Journal of Pediatric Psychology, 45(9), 2020, 977–982

doi: 10.1093/jpepsy/jsaa079
Original Research Article

The Impact of COVID-19 on Pediatric Adherence

and Self-Management
Jill M. Plevinsky ,1 PHD, Melissa A. Young,2 PSYD,
Julia K. Carmody ,3 PHD, Lindsay K. Durkin,4 MS,
Kaitlyn L. Gamwell,1 PHD, Kimberly L. Klages,1 PHD,

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Shweta Ghosh,5 PHD, and Kevin A. Hommel,1 PHD

1
Center for Adherence and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati
Children’s Hospital Medical Center, 2Department of Psychology, The Hospital for Sick Children, 3Division of
Gastroenterology and Nutrition, Boston Children’s Hospital, 4Department of Clinical Psychology, College of Health
Professions, Rosalind Franklin University of Medicine and Science, and 5Cancer and Blood Disorders Center,
Department of Psychiatry and Behavioral Medicine, Seattle Children’s Hospital
All correspondence concerning this article should be addressed to Kevin A. Hommel, PHD, Center for Adherence
and Self-Management, Division of Behavioral Medicine and Clinical Psychology, Cincinnati Children’s Hospital
Medical Center, 3333 Burnet Avenue, Cincinnati, OH 45229, USA. E-mail: [email protected]
Received 27 June 2020; revisions received 7 August 2020; accepted 7 August 2020

Abstract
The COVID-19 pandemic has presented unique circumstances that have the potential to both posi-
tively and negatively affect pediatric adherence and self-management in youth with chronic medi-
cal conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders,
school closures, changes in pediatric healthcare delivery) impact disease management at the indi-
vidual, family, community, and healthcare system levels. We also discuss how barriers to pediatric
adherence and self-management exacerbated by the pandemic may disproportionately affect un-
derserved and vulnerable populations, potentially resulting in greater health disparities. Given the
potential for widespread challenges to pediatric disease management during the pandemic, ongo-
ing monitoring and promotion of adherence and self-management is critical. Technology offers
several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover,
pediatric psychologists are uniquely equipped to develop and implement adherence-promotion
efforts to support youth and their families in achieving and sustaining optimal disease manage-
ment as the current public health situation continues to evolve. Research efforts addressing the
short- and long-term impact of the pandemic on pediatric adherence and self-management are
needed to identify both risk and resilience factors affecting disease management and subsequent
health outcomes during this unprecedented time.

Key words: adherence; pediatric chronic illness; COVID-19; self-management.

Introduction unnecessary treatment escalation (Carmody et al.,

Under typical circumstances, approximately 50% of 2019), as well as increased healthcare utilization
children and 65–90% of adolescents are nonadherent (McGrady & Hommel, 2013). Given the prevalence
to their treatment regimens (Hommel et al., 2009; and multi-faceted impact of nonadherence on pediat-
Logan et al., 2003; Rapoff, 2010). Nonadherence ad- ric health outcomes, the primary goal of this article is
versely impacts health outcomes and often leads to to identify and address how circumstances

Published by Oxford University Press on behalf of the Society of Pediatric Psychology 2020.
This work is written by US Government employees and is in the public domain in the US. 977
978 Plevinsky et al.

surrounding the COVID-19 pandemic may affect ad- 2020). Deficits in cognitive processes (e.g., executive
herence and self-management among youth with functioning) as a result of increased difficulties with
chronic medical conditions. This article will (a) pro- mood (Robinson et al., 2015; Snyder, 2013) likely in-
vide an overview of the ways in which the COVID-19 terfere with treatment adherence (Duke & Harris,
pandemic may exacerbate barriers to adherence and 2014; Stern et al., 2018). Specifically, when youths’
self-management; (b) address healthcare disparities in- self-management responsibilities outweigh their cogni-
cluding how COVID-19 may result in greater conse- tive capacity to successfully manage their treatment
quences for adherence and self-management among regimen, adherence and self-management behaviors
underserved populations; and (c) offer suggestions for suffer (Sonney & Insel, 2019). Additionally, increased
adapting and virtually delivering evidence-based inter- variability in daily structure and routine during the
ventions for monitoring and promoting pediatric ad- pandemic may contribute to increased forgetting and
herence and self-management during COVID-19. decreased self-monitoring, both of which are very

