children had received an earliest known comprehensive evaluation by age 36 months. The percentage of children with an earliest known comprehensive evaluation by age 36 months was similar for boys and girls, but was higher for non-Hispanic white children (45%) compared with non-Hispanic black children (40%) and Hispanic children (39%). Interpretation: Overall estimated ASD prevalence was 14.5 per 1,000 children aged 8 years in the ADDM Network sites in 2012. The higher estimated prevalence among sites that reviewed both education and health records suggests the role of special education systems in providing comprehensive evaluations and services to children with developmental disabilities. Disparities by race/ethnicity in estimated ASD prevalence, particularly for Hispanic children, as well as disparities in the age of earliest comprehensive evaluation and presence of a previous ASD diagnosis or classification, suggest that access to treatment and services might be lacking or delayed for some children. Public health action: The ADDM Network will continue to monitor the prevalence and characteristics of ASD among children aged 8 years living in selected sites across the United States. Recommendations from the ADDM Network include enhancing strategies to 1) lower the age of first evaluation of ASD by community providers in accordance with the Healthy People 2020 goal that children with ASD are evaluated by age 36 months and begin receiving community-based support and services by age 48 months; 2) reduce disparities by race/ethnicity in identified ASD prevalence, the age of first comprehensive evaluation, and presence of a previous ASD diagnosis or classification; and 3) assess the effect on ASD prevalence of the revised ASD diagnostic criteria published in the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition.
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Augmentative and alternative communication (AAC) interventions have been shown to be effective in supporting children with autism spectrum disorder (ASD) to communicate, particularly to request preferred items and activities. The aim of this systematic review was to examine the effectiveness of AAC interventions in supporting children to produce a broader range of communicative functions and determine the extent to which these interventions have been evaluated beyond immediate effectiveness to address maintenance, generalization, and social validity. A systematic search and application of inclusion criteria yielded 30 interventions that focused on communication functions beyond object requests. In many of the studies, flaws detracted from the certainty of evidence, and maintenance, generalization, and/or social validity were not addressed. Further research is needed to evaluate the extent to which AAC interventions can support children with ASD to communicate using a variety of communication functions, as well as to demonstrate sustained, transferable, and meaningful change.
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The authors provide a cautionary note on reporting accurate eta-squared values from multifactor analysis of variance (ANOVA) designs. They reinforce the distinction between classical and partial eta-squared as measures of strength of association. They provide examples from articles published in premier psychology journals in which the authors erroneously reported partial eta-squared values as representing classical etasquared values. Finally, they discuss broader impacts of inaccurately reported etasquared values for theory development, meta-analytic reviews, and intervention programs.