Investigating the effects of COVID-19 lockdown on Italian children and adolescents with and without neurodevelopmental disorders: a cross-sectional study.

We conducted a cross-sectional study to compare the impact of social distancing and lifestyle changes that occurred during Corona Virus Disease 2019 (COVID-19) lockdown on children and adolescents with and without Neurodevelopmental Disorders (NDDs). An online questionnaire was administered in order to investigate the effects of NDD condition, socio-demographic status, familiar/home environment and COVID-19 exposure on their lives during a two months period of social isolation. We used logistic regression, focusing on five endpoints (remote learning, lifestyle, stress/anxiety, sociality, scolding) to define the extent of these effects. Most questions were paired up to parents and children, to verify the occurrence of agreement. 8305 questionnaires were analyzed, 1362 of which completed by NDDs and 6943 by controls. Results showed that the presence of a NDD, compared to controls, had a significant impact on: Remote Learning (i.e. subjects with NDDs experienced more difficulties in attending online classes and studying), Sociality (i.e. subjects with NDDs missed their schoolmates less), Scolding (i.e. subjects with NDDs were scolded more often) and Anxiety (i.e. subjects with NDDs were perceived by their parents as more anxious). Substantial agreement between parents and children arose from questions concerning Remote learning, Lifestyle and Scolding. The current study actually points out that having a NDD gives account for a stronger influence on school performance and on behavioral and psychological aspects, during a two months lockdown. Such results may provide useful information to governments and school authorities on how carrying through supportive strategies for youth affected by NDDs. SUPPLEMENTARY INFORMATION: The online version contains supplementary material available at 10.1007/s12144-021-02321-2.

Evaluation of an adapted virtual training for master trainers of the WHO Caregiver Skills Training Program during the COVID-19 pandemic.

LAY ABSTRACT: The COVID-19 pandemic interrupted in-person professional activities. We developed and evaluated a remote training approach for master trainers of the Caregiver Skills Training Program. Master trainers support community practitioners, who in turn deliver the Caregiver Skills Training Program to caregivers of children with developmental delays or disabilities. The Caregiver Skills Training Program teaches caregivers how to use strategies to enhance learning and interactions during everyday play and home activities and routines with their child. The aim of this study was to evaluate the remote training of master trainers on Caregiver Skills Training Program. Twelve out of the 19 practitioners who enrolled in the training completed the study. The training consisted of a 5-day in-person session completed prior to the pandemic, followed by supporting participants' ability to identify Caregiver Skills Training Program strategies through coding of video recordings over 7 weekly meetings and group discussions and ended with participants independently coding a set of 10 videos for Caregiver Skills Training Program strategies. We found all but one participant was able to reliably identify Caregiver Skills Training Program strategies from video recordings despite a lack of ability to practice the Caregiver Skills Training Program strategies with children due to the pandemic. Taken together, our findings illustrate the feasibility and value of remote training approaches in implementing interventions.

Problems and prospects of telemedicine in neurodevelopmental disorders

Following the COVID-19 health emergency, the use of telemedicine, that is the provision of health services through telecommunications and internet technologies, has spread. This work presents a critical review of the characteristics, purposes, advantages and problems of telemedicine in the care of patients with neurodevelopmental disorders and the prospects that can be hypothesized in its application even beyond the pandemic emergency. (PsycInfo Database Record (c) 2023 APA, all rights reserved) (Italian) La situazione di emergenza sanitaria da COVID-19 ha favorito la diffusione della telemedicina, cioe dell'erogazione di prestazioni sanitarie attraverso le tecnologie delle telecomunicazioni e di internet. Il presente lavoro offre una rassegna critica sulle caratteristiche, le finalita, i vantaggi e le problematiche della telemedicina nella presa in carico di pazienti con disturbi del neurosviluppo e sulle prospettive che se ne possono intravedere anche oltre l'emergenza pandemica. (PsycInfo Database Record (c) 2023 APA, all rights reserved)

COVID-19 and lockdown?s psychological impact on children with neurodevelopmental disorders

