Background The pandemic corona virus outbreak is having an impact on the lives of every member of the society with lockdown measures to limit the virus spreading through Schools shutting down, limited contact with family and friends, as well as social and leisure activities severely curtailed. This also necessitated unavoidable changes to various healthcare services provision worldwide.
Emotional, behavioural, Neurodevelopmental and Intellectual disorders (EBNDID) including ADHD, Autism, Epilepsy and Cerebral palsy affect up to 15% of the childhood population.
Objectives We aimed to identify pragmatic changes made to services provision for Children and Young people (CYP) with EBNDIDs and help disseminate examples of best practice among CCH Clinicans, while preparing for future pandemic lockdowns.
Methods We carried out a literature review about the impact of COVID-19 pandemic on healthcare services provided for children and adolescent with ADHD from several databases including Pubmed, PMC, CINAHL, Embase, PsycINFO and Ovid, with no limitations in terms of language and date of publication from inception to Dec 2020. This was supplemented by an online scoping survey among selected members of the George-Still Forum (National ADHD Network) run between June and July 2020.
Results 62 responses were obtained from the online (62% rate). Several national and international professional bodies provided clinical guidance to clinicians about necessary service modifications to ensure that patients continue to have access to best evidence-based care despite the limitations imposed by the pandemic, but the awareness among frontline Paediatricians was limited. The clinical recommendations have centred around (i) expansion of various forms of remote and online services, (ii) Infection control strategies (iii) and staff redeployment to areas of higher clinical demands. 8% of the surveyed clinicians were not aware of any specific guidance for CYP with EBNDIDs.
Due to significant restriction to direct face-to-face clinician contacts and redeployment of staff from Community Child Health (CCH) services, many core clinical activities became limited and most new referrals were kept on hold except for urgent services. CCH teams experienced significantly increased waiting lists. During the pandemic, many CCH services increased their telemedicine capacity exponentially. Telephone consultation was the commonest method of remote contact with patients (98%).
Preliminary report has confirmed that the Black, Asian and Minority Ethnic staff and patient communities have been disproportionately affected by morbidity and mortality from COVID-19 infection. Parents and carers were encouraged to make more effective use of online resources including contacting NHS 111 or the GP and only if necessary to going the nearest Emergency Unit.
A wide array of online resources designed for CYP with EBNDID and their families including webinars, online videos, sleep tips, post-diagnosis support etc have become more popular.
Conclusions The pandemic has significantly impacted on routine service provision for new referral s to CCH clinics and for the existing patients. Discontinuation of medical treatment necessitated by health service disruptions should be avoided during the future pandemic lockdowns to avoid serious detrimental effects of escalating challenging behaviour among CYP with EBNID, stressful parent-child and intra-sibling relationships and exacerbation of family disruptions.