Over the past year, the novel coronavirus (COVID-19) pandemic has forced many world countries, including Italy, to take strict
restrictive measures as lockdown and social distancing. Children and adolescents exposed to the COVID-19 pandemic and social
distancing would appear to be at greater risk of developing psychiatric disorders. In the last year, the Child and Adolescence
Neuropsychiatry service at the Children\u27s Hospital Bambino Gesù in Rome has recorded a significant increase in cases of mood
disorders, self-injurious behaviors and suicidal ideation. These data underlined the need to define tailor-made intervention strategies
for children and adolescents during this time of social and health emergency

Pontillo, Maria

Vicari, Stefano

English

Hrčak - Portal of scientific journals of Croatia

S33Psychiatria Danubina, 2021; Vol. 33, Suppl. 11, pp 33-35 Conference paper  Medicinska naklada - Zagreb, CroatiaDEVELOPMENTAL PSYCHOPATHOLOGY IN THE COVID-19 PERIOD. COVID-19 PANDEMIC IMPACT ON CHILDREN AND ADOLESCENTS' MENTAL HEALTH Stefano Vicari1,2, & Maria Pontillo11Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience, Bambino ital,IRCSS, Rome, Italy 2Department of Life Sciences and Public Health, U  Sacro Cuore, Rome, Italy SUMMARY Over the past year, the novel coronavirus (COVID-19) pandemic has forced many world countries, including Italy, to take strict restrictive measures as lockdown and social distancing. Children and adolescents exposed to the COVID-19 pandemic and social distancing would appear to be at greater risk of developing psychiatric disorders. In the last year, the Child and Adolescence Neuropsychiatry service at the Children's Hospital Bambino Gesù in Rome has recorded a significant increase in cases of mood disorders, self-injurious behaviors and suicidal ideation. These data underlined the need to define tailor-made intervention strategies for children and adolescents during this time of social and health emergency.  Key words: COVID-19 pandemic  children  adolescents  anxiety - self-harm *  *  *  *  *  INTRODUCTIONOver the past year, the novel coronavirus (COVID-19) pandemic has forced many world countries to take strict measures to contain the contagion. Following the declaration of the state of a pandemic by the World Health Organization (WHO), the countries most affec-ted by the virus, in particular Italy, have taken res-trictive measures as lockdown and social distancing. These measures have significantly changed our daily habits, affecting all population groups, regardless of age, sex, or socio-economic conditions, and having numerous adverse effects on individual psychological well-being. Although children and adolescents are less severely affected by the COVID-19 pandemic, they represent a vulnerable category to the onset of psychopathological sequelae. Children and adolescents are exposed to high levels of stress due to continuous alternation between closure and reopening of schools, decreased of opportunities for socialization for a prolonged time, the reduction of daily physical activity, the alteration in the regulation of circadian rhythms due to sudden changes in the organization of daily routines, and the diffusion of collective fear. CHILDREN AND ADOLESCENTS AND THE PSYCHOLOGICAL EFFECTS OF THE COVID-19 PANDEMIC Recent studies confirm the presence of significant psychological effects in children and adolescents in consequence of the COVID-19 pandemic. In parti-cular, preschool children manifested an increase in irritability, inattention, disruptive behaviors, sleep dis-orders, agitation, and separation anxiety. Instead, pre-adolescents and adolescents exhibited an increment of feelings of uncertainty towards the future, fear, and anxiety (Jiao et al. 2000). Children and adolescents exposed to the COVID-19 pandemic and social dis-tancing would appear to be at greater risk of de-veloping psychiatric disorders, such as anxiety dis-orders, mood disorders, and disorders of post-trau-matic area, such as Acute Stress Disorder (Guessoum et al. 2020). Regarding studies conducted in Italy, the IRCSS Giannina Gaslini  of Genoa conducted an epide-miological investigation on the psychological impact of the COVID-19 pandemic on Italian families from March 2020 to April 2020. Results evidence that 65% of children under six years demonstrate an increment in irritability, sleep disorders, and anxiety disorders. While 71% of children over six years exhibit beha-vioral regression and a significant alteration of the sleep-wake rhythm. Adolescents, instead, experience greater emotional instability, increased irritability, and mood