The research aimed to investigate the first nationwide lockdown's psychological impact (March-May 2020) on children with neurodevelopmental disorders, as well as the onset of symptomatology stress-related according to the parents.Method: An online survey has been spread on social networks for one month (July 2020) ad-dressed to parents of children with neurodevelopmental disorders. The study included 443 Italian parents, especially from Lombardy, Tuscany, Lazio and Piedmont.Results: Parents reported children's difficulties in distance learning (61,2%). Children suspended specialized interventions (62,5%). A great number of parents reported the onset of symptoms in their children: attention problems, concentration difficulties, irritability, sleep disorders and anxiety. Specifically, half of the parents revealed symptoms' worsening of children's disorder (54,4%).Conclusions: The lockdown period have had a great psychological impact on children and adolescents with neurodevelopmental disorders and a worsening of their clinical status.

Automated Fact-Checking of Articles Related to Neurodevelopmental Disorders

False claims or Fake News related to the health care or medicine field on Social Media have garnered increasing amounts of interest, especially in the aftermath of the COVID-19 pandemic. False claims about the pan-demic which spread on social media have contributed to vaccine hesitancy and lack of trust in the advise of medical professionals. If not detected and disproved early, such claims can complicate future pandemic responses. We focus on false claims in the field of Neurodevelopmental Disorders (NDDs), which is an umbrella term for a group of disorders that includes Autism, ADHD, Cerebral Palsy, etc. In this paper we present our approach to automated systems for fact-checking medical articles related to NDDs. We also present an annotated dataset of 116 web pages which we use to test our model and present our results. © 2022 IEEE.

An approach for prevention planning based on the prevalence and comorbidity of neurodevelopmental disorders in 6-year-old children receiving primary care consultations on the island of Menorca.

BACKGROUND: Few studies have estimated the real prevalence of neurodevelopmental disorders according to the Diagnostic and Statistical Manual of Mental Disorders, 5th Edition (DSM-5) in Spain and worldwide. However, there are disparate prevalence figures. We consider research in this field essential to improve early detection, secondary prevention, and health planning. METHODS: The Minikid ADHD and TICS-Mini International Neuropsychiatric Interview for Children and Adolescents, the Autism Spectrum Quotient (Children's version, AQ- Child) and a protocol of general medical questions were administered for screening purposes. The PROLEXIA battery for children aged from 4 to 6 years was used for direct assessments. Parents provided information on emotional, medical, and school aspects. The final population evaluated using these tools consisted of 291 6-year-old subjects. RESULTS: The overall risk of presenting with a neurodevelopmental disorder was 55.4%. A 23.4% risk of presenting with attention-deficit/hyperactivity disorder (ADHD) in any modality (inattentive, hyperactive-impulsive and combined), a 2.8% risk of developing autism spectrum disorder (ASD), a 30.6% risk of presenting with a learning disorder with reading difficulties, a 5.5% risk of tics and a 22.5% risk of language problems (incomprehensible language or minor language problems) were detected in the sample. The most common combination of disorders was learning and language difficulties, accounting for 6.9% of the sample. The second most frequent combination was the presence of learning and language difficulties and ADHD, accounting for 4.5% of the sample. CONCLUSIONS: The prevalence of risks detected in our sample seems to be consistent with national and international studies. A significant proportion of our sample had never been previously diagnosed (85%), so early detection programs are recommended.

