Neurodivergent students. A continuum of skills with an emphasis on creativity and executive functions.

This study analyses Executive Functions (EF) and Creativity among neurodivergent students -including students with Attention Deficit Hyperactivity Disorder (ADHD), Dyslexia, Intellectual Disability (ID), Giftedness-, and a group with Neurotypical development. A sample of 181 secondary school students participated in the study. Creativity was assessed by using the PIC-J test, focusing on verbal and figural components of divergent thinking, while EF were evaluated through Nesplora Ice-Cream, a virtual reality tool assessing flexibility, working memory, and inhibition. Results showed statistically significant differences in Verbal Creativity, especially in Originality: students with ADHD outperformed their Neurotypical peers, while those with ID showed the lowest scores. Although no statistically significant differences emerged in Figural Creativity, students with ADHD showed the lowest scores in Elaboration or Figural details, whereas those with Dyslexia exhibited high levels of Figural Originality, similar to their Neurotypical peers. Concerning EF, students with ID had the highest scores in Interference and Perseveration, indicating poorer Flexibility. In contrast, Gifted students performed better than the other groups in Working Memory, while students with ADHD did not exhibit special difficulties in EF. These findings emphasize the importance of personalized interventions for Neurodivergent students, that recognize and capitalize on their unique strengths while addressing specific challenges.

How do children with language disorder perceive their peer interactions? A qualitative investigation.

Background and aims: Peer interaction difficulties are often elevated amongst children with language disorders, yet the mechanisms underlying these difficulties are unclear. Previous research indicates that poor conflict management, social withdrawal, emotion regulation difficulties, and reduced prosocial behavior may contribute to peer interaction difficulties. However, this research often uses adult perspectives, failing to acknowledge child perceptions of these experiences. The present study aimed to qualitatively investigate perceptions of peer interactions from the perspective of children with language disorders. Methods: Seven participants aged between 7- and 10-years-old took part. All participants were diagnosed with a language disorder and had language as their primary area of difficulty. Participants were recruited from a specialist language school and via an online database. Semi-structured interviews were conducted, with participants given the choice to answer questions verbally or creatively, using toys or drawing materials. Interview transcripts were analyzed using interpretative phenomenological analysis. Results: Participants valued play, conversation, and helping others. They felt that spending time with peers could alleviate loneliness. However, sometimes solitude was needed as social interaction could be overwhelming. Participants found conflict challenging and exhibited difficulties with regulating emotions. Participants relied on running away, retaliation, or asking an adult for help, to resolve conflict. Conclusions and implications: The findings suggest that children with language disorders are socially motivated and have relative strengths in displaying prosocial behavior. However, children with language disorders require support to promote positive relationships. This support includes help with making deeper connections with peers, opportunities to spend time alone when needed, and providing adept conflict resolution and emotion regulation strategies.

Camouflaging, internalized stigma, and mental health in the general population.

BACKGROUND: Camouflaging, the strategies that some autistic people use to hide their differences, has been hypothesized to trigger mental health ramifications. Camouflaging might reflect ubiquitous impression management experiences that are not unique to autistic people and similarly impact the mental health of non-autistic people. AIMS: We first examined whether individuals in the general population camouflage and manage impressions while experiencing mental health repercussions, and how gender and neurodivergent traits modified these associations. We then assessed how camouflaging and impression management arose from internalized stigma, and their inter-relationships in shaping mental health outcomes. METHODS: Data were collected from 972 adults from a representative U.S. general population sample, with measures pertaining to camouflaging, impression management, mental health, internalized stigma, and neurodivergent traits. Multivariate hierarchical regression and moderated mediation analyses were used to address the two research aims. RESULTS: Both camouflaging and self-presentation (a key component of impression management) were associated with mental health presentations in the general population, which overlapped with those previously reported in autistic people. These associations were more pronounced in women compared with men and were of different directions for individuals with higher autistic traits versus higher ADHD traits. Internalized stigma might be a key stressor that could elicit camouflaging and impression management through social anxiety, which in turn might lead to adverse mental health outcomes. CONCLUSIONS: These findings advance the conceptual clarity and clinical relevance of camouflaging and impression management across social and neurodiverse groups in the general population. The ramifications of camouflaging and impression management underscore the need to alleviate internalized stigma for better mental health across human groups.

