BackgroundThe COVID-19 pandemic has drastically increased demands on healthcare workers (HCWs) leaving them vulnerable to acute psychological distress, burnout and post-traumatic stress. In response, supportive services in a central London hospital mobilised mental health support specifically for HCWs.AimsThis rapid evaluation assessed HCW psychological welfare during the acute phase of the COVID-19 pandemic and their use of supportive services made available.MethodsDuring the acute phase of COVID-19 (April to May 2020) all staff working for the hospital were invited to complete an online survey assessing well-being (self-rated health, moral distress exposure, symptoms of burnout and psychological distress) and use of available supportive services (awareness of, use and perceived helpfulness). Associations among personal characteristics and psychological well-being were explored using correlations and linear regression.ResultsA total of 1127 staff participated in the rapid evaluation. On average, psychological distress was high (mean (SD): 22 (7.57)) regardless of role, with 84% of this sample scoring above the general population mean (14.5). Nearly half of the sample reported feeling emotionally drained and a profile emerged displaying higher levels of psychological distress and burnout in those who were younger and exposed to morally distressing situations, with this group also exhibiting greater support service use. Greater levels of burnout were associated with increased psychological distress when controlling for personal factors. During this acute phase of the pandemic, majority of staff used at least one service and rated it as helpful.ConclusionHCWs experienced high levels of psychological distress requiring continued support as the COVID-19 pandemic evolved. Although HCWs were aware of supportive services, uptake varied. In order to mitigate the risk of burnout and post-traumatic stress, long-term, effective strategies that facilitate staff accessing support are urgently required.

A broad range of studies demonstrate that sleep has a facilitating role in memory consolidation (see Rasch & Born, ). Whether sleep-dependent memory consolidation is also apparent in infants in their first few months of life has not been investigated. We demonstrate that 3-month-old infants only remember a cartoon face approximately 1.5-2 hours after its first presentation when a period of sleep followed learning. Furthermore, habituation time, that is, the time to become bored with a stimulus shown repetitively, correlated negatively with the density of infant sleep spindles, implying that processing speed is linked to specific electroencephalographic components of sleep. Our findings show that without a short period of sleep infants have problems remembering a newly seen face, that sleep enhances memory consolidation from a very early age, highlighting the importance of napping in infancy, and that infant sleep spindles may be associated with some aspects of cognitive ability.

Interest in social camouflaging has led to a multiplicity of measurement methods of uncertain validity. This two-part investigation first used a systematic review ("Study 1") to identify and appraise methods used to quantify camouflaging of autistic traits, using the Consensus-based Standards for the Selection of Health Status Measurement Instruments checklist. A total of 16 distinct measurement tools were identified; all are in the preliminary phases of psychometric evaluation. The systematic review highlighted: (1) the need for parent-report tools which specifically measure camouflaging; and (2) a lack of studies looking at associations between different methods of camouflaging, which limits understanding of their validity. "Study 2" aimed to begin to address these gaps in knowledge. We created a parent-report version of the Camouflaging Autistic Traits Questionnaire (CAT-Q) and evaluated its concurrent validity in autistic young people by examining associations with the self-report CAT-Q and a discrepancy measure. Discriminant validity was investigated by comparing all three methods of measuring camouflaging to a measure of social skills, to test whether they assess a construct distinct from social ability. The self-and parent-report CAT-Q were significantly related (r = 0.47, 95% CI = 0.24-0.65), and were related weakly (r = 0.20, 95% CI = À0.06 to 0.43) and strongly (r = 0.46, 95% CI = 0.23-0.64), respectively, to the discrepancy approach. No measure was associated with social skills. Improving the psychometric properties of these methods, and introducing a novel parentreport measure, may help selection of appropriate methods in future research and integration into clinical practice. Lay SummaryThe first study looked at published research to evaluate tools used to measure camouflaging in autism; showing that there is still much to learn about whether existing measures are accurate, and that there are no parent-report tools designed to measure camouflaging. The second study started to fill these gaps in knowledge, by developing and testing a parent-report camouflaging measure, and comparing it to other common ways of measuring camouflaging. This showed that, for teenagers, a new parent-report questionnaire can be useful for measuring camouflaging.

Purpose Camouflaging, or the use of strategies by autistic people to minimize the visibility of their autistic traits in social situations, is associated with stress, autistic burnout, depression, and suicidality among autistic adults. However, little is known about how autistic children and adolescents experience camouflaging, limiting our understanding of its onset and development. The present study filled this knowledge gap by examining camouflaging behaviour among autistic children and adolescents using a photo-elicitation approach.Methods Eight autistic children and adolescents aged 10 to 14 years (M = 11.88, SD = 1.89) attended an orientation session and were given two to three weeks to take photographs on the topic of camouflaging. Individual interviews were conducted with each participant about their photos. Inductive thematic analysis and an interpretive engagement framework were used to identify major themes within participant interviews and images.Results Qualitative analysis identified 12 themes reflecting motivations to camouflage (as a response to negative social experiences, as a learned habit), contexts of camouflaging (e.g., the audience), strategies and behaviours used to camouflage (suppressing autistic stimming behaviour, hiding the self), and perceived consequences of camouflaging (internal conflict, stress, needing time to recharge).Conclusion Results highlight that autistic children and adolescents as young as 10 years old engage in camouflaging behaviour which can be pervasive and automatic, and that this can be a stressful, confusing, and energetically draining experience. Better understanding of the development and experience of camouflaging in childhood can inform prevention of mental health concerns in adulthood.

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