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The pediatric self-management model (Modi et al., common barriers to adherence reported across almost
2012) conceptualizes pediatric disease management as all pediatric populations (Hanghoj & Boisen, 2014).
not only medication-taking but also healthcare main- While youth and their families may have experi-
tenance tasks (e.g., blood draws, routine procedures, enced some declines in functioning affecting adherence
appointment attendance), adjunct therapies (e.g., during this public health crisis, others may have no-
physical therapy), and health behaviors (e.g., exercise, ticed improvements in overall functioning that may
nutrition, sleep). The model poses that both modifi- support adherence and self-management. For one, the
able (i.e., psychological symptoms, treatment regi- impact of daily stressors that may impact adherence
mens) and nonmodifiable (i.e., cognitive function, such as missed school, participation in activities, and
socio-demographics) factors influence adherence to concerns about friends (Compas et al., 2012) likely
disease management tasks across the following four have lessened due to social distancing guidelines.
levels: individual, family, community, and healthcare Additionally, at least one study among adults with
system. While the long-term impact of COVID-19 on asthma (e.g., Kaye et al., 2020) observed a positive
health outcomes remains unknown, the immediate change in rates of adherence during the COVID-19
obstacles to self-management and treatment adherence pandemic, providing added support for improved ad-
are apparent and ever present across multiple systems,
herence and self-management for a subgroup of
and each of these domains has been strained by the
individuals.
pandemic. Therefore, it is important to identify and
address potential factors specific to the COVID-19 Family, Caregiver, and Community Factors
pandemic that may exacerbate poor adherence and The impact of variability in daily structure and routine
self-management and highlight how pediatric psychol- during the pandemic extends to caregivers and the
ogists can support these behaviors as the pandemic family system. Potential changes within the family sys-
continues.
tem, such as caregivers having to physically go into
work or working from home while simultaneously
Medication Adherence and Healthcare providing childcare and/or filling the role of a class-
Maintenance room teacher, may place greater demands on youth to
Individual Factors perform self-care tasks independently. In contrast, in-
Aspects of physical health, psychological functioning, creased parental supervision and support in the home
and cognitive processes that may ordinarily pose chal- may benefit adherence and self-management. This
lenges for self-management and adherence among may also be an opportune time to refine strategies to
youth may be even more detrimental during the pan- improve self-management in cases where parent sup-
demic. A reduced focus on symptom monitoring and port and supervision has increased. However, in-
potential disruptions in routine medical care due to creased parental involvement may exacerbate
COVID-19 may result in a false sense of physical difficulties in cases where parental over-involvement
health or treatment effectiveness, thus leading to a po- constrains the normative development of independent
tential lapse in treatment adherence (Hanghoj & self-management, especially in adolescents and young
Boisen, 2014). Psychological and behavioral problems adults who otherwise would be spending more time
are also associated with greater interruptions in pedi- outside the home and taking more responsibility for
atric adherence and self-management (Modi et al., their treatment regimen. Additionally, many children
2012). While many are adjusting well to the stay-at- and adolescents receive support and medical care at
home orders, several experts indicate that there has school or via routine visits with in-home medical per-
been an increase in internalizing and externalizing sonnel to support self-management and adherence, yet
symptoms in children and adolescents (Fegert et al., in many cases these supports were abruptly withdrawn
COVID-19 Pediatric Adherence 979

due to school closings and other COVID-19-specific Healthcare Disparities

precautions. Notably, the detrimental impacts of the COVID-19
pandemic that can exacerbate nonadherence are dis-
Healthcare System Factors proportionately higher in low-socioeconomic commu-
During the COVID-19 pandemic, a host of medical nities, compounding pre-existing health disparities.
procedures and treatments deemed non-critical, in- Over one-third of vulnerable populations have
cluding healthcare maintenance appointments (e.g., reported job losses and material hardship, which may
physicals, routine follow-ups) were canceled (Center have ended insurance coverage for many youth (Jenco,
for Disease Control and Prevention, 2020). 2020; Millett et al., 2020; Van Dorn et al., 2020).
Consequently, youth who were previously receiving Telehealth has offered benefits to vulnerable popula-
adjunct therapies (e.g., physical, occupational, or psy- tions (i.e., removing transportation barriers, not miss-
chosocial therapies) experienced an abrupt stop and/ ing work due to a child’s medical appointment). Still,