A model linking emotional dysregulation in neurodivergent people to the proprioceptive impact of joint hypermobility.

Emotional feelings are putatively ascribed to central representation of bodily states in the context of expectation and uncertainty in both internal state and external world. Neurodivergent people are more likely to experience co-occurring mental health challenges, although mechanistic insights underpinning this association are scarce. We therefore undertook a study to test whether imprecise processing of proprioceptive error signals may underlie the connection between neurodivergence and emotional dysregulation. In a cohort of people with complex chronic conditions, including chronic pain/fatigue, and complex trauma, and in a comparison group, we assessed presence of neurodivergence, variant connective tissue manifested through joint hypermobility, and emotional dysregulation. We present a data-informed conceptual model showing that variant connective tissue determines whether proprioceptive surprise is linked with emotional dysregulation in neurodivergent individuals. We suggest that future research in this area may have important clinical implications for the interaction of mental and physical wellbeing in neurodivergent people. This article is part of the theme issue 'Sensing and feeling: an integrative approach to sensory processing and emotional experience'.

The positive impact of identity-affirming mental health treatment for neurodivergent individuals.

Introduction: The medical and social definitions of neurodivergence have become a common topic of discussion in recent years, and the ways that we define, measure and report on conditions within the neurodivergent umbrella are changing. The objective of this study was to analyze differences in mental health symptom presentation at intake and compare treatment outcomes among three groups: clients with an affirming neurodivergent diagnosis, clients without an affirming diagnosis, and neurotypical clients. Methods: Data were collected at intake and discharge. Clients self-reported neurodivergent identity, neurodivergent diagnoses, as well as the severity of depression symptoms, anxiety symptoms and self-harm frequency. One-way multivariate analysis of variance tests were run to assess differences in mental health symptoms at intake and discharge based on neurodivergent identity and corresponding diagnosis. When MANOVAs indicated significant differences, follow-up univariate one-way ANOVAs were conducted for each dependent variable. Results: Neurodivergent clients reported significantly worse mental health symptoms at intake than neurotypical clients, regardless of diagnosis status. Additionally, clients who identified as neurodivergent but did not report an affirming medical diagnosis reported significantly worse mental health symptoms than those who did report an affirming medical diagnosis. By discharge from IOP treatment, no significant differences were found in symptom change scores between neurodivergent and neurotypical individuals, or neurodivergent individuals with an affirming diagnosis and those without. Discussion: These findings highlight the importance of acknowledging client identity as a key component of mental health treatment. The act of validating symptoms and experiences, allowing accommodations when requested, and exploring identity formation regardless of diagnosis, allowed all clients who identified as neurodivergent to benefit from treatment.

Evidence of mutual non-verbal synchrony in learners with severe learning disability and autism, and their support workers: a motion energy analysis study.

Introduction: Some research indicates that neurodivergent people are less likely than "neurotypical" people to adapt their movements to a partner's movements to facilitate interpersonal motor synchrony. Researchers therefore suggest synchrony deficits underlie the social differences associated with autism and other neurodivergences. Intensive Interaction (II) is a client-led approach, where Learning Support Workers (LSW) follow the lead of learners to create balanced and reciprocal interactions. Methods: We aimed to examine the balance of synchrony in learners with autism and Severe Learning Disabilities and their LSWs in a special education college where learners had prior experience with II. Using Motion Energy Analysis, we assessed the degree to which each partner acted as a leader, and hence which partner acted as a follower, during moments of close synchrony. Results: Overall, learners and LSWs showed higher than chance synchrony. There were no differences in the degree to which each partner led the moments of synchrony, or the amount pairs synchronized with zero-lag, where there was no delay between each partners' movements. Discussion: The equal balance of leading and following in the learner and LSW pairs demonstrates that both partners consistently adapted their movements to their partner's movements to facilitate synchrony. The findings tentatively challenge the notion of a synchrony deficit in autism and suggest synchrony can be present in cross-neurotype pairs in comfortable and engaging conditions. We discuss the potential for client-led, movement-based approaches to support smooth interactions across neurotypes.

