Journal of Childhood & Developmental Disorders

Introduction

The impact of the COVID-19 pandemic on child mental health is a significant public health issue. Widely recognized as ‘unprecedented’ in nature, the COVID-19 pandemic has resulted in social disruptions, including community, school and childcare closures that far exceeded anticipated durations. Although critical in reducing disease spread, community mitigation strategies also have impacts in the form of job losses, financial insecurity, social isolation and confinement-related stresses, that are expected to impact family and child well-being; these ideas stem largely from other studies of acute stress, such as family deterioration during the great recession. However, it is critical to understand the risk processes driving impacts on families and children during COVID-19; in the absence of such research, practitioners must rely on developmental research conducted under typical circumstances that may not be applicable to the unique context of the COVID-19 pandemic.

Emerging data confirm fears of the negative mental health impact of the pandemic. Early reports suggest increased prevalence of children’s depression, anxiety and behaviour problems during COVID-19. Findings regarding individuals age 16 and older from the UK Household Longitudinal Study document an increase in mental health problems relative to data collected prior to COVID-19 to April 2020; corresponding results have emerged in cross-national data from 59 countries. Regarding children’s mental health, 14% of parents in a June 2020 US national survey reported that their children’s mental health had worsened during the pandemic. Recent longitudinal data indicated large effect sizes regarding increases in children’s externalizing (d=1.59) and internalizing (d=1.31) problems. Thus, a critical next step is to identify key pathways of risk that can guide interventionists seeking to minimize the immediate impact and forestall a long-term increase in children’s mental health problems.

Impact on Development and Well-being

In this paper, we draw on ideas that social disruptions incurred during the COVID-19 pandemic and caregiver wellbeing may lead to disruptions in family-level and parent–child relations, all of which may account for child maladjustment. We conceptualize family-level functioning (cohesion, conflict and routines) and parenting quality (harshness, laxness and warmth) as proximal risk or protective factors for child mental health, each of which are amenable to existing evidence-based interventions. We further expand on these conceptualizations to examine whether pre-existing difficulties or pandemic-related disruptions in family and parenting factors predict declines in child adjustment with the onset of the pandemic.

Family cohesion, conflict and routines all have wellestablished implications for child adjustment. Family cohesion refers to the quality of emotional bonds among family members and is associated with reduced risk for youth externalizing problems and internalizing problems. Family conflict, including disagreements, anger and hostility among family members, is a robust risk factor for child maladjustment. Namely family conflict is associated with both internalizing and externalizing problems. Other work documents family cohesion and conflict as distinct constructs with unique implications for youth wellbeing. Family routines refer to regular practices in family life that are thought to promote predictability and organization, and in this study conceptualized as having regular family dinners, organized family activities, and regular wake and bedtimes for children. Developmental evidence from the Add Health study point to family connectedness (inclusive of the participation in daily routines around waking, regular meals together, and regular bedtimes) as highly protective against a number of longterm risks in adolescence. Maintaining family routines is protective for child developmental outcomes, even in contexts with elevated risk. We propose that the degree to which families maintain routines during the COVID-19 pandemic may thus may be a salient predictor of child well-being.

Genetic and Biological Factors

Parenting quality also impacts child adjustment; harsh and lax discipline conferring risk and parental warmth operating as a protective factor for children’s maladjustment. Harsh discipline refers to angry, coercive, over-reactive responses to children’s misbehaviour; whereas lax discipline refers to parenting that is overly permissive, failing to apply corrective feedback or consequences to misbehaviour. Finally, parental warmth refers to supportive, responsive and affectionate parenting practices. Decades of empirical evidence, across well over 1000 published studies document the robust implications of each of these parenting dimensions for children’s adjustment, in both crosssectional and longitudinal studies.

Parental warmth also did not predict children’s adjustment during the COVID-19 pandemic. Instead, our findings point to increases in harsh and lax discipline practices as more salient dimensions of risk for children’s internalizing and externalizing problems during the pandemic. Again, it is possible that disruptions to parental warmth would be impactful on a longer timescale than was captured in this study, but our findings suggest that promoting effective discipline practices during the COVID-19 pandemic may be a more fruitful avenue to supporting child well-being.

Family and parenting disruption during the COVID-19 pandemic appears to be a key risk pathway for children’s internalizing and externalizing problems. Specifically, deteriorated family cohesion, and increases in family conflict, harsh discipline and lax discipline foreshadow increases in children’s internalizing and externalizing problems during the pandemic. Additionally, pre-existing levels of parents’ poor mental health further elevates children’s risk for increased maladjustment during the pandemic. Family support practices that focus on helping families re-establish positive relations, effectively manage conflicts and use effective discipline practices are expected to be effective strategies for mitigating risk from the COVID-19 pandemic on children’s mental health problems.