Downloaded from http://journals.lww.com/jrnldbp by BhDMf5ePHKbH4TTImqenVHPymkXZPg+V3uteCedqkjUSRH5VpXTbKzQ8UagW+PsQ on 09/14/2020 Commentary Reflections on Children with Developmental and Behavioral Challenges Who Are Thriving While Sheltering in Place Megan H. Pesch, MD, MS,* Megan M. Julian, PhD,† Tiffany G. Munzer, MD* For many families, navigating life’s natural changes and transitions while attending to their child’s additional behavioral or developmental needs is not an easy un- dertaking. When the coronavirus disease 2019 (COVID- 19) pandemic spread throughout the world earlier this year, life as we knew it shut down abruptly. As de- velopmental and behavioral clinicians, finding that deli- cate balance between therapies, school services, medication, and social supports to meet the evolving needs of our patients is often challenging, even in the retrospective stability of the past several years. For our patients, many of whom thrive in predictability and struggle with transitions, COVID-19 upended their worlds overnight. School and special education supports were placed on hold, therapies were canceled, and home visits were suspended until further notice. De- velopmental and behavioral supports, which were es- sential for the daily functioning of many children, were suddenly no longer available. Their families faced addi- tional new social, emotional, and financial stresses. As clinicians, many of us worried for our patients and braced ourselves to virtually support families in crisis. In our practices at the University of Michigan, many of our patients and families have struggled with transition- ing to this “new normal.” However, a sizable subset has been described as thriving while social distancing. Even without school supports, private therapies, or in-person visits, some children are seemingly doing better than ever. In our practices, we have observed this in children who are socially anxious or rigid or who struggle with transitions or learning. The mother of an 8-year-old boy with learning disabilities, attention deficit hyperactivity disorder, and anxiety recently reported in a telehealth visit “I’m the least worried about him that I have been in years. He’s thriving at home, he’s happy and re- laxed.” Another parent of a young child with autism reported “He is gaining more words at home than he ever was at school.” Anecdotally, several families have mentioned that they are considering home-schooling as a permanent change, even when COVID-19 restrictions lift. Many families have stopped their children’s attention deficit hyperactivity disorder medication, citing that it was no longer needed in their new home routines. This phenomenon does not seem isolated to our practice; many colleagues around the country shared our experience and surprise. Many of these “thriving” chil- dren were experiencing less stress originating from the more unpredictable school environment. For instance, they experienced fewer overwhelming sensory inputs, peer interactions, social expectations, academic de- mands, or gross motor constraints. Some children expressed that they were happier than when they were in school and a desire for “things to not go back to normal.” We are gaining insight into the environmental and contextual factors that are contributing to these children’s behavioral changes and are considering how to use this knowledge going forward. In addition, some parents reflected that their daily schedules had slowed down without the pressures of getting out the door on time in the morning, commuting, and after-school therapies. Overall, parents were pleased that their children were doing well, but some experi- enced more frustrations while parenting in quarantine. Parents who expressed satisfaction with their current ar- rangements seemed to have children who temperamen- tally had slower adaptability and tendencies to withdraw. Other parents with higher activity and distractible chil- dren struggled more. Families of “thriving” children all seemed to have several commonalities: relatively stable households in organization, low chaos, high self-efficacy, and high predictability. These families also had parents who were able to be home with their children, had the luxury of greater financial stability, and/or had fewer psychosocial stressors. For the most part, these parents reported being adaptable to the child’s preferences. Critically, as children are spending increased time at home and have more limited access to outside support services, the effects of family functioning, psychosocial stress, and systemic disparities on their development are magnified. For children in families with more manage- able stressors, adequate material resources, financial stability, and psychological supports, sheltering in place at home has had somewhat limited negative effects. Pa- rental characteristics such as sensitivity, self-efficacy, and From the *Department of Pediatrics, Division of Developmental and Behavioral Pediatrics, Center for Human Growth and Development, University of Michigan, Ann Arbor, MI; †Department of Psychiatry, Division of Child and Adolescent Psychiatry, Center for Human Growth and Development, University of Michi- gan, Ann Arbor, MI. Received May 2020; accepted June 2020. Disclosure: The authors declare no conflict of interest. Address for reprints: Megan H. Pesch, MD, MS, 300 N. Ingalls Building, University of Michigan, Ann Arbor, MI 48109; e-mail: pesch@umich.edu. Copyright Ó 2020 Wolters Kluwer Health, Inc. All rights reserved. (J Dev Behav Pediatr 41:506–507, 2020) 506 | www.jdbp.org Journal of Developmental & Behavioral Pediatrics Copyright © 2020 Wolters Kluwer Health, Inc. Unauthorized reproduction of this article is prohibited.