A Scoping Review of Mental Health and Wellbeing Outcome Measures for Children and Young People: Implications for Children in Out-of-home Care.

Purpose: One of the challenges for mental health research is the lack of an agreed set of outcome measures that are used routinely and consistently between disciplines and across studies in order to build a more robust evidence base for how to better understand young people's mental health and effectively address diverse needs. Methods: This study involved a scoping review of reviews on consensus of the use of mental health and wellbeing measures with children and young people. We were particularly interested to identify if there are differences in measures that are recommended for children and young people with care experience including those with developmental disabilities. Findings: We identified 41 reviews, of which two had a focus on child welfare settings, three on childhood trauma and 14 focused on children and young people with developmental disabilities. Overall, our review highlights a lack of consensus and a diversity of measures within the field. We identified 60 recommended measures, of which only nine were recommended by more than one review. Conclusions: Our review highlights the need for greater agreement in the use of mental health outcome measures. While our review highlights that there is value in identifying measures that can be used with any child or young person, researchers need to take into account additional considerations when working with children and young people with care experience and those with developmental disabilities, to ensure measures are accessible and sensitive to their life experiences.

Overlap of eating disorders and neurodivergence: the role of inhibitory control.

BACKGROUND: Difficulties with inhibitory control have been identified in eating disorders (EDs) and neurodevelopmental disorders (NDs; including attention deficit hyperactivity disorder (ADHD) and autism spectrum disorder), and there appear to be parallels between the expression of these impairments. It is theorised that impairments in inhibitory control within NDs may represent a unique vulnerability for eating disorders (EDs), and this same mechanism may contribute to poorer treatment outcomes. This review seeks to determine the state of the literature concerning the role of inhibitory control in the overlap of EDs and neurodivergence. METHOD: A scoping review was conducted to summarise extant research, and to identify gaps in the existing knowledge base. Scopus, Medline, PsycInfo, Embase, and ProQuest were systematically searched. Studies were included if the study measured traits of ADHD or autism, and symptoms of ED, and required participants to complete a performance task measure of inhibitory control. Where studies included a cohort with both an ND and ED, these results had to be reported separately from cohorts with a singular diagnosis. Studies were required to be published in English, within the last 10 years. RESULTS: No studies explored the relationship between autism and EDs using behavioural measures of inhibitory control. Four studies exploring the relationship between ADHD and EDs using behavioural measures of inhibitory control met selection criteria. These studies showed a multifaceted relationship between these conditions, with differences emerging between domains of inhibitory control. ADHD symptoms predicted poorer performance on measures of response inhibition in a non-clinical sample; this was not replicated in clinical samples, nor was there a significant association with EDs. Both ADHD and ED symptoms are associated with poor performance on attentional control measures; where these diagnoses were combined, performance was worse than for those with a singular diagnosis of ADHD. This was not replicated when compared to those with only ED diagnoses. CONCLUSION: Impairments in attentional control may represent a unique vulnerability for the development of an ED and contribute to poor treatment outcomes. Further research is needed to explore the role of inhibitory control in EDs, ADHD and autism, including the use of both self-report and behavioural measures to capture the domains of inhibitory control.

'Nothing About Us, Without Us': Research Priorities for Autistic Girls, Women and Gender Diverse People in Australia.