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or prolonged interruption in services. Under typical the pandemic created additional barriers to healthcare
circumstances, such large gaps in treatment would be service delivery for underserved youth and their fami-
considered nonadherence. Moreover, the rapid adjust- lies, including barriers to telemedicine (e.g. inability to
ment to telemedicine was especially complex for pedi- acquire appropriate technology, affordability of inter-
atric healthcare systems, requiring medical centers to net access), changes to medical appointment schedul-
quickly adapt to using new technologies to provide ing, difficulty accessing interpreter services, and
care (Patel et al., 2020). Despite the gradual reopening visitor restrictions (e.g., only one caregiver being
of healthcare services, COVID-19-related precautions allowed to accompany the child) at the hospital.
(e.g., limited capacity for face-to-face appointments, Quickly having to learn and navigate new technology
additional time to sanitize equipment, extended wait systems to access healthcare can result in frustration
times, postponing of appointments) continue to pose and reduced utilization of care for these families as
threats to effective adherence and self-management. well (Children’s Health Fund, 2020). Additionally, ad-
These rapid deaccelerations in care delivery likely con- herence and self-management support via psychology,
tributed to unprecedented levels of nonadherence social work or child life services may be limited given
caused by healthcare system factors. Additionally, reduced capacity of these services due to limited staff
families with youth who are immunocompromised hours, reduction in hospital revenue resulting in tem-
may now be fearful of returning to the hospital for porary discontinuation of services, or time needed to
fear of contracting COVID-19 (Headley, 2020). transition to telehealth platforms. Last, pediatric
Overall, families’ experiences with lapses in insurance patients from underserved populations likely face re-
coverage, the burden of the cost of these services, lim- duced community supports (i.e., Boys and Girls Club)
ited accessibility to in-home medical personnel, and and reduced access to supportive health services via
worry about returning to routine in-person care dur- their school system (e.g., physical education, school
ing the pandemic are likely impacting pediatric disease nurse support). Given that the pandemic is differen-
management as well. tially affecting underserved populations, they are more
vulnerable and therefore at greater risk for poorer ad-
Physical Activity, Nutrition, and Sleep herence and self-management as a result.

Self-management behaviors that promote health out-

comes such as exercise, nutrition, sleep, social interac- Monitoring and Promoting Adherence and Self-
tion, and reducing sedentary behavior (e.g., screen Management During COVID-19
time) have likely also been altered by the pandemic. It is incumbent on providers to proactively identify
For example, many youth received the bulk of their and address challenges to adherence and self-
physical activity, nutritious meals, and social interac- management with communication at the forefront of
tion with peers at school (Wechsler et al., 2000), this process. Patient–caregiver–provider communica-
which was closed to reduce the spread of COVID-19. tion is critical to identifying adherence and self-
Stay-at-home orders are critical for reducing the management concerns and enacting individual, family,
spread of COVID-19 and, on one hand, may create or community, and healthcare system-level interventions
exacerbate poor adherence and self-management; but to identify and develop effective solutions to barriers.
they may also create opportunities for improved ad- For example, prior to the pandemic, a multidiscipli-
herence and self-management. Some families may be nary urban clinic serving youth with HIV developed a
cooking at home more leading to positive changes in robust and effective adherence support program,
diet, and a more flexible schedule may allow for more which relied on frequent clinic appointments, strong
time for daily physical activity, relaxation for stress patient–provider relationships, and directly observed
management, and hours of sleep per night. therapy. In response to the pandemic, the clinic
980 Plevinsky et al.

adapted this model and has been proactively contact- recording specific adherence behaviors over time
ing patients to assess medication needs, explain new (Plevinsky et al., 2020). This format can be particu-
clinic procedures, and provide relevant COVID-19 ed- larly useful for identifying problem areas and
ucation to patients and families via frequent phone problem-solving with families around their daily rou-
check-ins, directly observed therapy via telemedicine, tine in order to maximize adherence. Daily monitoring
and connecting patients with medication delivery serv- can improve adherence (Greaves et al., 2011) and fa-
ices (Armbruster et al., 2020). While resource and cilitate caregiver monitoring and implementation of
time intensive, this approach may serve to mitigate behavioral strategies to promote adherence (e.g., to-
risk factors and minimize consequences of nonadher- ken economy).
ence during this time. Adherence apps are one form of intervention freely
For patients with chronic conditions, regular outpa- available to youth and families with access to a smart
tient consultation and disease monitoring via telemedi- phone or tablet. These apps can provide scheduled

