Introduction
The world suddenly underwent a major and abrupt change with the advent of covid 19, a virus outbreak that was termed as a pandemic by the World Health Organization in March 2020.1 The impact of covid 19 is evident with schools and colleges shifting classes online and work from home becoming a way of life throughout the globe.2 The entire education system has shifted to online, which is not compatible with disabled children. Challenges of online learning coupled with the lack of outdoor activities deteriorate their development. And also, their parents’ stress increased.2 Moreover financial crises, unemployment, and poor physical health make the situation more unpleasant.3 Challenges of online learning along with the lack of recreational activities that can be done at home can prove to be frustrating to children with disabilities. Developing social skills and social interactions has been the hardest issue for differently-abled children. 3
Caregiver strain is considered a third-party disability according to The WHO classification of Functioning, Disability, and Health. Children with chronic neuro-disabilities face additional challenges due to their functional limitations and this may further stress their caregivers.4 Because of the sudden lockdown, providing homecare therapies by the caregivers would become challenging. Although home care interventions play an important role in rehabilitation, caregivers might not have learned the technique in an appropriate manner to achieve the desired functional outcome. Moreover, certain caregivers might have found them difficult to implement because of several reasons including lack of support from healthcare providers in form of communication and interaction, low self-efficacy and low level of knowledge and ability to carry out home care therapy, and poor functioning of the child.5
Purpose of the study
This study aimed a) To Review the impact of the Covid-19 pandemic on differently-abled children and their parents from the reported studies b) Discuss alternative measures for delivering health services for differently-abled children as reported in the published studies.6
Materials and Methods
A literature review was conducted through online sources of data available in Google Scholar, Unicef.org, and Science Direct.7 Studies published from January 2020 to October 2021 were included.8 Search terms include “covid 19”, “impact”, “differently-abled children”, “parents”, “caregivers” etc.
Results
Various qualitative and quantitative studies were reviewed and most of the studies revealed similar findings. The results observed from the various studies are organized as follows:
General characteristics
Approximately 80% of the caregivers were mothers, 16% of the caregivers were fathers and only 4% were other family members. In most of the studies, the age of the children was 6-10 years. 84% of the caregivers were working at home.3, 9
Problems faced by children
Results inferred from various qualitative and quantitative studies. There is a large variation from time to time. Different types of disabilities identified in various studies were: Autism Spectrum Disorders, Attention Deficit Hyperactivity Disorders, Developmental Coordination Disorder, Developmental Language Disorder, Dyslexia, Cerebral Palsy, Global Developmental Delay, Speech Disorder or Impediment, Mental Health Difficulties, and Sensory Processing Disorder.3 A lack of routine and the attached uncertainty can make children with disabilities feel more anxious, grumpy, restless, and develop unpleasant feelings.2 Boredom, change in routine, depression, and fear were reported in almost all studies.5 Stress experienced by parents can negatively affect their children. 3 During this pandemic, differentially-abled children are being exposed to violent discipline.4 Fear of physical illness and home confinement with social isolation were cited as contributing factors. Children with developmental disabilities are likely to be even more vulnerable to the negative mental health consequences of the pandemic as they may have limitations in understanding the rationale for pandemic-related changes such as disruptions to routine and school closure. A lack of access to the psychologist and therapist can contribute to worsening the mental health status of these children. This, in turn, can exacerbate behavioral challenges in these children, adding to the myriad of challenges already faced by caregivers.10
Problems faced by parents as evolved from qualitative studies
Parents described situations in which a child’s low level of understanding leads to distress because they could not understand why everything has changed.3 Most of the studies showed the following issues among parents of differently-abled children, Uncertainty about their future (6%), feeling of depression (12.7%), difficulties in managing work from home (14%), inability to socialize with others (16.7%). 3 Most of the studies reported high levels of depressive symptoms (62.5%), anxiety (20.5%), and stress symptoms (36.4%) among the caregivers of differently-abled children.11 Finally, working from home during the lockdown was associated with poor psychological health, and elder living at home poses greater stress to the caregivers.7 One of the greatest responsibilities of parents with young children is to explain to them, the current situation as transparently as possible, as effective communication about sensitive information has long term effect on the psychological well-being of the child Fear, along with insufficient knowledge of the pandemic leads to lack of understanding which leads to incorrect decision making.12, 13 Thus, caregivers should aim to spend quality time with their children.2, 9 Parents of children with developmental disabilities have greater levels of stress which also leads to a higher divorce rate attributed to the challenges of raising a child with additional needs.11
Implications
Innovations are required in the provision of service delivery to these children and their parents.12, 14 A system of online clinics and volunteer-based psychological interventions should be set up as an immediate priority to mitigate the effects of covid-19 on children with mental health issiues.2 Telemedicine and Telerehabilitation can be implemented.8 Telemedicine has an advantage in that people who cannot get to the clinic or do not like traveling can be reviewed.13 Other measures include Creative forms of activation and exposure, developing new routines like exercise, art or craft, and video-based social gathering are useful.8, 10, 11 Doing less schoolwork, withdrawing from peers, and having increased baseline anxiety are other symptoms that may now be attributed, rightly or wrongly, to a normative reaction to the pandemic. WHO recommends that those with disabilities should practice at least 150 minutes per week of moderate to vigorous-intensity physical activity where possible or at least engage in regular physical activity according to their abilities and avoid in activity.11 Therefore, greater communication among service providers and caregivers regarding the removal of barriers associated with an unfavorable perception of telerehabilitation, increasing education on home care therapy, and provision of psychological intervention may help to diminish mental health issues and strain associated with caregiving.3, 4, 5, 6, 7, 8
Limitations
As it is an emerging situation, original research articles are evolving. Also, field studies are less due to the current social distancing norms. There was a large variety of data from time to time from various countries, which made it difficult to present the findings
Conclusion
There is evidence in the literature that children with disabilities and their families are at a greater risk of experiencing poor mental health and being under substantially greater pressure than other families during the Covid-19 pandemic.3 Grater communication among service providers and caregivers regarding removal of barriers associated with an unfavorable perception of telerehabilitation, increasing education on the home care therapy, and provision of psychological intervention may help to diminish strain associated with caregiving.4, 10 In particular, social distancing and its effects are extremely novel and difficult to understand for children, especially those experiencing developmental and intellectual delays.2 Home confinement and family environment may become key risk factors for the mental health of differently-abled children and their parents. The use of telepsychiatry, telemedicine, and telerehabilitation, and other internet-based interventions may help to overcome such issues.14
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