Autistic girls, women and gender diverse people have specific needs that are underrepresented in research. Research priorities are often established by funding bodies, researchers, parents, carers and health professionals and may not meet the needs of the diverse Autistic community. This co-produced project aimed to identify what research would benefit the lives of Autistic girls, women and gender diverse people in Australia. We interviewed 47 Autistic girls, women and gender diverse people aged seven and above and obtained feedback from an additional 411 Autistic people through an online survey. Autistic young people identified six key research priorities including (1) better understanding and support at school, (2) understanding our experiences, strengths and challenges, (3) autism specific mental health support, (4) Autistic friendships and relationships, (5) experiences of gender diversity and (6) accommodations to make life easier for us. Eight key research priority areas were identified by Autistic adults including (1) understanding and supporting specific needs in adulthood, (2) experiences of trauma, abuse and sexual violence, (3) supporting mental health and wellbeing, (4) addressing barriers in healthcare, (5) understanding and supporting physical health needs, (6) addressing barriers in education and the workplace, (7) understanding the role of society, embracing neurodiversity and the importance of Autistic identity and (8) co-designing research and supports with Autistic people. We provide a discussion around the importance of focusing on these research priority areas in future autism research in Australia.

"A perfect storm": Autistic experiences of menopause and midlife.

LAY ABSTRACT: Previous studies report that menopause can be a very difficult transition for some autistic people. This study focuses on how autistic people experience menopause and what support and information might help them. Autistic Community Research Associates played an important role in the research and co-authored this article. We held four focus groups and eight interviews online with 24 autistic participants who lived in either Canada (n = 13) or the United Kingdom (n = 11). We analysed participant conversations using a method called reflexive thematic analysis. Participants described many intense challenges during menopause. Four themes and eight subthemes were identified across participant groups: (1) Complexity, multiplicity and intensity of symptoms (0 subthemes); (2) Life experience and adversity converging at midlife (three subthemes); (3) The importance of knowledge and connection (two subthemes); and (4) Barriers to support and care (three subthemes). The experiences of our participants may not be the same as other autistic people, and the study could have been more inclusive of diverse autistic groups. However, hearing about the experiences of others may provide reassurance to autistic people who struggle with menopause and let them know they are not alone.

Gender diversity is correlated with dimensional neurodivergent traits but not categorical neurodevelopmental diagnoses in children.

BACKGROUND: Gender clinic and single-item questionnaire-based data report increased co-occurrence of gender diversity and neurodevelopmental conditions. The nuances of these associations are under-studied. We used a transdiagnostic approach, combining categorical and dimensional characterization of neurodiversity, to further the understanding of its associations with gender diversity in identity and expression in children. METHODS: Data from 291 children (Autism N = 104, ADHD N = 104, Autism + ADHD N = 17, neurotypical N = 66) aged 4-12 years enrolled in the Province of Ontario Neurodevelopmental Network were analyzed. Gender diversity was measured multi-dimensionally using a well-validated parent-report instrument, the Gender Identity Questionnaire for Children (GIQC). We used gamma regression models to determine the significant correlates of gender diversity among age, puberty, sex-assigned-at-birth, categorical neurodevelopmental diagnoses, and dimensional neurodivergent traits (using the Social Communication Questionnaire and the Strengths and Weaknesses of ADHD Symptoms and Normal Behavior Rating Scales). Internalizing and externalizing problems were included as covariates. RESULTS: Neither a categorical diagnosis of autism nor ADHD significantly correlated with current GIQC-derived scores. Instead, higher early-childhood dimensional autistic social-communication traits correlated with higher current overall gender incongruence (as defined by GIQC-14 score). This correlation was potentially moderated by sex-assigned-at-birth: greater early-childhood autistic social-communication traits were associated with higher current overall gender incongruence in assigned-males-at-birth, but not assigned-females-at-birth. For fine-grained gender diversity domains, greater autistic restricted-repetitive behavior traits were associated with greater diversity in gender identity across sexes-assigned-at-birth; greater autistic social-communication traits were associated with lower stereotypical male expression across sexes-assigned-at-birth. CONCLUSIONS: Dimensional autistic traits, rather than ADHD traits or categorical neurodevelopmental diagnoses, were associated with gender diversity domains across neurodivergent and neurotypical children. The association between early-childhood autistic social-communication traits and overall current gender diversity was most evident in assigned-males-at-birth. Nuanced interrelationships between neurodivergence and gender diversity should be better understood to clarify developmental links and to offer tailored support for neurodivergent and gender-diverse populations.