The impacts of COVID-19 pandemic on children with neurodevelopmental disorder

Objective: In this study, we aimed to evaluate the impact of Covid-19 pandemic on children with neurodevelopmental disorders through Tele-Medicine system. Method: Children aged between 7-18 years old with neurodevelopmental disorders were evaluated. On the routine control visit day, they and their parents were called by phone via the Tele-Medicine system and a questionnaire prepared by the researchers was applied to evaluate the compliance process to the pandemic. The disease severity of the cases was evaluated by the Clinical Global Impression Scale. Results: In our study, 17.6% of the cases were girls and 82.4% were boys. The average age is 11.66 +/- 3.46 years. In this study 51% of the cases were diagnosed with Autism Spectrum Disorder;47.1% with Intellectual Disability and 17.6% with Special Learning Disorder. The comorbidity of Attention Deficit and Hyperactivity Disorder was found to be 49%. Increased anxiety is reported by 25.5% of the cases, appetite and nutritional problems by %37.3 and sleep pattern changes by 62.7%. Pre-pandemic score of Clinical Global Impression Scale was evaluated as 3.82 +/- 0.81, and the score during the pandemic as 4.09+/-0.87. Discussion: It was found that, in the early period of the Covid-19 pandemic, the most common problems of the cases with neurodevelopmental disorder were the sleep pattern changes, appetite and nutritional problems and increased anxiety. It is thought that our findings will guide psychosocial support interventions for children and adolescents with developmental problems during the pandemic. (PsycInfo Database Record (c) 2022 APA, all rights reserved) (Turkish) Amac: COVID19 pandemisinin, norogelisimsel bozuklugu olan cocuklar uzerine olan etkisinin Tele-Tip uygulamasi ile degerlendirilmesi amaclanmistir. Yontem: Calismada, norogelisimsel bozukluk tanisi olan 7-18 yas araligindaki cocuk ve gencler degerlendirilmistir. Randevu tarihlerinde Tele-Tip Sistemi kapsaminda telefonla aranip kendileri ve ebeveynleriyle gorusulmus, pandemiye uyum surecini degerlendirmek amaciyla arastirmacilarin hazirladigi anket uygulanmistir. Pandemi oncesi ve sonrasi hastalik siddeti Klinik Global Izlenim Olcegi ile degerlendirilmistir. Bulgular: Degerlendirilen 51 olgunun %17.6'si kiz, %82.4'u erkektir. Yas ortalamasi 11.66 +/- 3.46 yildir. Calismaya alinan olgularin %51'i Otizm Spektrum Bozuklugu;%47.1'i Zihinsel Yetersizlik;%17.6'si Ozel Ogrenme Bozuklugu tanisi ile izlenmektedir. Dikkat Eksikligi ve Hiperaktivite Bozuklugu komorbiditesi %49 olarak saptanmistir. Olgularin %25.5'i kaygi artisi, %37.3'u istah ve beslenme duzeni degisikligi, %62.7'si uyku degisikligi bildirmistir. Olgularin pandemi oncesi Klinik Global Izlenim Olcegi puani 3.82+/-0.81, pandemi surecindeki puani 4.09+/-0.87 olarak degerlendirilmistir. Sonuc: Covid-19 pandemisinin erken doneminde, norogelisimsel bozukluk tanisi ile izlemde olan cocuk ve genclerin en sik uyku duzeni degisiklikleri, istah ve beslenme sorunlari ve kaygi artisi saptanmistir. Bulgularimizin pandemi surecinde gelisimsel sorunlari olan cocuk ve genclere yonelik gelistirilecek psikososyal destek mudahalelerine yol gosterici olacagi dusunulmustur. (PsycInfo Database Record (c) 2022 APA, all rights reserved)

Technologies to support the diagnosis and/or treatment of neurodevelopmental disorders: A systematic review.

In recent years, there has been a great interest in utilizing technology in mental health research. The rapid technological development has encouraged researchers to apply technology as a part of a diagnostic process or treatment of Neurodevelopmental Disorders (NDDs). With the large number of studies being published comes an urgent need to inform clinicians and researchers about the latest advances in this field. Here, we methodically explore and summarize findings from studies published between August 2019 and February 2022. A search strategy led to the identification of 4108 records from PubMed and APA PsycInfo databases. 221 quantitative studies were included, covering a wide range of technologies used for diagnosis and/or treatment of NDDs, with the biggest focus on Autism Spectrum Disorder (ASD). The most popular technologies included machine learning, functional magnetic resonance imaging, electroencephalogram, magnetic resonance imaging, and neurofeedback. The results of the review indicate that technology-based diagnosis and intervention for NDD population is promising. However, given a high risk of bias of many studies, more high-quality research is needed.

Parental Perceptions of the Impact of the COVID-19 Pandemic on the Sleep of Children With Neurodevelopmental Disorders.

