Navigating change: The journey of the child guidance clinic before and after the COVID-19 pandemic

Abstract

Mental health is crucial for child and adolescent development, but lack of resources often leads to silent suffering and missed opportunities. Establishing child guidance clinics (CGCs) is a step toward holistic care. During COVID, children faced disruptions to schooling, isolation, family stress, and increased digital exposure, leading to a rise in mental health issues. The stressors have left a long-term psychological impact on our lives even after years post-COVID. The study examines the 10-year journey of a CGC that which navigated the changes brought about by COVID-19, highlighting the importance of mental health for child and adolescent development. The CGC’s register, which has systematic documentation of patient details, was used to retrospectively analyze patient records for the last 10 years. Data were extracted and organized to identify trends and patterns across diagnoses. Post-COVID-19, cases of autism spectrum disorder, intellectual disability, global developmental delay, Attention deficit hyperactivity disorders (ADHD), and behavioral disorders have increased. There are fluctuations in cases of Obsessive compulsive disorder (OCD), phobia, depression, and anxiety. Emotional disorders, though initially had fluctuating numbers, have also increased after the pandemic. However, expressive speech disorders, psychosis, and learning disabilities were found to be stable without many shifts. Conclusion: CGCs in India are vital in addressing the mental health needs of children and adolescents. Post-COVID, the increase in mental health concerns of children and adolescents demands more focused care and a multi-disciplinary team approach.

According to the Population Division of the Department of Economic and Social Affairs, United Nations,[1] in India, there are 431,053,833 children and adolescents under the age of 18 years, accounting for approximately 30% of the total population. According to the 2015–2016 National Mental Health Survey,[2] 7.3% of people between the ages of 13 and 17 years have a mental condition. The survey also revealed that 9.8 million children needed some kind of active intervention and that one in every 100 children under the age of 6 years had a disability. The importance of child and adolescent mental health lies in its profound impact on overall development, including emotional, social, and cognitive growth. It plays a critical role in shaping healthy behaviors and resilience, contributing to the well-being of families and communities. Children and adolescents were significantly impacted by the COVID-19 pandemic, experiencing unprecedented challenges such as the temporary closure of daycare centers and schools, a shift to online homeschooling, restricted access to recreational facilities, and various other limitations.[3,4] This led to social isolation from peers, educators, extended family, and the broader community, thereby heightening the risk of mental health issues, including anxiety and depression. Furthermore, the interruption of their daily routines resulted in some children spending increased amounts of time on computers, smartphones, or watching television, while engaging in insufficient physical activity spending more solitary time. Previous research has indicated that excessive screen time adversely affects children’s cognitive and socio-emotional development[5] and is linked to sleep disturbances, which further exacerbate their physical and psychological well-being.[6] Children’s neurobiological and socioemotional development may be hampered by stressor exposure.[7] According to a study of 1,700 kids and teenagers from 104 countries, high amounts of stress could impact a child’s brain development.[8] During COVID-19, children’s irritability, sleep problems, anxiety, and sadness increased in tandem with their growing fear of getting the disease and other risk factors.[4,5,6,7,8,9] Given the potential for long-lasting consequences, it is critical to comprehend how the epidemic has impacted children’s mental health. Due to the lack of resources/facilities, 50% of children with mental illness have never attended an educational institution. Immunization campaigns and child and adolescent health care have advanced, but advancements in child and adolescent mental health services have not kept pace with them. The mental health requirements of the majority of children and adolescents are still unmet, and access to mental health services needs to be a component of integrated care for children and adolescents.[10]

The first child guidance clinic (CGC) in India was established in 1937 at the Sir Dorabji Tata Trust, now the Tata Institute of Social Sciences (TISS) in Mumbai. This marked the beginning of formal child mental health services in India.[11] Over the past few decades, the services of CGCs have expanded, with multidisciplinary teams addressing diverse psychological and developmental needs.

The advent of COVID-19 has intensified the need to create CGCs in India. This sudden rise led us to review our own data of CGC to observe the changes that our clinic underwent and if it has witnessed a similar pattern. Examining the data helped us develop a better understanding the current situation and preparing for what the future holds. After the COVID-19 pandemic, as we still battle its long-term psychological impact on our life and existing services already overwhelmed, expanding mental health infrastructure now seems to be inevitable and essential for the future.[12] The present study examines the 10 years journey of a CGC that navigated the changes brought about by COVID-19, highlighting the importance of mental health for child and adolescent development and the need for a prepared tomorrow.