Rational inattention: A new theory of neurodivergent information seeking.

This paper presents rational inattention as a new, transdiagnostic theory of information seeking in neurodevelopmental conditions that have uneven cognitive and socio-emotional profiles, including developmental language disorder (DLD), dyslexia, dyscalculia and autism. Rational inattention holds that the optimal solution to minimizing epistemic uncertainty is to avoid imprecise information sources. The key theoretical contribution of this report is to endogenize imprecision, making it a function of the primary neurocognitive difficulties that have been invoked to explain neurodivergent phenotypes, including deficits in auditory perception, working memory, procedural learning and the social brain network. We argue that disengagement with information sources with low endogenous precision (e.g. speech in DLD, orthography-phonology mappings in dyslexia, numeric stimuli in dyscalculia and social signals in autism) constitutes resource-rational behaviour. We demonstrate the strength of this account in a series of computational simulations. In experiment 1, we simulate information seeking in artificial agents mimicking an array of neurodivergent phenotypes, which optimally explore a complex learning environment containing speech, text, numeric stimuli and social cues. In experiment 2, we simulate optimal information seeking in a cross-modal dual-task paradigm and qualitatively replicate empirical data from children with and without DLD. Across experiments, simulated agents' only aim was to maximally reduce epistemic uncertainty, with no difference in reward across information sources. We show that rational inattention emerges naturally in specific neurodivergent phenotypes as a function of low endogenous precision. For instance, an agent mimicking the DLD phenotype disengages with speech (and preferentially engages with alternative precise information sources) because endogenous imprecision renders speech not conducive to information gain. Because engagement is necessary for learning, simulation demonstrates how optimal information seeking may paradoxically contribute negatively to an already delayed learning trajectory in neurodivergent children. RESEARCH HIGHLIGHTS: We present the first comprehensive theory of information seeking in neurodivergent children to date, centred on the notion of rational inattention. We demonstrate the strength of this account in a series of computational simulations involving artificial agents mimicking specific neurodivergent phenotypes that optimally explore a complex learning environment containing speech, text, numeric stimuli, and social cues. We show how optimal information seeking may, paradoxically, contribute negatively to an already delayed learning trajectory in neurodivergent children. This report advances our understanding of the factors shaping short-term decision making and long-term learning in neurodivergent children.

Exploring the presence and impact of sensory differences in children with Developmental Coordination Disorder.

BACKGROUND: Children with Developmental Coordination Disorder (DCD) can experience sensory differences. There has been limited exploration of these differences and their impact on children with DCD. AIMS: i) To explore the presence and impact of sensory differences in children with DCD compared to children without DCD; ii) To examine whether sensory differences are related to motor ability, attention deficit hyperactivity disorder (ADHD), or autistic traits. METHOD: Parents of children (8-12 years) with (n = 23) and without (n = 33) DCD used standardised questionnaires to report on their children's sensory differences, autistic traits, and ADHD traits. Motor abilities were assessed through the Movement Assessment Battery for Children-2. Data were explored both categorically (between-groups) and dimensionally. RESULTS: Children with DCD had significantly higher levels of sensory differences than children without DCD. Sensory differences also had a significantly greater impact on daily activities for children with DCD. Higher levels of ADHD and autistic traits, but not motor ability, were significant independent predictors of higher levels of sensory difference. CONCLUSION: Children with DCD experience high levels of sensory differences, which impact on their daily lives. These sensory differences may be a marker for additional neurodivergence in children with DCD. Practitioners should consider the sensory needs of children with DCD. WHAT THIS PAPER ADDS: This paper provides insight into the sensory features of children with DCD and the impact that sensory differences can have on daily living. Using parent-report, we found that children with DCD had increased sensory differences relative to children without DCD. These included increased hyperresponsiveness, increased hyporesponsiveness, and increased sensory interests, repetitions, and seeking behaviours (SIRS). We also found that sensory differences had a greater impact on daily living for children with DCD compared to children without DCD. Across the whole sample, autistic traits predicted hyperresponsivity and hyporesponsivity patterns; whereas traits of hyperactivity and impulsivity predicted SIRS. Motor abilities did not uniquely predict sensory differences, suggesting that other traits of neurodivergence may contribute to the sensory differences in DCD. Taken together, these findings highlight the necessity of considering sensory needs when supporting children with DCD. They also suggest that if sensory differences are identified in children with DCD, it may be due to the presence of co-occurring neurodivergent traits or conditions.