INTRODUCTION: Little is known about the impact of the COVID-19 pandemic on sleep in schoolaged children with neurodevelopmental disorders. This study aimed to (1) determine and describe the impact of the COVID-19 pandemic, and (2) identify and describe contributing factors. METHOD: Parents of children with neurodevelopmental disorders and insomnia symptoms (n = 100) were surveyed to determine if their child's sleep had changed because of the COVID-19 pandemic. Parents who reported changes were asked to describe how the pandemic influenced their child's sleep. RESULTS: Most parents (66%) reported the pandemic did not worsen their child's sleep, 30% stated their child's sleep had worsened, and 4% reported an improvement. Stress and anxiety about the pandemic, disrupted routines, and increased screen time were common parent-identified contributing factors. DISCUSSION: Health care providers should explore strategies to mitigate contributing factors, such as anxiety about the pandemic, disrupted routines, and increased screen time.

Congenital Infection Influence on Early Brain Development Through the Gut-Brain Axis.

The mechanisms by which various pathogens cause congenital infections have been studied extensively, aiding in the understanding of the detrimental effects these infections can have on fetal/neonatal neurological development. Recent studies have focused on the gut-brain axis as pivotal in neurodevelopment, with congenital infections causing substantial disruptions. There remains controversy surrounding the purported sterility of the placenta as well as concerns regarding the effects of exposure to antibiotics used during pregnancy on neonatal microbiome development and how early exposure to microbes or antibiotics can shape the gut-brain axis. Long-term neurodevelopmental consequences, such as autism spectrum disorder, attention deficit hyperactivity disorder, and cerebral palsy, may be attributable, in part, to early life infection and changes in the immature gut microbiome. The goal of this review is thus to critically evaluate the current evidence related to early life infection affecting neurodevelopment through the gut-brain axis.

Mental-health before and during the COVID-19 pandemic in adults with neurodevelopmental disorders.

The COVID-19 pandemic negatively impacted mental health globally. Individuals with neurodevelopmental disorders (NDDs), including autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD), are at elevated risk of mental health difficulties. We investigated the impact of the pandemic on anxiety, depression and mental wellbeing in adults with NDDs using data from the Avon Longitudinal Study of Parents and Children (n = 3058). Mental health data were collected pre-pandemic (age 21-25) and at three timepoints during the pandemic (ages 27-28) using the Short Mood and Feelings Questionnaire, Generalized Anxiety Disorder Assessment-7, and Warwick Edinburgh Mental Wellbeing Scale. ADHD and ASD were defined using validated cut-points of the Strengths and Difficulties Questionnaire and Autism Spectrum Quotient, self-reported at age 25. We used multi-level mixed-effects models to investigate changes in mental health in those with elevated ADHD/ASD traits compared to those without. Prevalences of depression, anxiety and poor mental wellbeing were higher at all timepoints (pre-pandemic and during pandemic) in those with ADHD and ASD compared to those without. Anxiety increased to a greater extent in those with ADHD (ß = 0.8 [0.2,1.4], p = 0.01) and ASD (ß = 1.2 [-0.1,2.5], p = 0.07), while depression symptoms decreased, particularly in females with ASD (ß = -3.1 [-4.6,-1.5], p = 0.0001). On average, mental wellbeing decreased in all, but to a lesser extent in those with ADHD (ß = 1.3 [0.2,2.5], p = 0.03) and females with ASD (ß = 3.0 [0.2,5.9], p = 0.04). To conclude, anxiety disproportionately increased in adults with NDDs during the pandemic, however, the related lockdowns may have provided a protective environment for depressive symptoms in the same individuals.

Understanding patient characteristics and medication prescriptions in children with mental health and neurodevelopmental disorders referred to a sleep clinic-A quality improvement/quality assurance analysis.