MATERIALS AND METHODS

This is a retrospective observational study carried out in a secondary care hospital in eastern India with the necessary permission from the hospital administration. The need for ethical approval was waived off by the ethical committee of Tata Main Hospital because it is a retrospective with a purely observational review of database records. Similarly, the need for informed consent was also waived off by the ethical committee. As the study involved a review of past records without any direct interventions or patient contact, it posed no physical or psychological risk to participants, aligning with ethical guidelines for waiving consent. The data were collected from the patient’s record, which is physically maintained in the form of a register kept in the CGC of the psychiatry department and entry is done on daily basis. The register has the patient’s identification details along with diagnosis according to ICD-10 DCR. Assessment tools included the Childhood Autism Rating Scale (CARS), the Indian Scale of Assessment of Autism (ISAA), ADHD Symptom Checklist, Child Behavior Checklist (CBCL), Malin’s Intelligence Scale for Indian Children (MISIC), Seguin Form Board (SFBT), Vineland Social Maturity Scale (VSMS), etc. Descriptive analysis was administered to get the data trend.

RESULTS

Diagnostic breakup of patients visiting child guidance from the year 2013 to 2023 is given in Table 1. Table 2 shows the percentage change in diagnosis from pre-pandemic to post-pandemic. The diagnostic trend of CGC (2013–2023) is shown in Figure 1.

Table 1.

Diagnostic Breakup of patients visiting the child guidance clinic from the year 2013 to 2023

Diagnosis	2013	2014	2015	2016	2017	2018	2019	2020	2021	2022	2023
Intellectual disability/Global developmental delay	81	50	63	65	137	121	93	32	70	123	180
Attention deficit hyperactivity disorder	84	58	62	49	92	99	108	44	71	118	130
Autism spectrum disorder	13	23	15	37	42	50	57	43	50	105	112
Emotional disorder	50	30	31	30	51	59	61	38	36	89	97
Behavioral problems/addiction	35	17	25	32	53	51	49	29	48	57	62
Expressive speech disorder	12	6	10	11	15	25	18	16	18	27	16
Psychosis	6	2	0	0	3	3	2	0	5	4	1
Learning disability	10	6	13	7	13	12	7	3	4	0	4
Obsessive-compulsive disorder (OCD)/phobia/dep/anxiety	35	28	25	20	17	25	16	12	14	4	25

Table 2.

Percentage change in diagnosis from pre-pandemic to post-pandemic

Diagnosis	Pre-Pandemic (Average of 2013-2019)	Post-Pandemic (Average 2020-2023)	Percentage Change
Intellectual disability/Global developmental delay	87.14	101.25	+16.19%
Attention-deficit hyperactivity disorder	78.86	90.75	+15.08%
Autism spectrum disorder	33.86	77.50	+128.88%
Emotional disorder	44.57	65.00	+45.84%
Behavioral problems/addiction	37.43	49.00	+30.91%
Expressive speech disorder	13.86	19.25	+38.89%
Psychosis	2.29	2.50	+9.17%
Learning disability	9.71	2.75	-71.68%
Obsessive-compulsive disorder/phobia/dep/anxiety	23.71	13.75	-42.01%

Figure 1.

Diagnositic trend of Child Guidance Clinic (2013-2023)

DISCUSSION

The increase in cases of autism spectrum disorder (ASD) over the decade aligns with global trends, indicating rising awareness and diagnosis rates. Studies have shown a similar upward trajectory in ASD diagnoses. The increase in numbers could be attributed to several factors, including changes in healthcare access, heightened awareness, and altered diagnostic practices during and after the pandemic and the impact of social isolation. However, more research in this field is needed to establish the facts and strategies to manage this evolving situation.[13] Similar findings have been seen in a nationwide study in Finland that reported that new ADHD diagnoses doubled from 238 per 100,000 individuals in 2020 to 477 per 100,000 in 2022, with the most pronounced increase observed among females aged 13–30 years.[14] The pandemic disrupted normal routines and increased screen time, contributing to the exacerbation of ADHD symptoms and potentially leading to more diagnoses. Research indicates that the stress and anxiety associated with the pandemic may have triggered symptoms in children.[4,9] Additionally, the shift to online learning and the lack of structured environments during lockdowns made it more challenging for children with ADHD to cope, resulting in increased referrals to mental health services.[15] The increase in diagnoses of ASD and ADHD post-pandemic may be attributed to both enhanced awareness and potential changes in actual prevalence. Enhanced public and professional awareness have led to improved recognition and diagnosis of these conditions. However, disentangling the effects of increased awareness from true changes in prevalence requires further longitudinal research.

