Table 2:

Considerations for special groups of children who are at elevated risk of psychiatric morbidity during COVID-19

	Special groups
Pre-existing mental illness	• Specific concerns include the exacerbation of symptoms, non-compliance to treatment, and difficulties in adjusting to new routines.
	• Children with autistic spectrum disorders do not adapt well to change, and the wearing of masks is sometimes problematic in those with tactile sensitivities.
	• Caregivers of children with OCD, who may have contamination obsessions or compulsive hand washing, find it challenging to navigate the need for sanitising.
	• Confinement and the lack of sufficient physical activity can worsen the low frustration tolerance of children with Attention Deficit Hyperactivity Disorder.
Institution-based children	• Most of the emphasis on children housed in children’s homes, juvenile detention centres, child and youth care centres and ‘places of safety’, has been on curbing the transmission of COVID-19.
	• The poor conditions of most facilities, potential exposure to violence, lack of contact with family, and the suspension of academic and therapeutic programmes magnifies the unmet medical, mental health and social needs of this vulnerable population.
Child-headed households	• There is a dearth of information on the psychosocial impact of the pandemic on child-only households in South Africa.
Survivors of maltreatment	• COVID-19 has had a deleterious effect on the victims of abuse in terms of diminished access to support structures (shelters, police, extended family, support groups).
	• Poverty, overcrowding and unemployment have further contributed to increases in domestic and gender-based violence.
Children with limited access to medical care	• International data (30,31) suggest a decrease in clinic visits, vaccinations and treatment follow-ups, and delays in screenings, referrals and assessments for various medical conditions.