Impact of the COVID-19 Pandemic on the Pediatric Hospital Visits: Evidence from the State of Florida

Improving early detection, diagnosis and intervention for children with autism spectrum disorder: A cross-sectional survey in China

BACKGROUND

Detection and diagnosis of autism spectrum disorder (ASD) are prerequisites for early interventions. However, few studies focused on this topic.

AIM

This study aims to characterize the timing from symptom detection to intervention in children with ASD and identify predictors of age at ASD diagnosis, presence of intervention, and the time lag between detection and diagnosis.

METHODS AND PROCEDURES

A cross-sectional survey was conducted with 303 parents (111 fathers and 192 mothers, 21-54 years) of children with ASD in Guangzhou, China.

OUTCOMES AND RESULTS

The median time from symptom observation to the first doctor visit was 3 months, while the time to ASD diagnosis averaged 6 months. Most children (76.24 %) were diagnosed within one year after detection, and 25.58 % had no intervention after diagnosis. Predictors of earlier ASD diagnosis included ASD-related symptoms identified at an older age, less serious symptoms, and initial symptoms with atypical motor development and sensory anomalies. ASD-related symptoms observed at an older age, initial symptoms with social deficits, sensory anomalies, and without language impairment, primary caregivers other than parents, families with lower income, and less social support utilization increased the odds of a time lag between detection and diagnosis. Children with fathers having lower education were less likely to receive interventions.

CONCLUSIONS AND IMPLICATIONS

Earlier ASD identification and intervention might be facilitated by health education on typical symptoms of ASD for parents with young children and incorporating ASD screening during routine health examinations for children. For children whose primary caregivers are not their parents and from lower-income families, additional support may be required for timely diagnosis after reporting ASD-related symptoms. Moreover, more intervention supports are expected for children whose fathers have lower education levels. Helping families take full advantage of support is also important for early diagnosis and intervention.

Ingestion of Illicit Substances by Young Children Before and During the COVID-19 Pandemic

Importance

Information about the trend in illicit substance ingestions among young children during the pandemic is limited.

Objectives

To assess immediate and sustained changes in overall illicit substance ingestion rates among children younger than 6 years before and during the COVID-19 pandemic and to examine changes by substance type (amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids) while controlling for differing statewide medicinal and recreational cannabis legalization policies.

Design, Setting, and Participants

Retrospective cross-sectional study using an interrupted time series at 46 tertiary care children's hospitals within the Pediatric Health Information System (PHIS). Participants were children younger than 6 years who presented to a PHIS hospital for an illicit substance(s) ingestion between January 1, 2017, and December 31, 2021. Data were analyzed in February 2023.

Exposure

Absence or presence of the COVID-19 pandemic.

Main Outcome(s) and Measure(s)

The primary outcome was the monthly rate of encounters for illicit substance ingestions among children younger than 6 years defined by International Statistical Classification of Diseases, Tenth Revision, Clinical Modification diagnosis code(s) for poisoning by amphetamines, benzodiazepines, cannabis, cocaine, ethanol, and opioids. The secondary outcomes were the monthly rate of encounters for individual substances.

Results

Among 7659 children presenting with ingestions, the mean (SD) age was 2.2 (1.3) years and 5825 (76.0%) were Medicaid insured/self-pay. There was a 25.6% (95% CI, 13.2%-39.4%) immediate increase in overall ingestions at the onset of the pandemic compared with the prepandemic period, which was attributed to cannabis, opioid, and ethanol ingestions. There was a 1.8% (95% CI, 1.1%-2.4%) sustained monthly relative increase compared with prepandemic trends in overall ingestions which was due to opioids. There was no association between medicinal or recreational cannabis legalization and the rate of cannabis ingestion encounters.

Conclusions and Relevance

In this study of illicit substance ingestions in young children before and during the COVID-19 pandemic, there was an immediate and sustained increase in illicit substance ingestions during the pandemic. Additional studies are needed to contextualize these findings in the setting of pandemic-related stress and to identify interventions to prevent ingestions in face of such stress, such as improved parental mental health and substance treatment services, accessible childcare, and increased substance storage education.

The impact of COVID-19 on adolescents with eating disorders: Increased need for medical stabilization and decreased access to care

OBJECTIVE

We aimed to identify trends of patients with eating disorders (EDs) requiring hospitalization before and during the pandemic at a children's hospital in the southeastern United States.

METHOD

A retrospective chart review was completed for 71 adolescents and young adults (ages 10-21 years; M = 14.61, SD = 2.121).

RESULTS

Results indicated a 188% increase in ED hospital admissions since the pandemic, with patients presenting with increased rates of comorbid mental health diagnoses (p = .009). During COVID-19, the development of temporary outpatient multidisciplinary discharge plans (i.e., "bridge plans") were utilized more often due to difficulties accessing the appropriate level of care (p = .039).

DISCUSSION

Results suggest a significant increase in youth requiring medical stabilization for EDs since the start of the COVID-19 pandemic (2.9 times more than prepandemic), as well as a need for greater advocacy to increase specialized mental health services along the full continuum of care.

PUBLIC SIGNIFICANCE STATEMENT

This study brings awareness to the significant increase in patients needing medical stabilization secondary to restrictive EDs and increased rates of comorbid mental health diagnoses in this patient population since the onset of the COVID-19 pandemic. Patients during COVID-19 were less likely to directly transition to treatment likely secondary to the strain COVID-19 placed on mental health systems/treatment centers. Increased advocacy for specialized care for eating disorder patients.