Introduction: Motivated by challenges faced in outpatient sleep services for mental health and neurodevelopmental disorders (MHNDD) during the COVID-19 clinical shutdown, a pan-Canadian/international working group of clinicians and social scientists developed a concept for capturing challenging sleep and wake behaviours already at the referral stage in the community setting. Methods: In a quality improvement/quality assurance (QIQA) project, a visual logic model was the framework for identifying the multiple causes and possible interventions for sleep disturbances. Intake forms informed clinicians about situational experiences, goals/concerns, in addition to the questions from the Sleep Disturbances Scale for Children (SDSC), the ADHD Rating Scale-IV and medication history. Descriptive statistics were used to describe the sample. Results: 66% of the pilot study patients (n = 41) scored in the SDSC red domains (highest scoring) with highest sub-scores for insomnia (falling asleep 73%; staying asleep: 51%) and daytime somnolence (27%). A total of 90% of patients were taking at least one medication; 59% sleep initiation/sleep medications, 41% in combination with further non-stimulant medications, 9% with stimulants, 27% with antidepressants and 18% with antipsychotics. Polypharmacy was observed in 62% of all patients and in 73% of the ones medicated for sleep disturbances. Qualitative information supported individualisation of assessments. Conclusion: Our intake process enabled a comprehensive understanding of patients' sleep and wake profiles prior to assessment, at the referral stage. The high prevalence of insomnia in patients, combined with polypharmacy, requires special attention in the triaging process at the community level.

Relationship between children with neurodevelopmental disorders and their caregivers and friends during early phase of COVID-19 school closure in Japan: Association with difficulty in implementing infection prevention measures.

BACKGROUND: Due to the COVID-19 pandemic people had to implement various infection prevention measures. Researchers have reported the difficulties experienced by children with neurodevelopmental disorders in implementing these measures and their caregivers' resultant anxiety and stress. This study examined the relationship between these difficulties and the deterioration of the children's relationships with their caregivers and friends during school closure and after school reopened. METHODS: A total of 150 caregivers of children with neurodevelopmental disorders answered a questionnaire asking about parent‒child relationships, their child's friendships, and the presence or absence of difficulty in implementing infection prevention measures at three time points: before the pandemic, while schools were closed, and after school reopened. The frequency and percentages of the child's behavioral problems, deterioration in their relationships, and difficulty implementing infection control measures were calculated. Using the relationship deterioration scores, independent and multiple regression analyses were performed for the presence or absence of difficulty implementing infection control measures, presence or absence of caregivers' mental health concerns, and the presence or absence of deterioration of one or more problematic behaviors. RESULTS: Overall, 84.1% of the children displayed difficulties implementing infection prevention measures. No relationship was observed between difficulty with infection prevention measures and deterioration in their relationships with parents and friends when schools were closed. After school reopened, however, deterioration in parent‒child relationships correlated positively with difficulty in hand-washing, and deterioration of friendships correlated positively with the maintenance of social distancing and difficulty in hand-washing. Deterioration of friendships correlated negatively with difficulty in voluntarily complying with stay-at-home requests. CONCLUSION: Difficulty in implementing infection prevention measures was related to deterioration in social relationships with parents and friends of children with neurodevelopmental disorders during the school reopening period, following COVID-19 school closure in Japan. Under a condition requiring heightened infection control, close monitoring may be necessary for the social relationships in children with neurodevelopmental disorders.

Support needs of Children and Young People with Autism (ASD) during the Covid-19 Pandemic- Learning from a local picture