Navigating the multiple dimensions of the creativity-mental disorder link: a Convergence Mental Health perspective.

BACKGROUND: This paper discusses a paradox in mental health. It manifests as a relationship between adverse "bad" effects (suffering, clinical costs, loss of productivity) in individuals and populations and advantageous "good" aspects of mental disorders. These beneficial aspects (scientific, artistic and political accomplishments) emanate at the societal level through the frequently unprecedented creativity of people suffering from mental disorders and their relatives. Such gains can contribute to societal innovation and problem-solving. Especially in times of accelerated social-ecological change, approaches are needed that facilitate best-possible mental health care but also recognize creative ideas conducive to beneficial clinical and social-ecological innovations as soon as possible. DISCUSSION: This paper emphasizes the need to account for creativity as a crucial component in evolving mental health systems and societies. It highlights the need for wide-ranging approaches and discusses how research targeting multiple facets (e.g., brain level, cognitive neuroscience, psychiatry, neurology, socio-cultural, economic and other factors) might further our understanding of the creativity-mental disorder link and its importance for innovating mental health systems and societies. CONCLUSION: Our discussion clarifies that considerable research will be needed to obtain a better understanding of how creativity associated with mental disorders may help to create more sustainable societies on a fast-changing planet through innovative ideas. Given the current-state-of-the-art of research and healthcare management, our discussion is currently speculative. However, it provides a basis for how pros and cons might be studied in the future through transdisciplinary research and collaborations across sectors of society.

Pregnancy in autistic women and social medical considerations: scoping review and meta- synthesis.

Introduction: This article addresses a topic that has been largely overlooked by scientific literature, namely pregnancy in autistic women. Generally, the issue of sexuality in disability, particularly in disabled women, autistic or otherwise, has been underexplored. However, it is necessary to scientifically investigate this topic to propose adequate social and health policies. Therefore, we chose to conduct a scoping review to answer three main questions: "What does it mean for an autistic woman to be pregnant?"; "How do these two conditions coexist?"; "Are health services prepared to receive this population adequately or does autism become a stigma for pregnant women?" Methods: We conducted a systematic review and qualitative thematic synthesis following the Preferred Reporting Guidelines for Systematic Reviews and Meta-Analyses on autistic women and pregnancy in the last 10 years. Results: The studies included in our review are 7, extremely diverse in terms of methodologies and sample sizes. Despite the heterogeneity of samples and methodologies, all research tends to highlight the following results. For autistic women during pregnancy, three areas seem to be the most difficult: sensory issues, mood disorders, and relationships with specialists. Discussion: Our study found that women with ASD face unique challenges during childbirth that differ from those of neurotypical women. Participants often felt belittled, ignored, and uninformed about the care they received, and being placed at the centre of attention was often seen as negative and hindering rather than positive. However, the research shows us how some "expected" results, such as difficulties in breastfeeding, have been disproven.

Neurodiversity, Networks, and Narratives: Exploring Intimacy and Expressive Freedom in the Time of Covid-19.

