Mental health of parents of children with autism spectrum disorder during COVID-19 pandemic: A systematic review

Table 1 Summary of the studies included in this systematic review

Ref.	Country	Research type	Data collection instrument	Sample	Main results	Critical appraisal toll
Alhuzimi[28], 2021	Saudi Arabia	Cross-sectional descriptive	Demographic Form	150 parents of children with ASD	While 94% of the parents reported that their stress levels increased in the COVID-19 pandemic, 78.7% of them reported that the pandemic negatively affected their emotional well-being. The parents stated that the support they received from their relatives during this process reduced their stress levels, fatigue and improved emotional their wellbeing	19/22 STROBE
			The Parent Stress Index-Short Form
			The General Health Questionnaire
Althiabi[34], 2021	Saudi Arabia	Cross-sectional descriptive	Demographic Form	211 parents of children with ASD	The parents reported that, in the COVID-19 pandemic, they had difficulty calming their children due to changes in routine and experienced fear and anxiety. They reported that they had difficulties in finding activities and games to keep their children entertained at home. During this process, the parents reported that they sought help from their friends, teachers, doctors and psychologists	21/22 STROBE
			The General Health Questionnaire
			The Hospital Anxiety and DepressionScale
			The Family Impact Questionnaire
Amorim et al[29], 2020	Portugal	Comparative, cross-sectional descriptive	Questionnaire form created by researchers	43 parents of children with ASD and 56 control group participants (parents of children without neurodevelopmental problems)	In the study, it was determined that the parents of children with ASD had higher anxiety levels than those with healthy children. The parents reported that they felt tired during the pandemic as they had to spend extra time on their children with ASD. In the study, 55.8% of the parents of children with ASD and 29.6% of the control group reported that the pandemic had a negative effect on emotion management. Social isolation, inability to spend time outside, sudden changes in routines, boredom and distance education practices were reported as the most difficult areas for parents. The parents stated that they frequently talked to their families, close friends, colleagues, and some parents received support from a therapist	17/22 STROBE
Bent et al[31], 2020	China	Qualitative	Interview formcreated byresearchers	15 parentsofchildren withASD	The parents had trouble explaining COVID-19 and safety measures to their children. Sudden changes in routines increased children’s crying spells and aggression. The parents had difficulty coping with these behavioral problems and adapting to e-learning. The participants reported that they exercised, practiced yoga, meditation, prayed, read newspapers and talked with their close friends online during this period.	9/10 CASP
Colizzi et al[30], 2020	Italy	Cross-sectional descriptive	40-question questionnaire created by researchers	527 parents of children with ASD	The parents reported that having a single child, the inability of the child with ASD to speak, the male gender of the child and a single parent having the child's responsibility were among the factors increasing their stress during the pandemic. 19.1% of the parents reported that they received support from a neuropsychiatrist due to the onset of new behavioral problems in their children and due to feeling helpless. The sudden curfew restrictions caused stress for the parents and their children. 47.4% of the participants stated that they needed more health services during the pandemic, 30% needed to strengthen their home support systems, and 16.8% needed more state support in quarantine	18/22 STROBE
Liu et al[36], 2021	China	Quasi-experimental	The Self-rating Anxiety Scale	125 mothers having children with ASD	With web-based support, it was found that the mothers' stress and anxiety levels decreased in the COVID-19 pandemic period. The parents reported feeling relaxed as the program facilitated parent-child interaction	20/22 STROBE
			The Self-rating Depression Scale
			The Parenting Stress Index-Short Form
			The Herth Hope Index
Lugo-Marín et al[33], 2021	Spain	Cross-sectional descriptive	The Child Behavior Checklist	104 children with ASD, their parents and caregivers	In the data collected 8 wk after the lockdown onset, it was observed that there was an increase in somatization, obsessive-compulsive, interpersonal sensitivity, depression, anxiety, hostility, phobic anxiety, paranoid ideation and psychoticism in the parents	21/22 STROBE
			The Symptom Checklist 90 Revised
Manning et al[32], 2020	The United States of America	Cross-sectional descriptive	Questionnaire form created by researchers	474 parents of children with ASD	It was determined that the children with ASD and their parents experienced high levels of stress and fear during the pandemic. The children who had to spend a long time at home exhibited aggressive and problematic behaviors, causing more stress in their parents and making it difficult to cope. 54.5% of the participants stated that they were worried about their children being at home all the time, 52.1% were afraid that they or their children could be infected with COVID-19, and 30.7% stated that they experienced stress due to economic problems. The parents reported that they received the most support from family, friends, school guidance, therapy center and parent support group, respectively, during the pandemic.	18/22 STROBE
Mumbardo-Adam et al[35], 2021	Spain	Cross-sectional descriptive	A semi-structured online survey	47 individuals with ASD and parents	The parents reported that they developed new strategies to better manage quarantine with their children with ASD. During this period, 36.2% of the parents reported that they communicated with their relatives online, and 23.4% received online psychological support	20/22 STROBE
Mutluer et al[17], 2020	Turkey	Cross-sectional descriptive	Sociodemographic FormThe Beck Anxiety	87 individuals with ASD and parents	The parents reported that children with ASD felt under house arrest because they had difficulty obeying social distancing rules and did not want to wear masks. The participants stated that their children's sleep patterns were disturbed during the pandemic, and they also had sleep problems. The majority of the parents said they could not continue distance education and needed support in this regard. It was determined that 25% of the parents had minimal anxiety, 29% had mild anxiety, 21% had moderate anxiety, and 25% had severe anxiety. The parents reported that they provided each other rest breaks when there was more than one adult at home who could take care of the child with ASD	17/22 STROBE
			Inventory (for parents)
			The Aberrant Behavior
			Checklist (for children)
			The Pittsburgh Sleep Quality Index (for children)
Wang et al[37], 2021	China	Cross-sectional descriptive	Sociodemographic Form	1764 parents of children with ASD and 4962 parents of typically developing children	It was found that the parents of children with ASD had more deterioration in their diet, less physical exercise, less social support, higher levels of psychological stress, anxiety and depression, and worse coping strategies than the parents of children with normal development	22/22 STROBE
			The COVID-19 Questionnaire
			The Connor-Davidson Resilience ScaleThe Simplified Coping Style Questionnaire
			The Self-Rating Anxiety Scale
White et al[38], 2021	The United States of America	Cohort study	Brief Family Distress Scale	3502 parents of children with ASD	80% of the parents reported disruptions in their children's special education. 64% of them stated that these disruptions had severely or moderately impacted their children’s ASD symptoms, behaviors or challenges. Increasing distress and stress negatively affected their lives	22/22 STROBE

ASD: Autism spectrum disorder; COVID-19: Coronavirus disease 2019.