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Letter to the Editor



Juhi GUPTA1,
Priyanka MADAAN2,
Sheffali GULATI1

1Child Neurology Division, Center of Excellence & Advanced Research
on Childhood Neurodevelopmental Disorders, Department of Pediatrics,
All India Institute of Sciences, New Delhi, India
2Pediatric Neurology Unit, Department of Pediatrics,
Advanced Pediatrics Centre, Post Graduate Institute
of Medical Education & Research (PGIMER), Chandigarh, India-160012
Received: 02-June-2020
Revised: 19-June-2020
Accepted: 26-June-2020
Online first: 27-June-2020

Dear Sir,

The global pandemic caused by SARS-CoV-2 virus has intensified the array of difficulties faced by children with special needs. This group of children encompasses a wide repertoire of etiologies including children with neuro-developmental disabilities like cerebral palsy, autism spectrum disorders (ASD), attention deficit hyperactivity disorder (ADHD), intellectual disabilities, epilepsy, speech and language disorders and vision and hearing impairments (Arora et al., 2018).
These children are more prone to SARS-CoV-2 infection due to dependence on caretakers, limited ability to practice precautions, frequent hospital visits, and higher prevalence of co-morbidities such as gastroesophageal reflux, etc. (Courtenay & Perera, 2020). The constant need for an accompanying caregiver not only poses a greater risk of infection to these children but also poses a challenge when these children require home isolation or hospital admission on being infected. Hence, disabled-friendly quarantine and health-care facilities which are accessible to these children and their families are much needed. These facilities should be strengthened with provisions such as disabled-friendly toilets, staff trained in sign language, wheelchairs, ramps, etc. in order to deliver respectful care without discrimination and stigma (UNICEF COVID-19 Response: Considerations for Children and Adults with Disabilities, 2020). Transport facilities should also be intensified to meet the travel needs of children with neuro-motor impairments. Establishment of these facilities will require financial provisions which should be given due consideration while making policies and assembling funds for COVID-19 response.
Longer indoor time, limited or no excursions, and social distancing can lead to increased anxiety and behavioural issues in children with neuro-developmental disorders (Courtenay & Perera, 2020). These problems are compounded by the introduction of practices such as using masks and repeated handwashing which is a definite deviation from their routines. During this time, children tend to require more one-to-one time with parents which in turn can lead to heightened parental stress eventually culminating in a vicious cycle. This matter should be addressed with a multidisciplinary response wherein pediatric neurology, child psychology, physiotherapists, and occupational therapists provide a consistent support to the families using teleconsultation (including video consults and video-based therapies) wherever feasible. Care-givers should also be empowered by explaining behavioural interventions tailored for the child and hiking or adding new antipsychotic medications should be avoided (Cortese et al., 2020).
Along with children, it is a perplexing time for caregivers who struggle to balance work at home along with domestic responsibilities. The World over, reports of domestic violence and child abuse are on the rise (Cluver et al., 2020). This highlights the necessity to acknowledge the mental health needs of the caregivers which is even more essential for those who are parenting a child with special needs. Timely breaks and sharing the responsibilities of caretaking may be helpful in these scenarios.
With the closure of schools and most classes being conducted via web portals, the disruption of special education and schooling programmes is another hardship faced by children with special needs who have limited access and capability to use these online learning platforms. This issue can be ameliorated with use of augmentative and alternative communication (AAC) strategies and use of inclusive language by teachers (UNICEF COVID-19 Response: Considerations for Children and Adults with Disabilities, 2020). Not only school education but the public health messages regarding the pandemic should be disabled-friendly with use of upper case bold prints, braille and easy-to-read or see versions.


Making healthcare facilities more accessible to differently-abled children, use of assistive technology, establishing a daily routine along with empowerment of caregivers with home-based interventions and attending to their emotional needs are central to a disability-inclusive response to pandemic. Children with special needs as well as their caregivers have unique challenges during COVID-19 pandemic which should be taken care of with respect and empathy.

Conflict of Interest
Authors declare no conflict of interest.


Arora, N. K., Nair, M. K. C., Gulati, S., Deshmukh, V., Mohapatra, A., Mishra, D., Patel, V., Pandey, R. M., Das, B. C., Divan, G., Murthy, G. V. S., Sharma, T. D., Sapra, S., Aneja, S., Juneja, M., Reddy, S. K., Suman, P., Mukherjee, S. B., Dasgupta, R., … Vajaratkar, V. (2018). Neurodevelopmental disorders in children aged 2–9 years: Population-based burden estimates across five regions in India. PLOS Medicine, 15(7), e1002615.

Cluver, L., Lachman, J. M., Sherr, L., Wessels, I., Krug, E., Rakotomalala, S., Blight, S., Hillis, S., Bachman, G., Green, O., Butchart, A., Tomlinson, M., Ward, C. L., Doubt, J., & McDonald, K. (2020). Parenting in a time of COVID-19. The Lancet, 395(10231), e64.

Cortese, S., Asherson, P., Sonuga-Barke, E., Banaschewski, T., Brandeis, D., Buitelaar, J., Coghill, D., Daley, D., Danckaerts, M., Dittmann, R. W., Doepfner, M., Ferrin, M., Hollis, C., Holtmann, M., Konofal, E., Lecendreux, M., Santosh, P., Rothenberger, A., Soutullo, C., … Simonoff, E. (2020). ADHD management during the COVID-19 pandemic: Guidance from the European ADHD Guidelines Group. The Lancet Child & Adolescent Health, 4(6), 412–414.

Courtenay, K., & Perera, B. (2020). COVID-19 and people with intellectual disability: Impacts of a pandemic. Irish Journal of Psychological Medicine, 1–6.

UNICEF COVID-19 response: Considerations for children and adults with disabilities. (2020).


How to cite this article: Gupta, J., Madaan, P., Gulati, Sh. COVID-19: Implications for Children with Special Needs. Journal for ReAttach Therapy and Developmental Diversities, 2020 Jul 05; 3(1):1-3.

Copyright ©2020 Gupta, J., Madaan, P., Gulati, Sh. This is an open-access article distributed under the terms of the Creative Commons Attribution-NonCommercial 4.0 International License (CC BY-NC 4.0)

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