Author: Anisha Holla

Contributors: Mayesha Ahmed, Tamia Jones, Alexandra Louis, David Tan

AbstractThe ongoing COVID-19 pandemic has had unparalleled implications for people of all ages, genders, nationalities, and ethnicities. Regardless of direct contraction of the virus, the period of quarantine provoked by the transmissibility of the Sars-COV-2 virus has had countless implications for those who have been relegated to their houses, particularly when analyzing mental health. The purpose of the following study is to analyze the impacts of the COVID-19 pandemic on the mental health of children and adolescents of ages 5 to 24 years with pre-existing developmental disorders. In order to collect data, a survey was created utilizing a variety of scales adopted from PhenX Toolkit and subsequently distributed to parents of adolescents with and without pre-existing developmental disorders. The responses to the survey were then analyzed to find that overall, children with pre-existing developmental disorders are more prone to increases in argumentative tendencies, increases in displays of anger, and decreases in overall mental health. Overall the results of the study imply a need for the implementation of virtual programming specifically targeted towards children and adolescents with developmental disorders, designed to mitigate the mental health impacts of the COVID-19 pandemic on this particular demographic group.

Keywords– developmental disorders, adolescents, children, mental health, services

INTRODUCTION

The purpose of the aforementioned study was to analyze the effect of the COVID-19 pandemic on adolescents with pre-existing mental health disorders. Regardless of direct contraction, the extensive period of quarantine necessitated by the pandemic has decreased social interaction as well as accessibility to widely-used institutions, such as daycare, school facilities, or after-school programming. It has been found by previous studies conducted by Mental Health America that the occurrence of anxiety has increased by approximately 370% over the course of the quarantine period described earlier, and similarly, the prevalence of depression has increased by an estimated 394% (Lamar, 2020). 

This increased prevalence of anxiety and depression has particularly impacted younger populations of ages younger than 25, with 80% of individuals in this category experiencing symptoms of anxiety and an alarming 90% experiencing symptoms of depression. Within this younger population, minority groups were found to be affected to an even greater extent, with communities such as the LGBTQ+ subgroup facing depression rates of over 90%. Given the overt impacts of quarantining measures on the general American population, and more specifically younger populations, it is equally important to analyze the effects of the pandemic on smaller segments of the population, such as children and adolescents with pre-existing developmental disorders. 

Before conducting the study, it was hypothesized that children and adolescents with pre-existing developmental disorders would be disproportionately impacted by the social distancing measures taken as a result of the pandemic, given that they are typically more dependent on third-party facilities whose services will most likely be closed or disrupted by the COVID-19 outbreak. 

Additionally, adolescents and children with developmental disorders are more likely to benefit from thorough peer support systems, which have likely also been disbanded or moved to virtual formats as a result of the state of pandemic. The findings, which bolstered the hypothesis that children and adolescents with developmental disorders are disproportionately affected by the pandemic, have profound implications for policy makers and private institutions. The results reveal to these authorities that alternatives must be pursued in order to promote mental well-being among this segment of the population, especially amidst the social isolation that has arisen as a direct result of the country being declared in a state of pandemic.  

MATERIALS AND METHODS

In order to collect accurate and reliable data, a survey was created by a team of 8 students using common scales to quantify mental states such as depression and anxiety obtained from PhenX toolkit. Questions aimed to assess the correlation between a variety of different demographic factors such as income, age group, geographical location, and presence of developmental disorders and mental health amidst the pandemic. 

Questions included on the survey prompted participants to indicate their annual household income group, their child’s age group, whether the child has been diagnosed with a developmental disorder, whether the child has been diagnosed with a mental disorder, which specific disorder the child falls under, the zip code of residence, changes in the child’s argumentative tendencies, changes in the child’s displays of anger, changes in the child’s socialization with others, changes in the child’s social participation, changes in the child’s activity engagement, changes in private/public services offered to the child, and changes in frequency of socialization with peers. 

The survey was disseminated to parents of children with and without developmental disorders using a variety of social media support groups for parents with children with developmental disorders. The survey was also distributed to school officials and administrators to spread to parents of students, respectively. Using the 63 unique responses received from across the country, various data analysis platforms such as R Script and Excel were used to closely examine the data and note any trends and patterns between mental well-being and variables such as income, presence of developmental disorders, age, and disruption of services. The data and associated analyses are displayed in the ‘results’ section that follows. 

