What is the effect of pharmacological treatment for attention-deficit/hyperactivity disorder in children with comorbid tic disorders? A Cochrane Review summary with commentary.

Abstract

Objective: The Covid-19 related pandemic has negatively impacted NHS service provision We investigated its effect on specialist paediatric neuro-rehabilitation services in England and Wales Methods: A questionnaire was sent to UK National Neuro-rehabilitation network members by survey monkey app Questions explored: (1) centre details;(2) Covid-19 impact;(3) mitigation strategies;(4) recovery planning Results: 19 centres responded, including 17 Regional Neuroscience Centres;one stand-alone neurorehabilitation unit;one community-based specialist unit 18 reported Covid-19 had had a significant impact on service provision Six reported the impact was wholly negative;9 mainly negative, with some positive aspects;3 mainly positive, with some negative aspects;one was unsure 16 reported having fewer neurorehabilitation beds than pre-Covid-19;in 2, >80% were closed;2, 61-80%;3, 41-60%;7, 21-40% and 2, <20% Six indicated they were unable to accept internal or external referrals;3 only in exceptional circumstances 7 centres offer full rehabilitation to existing inpatients;11 only restricted rehabilitation 14 had discharged inpatients early;8 provided outpatient therapy post-discharge, 6 could not Two-thirds of centres transferred patients out at the start of the crisis, 9 to another neurorehabilitation unit and 3 to district hospitals Outpatient services were closed in 5 centres;operating fully (2);on a limited basis (8);on an increased basis due to reduced inpatient work (2) No community teams were offering normal services 9 centres were concerned about service restoration in the short term;12 in the medium term;10 in the long term Only 5 reported having a neurorehabilitation recovery plan Conclusion: Results highlight importance of developing robust neurorehabilitation service recovery plans to prevent children with acquired disability being further disadvantaged