changes. Finally, the severity of the symptoms manifested by children and adolescents would seem to correlate to the degree of discomfort with which their parents have lived the lockdown and social distancing (Uccella et al. 2021). Esposito et al. (2021) detected the most severe psychological consequences in boys with a relative or acquaintance who contracted COVID-19 (Esposito et al. 2021). According to Pigaiani et al. (2020), the personal well-being of adolescents during the COVID-19 pandemic could be positively influenced by specific environmental variables, as the possibility to express Stefano Vicari & Maria Pontillo: DEVELOPMENTAL PSYCHOPATHOLOGY IN THE COVID-19. PERIOD COVID-19 PANDEMIC IMPACT  ON CHILDREN AND ADOLESCENTS' MENTAL HEALTH          Psychiatria Danubina, 2021; Vol. 33, Suppl. 11, pp 33-35 S34 emotions in the family context or to receive support from teachers at school. Regarding individual vari-ables, the ability to use coping strategies based on planning and behavioral activation played a critical role; for example, the ability to organize time in structured activities such as reading or doing physical activity (Pigaiani et al. 2020).  Over the past year, tertiary care centers are con-ducting studies on the psychological effects of the COVID-19 pandemic on children and adolescents with neuropsychiatric disorders. The IRCSS Fondazione Stella Maris , for example, involved 700 families of children and adolescents with neuropsychiatric disor-ders aged 1 to 18 years. Results show that in preschool children (1-5 years), there was an increase in anxiety and somatic complaints, associated with an increase in sleep disorders and eating difficulties, with refusal of food. Moreover, in children and adolescents between 6 and 18 years, there was an increase in obsessive-com-pulsive symptomatology, associated with the appea-rance of symptoms related to Post-Traumatic Stress Disorder and an increase in psychotic symptoms (Conti et al. 2020). COVID-19 PANDEMIC AND PSYCHO-LOGICAL EFFECTS ON CHILDREN AND ADOLESCENTS: OUR DATA  During the COVID-19 pandemic and over the past year, our Child and Adolescence Neuropsychiatry service at the Children's Hospital inRome has recorded a significant increase in the psychological distress of children and adolescents. During the first wave (March-June 2020) and during the second wave (October 2020-January 2021), the percentage of requests to our emergency department for conditions of extreme neuropsychiatric urgency has almost doubled. More specifically, in April 2020, 61% of neuro-psychiatric consultations concerned suicidal ideation and suicide attempts (compared to 36% in April 2019). In January 2021, during the second pandemic wave, 63% of consultations were carried out for suicidal ideation and suicide attempt (compared to 39% in January 2020), with a consequent increase in hospi-talizations, from 17% in January 2020 to 45% in January 2021. Self-injurious behaviors (specially cut injuries) were detected in 52% of hospitalizations in January 2021, in comparison to 29% of the previous year. Our Child and Adolescence Neuropsychiatry service has, therefore,witnessed a significant increase in cases of self-injurious behaviors and suicidal ideation in the last year. These results are in line with what emerges from the international emergency data, in particular, in comparison with the United Kingdom scenery (Ougrin et al. 2021). HOW TO INTERVENE ON THE PSYCHOLOGICAL EFFECTS OF COVID-19 PANDEMIC IN CHILDREN AND ADOLESCENTS The results of the studies previously illustrated draw attention to the need to define tailor-made intervention strategies for children and adolescents during a health and social emergency, such as that of COVID-19 that we are still experiencing. These interventions must be based on a cooperative model, as on close collaboration and communication between the school, social, and family systems for the detection and early management of stress-related psychiatric symptoms in children, adolescents, and their families (Zhou 2020). In the Italian context, the Istituto Superiore di , in the document Indicazioni ad interim per un appropriato sostegno della salute mentale nei minori di durante la pandemia COVID-19 , offers valuable indications to provide emotional support and enhance the awareness of children and adolescents to promote mental well-being, especially during an emergency. It is essential to listen to the experience of our children and welcome the emotions they experience. It is good to provide realistic information using a language appro-priate to the stage of development. During the expla-nation, it can be helpful