RESULTS

Using the 63 responses gathered from respondents across the United States, a variety of variables were examined for trends and patterns. For the purpose of this study, the definition of ‘mental health’ was based on responses to questions discussing changes in mental health related behavior such as changes in argumentative tendencies, changes in displays of anger, and changes in socializing with others. 

Presence of Developmental Disorders and Mental Health

Figure 1.1 

The figure depicts the differing effects of isolation on the overall mental health of children and adolescents with/without developmental disorders. 5 subjective categories were created and the respondents in each category were separated based on the presence of a developmental disorder, revealing the greater prevalence of negative impacts on children and adolescents with developmental disorder, compared to those without.

In figure 1.1, “yes” refers to the respondents who indicated their child does have a pre-existing developmental disorder and “no” refers to those who indicated their child did not. The data displayed in this figure can be further broken down to demonstrate the relationship between presence of a developmental disorder and change in argumentative tendencies. 

Presence of Developmental Disorders and Argumentative Tendencies

Figure 1.2

The bar graph depicts the differing effects of isolation on the argumentative tendencies of children and adolescents with/without developmental disorders. 5 subjective categories were created to quantify changes in argumentative tendencies and respondents in each category were separated based on the presence of a developmental disorder. The figure reveals a higher occurrence of “great increases” in argumentative tendencies among those with developmental disorders, compared to those without. 

The other category that was used to define “mental health” was displays of anger.

Presence of Developmental Disorders and Displays of Anger

Figure 1.3 

The bar graph depicts the differing effects of isolation on frequency of anger displays in children and adolescents with/without developmental disorders. 5 subjective categories were created to quantify changes in anger display frequency and respondents in each category were divided based on the presence of a developmental disorder. The figure displays a higher occurrence of  general increases in displays of anger among respondents with developmental disorders, compared to those without. 

It is also helpful to analyze, within the category of adolescents with developmental disorders, the impact of household income on mental health. 

Household Income and Mental Health Impacts

Figure 1.4

The bar graph depicts the differing effects of isolation on overall mental health in children and adolescents with developmental disorders, divided by income range. 6 income brackets were defined and respondents in each category were divided based on their responses to the survey question regarding the effects of isolation on overall mental health. The figure displays a higher occurrence of general negative mental health impact among respondents in lower income brackets.

It is also helpful, among the category of adolescents and children with developmental disorders, to examine the relationship between age group and mental health impacts of the COVID-19 pandemic. 

Age of Child and Mental Health Impacts

Figure 1.5 

The figure depicts the differing effects of isolation on overall mental health in children and adolescents with developmental disorders, divided by age. 6 age brackets were defined and respondents in each category were divided based on their responses to the survey question regarding the effects of isolation on overall mental health. The figure displays a higher occurrence of general negative mental health impact among respondents in lower age groups.

The last variable that it may be helpful to examine in relation to impact on mental health is disruption of services. Before the study was performed, it was hypothesized that children with developmental disorders would face more negative mental health implications in the face of the COVID-19 pandemic particularly because of disruption of specific services. Therefore, it is essential to analyze the correlation between disruption (or lack thereof) of public/private services and mental health. 

Disruption of Government Services and Mental Health Impacts

Figure 1.6

The figure depicts the differing effects of isolation on overall mental health in children and adolescents with developmental disorders, divided by disruption of government services (where applicable). Respondents were categorized based on the presence of disruption to government-provided services and further divided based on their responses to the survey question regarding the effects of isolation on overall mental health. The figure displays a higher occurrence of general negative mental health impact among respondents who experienced significant disruption of government services.

The relationship between disruption of private services and mental health impacts of the COVID-19 pandemic are displayed in the chart below, figure 1.7.

Disruption of Private Services and Mental Health Impacts

Figure 1.7

The figure depicts the differing effects of isolation on overall mental health in children and adolescents with developmental disorders, divided by disruption of private services (if/where applicable). Respondents were categorized based on the presence of disruption to private services and further divided based on their responses to the survey question regarding the effects of isolation on overall mental health. The figure displays a higher prevalence of general negative mental health impact among respondents who experienced significant disruption of private services. 