The Narratives of Neurodiversity Network (NNN) is a neurodivergent academic, creative, and educator collective that came together with allies during the Covid-19 pandemic to create a network centred around emerging narratives about neurodiversity and exploring new ways of learning and socialising. The network focuses on exploring the roles of written, spoken, and visual narratives across cultural locations about neuro-atypical experiences in generating improved agency and self-advocacy for those who have been subject to pathologization through neuro-normativity and intersecting oppression. During the last year, widening access to digital platforms has provided a space to explore these issues outside of traditional academic spaces. We run a monthly "Salon," our mixed-media "reading, listening, and watching" group, in an effort to find positive representation within contemporary culture. Discussions have moved beyond mimesis and into a consideration of how narrative and storyworlds can question the supposed naturalness of certain ways of being in and perceiving the world. This article interrogates the network's core principles of nonhierarchical co-production, including the roles of creativity, community, identity, and emancipatory research which were animated by the new techno-social context. We consider the cultural lives of neurodiversity in the West and beyond, including ethical and aesthetic dimensions. We share a faith in the power of storytelling to inform new social identities for neurodivergent people and to inform scientific understandings of atypical cognition. In exploring this, we speak through a porous first-person plural narrator, to unsettle the idea that there is a hegemonic "we" speaking on behalf of all neurodivergent people.

Common Intersection of Autism and Gender Diversity in Youth: Clinical Perspectives and Practices.

Autism and gender diversity often intersect. Many transgender youth seeking gender-related medical interventions are autistic. Clinicians serving these youth lack an autism-specific evidence base to guide gender care decisions. At present, care decisions are based on extrapolation of care models from transgender youth samples, generally. At this point, there is no evidence to suggest that autistic youth are likely to experience shifts in gender or gender-related medical requests, although this has been insufficiently studied. In this article, cowritten by expert clinicians and autistic gender-diverse collaborators, an overview of clinical care considerations and the current evidence base is provided.

Accessing healthcare during the COVID-19 pandemic: a qualitative exploration of the experiences of parents and carers of children with chronic illness to inform future policies in times of crisis.

BACKGROUND: The purpose of thispaper is to explore the experiences of parents and carers of children with chronic health conditions in accessing healthcare during the Covid-19 pandemic. Children with chronic conditions typically rely on both planned and unplanned care, and contact with healthcare professionals over extensive periods of time. Their distinct care needs render these children vulnerable to even to minor changes in healthcare provision. The wide-ranging care disruptions during the pandemic were therefore likely drastically to affect their health and wellbeing; an assessment of the effects of Covid-19 policies on healthcare access and quality of care delivered for this group is needed. METHODS: From 25/01/2022 to 25/05/2022, four focus groups were held with parents/carers of children with diabetes, neurodivergence, mental health conditions, and medical complexities to explore their experiences in navigating the healthcare system during the pandemic. Interviews were transcribed and then subjected to thematic analysis using NVivo qualitative research software. RESULTS: Our results indicate that children with chronic health conditions (and their parents/carers) experienced difficulties accessing healthcare during the pandemic. Problems with late diagnosis, prolonged waiting times, and deficiencies with telemedicine were identified, as were impacts of healthcare disruptions on children's wellbeing, and the wellbeing of wider families. We found that children with neurodivergence and those with mental health conditions were particularly affected with their health needs repeatedly de-prioritised. Furthermore, the loss of contact with multi-specialty clinical teams profoundly affected parents and carers, leaving them feeling isolated in managing their children's health. These diminished relationships became another vector for uncertainty in supporting children's health. CONCLUSION: The effects of healthcare disruptions on the welfare of children with chronic conditions (and their families), are well evidenced in this work, providing deeper understandings of the relationships between these children, their families and clinicians. The evidence in this paper aims to inform future policy and ethical guidelines so that the needs of children with long-term health conditions can be properly considered in times of crisis.