CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions.
CRISIS AFAR: an international collaborative study of the impact of the COVID-19 pandemic on mental health and service access in youth with autism and neurodevelopmental conditions.
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DOI：
10.1186/s13229-022-00536-z
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发表时间：
2023-02-14
期刊：
影响因子：
6.2
通讯作者：
中科院分区：
文献类型：
--
作者：
有记录表明，一般人群在COVID-19大流行期间出现了不同的心理健康结果。这种异质性尚未在患有自闭症谱系障碍（ASD）和相关神经发育障碍（NDD）的青少年中进行系统评估。为了确定ASD/NDD青少年流行影响的独特模式及其预测因素，我们重点关注了与流行相关的症状变化和获得服务的机会。 使用自然主义的观察设计，我们评估了父母对冠状病毒健康和影响调查倡议（CRISIS）适应自闭症和相关神经发育状况（AFAR）的反应。汇总了14个欧洲和北美研究中心的横断面AFAR数据，获得了N = 1275例ASD/NDD患者（年龄= 11.0 ± 3.6岁;女性n = 277）的临床特征良好的样本。为了确定具有不同结果的亚组，我们对11个测量症状变化和获得服务的变量进行了分层聚类。然后，随机森林分类评估了社会人口统计学、大流行前服务率、ASD相关症状的临床严重程度以及COVID-19大流行经历/环境在预测结果亚组中的重要性。聚类显示了四个亚组。一个亚组-仅症状恶化（20%）-包括一系列症状恶化但服务中断与总样本平均值相似的青年。其他三个亚组临床上相对稳定，但在服务获得方面存在差异：主要是修改服务（23%），主要是失去服务（6%）和平均服务/症状变化（53%）。一系列大流行前服务、大流行环境（例如，COVID-19新病例、限制）、经验（例如，COVID-19担忧），年龄预测每个结果亚组。该研究的显著局限性在于其横截面性质，并侧重于大流行的前六个月。同时评估大流行第一阶段期间症状变化和服务获得的变化，揭示了ASD/NDD青年的不同结局特征。亚组的特点是不同的预测模式，在一组前和流行病相关的经验/背景。这些成果可为今后危机中的恢复工作和准备工作提供参考;它们还突出表明，国际数据共享和合作对于满足危机时期最脆弱群体的需求至关重要。在线版本包含补充材料，可通过10.1186/s13229-022-00536-z获取。
Heterogeneous mental health outcomes during the COVID-19 pandemic are documented in the general population. Such heterogeneity has not been systematically assessed in youth with autism spectrum disorder (ASD) and related neurodevelopmental disorders (NDD). To identify distinct patterns of the pandemic impact and their predictors in ASD/NDD youth, we focused on pandemic-related changes in symptoms and access to services. Using a naturalistic observational design, we assessed parent responses on the Coronavirus Health and Impact Survey Initiative (CRISIS) Adapted For Autism and Related neurodevelopmental conditions (AFAR). Cross-sectional AFAR data were aggregated across 14 European and North American sites yielding a clinically well-characterized sample of N = 1275 individuals with ASD/NDD (age = 11.0 ± 3.6 years; n females = 277). To identify subgroups with differential outcomes, we applied hierarchical clustering across eleven variables measuring changes in symptoms and access to services. Then, random forest classification assessed the importance of socio-demographics, pre-pandemic service rates, clinical severity of ASD-associated symptoms, and COVID-19 pandemic experiences/environments in predicting the outcome subgroups. Clustering revealed four subgroups. One subgroup—broad symptom worsening only (20%)—included youth with worsening across a range of symptoms but with service disruptions similar to the average of the aggregate sample. The other three subgroups were, relatively, clinically stable but differed in service access: primarily modified services (23%), primarily lost services (6%), and average services/symptom changes (53%). Distinct combinations of a set of pre-pandemic services, pandemic environment (e.g., COVID-19 new cases, restrictions), experiences (e.g., COVID-19 Worries), and age predicted each outcome subgroup. Notable limitations of the study are its cross-sectional nature and focus on the first six months of the pandemic. Concomitantly assessing variation in changes of symptoms and service access during the first phase of the pandemic revealed differential outcome profiles in ASD/NDD youth. Subgroups were characterized by distinct prediction patterns across a set of pre- and pandemic-related experiences/contexts. Results may inform recovery efforts and preparedness in future crises; they also underscore the critical value of international data-sharing and collaborations to address the needs of those most vulnerable in times of crisis. The online version contains supplementary material available at 10.1186/s13229-022-00536-z.
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影响因子：
6.4
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