DISCUSSION

Interpretation of the Results and Implications

The analysis of the above graphs revealed many different discussion points relevant to the mental health impacts of the COVID-19 pandemic on adolescents and the potential reasons behind these mental health impacts. Firstly, as seen in figure 1.1, the negative impacts of the COVID-19 pandemic on mental health (as defined by increased argumentative tendencies and displays of anger) are much more prevalent among children/adolescents with developmental disorders,as hypothesized before the study was performed. When broken down into the two categories (argumentative tendencies and displays of anger), it can be seen by figures 1.2 and 1.3, respectively, that children/adolescents with pre-existing developmental disorders were far more likely to experience great or slight increases in argumentative tendencies and displays of anger. This can be compared to the control group of children/adolescents without pre-existing developmental disorders, who were much more likely to either witness no change in argumentative tendencies and displays in anger, and in some cases, even decreased occurrences of these two behavioral phenomena. 

When analyzing figure 1.2, it can be noted that 33.33% of surveyed adolescents with developmental disorders experience a great increase in argumentative tendencies, while only 8.10% of children/adolescents without developmental disorders experienced this same great increase. A similar trend can be seen in figure 1.3. While only 11.1% of the control group experienced great increases in displays of anger, this number was much higher for children/adolescents with developmental disorders, resting at 25.0%. This shows that there is, in fact, a significant difference between the effects of the COVID-19 pandemic on children/adolescents with and without pre-existing developmental disorders. In order to determine the reasons why, it is necessary to conduct data analysis examining the relationship between mental health effects of the pandemic and other variables, such as income, age, and disruption of services. 

Figure 1.4 models the distribution of  mental health impacts of COVID-19 in relation to household income. The figure reveals that those in lower income brackets tend to face a more dramatic negative impact on mental health as a result of COVID-19. 100% of those in the <$25000 income bracket, for example, reported a great negative impact on mental health as a result of the pandemic, while 0% of those in the highest income bracket reportes the same. These findings suggest that the negative mental impacts of the COVID-19 pandemic on children/adolescents could largely be a result of financial burden and added stress created by job insecurity faced by the household’s breadwinners. 

Figure 1.5 examines the relationship between age and mental health impacts of the COVID-19 pandemic. The graph shows that among children with pre-existing developmental disorders, the pandemic most negatively affected the mental health of older extremes and younger extremes, with the 18-24 year category facing the most negative mental health impacts (in terms of percentage), followed by the 14-17 year category. These results suggest that older ages have been impacted most negatively among children with developmental disorders, which may be a result of older adolescents being more dependent on external services for mental well-being, such as educational institutions and possibly the company of acquaintances. 

Figures 1.6 and 1.7 both display the relationship between disruption of services and impact of the COVID-19 pandemic on mental health. As displayed by figure 1.6, adolescents/children whose government-provided services were disrupted by the pandemic were significantly more likely to face negative mental health impacts as a result of the pandemic. 100% of those whose government services were disrupted reported negative mental health impacts as a result of the pandemic, while only 68.8% of those whose services weren’t disrupted reported the same. Similarly, the disruption of private services was found to have a significant correlation with the mental health impacts of the pandemic, with 53.8% of children/adolescents with disrupted access to private services reporting a great decrease in mental health, compared to only 18.8% children/adolescents with continued access to private services reporting the same. 

These findings support the hypothesis formulated at the onset of the study, which stated that the disruption/continuation of services will have a strong correlation with the mental health impacts of the pandemic on children/adolescents with pre-existing developmental disorders. There may have been some limitations that did impact the results of the study. Firstly, due to ethical concerns regarding a parent’s right to privacy with respect to their child’s health, all survey questions were accompanied by the answer choice “prefer not to answer.” Given that respondents may have provided answers to select questions and indicated that they prefer not to answer others, there was no controlled number of participants (n) that remained constant throughout the study Instead, different variables being analyzed (i.e. income, age) had different numbers of total responses to analyze, potentially skewing the data results. Additionally. The survey was conducted on a time constraint. Ideally, a larger number of responses would be pursued, but due to necessity to adhere to time constraints, there was only limited time to market and distribute the survey used to garner data. Lack of resources, particularly fiscal resources, also posed an obstacle to the aforementioned research, as the survey was not mass produced and distributed on a wide-scale. Instead, free informal social media platforms such as Instagram and Facebook were used to target parents of children/adolescents and encourage this specific group to fill out the survey. The fact that the survey was distributed and labeled as optional may have also created voluntary response bias, eliciting responses only from those with extreme opinions (i.e. social distancing has affected their child(ren) to an abnormally large degree. 

