Trajectories of Child Emotional and Behavioural Difficulties Before and During the COVID-19 Pandemic in a Longitudinal UK Cohort

Abstract

Background: There are concerns that the COVID-19 pandemic and its associated public health mitigation measures will have detrimental effects on emotional and behavioural problems in children. However, longitudinal studies with pre-pandemic data are scarce. In a UK cohort, we quantify the impact of the COVID-19 pandemic on trajectories of children’s emotional and behavioural difficulties measured before and during the pandemic.Methods: Data were from 708 children (Mean age = 3·45 years, SD = 3·13) part of the third generation of a birth cohort study, the Avon Longitudinal Study of Parents and Children (ALSPAC). Study sample comprised children whose parents provided previous pre-pandemic surveys and a survey between 26 May and 5 July 2020 that focused on the impact of the COVID-19 pandemic as restrictions in the UK were eased. The children had up to seven measurements of emotional and behavioural difficulties from infancy to late childhood (including the most recent measures during the pandemic). 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. Findings: We found that children’s emotional and behavioural difficulties increased during infancy, peaked around the age of 2, and then declined 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: 0·1 to 0·3, p Interpretation: The COVID-19 pandemic may be associated with greater persistence of emotional and behavioural difficulties after the age 2. Further evidence and monitoring of emotional and behavioural difficulties are required to fully understand the impact of the pandemic on this population, given ongoing and likely further periods of restrictions.Funding: This work was supported by the UK Medical Research Council and Wellcome (Grants 217065/Z/19/Z and 102215), the European Research Commission grant (Grant Ref: 758813 MHINT), the Elizabeth Blackwell Institute, University of Bristol, with funding from QR SPF (Quality-Related Strategic Priorities Fund), and UKRI Research England the Faculty Research Director’s discretionary fund and the University of Bristol. A comprehensive list of grants funding is available on the ALSPAC website (http://www.bristol.ac.uk/alspac/external/documents/grant-acknowledgements.pdf).Declaration of Interests: All authors declare no conflicts of interest.Ethics Approval Statement: Ethical approval for the study was obtained from the ALSPAC Ethics and Law Committee and the Local Research Ethics Committees. All participants provided fully informed consent and the study is GDPR compliant.