AimsChildren with ASD are known to find alterations within their routines particularly distressing.[1 2 3] Children with Special Educational Needs (SEND) may be especially vulnerable to the negative effects of abrupt changes and prolonged periods of isolation.[4]Aim: To identify the reasons carers of children with ASD accessed our service during the covid-19 pandemic and glean how best to serve their needs should there be further lock-downs.Methods• We identified clients that contacted the Autism Service between March and November 2020 (N=26)• A consent protocol, telephone interview template and risk management protocol was developed and administered by a trained interviewer.• Up to 3 attempts were made to reach the service user• Clients were informed that ‘There will be no direct risks or negative impact on your child, or on the service that you will receive from us, now or in the future if you choose not to participate or if you give us negative feedback.’• The Interviewer collected information about the reason for making contact, whether it was covid specific, how helpful the response was and suggestions for future lockdowns.• Qualitative methodology was used to collate and analyze the data.Results• Of 26 clients identified, 2were siblings. Telephone interviews were conducted with 16/25 (64%) parents/carers.• 11/16 (69%) attributed the reason for making contact to Covid-19 impact on their child or services they hoped to receive. These were as follows: Concern about language regression and therapy provision, deterioration in behaviour, sleep problems, increasing anxiety, need for respite and enquiry about post diagnosis support.• 50% (8/16) felt the response received was helpful for the reason they made contact. (Contact was made for some needs that would not be dealt with by the Paediatric service.)• Respondents made suggestions about how we could improve: communication, response time to queries and overall support e.g. access to on line resources, sleep course and virtual support groups whilst also acknowledging that some suggestions were unrealistic in the face of a killer pandemic. What was most valued was someone to talk to/listen.ConclusionParents of children with SEND reported larger increases in stress and anxiety than their counterpart’s children during the COVID-19 lockdown.[2] In our busy service, a very small proportion of parents made contact for help. The reason for contact was anxiety in 3/16 (19%).Respondents’ suggestions have since been addressed through offer of virtual workshops and a National Autistic Society Family support Worker to address post diagnosis queries releasing clinicians time for where their expertise is most required.ReferencesThe Lancet Psychiatry. [Online] 7 (6), 481–483.Eshraghi, A. A. et al. (2020) COVID-19: Overcoming the challenges faced by individuals with autism and their families.Journal of Autism and Developmental Disorders. [Online] [ https://doi.org/10.1007/s10803-020-04577-2 Asbury, K. et al. (2020) How is COVID-19 Affecting the Mental Health of Children with SEND and Their Families?Research in Developmental Disabilities. [Online] 108103822. Alhuzimi, T. (2021)Stress and emotional wellbeing of parents...CMAJ. [Online] 192 (21), E587–E587.Smile, S. C. (2020) Supporting children with ASD in the face of the COVID-19 pandemic

The Impact of Covid-19 Pandemic on Services for Persons with Neurodevelopmental Disorders: An Italian Case

The COVID-19 pandemic has had severe effects on social health services worldwide. Many people with neurodevelopmental disorders have lost their professional support. The interruption of supportive assistance has been devastating since it has negatively affected their continuity of care as well as their social inclusion and socialization. This paper aims to illustrate the impact of the COVID-19 on an Italian Public Social Health System Services for people with disability. It highlights and discusses the strategy that was adopted in order to ensure the continuity of care assistance provided to the service clients as the organization of emergency remote support and individual support services for independent living. An exploratory study was conducted involving the entire population of people with neurodevelopmental disorders (n=333) included in the Disability System Services of Udine (Friuli Venezia Giulia Region, North-East Italy) to analyze the main repercussions occurred on the organization of services during the pandemic period. A comparative analysis of the number of persons enrolled in the different types of support services and of individuals' support needs, evaluated throught the Support intensity scale (SIS), pre- and post-pandemic crisis (January 2020 - January 2021) was conducted. The data shows that, despite the enormous difficulties, the adopted strategy has succeeded in limiting the risks of isolation and the negative impact on individual interventions, and opened the way to new alternative and innovative strategies for planning and implementing support.

Attention Deficit Hyperactivity Disorder Assessment Based on Patient Behavior Exhibited in a Car Video Game: A Pilot Study.

Symptoms of Attention Deficit Hyperactivity Disorder (ADHD) include excessive activity, difficulty sustaining attention, and inability to act in a reflective manner. Early diagnosis and treatment of ADHD is key but may be influenced by the observation and communication skills of caregivers, and the experience of the medical professional. Attempts to obtain additional measures to support the medical diagnosis, such as reaction time when performing a task, can be found in the literature. We propose an information recording system that allows to study in detail the behavior shown by children already diagnosed with ADHD during a car driving video game. We continuously record the participants' activity throughout the task and calculate the error committed. Studying the trajectory graphs, some children showed uniform patterns, others lost attention from one point onwards, and others alternated attention/inattention intervals. Results show a dependence between the age of the children and their performance. Moreover, by analyzing the positions by age over time using clustering, we show that it is possible to classify children according to their performance. Future studies will examine whether this detailed information about each child's performance pattern can be used to fine-tune treatment.

