Family Caregiving During the COVID-19 Pandemic

Background: The Coronavirus Disease-2019 (COVID-19) pandemic has taken a disproportionate toll on people with intellectual and developmental disabilities (I/DD) as well as their family caregivers. This is especially true for older family caregivers, many of whom assume dual or compound caregiving roles, and provide care as they undergo their own aging experiences. This research brief presents findings from family caregivers of adults with I/DD to better understand how the COVID-19 pandemic has affected their lives. Method: Thirty family caregivers from across the state participated in a one-hour special COVID-19 virtual discussion group. All participant identifiers were deleted from a session transcript that was examined by two independent researchers to identify common themes using content analysis. The themes were grouped into the area of challenges and unexpected positive outcomes. Results: The most common challenge identified by the participants was limited access to medical services such as cancellation of appointments and obtaining medications. The quick transition to telehealth without adequate training for users or clinicians was also seen as a challenge. The increased use of technology also raised challenges in other areas of life such as education and employment. These challenges were related to inadequate equipment, internet service, having to share the limited equipment, and insufficient experience using technology. Caregivers also reported feeling socially isolated including not being able to leave their homes or see family or friends. They also described frustration of being together all the time. Caregivers also reported several unexpected positive consequences (‘silver linings’). A common theme was that the pandemic slowed life’s pace allowing for more flexibility, more time with their families, and gratitude for everyday things. While technology was discussed as a challenge, it was also mentioned as a positive in that it allowed for social connectedness. Several creative uses of Zoom to connect with family and friends were discussed including virtual game nights, dance parties, cocktail parties, and happy hours. Some shared that their family members were able to make friends more easily online where they had difficulties doing so in-person. Helpful strategies for coping with the quarantine such as physical activity and hobbies were also shared. Conclusion: The duration of COVID-19 and its ramifications are unknown. Many challenges experienced by family caregivers are not new, rather they are intensified due to the pandemic. Family caregivers indicated challenges and needs related to accessing medical services and use of telehealth. Strategies that build on family caregivers’ concerns and strengths are needed to offset the burden posed by COVID‑19. Family Support Navigators (FSNs) and other supportive individuals can play an integral role in helping family caregivers during these unprecedented times

Effects of maternal and paternal smoking on attentional control in children with and without ADHD

Maternal smoking during pregnancy is a risk factor for attention-deficit/hyperactivity disorder (ADHD), but data on its adverse effects on cognitive functioning are sparse and inconsistent. Since the effect of maternal smoking during pregnancy may be due to correlated genetic risk factors rather than being a pure environmental effect, we examined the effect of prenatal exposure to smoking on attentional control, taking into account the effects of both maternal and paternal smoking, and examined whether these effects were genetically mediated by parental genotypes. We further examined whether the effect of prenatal exposure to smoking on attentional control interacted with genotypes of the child. Participants were 79 children with ADHD, ascertained for the International Multi-centre ADHD Gene project (IMAGE), and 105 normal controls. Attentional control was assessed by a visual continuous performance task. Three genetic risk factors for ADHD (DRD4 7-repeat allele of the exon 3 variable number of tandem repeats (VNTR), DAT1 10/10 genotype of the VNTR located in the 3′ untranslated region, and the DAT1 6/6 genotype of the intron 8 VNTR) were included in the analyses. Paternal smoking had a negative effect on attentional control in children with ADHD and this effect appeared to be mediated by genetic risk factors. The prenatal smoking effect did not interact with genotypes of the child. Maternal smoking had no main effect on attentional control, which may be due to lower smoking rates. This study suggests that the effects of paternal smoking on attentional control in children with ADHD should be considered a proxy for ADHD and/or smoking risk genes. Future studies should examine if the results can be generalized to other cognitive domains

European consensus statement on diagnosis and treatment of adult ADHD: The European Network Adult ADHD.

BACKGROUND: Attention deficit hyperactivity disorder (ADHD) is among the most common psychiatric disorders of childhood that persists into adulthood in the majority of cases. The evidence on persistence poses several difficulties for adult psychiatry considering the lack of expertise for diagnostic assessment, limited treatment options and patient facilities across Europe. METHODS: The European Network Adult ADHD, founded in 2003, aims to increase awareness of this disorder and improve knowledge and patient care for adults with ADHD across Europe. This Consensus Statement is one of the actions taken by the European Network Adult ADHD in order to support the clinician with research evidence and clinical experience from 18 European countries in which ADHD in adults is recognised and treated. RESULTS: Besides information on the genetics and neurobiology of ADHD, three major questions are addressed in this statement: (1) What is the clinical picture of ADHD in adults? (2) How can ADHD in adults be properly diagnosed? (3) How should ADHD in adults be effectively treated? CONCLUSIONS: ADHD often presents as an impairing lifelong condition in adults, yet it is currently underdiagnosed and treated in many European countries, leading to ineffective treatment and higher costs of illness. Expertise in diagnostic assessment and treatment of ADHD in adults must increase in psychiatry. Instruments for screening and diagnosis of ADHD in adults are available and appropriate treatments exist, although more research is needed in this age group

Peer-Mediated Family Support Project: Evaluation of Changes in Family Quality of Life

The Family Quality of Life (FQOL) approach represents a paradigm shift from fixing to supporting people with intellectual/developmental disabilities (I/DD) by changing the focus from the individual to the family and highlighting strengths rather than deficiencies. Aging family caregivers of individuals with I/DD often encounter obstacles, including accessibility, acceptability, and affordability of services. Little is known about best practices to support aging families of adults with I/DD. Understanding how a state-wide peer-mediated family support project implemented in this study helped improve the FQOL of aging caregivers is important in broadening participation of other caregivers in these types of programs. To address these gaps in the literature, Michigan Older Caregivers of Emerging Adults with Autism and Neurodevelopmental Disabilities (MI-OCEAN), a peer-mediated state-wide family support project program, was implemented. The purpose of this study was to examine global and domain-level FQOL changes among aging caregivers of adults with I/DD after participating in MI-OCEAN. This study used a quasi-experimental research design grounded in the FQOL framework with pretest and posttest data gathered from 82 caregivers. Quantitative analyses were conducted to (a) identify changes in domain and global levels of FQOL after participating in MI-OCEAN and (b) how these changes influenced global FQOL. Results of the dependent sample t tests indicated statistically significant changes in eight of the nine domains and global FQOL. Correlation analysis indicated that five of the nine domains (family relationships, support from others [informal support], influence of values, leisure/ recreation, and community participation) were significantly associated with changes in global FQOL. Multiple regression analyses indicated that about 16% of the improvement in global FQOL could be explained by the FQOL domain of informal support. Results highlight the need to invest in improving informal social support for aging caregivers. This study adds to emerging evidence of the benefits of MI-OCEAN in improving the mental health and well-being of aging family caregivers. Peer-mediated family support programs can be an effective method of improving the mental health of aging caregivers of adults with I/DD