There has been a noticeable increase in cases of intellectual disability (ID) and global developmental delay (GDD) among children. The pandemic has disrupted early childhood development through reduced access to essential health and educational services, increased stress on families, and social isolation, all of which are critical factors influencing developmental outcomes in children.[12] The closure of schools and early intervention programs has delayed the identification and management of developmental delays, potentially leading to an increase in the number of diagnosed cases.[16] In contrast, the low and stable numbers for psychosis and learning disabilities suggest either under-diagnosis or a genuine lower prevalence, which is consistent with national data from India. Mental health awareness and access to care remain challenges, potentially impacting the diagnosis rates of more severe conditions such as psychosis.[2]

Behavioral problems and addictions have increased over the past few years. The COVID-19 pandemic has significantly impacted the mental health of adolescents, leading to an increase in behavioral problems and internet addiction. The restrictions and social isolation measures implemented to curb the spread of the virus resulted in increased screen time and reliance on digital devices for education, decreased social interaction, and a lack of physical activity.[5] All these factors have contributed to the development of internet addiction, leading to negative consequences in daily life.[17]

There have been fluctuations in the cases of emotional disorders. The increase in cases in the last 2 years after the pandemic reflects the probable effects of prolonged social isolation, disruption of routines, increased digital exposure, uncertainty about the future, and increased awareness among people.[12,17]

The expressive speech disorder pattern has mostly remained similar, with few changes and without many jumps in number of cases. The fluctuating numbers of individuals with OCD/phobia/depression/anxiety highlight the complexity of these conditions, which are often exacerbated by socioeconomic factors. The decrease in 2020 followed by an increase in subsequent years may correlate with the global mental health impacts of the COVID-19 pandemic, where initial declines in reported cases were followed by increases as awareness and help-seeking behavior improved post-lockdown.[12]

Post-COVID mental health trends in similar Low middle income country like Brazil also showed varied impacts on children and adolescents. Regular visits to health care services and observing children’s growth and development provide an opportunity for constant monitoring of the child. The reduction in visit has acted as a barrier to diagnosing problems with child development and also in carrying out early interventions where necessary.[18]

Challenges faced by the child guidance clinic

Disruptions in mental health services

Lockdowns and the reallocation of healthcare resources to COVID-19 treatment reduced access to CGCs, delaying early diagnosis and interventions.

Increase in mental health disorders

Prolonged isolation, digital overexposure, and family stress led to a rise in mental health issues, thus overwhelming the existing services.

Limited access to in-person assessments

Many children with learning disabilities, ASD, and ADHD missed crucial early interventions due to school closures and restricted clinic visits.

Challenges in telepsychiatry

While digital consultations expanded, internet access issues, digital illiteracy, and lack of privacy at home made remote mental health care difficult, especially in lower-income families.

Parental stress and family conflicts

Economic hardships, job losses, and pandemic-related uncertainties increased household stress, worsening children’s behavioral and emotional issues.

Addressing these challenges requires integrating telepsychiatry into routine care, strengthening school-based mental health programs, and expanding community support networks for children and families.

Limitations

This study’s retrospective design and reliance on secondary data may introduce biases due to potential inconsistencies, missing records, and limited control over confounding variables. As a single-center study, findings may not be fully generalizable, warranting future prospective research for validation. Future multicenter studies, including public healthcare settings, are needed for a broader perspective. Inconsistencies in record-keeping over the 10 years may affect data accuracy

Implications

Future research should focus on longitudinal studies to assess the long-term psychological effects of the pandemic and evaluate the effectiveness of post-pandemic mental health interventions. A nationwide approach integrating digital platforms, community-based programs, and public-private partnerships can help scale CGC services for broader accessibility and impact.

CONCLUSION

This study highlights the rising burden of child mental health disorders, emphasizing the need for expanded CGCs, early intervention, and policy reforms to improve access. Future research should focus on long-term post-pandemic effects, digital interventions, and public-private service disparities to strengthen mental healthcare frameworks.

Authors’ contributions

HB was responsible for conceptualization, methodology, data collection, data analysis, manuscript writing, review and editing. MKS has also contributed to the conceptualization, methodology, data collection, and manuscript review. Both authors have read and approved the final version submitted and take responsibility for all aspects of the work.

Data availability statement

Data are available from the authors upon reasonable request and with permission of the hospital.

Ethical statement

This is a retrospective observational study carried out in a Tata Main Hospital, Jamshedpur with the necessary permission from the hospital administration. The need for ethical approval was waived off by the ethical committee of Tata Main Hospital because it is a retrospective study with purely observational review of database records.

Conflicts of interest

There are no conflicts of interest.

Funding Statement

Nil.