Mental health profiles of children and adolescents with autism during the COVID-19 pandemic

Objectives: The confinements in Canadian provinces adversely affected children's mental health during the COVID-19 pandemic, and children with autism were particularly vulnerable. The purpose of this study was to identify subgroups of children with autism with distinct patterns of mental health change, in order to understand the child-, parent-, and system-specific factors associated with them and to inform future interventions. Method: The researchers extracted data from a large Ontario cohort (n=1,570), which included 265 children with autism (mean age=10.9 years, 76% male). They used dynamic cluster analysis to divide the distinct mental health profiles into six measures (mood, anxiety, OCD symptoms, irritability, inattention, hyperactivity) and examined differences between the groups. They also examined the characteristics of children who accessed acute mental health services. Results: The optimal number of clusters was set at two. The first included those who had experienced a deterioration in mental health across the six measures (61.3%, 95% confidence interval=54.9-67.4) and the second included young people whose mental health had not changed (38.7%, 95% confidence interval=32.6-45.1). Factors associated with poorer mental health in children were more pre-existing internalised symptoms and high levels of stress related to COVID-19. Parental mental health problems and system-specific factors, such as loss of learning support, access to doctors and material difficulties, were also linked to this deterioration. Access to acute mental health services was primarily a result of financial insecurity and loss of services. Conclusions: More than half of the children with autism experienced a deterioration in mental health, and individual (pre-existing mental health disorders, COVID-19 stress), parental (parental mental health) and systemic (loss of services and material hardship) characteristics were related, paving the way for multi-level clinical and policy interventions.