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cine are critical to promoting continued adherence reminders, allow users to track adherence behaviors
and self-management during the pandemic. While pro- over time, and allow users to share these reports with
viders may have reservations about the effectiveness of their providers (Carmody et al., 2019). App-based
telemedicine, pre-COVID-19 studies directly compar- medication adherence interventions have been associ-
ing traditional face-to-face versus telemedicine serv- ated with short-term improvements in adherence
ices have not found telemedicine to be inferior (Badawy et al., 2017), therefore these solutions can
(Bahrani et al., 2017; Tates et al., 2017). Virtual com- serve to supplement behavioral health interventions
munication platforms such as messaging embedded in via telemedicine, or bridge patients until more inten-
the electronic medical record and HIPAA-compliant sive adherence interventions (e.g., accessing a psychol-
smartphone applications (e.g., Doximity) can also en- ogist) are available.
able communication sharing in the absence of face-to-
face visits. Many of these platforms also enable
Summary and Future Directions
patients to share pictures, videos, and other helpful
data so that providers can deliver targeted recommen- Although the circumstances surrounding the COVID-
dations and support. Regardless of the platform, it is 19 pandemic and its broad impact (both positive and
crucial for providers to recognize how various aspects negative) across individual, family, community, and
of the pandemic may be contributing to poorer adher- healthcare systems factors impact pediatric adherence
ence and self-management as previously discussed. and self-management, pediatric psychologists have the
Providers should maintain a non-judgmental stance in expertise to recognize, assess, and address these chal-
order to yield more accurate information while avoid- lenges to promote health outcomes. Future research
ing evasive or defensive reactions (Rapoff, 2010). ought to utilize a mixed-methods approach to examine
Many families are having to make compromises re- how the COVID-19 pandemic has affected pediatric
garding how time and resources are spent, and it is adherence and self-management in order to best in-
critical that providers take the time to understand form clinical care and healthcare policy development.
each family’s circumstances in order to align and set Research is especially needed to examine the extent to
the stage for collaborative problem-solving. which the pandemic has exacerbated pre-existing pedi-
Increased assessment and monitoring are also rec- atric healthcare disparities that affect these outcomes
ommended, as a variety of strategies exist to assess ad- and health outcomes broadly. Digital tools, such as
herence, including assays, observation, electronic electronic adherence monitors, adherence-promotion
monitors, pill counts, provider estimates, and patient/ mobile apps, and telehealth can be used to facilitate
caregiver report (McGrady et al., 2018). While access these efforts (Stiles-Shields et al., 2020).
to bioassays may be restricted in the COVID-19 pan- Youth with chronic medical conditions and their
demic, others can be modified and implemented in the families are resilient, and with support from their
absence of face-to-face visits. Video observation (i.e., medical teams and behavioral health providers, can
either live or recorded and shared electronically) can achieve optimal adherence and self-management de-
offer insight into how well a treatment regimen is per- spite the challenges brought about by the COVID-19
formed (e.g., exercises for physical therapy, inhaler pandemic. However, we must acknowledge the poten-
use, chest wall oscillation, etc.). Moreover, home tial enduring adverse effects of the pandemic on pedi-
observations can reveal contemporaneous variables re- atric adherence and self-management. Long-standing
lated to treatment adherence that may be amenable to adverse effects may come as a result of unemployment
intervention (Mash & Terdal, 1988). Patient and par- and associated loss of family healthcare benefits, as
ent reports including global reports, structured inter- well as youth and caregiver mental health sequelae
views and questionnaires, and daily diaries can be due to prolonged social isolation or other pandemic-
easily adapted to telemedicine with patients or parents induced stressors. Families may also receive reduced
COVID-19 Pediatric Adherence 981

support from illness-specific non-profit foundations Duke, D. C., & Harris, M. A. (2014). Executive function, ad-
due to financial strain. Furthermore, youth with co- herence, and glycemic control in adolescents with type 1
morbid learning disabilities may receive reduced spe- diabetes: A literature review. Current Diabetes Reports,
cial education support from schools in developing 14, 532.
Fegert, J. M., Vitiello, B., Plener, P. L., & Clemens, V.
skills necessary for optimal adherence and self-
(2020). Challenges and burden of the coronavirus 2019
management (e.g., problem-solving).
(COVID-19) pandemic for child and adolescent mental
As the current public health situation evolves, pedi- health: A narrative review to highlight clinical and re-
atric providers will need to continue to support these search needs in the acute phase and the long return to nor-
youth and their families in being able to adapt to mality. Child and Adolescent Psychiatry and Mental
uncertainties, establish new routines, access healthcare Health, 14, 20. https://doi.org/10.1186/s13034-020-
(e.g., medications, medical interventions, healthcare 00329-3
services), and use new technologies (e.g., telemedicine, Greaves, C. J., Sheppard, K. E., Abraham, C., Hardeman,

