The impact of routines on emotional and behavioural difficulties in children and on parental anxiety during COVID-19

  1. Vera Lees
  2. Rosie Hay
  3. Helen Bould
  4. Alex S. F. Kwong
  5. Daniel Major-Smith
  6. Daphne Kounali
  7. Rebecca M. Pearson

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Abstract

The Covid-19 pandemic and related public health measures, including lockdowns and school closures, have impacted on mental health of children.

Aims and hypothesis

We hypothesised that there would be an association between maintaining a routine during lockdown and both lower emotional and behavioural difficulties in children and lower parental anxiety. Routine was taken as keeping to the same basic activities such as mealtimes and bedtimes. We also hypothesised that children of ‘keyworker’ parents would have fewer emotional and behavioural symptoms due to having maintained more normal routines. The key reason was that children of keyworkers still attended school or nursery and parents would have been getting up and coming home at the same times as pre-Covid. Keyworker status was defined as those whose work was essential to Covid-19 response, including work in health and social care and other key sectors.

Methods

We used data from the Avon Longitudinal Study of Parents and Children (ALSPAC) to explore associations between maintaining a routine, and emotional and behavioural difficulties in children, using linear regression models. All eligible ALSPAC-G2 participants were sent the survey and the responders are representative of the eligible G2 population. We included measures of parental anxiety. We separately explored associations with having a keyworker parent. We used the Carey Infant Temperament Questionnaire and the Revised Rutter Parent Scale for Preschool Children to establish levels of emotional and behavioural difficulties. The measures were chosen to match previous waves in multi-generations in ALSPAC where they had been shown to be predictive of later mental health in children. The scales measure emotional and behavioural problems.

Results

Two hundred eighty-nine parents completed questionnaires about their 411 children. Keeping a routine was associated with emotional and behavioural difficulty scores 5.0 points lower (95% CI −10.0 to −0.1), p  = 0.045 than not keeping a routine. Parents who reported keeping a routine had anxiety scores 4.3 points lower (95% CI −7.5 to −1.1), p  = 0.009 than those who did not. Children of keyworkers tended to have lower emotional and behavioural difficulty scores [−3.1 (95%CI −6.26 to 0.08), p  = 0.056] than children of non-keyworkers. All models were adjusted for relevant potential confounders.

Conclusion

Maintaining a routine may be beneficial for both child emotional wellbeing and parental anxiety, although it is also possible that lower parental anxiety levels made maintaining a routine easier. Being the child of a keyworker parent during lockdown may have been protective for child emotional wellbeing.

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  1. Version published to 10.3389/frcha.2023.1114850
  2. ScreenIT

    SciScore for 10.1101/2022.03.25.22272950: (What is this?)

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

    Table 1: Rigor

    Ethicsnot detected.
    Sex as a biological variableThe Avon Longitudinal Study of Parents and Children (ALSPAC) is an ongoing population-based study that recruited pregnant women residing in Avon in the south west of England with expected delivery dates between 1st April 1991 and 31st December 1992.14-16 The cohort consists of mothers and their partners (G0) associated with 15,454 pregnancies, resulting in 15,589 foetuses (G1) of which 14,901 were alive at 1 year of age.
    Randomizationnot detected.
    Blindingnot detected.
    Power Analysisnot detected.

    Table 2: Resources

    Software and Algorithms
    SentencesResources
    Study data were collected and managed using REDCap electronic data capture tools hosted at the University of Bristol.20 Measures of Routine: Participants were asked whether they kept a similar routine (e.g. bedtime, mealtimes) to how things were before the official lockdown was announced on 23rd March 2020, with response options “no, not at all”, “yes, a bit”, “yes, a lot” and, “yes, completely”.
    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:
    Strengths and Limitations: This is a novel study looking at the effect of Covid-19 pandemic on younger children, using longitudinal pre- and during-pandemic data from the ALSPAC cohort. Although this provides a good size sample, the population in the sample is limited in ethnic diversity and geographical spread, which may limit the generalisability of our results to other populations. The cross-sectional nature of this work means that, although we have described an association between keeping routine and fewer behavioural and emotional difficulties in children, we are unable to determine the direction of causality, i.e. we cannot conclude that keeping to routine leads to lower emotional and behavioural difficulties, since it is also possible that children having fewer emotional and behavioural difficulties makes it easier to follow a routine. Other possible explanations for these results are that like all cohort studies, ALSPAC has incomplete recruitment and loss to follow-up; the current recruitment at a relatively young age and the focus of analyses in cross-generational effects are more specific to ALSPAG-G2.16 Furthermore, whilst we have attempted to adjust for factors that may confound the relationship between routine and emotional and behavioural difficulties, it is possible that residual confounding from unmeasured variables may affect this apparent relationship. The association between routine and lower parental anxiety is cross-sectional, so we do not know whether ro...

    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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  3. Version published to 10.1101/2022.03.25.22272950v1 on medRxiv