Limitations of Study

There may have been some limitations that did impact the results of the study. Firstly, due to ethical concerns regarding a parent’s right to privacy with respect to their child’s health, all survey questions were accompanied by the answer choice “prefer not to answer.” Given that respondents may have provided answers to select questions and indicated that they prefer not to answer others, there was no controlled number of participants (n) that remained constant throughout the study Instead, different variables being analyzed (i.e. income, age) had different numbers of total responses to analyze, potentially skewing the data results.

 Additionally. The survey was conducted on a time constraint. Ideally, a larger number of responses would be pursued, but due to necessity to adhere to time constraints, there was only limited time to market and distribute the survey used to garner data. Lack of resources, particularly fiscal resources, also posed an obstacle to the aforementioned research, as the survey was not mass produced and distributed on a wide-scale. Instead, free informal social media platforms such as Instagram and Facebook were used to target parents of children/adolescents and encourage this specific group to fill out the survey. The fact that the survey was distributed and labeled as optional may have also created voluntary response bias, eliciting responses only from those with extreme opinions (i.e. social distancing has affected their child(ren) to an abnormally large degree.

CONCLUSION

A thorough analysis of the data reveals multiple overarching conclusions regarding the effects of the COVID-19 pandemic on the mental health of children/adolescents with pre-existing developmental disorders. The primary conclusion that can be drawn from the collected data is that the COVID-19 pandemic has had a more negative impact on children/adolescents with pre-existing developmental disorders than it has had on children/adolescents without pre-existing developmental disorders, in terms of mental health. 

It was also found that there was a strong correlation between household income and mental health impacts; age and mental health impacts; and disruption of services and mental health impacts, with children/adolescents with pre-existing developmental disorders in lower income groups, older age groups, and groups facing more service disruption being impacted more negatively by the pandemic and its side effects. Although more experimentation would have to be conducted to reveal a causal relationship, these findings provide a foundation for future studies hypothesizing that financial stress, social isolation from friends, and disruption of services may all be contributing factors to the disproportionate impact of the COVID-19 pandemic on children/adolescents with pre-existing developmental disorders.

Acknowledgments

I thank Mentoring in Medicine Inc. for providing the resources and leadership necessary to collect sufficient data for analysis and to synthesize this data into a coherent paper. I also thank Mr. Andrew Morrison and the MIM Leadership Team for coordinating the internship under which the paper was written and providing a timeline for its publication.

References

  1. Asbury, K., Fox, L., Deniz, E., Code, A., & Toseeb, U. (2020, July 31). How is COVID-19 Affecting the Mental Health of Children with Special Educational Needs and Disabilities and Their Families? https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7393330/
  2. Guessoum, S., Lachal, J., Radjack, R., Carretier, E., Minassian, S., Benoit, L., & Moro, M. (2020, September). Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7323662/
  3. Lamar, D. (2020, June 25). Mental Health America Data Shows Impacts of COVID-19 on Mental Health. https://nationalhealthcouncil.org/blog/mental-health-america-data-shows-impacts-of-covid-19-on-mental-health/
  4. Maes, N. (2020, May 01). How COVID-19 Impacts Teens’ Mental Health. https://chicagohealthonline.com/how-covid-19-impacts-teens-mental-health/
  5. Nirmita Panchal, R., & 2020, A. (2020, August 21). The Implications of COVID-19 for Mental Health and Substance Use. https://www.kff.org/coronavirus-covid-19/issue-brief/the-implications-of-covid-19-for-mental-health-and-substance-use/\
  6. People with Developmental and Behavioral Disorders. (n.d.). https://www.cdc.gov/coronavirus/2019-ncov/need-extra-precautions/people-with-developmental-behavioral-disabilities.html
  7. Pogored. (2020, June 22). Is COVID-19 Affecting Your Teen’s Mental Health? https://health.clevelandclinic.org/is-covid-19-affecting-your-teens-mental-health/