Downloaded from https://academic.oup.com/jpepsy/article/45/9/977/5905613 by guest on 25 November 2022

adherence apps) to promote disease management and W., Roden, M., Evans, P. H., & Schwarz, P; The IMAGE
reduce poor health outcomes. Study Group (2011). Systematic review of reviews of inter-
vention components associated with increased effective-
ness in dietary and physical activity interventions. BMC
Acknowledgments Public Health, 11, 1–12.
We are grateful for support from the National Institutes of Hanghoj, S., & Boisen, K. A. (2014). Self-reported barriers
Health, including the National Institute of Child Health and to medication adherence among chronically ill adolescents:
Human Development (T32 HD068223). A systematic review. Journal of Adolescent Health, 54,
Conflicts of interest: None declared. 121–138.
Headley, M. (2020). Managing medication adherence during
COVID-19. https://www.psqh.com/analysis/managing-
References medication-adherence-during-covid-19 Retreived July 23,
Armbruster, M., Fields, E. L., Campbell, N., Griffith, D. C., 2020.
Kouoh, A. M., Knott-Grasso, M. A., & , . . . Agwu, A. L. Hommel, K. A., Davis, C. M., & Baldassano, R. N. (2009).
(2020). Addressing health inequities exacerbated by Objective versus subjective assessment of oral medication
COVID-19 among youth with HIV: expanding our toolkit. adherence in pediatric inflammatory bowel disease.
Journal of Adolescent Health, 67, 290–295. https://doi. Inflammatory Bowel Disease, 15, 589–593. https://doi.
org/10.1016/j.jadohealth.2020.05.021 org/10.1002/ibd.20798
Badawy, S. M., Thompson, A. A., & Kuhns, L. M. (2017). Jenco, M. (2020). Study: COVID-19 pandemic exacerbated
Medication adherence and technology-based interventions hardships for low-income, minority families. https://www.
for adolescents with chronic health conditions: a few key aappublications.org/news/2020/06/03/covid19hard-
considerations. JMIR mHealth and uHealth, 5, e202. ships060320 Retrieved July 23, 2020.
Bahrani, K., Singh, M. B., Bhatia, R., Prasad, K., Vibha, D., Kaye, L., Theye, B. T., Smeenk, I., Gondalia, R., Barrett, M.
Shukla, G., & , . . . Patterson, V. (2017). Telephonic review A., & Stempel, D. A. (2020). Changes in medication ad-
for outpatients with epilepsy—A prospective randomized, herence among patients with asthma and COPD during
parallel group study. Seizure, 53, 55–61. https://doi.org/ the COVID-19 pandemic. The Journal of Allergy Clinical
10.1016/j.seizure.2017.11.003 Immunology: In Practice, 8, 2384–2385.
Carmody, J. K., Plevinsky, J., Peugh, J. L., Denson, L. A., Logan, D., Zelikovsky, N., Labay, L., & Spergel, J. (2003).
Hyams, J. S., Lobato, D., & , . . . Hommel, K. A. (2019). The illness management survey: Identifying adolescents’
Longitudinal non-adherence predicts treatment escalation perceptions of barriers to adherence. Journal of Pediatric
in paediatric ulcerative colitis. Alimentary Pharmacology Psychology, 28, 383–392.
& Therapeutics, 50, 911–918. Mash, E. J., & Terdal, L. G. (1988). Behavioral assessment
Center for Disease Control and Prevention (2020). Interim of childhood disorders. The Guilford Press.
CDC guidance on handling non-COVID-19 public health McGrady, M. E., Holbein, C. E., Smith, A. W., Morrison, C.
activities that require face-to-face interaction with clients F., Hommel, K. A., Modi, A. C., & , . . . Ramsey, R. R.
in the clinic and field in the current COVID-19 pandemic. (2018). An independent evaluation of the accuracy and us-
https://www.cdc.gov/coronavirus/2019-ncov/hcp/non- ability of electronic adherence monitoring devices. Annals
covid-19-client-interaction.html Retrieved July 23, 2020. of Internal Medicine, 169, 419–422. https://doi.org/10.
Children’s Health Fund (2020). Telehealth helps with access 7326/m17-3306
barriers during COVID-19, but also underlies systemic McGrady, M. E., & Hommel, K. A. (2013). Medication ad-
inequities. https://www.childrenshealthfund.org/telehealth- herence and health care utilization in pediatric chronic ill-
helps-with-access-barriers-during-covid-19-but-also-under- ness: A systematic review. Pediatrics, 132, 730–740.
lines-systemic-inequities/ Retrieved July 23, 2020. Millett, G. A., Jones, A. T., Benkeser, D., Baral, S., Mercer,
Compas, B. E., Jaser, S. S., Dunn, M. J., & Rodriguez, E. M. L., Beyrer, C., & , . . . Sullivan, P. S. (2020). Assessing dif-
(2012). Coping with chronic illness in childhood and ado- ferential impacts of COVID-19 on black communities.
lescence. Annual Review of Clinical Psychology, 8, Annals of Epidemiology, 47, 37–44. https://doi.org/10.
455–580. 1016/j.annepidem.2020.05.003
982 Plevinsky et al.