to emphasize that both national and international actions of contrast and protection are being put in place, avoiding infusing anxiety and worries. It is recommended to provide children and ado-lescents with readings and information material ade-quately prepared by experts according to the stage of development, limiting the consultation of several dubious sources of information. The material should provide information about the current COVID-19 pan-demic, but principally illustrate practical indications for the safety of our health, such as hand and environmental hygiene or the methods of social interaction respecting distancing and safety rules. In every family, it is efficacy to build habits and pro-mote activities and lifestyles that favor the resumption of daily activities. Especially during periods of in-creased restriction and lockdown, it could be helpful to establish a basic family routine starting from the orga-nization of priorities, such as school activities or physical activity. It is essential to promote a balanced lifestyle based on regular nutrition and physical exercise. For the little ones, it is positive to structure spaces and playtimes, proposing new playful activities that also involve other family members, reducing the time spent using electronic devices. For teenagers, it may be helpful to engage in a specific task for a limited time and in a quiet place. In conclusion, it is important to propose models with coping strategies to contrast the climate of concern that Stefano Vicari & Maria Pontillo: DEVELOPMENTAL PSYCHOPATHOLOGY IN THE COVID-19. PERIOD COVID-19 PANDEMIC IMPACT  ON CHILDREN AND ADOLESCENTS' MENTAL HEALTH          Psychiatria Danubina, 2021; Vol. 33, Suppl. 11, pp 33-35 S35characterizes this time through the investment of individual and family time in positive activities and supporting and enhancing the autonomy of the child and adolescent through the adoption of new goals  Acknowledgements: None.Conflict of interest: None to declare.Contribution of individual authors:Stefano Vicari and Maria Pontillo developed the original idea and wrote the final draft of the article. All authors have read and approved the final version. References 1. Conti E, Sgandurra G, De Nicola G, Biagioni T, Boldrini S, Bonaventura E et al.: Behavioural and emotional changes during COVID-19 lockdown in an italian paediatric population with neurologic and psychiatric disorders. Brain Sci 2020; 10:E918. 2. Esposito S, Giannitto N, Squarcia A, Neglia C, Argentiero A, Minichetti P et al.: Development of psychological problems among adolescents during school closures because of the COVID-19 lockdown phase in Italy: a cross-sectional survey. Front Pediatr 2021; 8:628072 3. Gruppo di lavoro ISS Salute mentale ed emergenza COVID-19: Indicazioni ad interim per un appropriato sostegno della salute mentale nei minori di età durante la pandemia COVID-19. Versione del 31 maggio 2020. Roma: Istituto Superiore di Sanità; 2020. (Rapporto ISS COVID-19 n. 43/2020) 4. Guessoum SB, Lachal J, Radjack R, Carretier E, Minassian S, Benoit L et al.: Adolescent psychiatric disorders during the COVID-19 pandemic and lockdown. Psychiatry Res 2020; 291:113264 5. Jiao WY, Wang LN, Liu J, Fang SF, Jiao FY, Pettoello-Mantovani M et al.: Behavioral and emotional disorders in children during the COVID-19 Epidemic. J Pediatr 2020; 221:264-266.e1 6. Ougrin D, Wong BH, Vaezinejad M, Plener PL, Mehdi T, Romaniuk L et al.: Pandemic-related emergency psychiatric presentations for self-harm of children and adolescents in 10 countries (PREP-kids): a retrospective international cohort study. Eur Child Adolesc Psychiatry 2021; 7:1 137. Pigaiani Y, Zoccante L, Zocca A, Arzenton A, Menegolli M, Fadel S et al.: Adolescent lifestyle behaviors, coping strategies and subjective wellbeing during the COVID-19 pandemic: an online student survey. Healthcare (Basel) 2020; 8:472 8. Uccella S, De Grandis E, De Carli F, D'Apruzzo M, Siri L, Preiti D et al.: Impact of the COVID-19 outbreak on the behavior of families in Italy: a focus on children and adolescents. Front Public Health 2021; 9:608358  9. Zhou X: Managing psychological distress in children and adolescents following the COVID-19 epidemic: a cooperative approach. Psychol Trauma 2020; 12(S1):S76-S78 Correspondence: Prof. Stefano Vicari, MD, PhD Child and Adolescent Neuropsychiatry Unit, Department of Neuroscience,  Bambino  S 00146 Rome, Italy E-mail: stefano.vicari@opbg.net 

DEVELOPMENTAL PSYCHOPATHOLOGY IN THE COVID-19 PERIOD. COVID-19 PANDEMIC IMPACT ON CHILDREN AND ADOLESCENTS\u27 MENTAL HEALTH

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