Trajectories of child emotional and behavioural difficulties before and during the COVID-19 pandemic in a longitudinal UK cohort

  1. Elise Paul
  2. Daphne Kounali
  3. Alex S. F. Kwong
  4. Daniel Smith
  5. Ilaria Costantini
  6. Deborah A. Lawlor
  7. Kapil Sayal
  8. Helen Bould
  9. Nicholas J. Timpson
  10. Kate Northstone
  11. Melanie Lewcock
  12. Kate Tilling
  13. Rebecca M. Pearson

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Abstract

Importance

COVID-19 public health mitigation measures are likely to have detrimental effects on emotional and behavioural problems in children. However, longitudinal studies with pre-pandemic data are scarce.

Objective

To explore trajectories of children’s emotional and behavioural difficulties during the COVID-19 pandemic.

Design and setting

Data were from children from the third generation of a birth cohort study; the Avon Longitudinal Study of Parents and Children - Generation 2 (ALSPAC-G2) in the southwest of England.

Participants

The study population comprised of 708 children (median age at COVID-19 data collection was 4.4 years, SD=2.9, IQR= [2.2 to 6.9]), whose parents provided previous pre-pandemic surveys and a survey between 26 May and 5 July 2020 that focused on information about the COVID-19 pandemic as restrictions from the first lockdown in the UK were eased.

Exposures

We employed multi-level mixed effects modelling with random intercepts and slopes to examine whether children’s trajectories of emotional and behavioural difficulties (a combined total difficulties score) during the pandemic differ from expected pre-pandemic trajectories.

Main outcomes

Children had up to seven measurements of emotional and behavioural difficulties from infancy to late childhood, using developmentally appropriate scales such as the Emotionality Activity Sociability Temperament Survey in infancy and Strengths and Difficulties Questionnaire in childhood.

Results

The observed normative pattern of children’s emotional and behavioural difficulties pre-pandemic, was characterised by an increase in scores during infancy peaking around the age of 2, and then declining throughout the rest of childhood. Pre-pandemic, the decline in difficulties scores after age 2 was 0.6 points per month; but was approximately one third of that in post-pandemic trajectories (there was a difference in mean rate of decline after age 2 of 0.2 points per month in pre vs during pandemic trajectories [95 % CI: 0.10 to 0.30, p <0.001]). This lower decline in scores over the years translated to older children having pandemic difficulty scores higher than would be expected from pre-pandemic trajectories (for example, an estimated 10.0 point (equivalent of 0.8 standard deviations) higher score (95% CI: 5.0 to 15.0) by age 8.5 years). Results remained similar although somewhat attenuated after adjusting for maternal anxiety and age.

Conclusion and relevance

The COVID-19 pandemic may be associated with greater persistence of emotional and behavioural difficulties after the age 2. Emotional difficulties in childhood predict later mental health problems. Further evidence and monitoring of emotional and behavioural difficulties are required to fully understand the potential role of the pandemic on young children.

Key Findings

Question

How has the COVID-19 pandemic influenced emotional difficulties in young children?

Findings

Using repeated longitudinal data from before and during the pandemic we provide evidence that emotional difficulty scores of primary school aged children are higher by an estimated 10.0 points (0.8 standard deviations) (95% CI: 5.0 to 15.0) by age 8.5 years than would be expected based on pre pandemic data.

Meaning

The level of difference in emotional difficulties found in the current study has been linked to increased likelihood of mental health problems in adolescence and adulthood. Therefore, this increase in difficulties needs careful monitoring and support.

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  1. ScreenIT

    SciScore for 10.1101/2021.05.11.21257040: (What is this?)

    Please note, not all rigor criteria are appropriate for all manuscripts.

    Table 1: Rigor

    NIH rigor criteria are not applicable to paper type.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Data were collected using REDCap (Research Electronic Data CAPture tools),16 a secure web application for building and managing online data collection exercises hosted at the University of Bristol.
    REDCap
    suggested: (REDCap, RRID:SCR_003445)

    Results from OddPub: We did not detect open data. We also did not detect open code. Researchers are encouraged to share open data when possible (see Nature blog).

    Results from LimitationRecognizer: We detected the following sentences addressing limitations in the study:
    A further limitation is that temperament scales were used at younger ages (0-3) and emotion difficulty scales at later ages (3+). Evidence shows these two constructs are strongly linked,34, 35 however, there is a debate regarding the extent to which temperament is the same construct or a precursor of emotional difficulty.33, 34 Importantly, we have used equivalent constructs at each age in both pre and during the pandemic surveys and demonstrate that correlations between measures were similar to correlations between the same measure across ages. Thus, while caution is needed regarding interpretation of age-related change (e.g. the decline from 2 years might in part be due to differences in the two scales) at both time points, differences between pre and during the pandemic scores should not be markedly influenced by differences in the scales. Given that the ALSPAC-G2 children are offspring of an original cohort born in the same period of time from 1991-1992, the age of the child during the pandemic is intrinsically linked to the age of their mother at their birth. By definition, older children have mothers who were younger when they were born. For example, a mother of a child who turned eight-years-old in 2020 would have been 21-22 years old at their birth. In contrast, a mother of a child who turned eight-years old in a 2017 pre-pandemic assessment would have been 18-19 years old at their birth. Given that young maternal age is a known risk factor for higher offspring emotio...

    Results from TrialIdentifier: No clinical trial numbers were referenced.

    Results from Barzooka: We did not find any issues relating to the usage of bar graphs.

    Results from JetFighter: We did not find any issues relating to colormaps.

    Results from rtransparent:
    • Thank you for including a conflict of interest statement. Authors are encouraged to include this statement when submitting to a journal.
    • Thank you for including a funding statement. Authors are encouraged to include this statement when submitting to a journal.
    • No protocol registration statement was detected.

    Results from scite Reference Check: We found no unreliable references.

    About SciScore

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  2. Version published to 10.1101/2021.05.11.21257040v1 on medRxiv