1. Context
Coronavirus disease 2019 (COVID-19) has become a pandemic (1), and many governments have announced definitive measures to restrict its spread. Staying at home is one of these measures for parents and children. Under these circumstances, caring for children with special healthcare needs such as autism spectrum condition (ASC), attention deficit and hyperactivity disorder (ADHD), hearing impairments, and cerebral palsy can be difficult for families and caregivers. Usually, these children receive interventions in private institutes and hospitals, or at home for many hours a week by particular therapists. However, it is not currently possible for both children and parents to receive physical support from their therapists. It is also not possible for them to participate in outdoor interventions. These essential measures for our safety must be managed to prevent extra parental pressure and child difficulties. This letter aims to provide essential recommendations to support families to handle children with special healthcare needs in this situation.
2. Helpful Recommendations for Parents and Caregivers of Children with Special Healthcare Needs
2.1. Create a Regular but Flexible Program
If you have a child in your family who has special health care needs, you can develop and practice a written emergency care program that includes the needs of your child, such as medications or assistive devices. You can allow your child to help in creating the plan as much as possible. Particular therapists of the child can work with the family to assure that the child’s demands are met in the household emergency program and the recognition of assistance channels in your community (2). For example, it is widely reported that children with attention deficit and hyperactivity disorder (ADHD) have executive functioning deficits (3), and they could show problems in planning their daily life activities (4), especially when their routine is broken. For this reason, it is essential, especially currently, to structure daily life activities. It would be useful to subdivide the daily activities, assigning a different room for each one of them.
2.2. Talking About the Coronavirus
Talk to your children about what happened, but remember to consider the children’s age and kind of disability and use a method that is understandable to them. For example, it may be hard to understand how much information a child with autism is receiving through television and conversations. Adults may seek clues that present data on the emotions and concerns of these children (2). Most children with autism have sensory processing disorders (SPD) (5), and they like to put things in their mouths or touch different surfaces (6). The coronavirus enters the body by placing contaminated objects in the mouth, touching contaminated objects, or hand contact with the eyes, nose, and mouth (7). Therefore, people with autism are more vulnerable to COVID-19 than other people are, and they need more care (8). Thus, their parents can use pictures of social stories for children with autism to talk about preventative measures such as hand washing.
2.3. Use of Games or Play Activities
In the current situation, it will be critical to handle play activities. Select activities that your child prefers. For example, serious games can help recognize facial expressions and emotional gestures in children with autism spectrum disorder (ASD) (9).
2.4. Promoting Physical Activity
Keeping regular physical activity in a safe home environment is an essential approach for healthy living during the COVID-19 crisis (10). In this period, families have extensive responsibilities. For children with special healthcare needs to have a good time on isolation days, families should encourage them by doing physical activities with their children, including games and exercise. Depending on the age and health status of children and other family members who can cooperate in activities, exercising for at least 20 min at a high intensity or 30 min at a moderate intensity every day may be among the options (11).
2.5. Take Care of Yourself and Your Child
Try helpful coping strategies such as ensuring enough rest and eating sufficient and healthy food. In the long term, these activities can better your mental and physical well-being (12).
2.6. Perform and Share Special Interests with Parents or Caregivers
At this time, when parents and children stay in the house, they can design some activities to generate special interests. There is some evidence identifying the probable benefits that can generate special interests. Trains, maps, animals, voice acting, certain dolls, pets, fantasy things, comic books, electronics, music or sing, manual work, imitate sounds, and facial expressions and history can be just several special interests (13). Remember to ask your child about what he/she likes to do. The choice builds their confidence.
2.7. Online Therapy
It is well known that psychiatric vulnerabilities or comorbidities are high in children with special healthcare needs (14). The current condition of the COVID-19 pandemic can be psychologically challenging for children with special healthcare needs. Therefore, if the children are involved in psychotherapy before the COVID-19 pandemic, they must still follow it. As numerous therapists have discontinued their direct treatment, it is highly recommended to continue the psychotherapy in an online video or audio format by similar weekly dates. Also, in the case of disorders leading to physical disabilities such as cerebral palsy, the necessary counseling and training on home adaptation, or performing the necessary movement exercises with telerehabilitation methods, including video training, can be provided to their caregivers.
2.8. Weekly Online Consultations for Parents and Caregivers of Children with Special Needs
The parents of children with special healthcare needs undergo extra pressure and are sensitive to the parents of typical children (15, 16). At present, parents are sole in caring for their children with special healthcare needs. Hence, this can be a significant danger as a source of stress. Therefore, the opportunity for a weekly online consultation with therapists of their children can be extremely effective. This consultation can be an exchange of dialogues with a focus on suitable procedures to control the challenging period of the COVID-19 pandemic and promote the parents on children’s coping approaches.
2.9. Keep in Contact with Your Child’s School
Check-in with your child’s school and teachers about how educational service delivery may change in the coming weeks. If schools offer distance-learning opportunities to students without disabilities, the same support should give to students with disabilities. Do not think pressured to exactly replicate school at home. With flexibility, you may identify new ways to learn and grow together that would be more difficult in typical times (17). For example, in another group of children with special needs, e.g., hearing impairment children, it is suggested that education for them be televised in the presence of a person familiar with the sign language or subtitles.