Modi, A. C., Pai, A. L., Hommel, K. A., Hood, K. K., Sonney, J., & Insel, K. C. (2019). Exploring the intersection
Cortina, S., Hilliard, M. E., & , . . . Drotar, D. (2012). of executive function and medication adherence in
Pediatric self-management: A framework for research, school-age children with asthma. Journal of Asthma, 56,
practice, and policy. Pediatrics, 129, e473–e485. https:// 179–189. https://doi.org/10.1080/02770903.2018.
doi.org/10.1542/peds.2011-1635 1441870
Patel, P. D., Cobb, J., Wright, D., Turer, R. W., Jordan, T., Stern, A., Driscoll, C. F. B., Ohanian, D., & Holmbeck, G.
Humphrey, A., & , . . . Rosenbloom, S. T. (2020). Rapid N. (2018). A longitudinal study of depressive symptoms,
development of telehealth capabilities within pediatric pa- neuropsychological functioning, and medical responsibil-
tient portal infrastructure for COVID-19 care: Barriers, ity in youth with spina bifida: Examining direct and medi-
solutions, results. Journal of the American Medical ating pathways. Journal of Pediatric Psychology, 43,
Informatics Association, 27, 1116–1120. https://doi.org/ 895–905.
10.1093/jamia/ocaa065 Stiles-Shields, C., Plevinsky, J. M., Psihogios, A. M., &
Plevinsky, J. M., Gutierrez-Colina, A. M., Carmody, J. K., Holmbeck, G. N. (2020). Considerations and future direc-
Hommel, K. A., Crosby, L. E., McGrady, M. E., & , . . . tions for conducting clinical research with pediatric popu-

Downloaded from https://academic.oup.com/jpepsy/article/45/9/977/5905613 by guest on 25 November 2022

Modi, A. C. (2020). Patient-reported outcomes for pediat- lations during the COVID-19 pandemic. Journal of
ric adherence and self-management: A systematic review. Pediatric Psychology, 45, 720–724. https://doi.org/10.
Journal of Pediatric Psychology, 45, 340–357. https://doi. 1093/jpepsy/jsaa055
org/10.1093/jpepsy/jsz096 Tates, K., Antheunis, M. L., Kanters, S., Nieboer, T. E., &
Rapoff, M. A. (2010). Adherence to pediatric medical regi- Gerritse, M. B. (2017). The effect of screen-to-screen
mens (2nd edn). Springer Science & Business Media. versus face-to-face consultation on doctor-patient
Robinson, K. E., Pearson, M. M., Cannistraci, C. J., communication: An experimental study with simulated
Anderson, A. W., Kuttesch, J. F., Wymer, K., & , . . . patients. Journal of Medical Internet Research, 19, e421.
Compas, B. E. (2015). Functional neuroimaging of work- Van Dorn, A., Cooney, R. E., & Sabin, M. L. (2020).
ing memory in survivors of childhood brain tumors and COVID-19 exacerbating inequalities in the US. Lancet
healthy children: Associations with coping and psychoso- (London, England), 395, 1243–1244.
cial outcomes. Child Neuropsychology, 21, 779–802. Wechsler, H., Devereaux, R. S., Davis, M., & Collins, J.
Snyder, H. R. (2013). Major depressive disorder is associated (2000). Using the school environment to promote
with broad impairments on neuropsychological measures physical activity and healthy eating. Preventative
of executive function: A meta-analysis and review. Medicine, 31, S121–S137. https://doi.org/10.1006/pmed.
Psychological Bulletin, 139, 81–132. 2000.0649