Guidance for the Treatment and Management of COVID-19 Among People with Intellectual Disabilities.

The current COVID-19 pandemic is a pressing world crisis and people with intellectual disabilities (IDs) are vulnerable due to disparity in healthcare provision and physical and mental health multimorbidity. While most people will develop mild symptoms upon contracting severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), some will develop serious complications. The aim of this study is to present guidelines for the care and treatment of people with IDs during the COVID-19 pandemic for both community teams providing care to people with IDs and inpatient psychiatric settings. The guidelines cover specific issues associated with hospital passports, individual COVID-19 care plans, the important role of families and carers, capacity to make decisions, issues associated with social distancing, ceiling of care/treatment escalation plans, mental health and challenging behavior, and caring for someone suspected of contracting or who has contracted SARS-CoV-2 within community or inpatient psychiatric settings. We have proposed that the included conditions recommended by Public Health England to categorize someone as high risk of severe illness due to COVID-19 should also include mental health and challenging behavior. There are specific issues associated with providing care to people with IDs and appropriate action must be taken by care providers to ensure that disparity of healthcare is addressed during the COVID-19 pandemic. We recognize that our guidance is focused upon healthcare delivery in England and invite others to augment our guidance for use in other jurisdictions.

[Telerehabilitation of Subjects with Neurodevelopmental Disorders During Confinement due to COVID-19]. / Telerrehabilitación de sujetos con trastornos del neurodesarrollo durante el confinamiento por COVID-19.

Introduction: Social distancing measures due to the COVID-19 pandemic prevented many children with neurodevelopmental disorders from accessing face-to-face treatments. Telerehabilitation grew at this time as an alternative therapeutic tool. In this study we analysed remote cognitive rehabilitation in neurodevelopmental disorders. Methods: This was a prospective, quasi-experimental (before-after) study that included 22 patients (mean age 9.41 years) with neurodevelopmental disorders who had telerehabilitation for over six months. Results: After six months of telerehabilitation, a statistically significant improvement was found with a large effect size in these areas: attention (sustained, selective and divided), executive functions (verbal and visual working memory, categorisation, processing speed), visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia) and language (comprehensive and expressive). On the Weiss Functional Impairment Scale, all areas (family, learning and school, self-concept, activities of daily living, risk activities) improved with statistical significance. We found a positive correlation between the number of sessions and the improvement observed in executive functions (visual working memory, processing speed), attention (sustained attention, divided attention) and visuospatial skills (spatial orientation, perceptual integration, perception, simultanagnosia). We did not find statistical significance between the family structure and the number of sessions carried out. A high degree of perception of improvement and satisfaction was observed in the parents. Conclusions: Telerehabilitation is a safe alternative tool which, although it does not replace face-to-face therapy, can achieve significant cognitive and functional improvements in children with neurodevelopmental disorders.

Perspective: Chicken Models for Studying the Ontogenetic Origin of Neuropsychiatric Disorders.

Nutrients and xenobiotics cross the blood-placenta barrier, potentially depositing in the fetal brain. The prenatal exposure affects the neuroendocrine and microbial development. The mechanism underlying maternal risk factors reprograming the microbiota-gut-brain axis with long-term effects on psychosocial behaviors in offspring is not clear. In humans, it is not possible to assess the nutrient or xenobiotic deposition in the fetal brain and gastrointestinal system for ethical reasons. Moreover, the maternal-fetal microbe transfer during gestation, natural labor, and breast-feeding constitutes the initial gut microbiome in the progeny, which is inevitable in the most widely utilized rodent models. The social predisposition in precocial birds, including chickens, provides the possibility to test behavioral responses shortly after being hatched. Hence, chickens are advantageous in investigating the ontogenetic origin of behaviors. Chicken embryos are suitable for deposition assessment and mechanistic study due to the accessibility, self-contained development, uniform genetic background, robust microbiota, and easy in vivo experimental manipulation compared to humans and rodents. Therefore, chicken embryos can be used as an alternative to the rodent models in assessing the fetal exposure effect on neurogenesis and investigating the mechanism underlying the ontogenetic origin of neuropsychiatric disorders.