References
-
1.
Farhoudian A, Baldacchino A, Clark N, Gerra G, Ekhtiari H, Dom G, et al. COVID-19 and Substance Use Disorders: Recommendations to a Comprehensive Healthcare Response. An International Society of Addiction Medicine Practice and Policy Interest Group Position Paper. Basic Clin Neurosci. 2020;11(2):133-50. [PubMed ID: 32855772]. [PubMed Central ID: PMC7368103]. https://doi.org/10.32598/bcn.11.covid19.1.
-
2.
Centers for Disease Control and Prevention. Children and Youth with Special Healthcare Needs in Emergencies. 2019. Available from: https://www.cdc.gov/childrenindisasters/children-with-specialhealthcare-needs.html.
-
3.
Biederman J, Monuteaux MC, Doyle AE, Seidman LJ, Wilens TE, Ferrero F, et al. Impact of executive function deficits and attention-deficit/hyperactivity disorder (ADHD) on academic outcomes in children. J Consult Clin Psychol. 2004;72(5):757-66. [PubMed ID: 15482034]. https://doi.org/10.1037/0022-006X.72.5.757.
-
4.
Barkley RA, Murphy KR. The Nature of Executive Function (EF) Deficits in Daily Life Activities in Adults with ADHD and Their Relationship to Performance on EF Tests. J Psychopathol Behav Assess. 2010:137-58.
-
5.
Tomchek SD, Dunn W. Sensory processing in children with and without autism: a comparative study using the short sensory profile. Am J Occup Ther. 2007;61(2):190-200. [PubMed ID: 17436841]. https://doi.org/10.5014/ajot.61.2.190.
-
6.
Stein LI, Polido JC, Mailloux Z, Coleman GG, Cermak SA. Oral care and sensory sensitivities in children with autism spectrum disorders. Spec Care Dentist. 2011;31(3):102-10. [PubMed ID: 21592164]. https://doi.org/10.1111/j.1754-4505.2011.00187.x.
-
7.
Cirrincione L, Plescia F, Ledda C, Rapisarda V, Martorana D, Moldovan RE, et al. COVID-19 Pandemic: Prevention and Protection Measures to Be Adopted at the Workplace. Sustainability. 2020;12(9). https://doi.org/10.3390/su12093603.
-
8.
den Houting J. Stepping Out of Isolation: Autistic People and COVID-19. Autism Adulthood. 2020;2(2):103-5. https://doi.org/10.1089/aut.2020.29012.jdh.
-
9.
Boucenna S, Narzisi A, Tilmont E, Muratori F, Pioggia G, Cohen D, et al. Interactive Technologies for Autistic Children: A Review. Cogn Computation. 2014;6(4):722-40. https://doi.org/10.1007/s12559-014-9276-x.
-
10.
Chen P, Mao L, Nassis GP, Harmer P, Ainsworth BE, Li F. Coronavirus disease (COVID-19): The need to maintain regular physical activity while taking precautions. J Sport Health Sci. 2020;9(2):103-4. [PubMed ID: 32099716]. [PubMed Central ID: PMC7031771]. https://doi.org/10.1016/j.jshs.2020.02.001.
-
11.
U.S. Department of Health and Human Services. hysical activity guidelines for Americans. Washington, DC: U.S. Department of Health and Human Services; 2018. Available from: http://health.gov/sites/default/files/2019-09/Physical_Activity_Guidelines_2nd_edition.pdf.
-
12.
World Health Organization. Mental health and psychosocial considerations during the COVID-19 outbreak. 2020, [cited 2020 Mar 18]. Available from: https://apps.who.int/iris/bitstream/handle/10665/331490/WHO-2019-nCoV-MentalHealth-2020.1-eng.pdf.
-
13.
Lee EAL, Black MH, Falkmer M, Tan T, Sheehy L, Bolte S, et al. "We Can See a Bright Future": Parents' Perceptions of the Outcomes of Participating in a Strengths-Based Program for Adolescents with Autism Spectrum Disorder. J Autism Dev Disord. 2020;50(9):3179-94. [PubMed ID: 32076957]. https://doi.org/10.1007/s10803-020-04411-9.
-
14.
Peek L, Stough LM. Children with disabilities in the context of disaster: a social vulnerability perspective. Child Dev. 2010;81(4):1260-70. [PubMed ID: 20636694]. https://doi.org/10.1111/j.1467-8624.2010.01466.x.
-
15.
Drogomyretska K, Fox R, Colbert D. Brief Report: Stress and Perceived Social Support in Parents of Children with ASD. J Autism Dev Disord. 2020. [PubMed ID: 32200467]. https://doi.org/10.1007/s10803-020-04455-x.
-
16.
Skok A, Harvey D, Reddihough D. Perceived stress, perceived social support, and wellbeing among mothers of school-aged children with cerebral palsy. J Intellect Dev Disabil. 2006;31(1):53-7. [PubMed ID: 16766323]. https://doi.org/10.1080/13668250600561929.
-
17.
American Psychological Association. Advice for caregivers of children with disabilities in the era of COVID-19. 2020. Available from: https://www.apa.org/research/action/children-disabilities-covid-19.