Children’s Attention and Self-Regulatory Behavior before and during the COVID-19 Pandemic

Abstract

Objective:

To investigate changes in children’s self-regulatory behavior before and during the COVID-19 pandemic.

Method:

Participants were parents of children ages 4-13 (n= 45 mean 7.5, SD: 2.6) who participated in the Baltimore Generations Study before the pandemic. They reported on their child’s self-regulation (SR) using the Parent Observation of Child Adaptation (POCA). During the pandemic, they were recontacted to report on child SR, disruptions to family life (Coronavirus Impact Scale), and parenting stress (Parenting Stress Index). Pre-pandemic to pandemic changes in SR were compared with repeated measures ANOVA.

Results:

There were significant decreases in child SR (poorer concentration, attention, task engagement and persistence, and greater impulsivity) pre-pandemic to pandemic. During the pandemic, parenting stress was correlated with lower child SR (rs range = −.52 to −.34, ps < .05). Pandemic-related family disruptions were associated with changes in children’s impulsivity (F (1, 42) = 5.28, p = .03); children with four or more disruptions (67%) showed less ability to wait their turn during the pandemic compared to pre-pandemic (M (SD) = 3.34 (.93) vs. 4.41 (1.21), vs. t (28) = 3.93, p < .001). There was no change in SR for children with fewer than four disruptions.

Conclusion:

Results highlight modest pandemic-associated decrements in child attention, task persistence, and task engagement alongside increases in impulsivity. We did not find evidence of broad or severe impacts; however, children whose families have been disproportionately impacted by the pandemic may need focused support in school and at home to avoid widening pre-pandemic health and educational disparities.

INTRODUCTION

The COVID-19 pandemic has affected family routines, caregiving, school and childcare, economic stability, and health. While the full impact of these disruptions on children remains unknown, prior theoretical and empirical work examining adaptation to chronic stress suggests the potential for long-term health and behavior consequences in vulnerable children and families.^1,2 Early COVID-specific models are emerging, for example, Cheng and Conca-Cheng highlight four levels of pandemic impact including COVID-19 morbidity and mortality, community-level stressors, family trauma, and more distal consequences like delayed well-child visits, obesity, and under-immunization.³ These consequences have been borne, disproportionately, by families living in economic precarity before the pandemic as well as families of color.⁴

Child self-regulatory behavior may be a leading indicator of pandemic-related child disruptions. Self-regulation, the ability to monitor, evaluate, deploy and inhibit behavior or emotions to attain a behavioral goal^5,6 is closely related to emotion regulation, fear, and impulsivity.⁷ Links between chronic stress and child self-regulation are well documented.^5-7 Poor self-regulation in childhood is linked to life course consequences for health and health behavior, educational attainment, and interaction with the criminal justice system.^8,9 Therefore, identifying pandemic-related threats to self-regulatory development and variability in risk and resilience is critical.

During the pandemic, stressors such as parental mental health symptoms and stress, grief and loss, food and housing insecurity, and social isolation have burgeoned. At the same time, child buffers such as stable adult relationships, peer networks, and routines have been jeopardized by school and childcare closures and physical distancing requirements. Parent distress and family functioning may exacerbate child emotional and behavioral problems.^10-12 Developmental models of children’s self-regulation have highlighted the role of parenting in promoting children’s self-regulation and coping strategies and decreasing behavioral problems.^13-16 Pandemic impacts on children and adolescents may also vary by parent capacities.¹⁷ Among children ages 6-13 during the pandemic, Morelli and colleagues found that parental self-efficacy mediated the relationship between parental distress and children's emotional well-being; this suggests parent confidence in their role buffers the experience of psychosocial stress and activated personal resources in children.¹⁷

While pandemic-associated changes in child self-regulation have been hypothesized, to date, few studies have examined this question.¹⁸ Glynn et al. found that 64% of mothers of preschoolers reported increases in child externalizing problems on the Strengths and Difficulties questionnaire during the pandemic.¹⁸ Children whose parents enacted strong behavioral routines experienced fewer behavioral consequences, suggesting a time-sensitive need to mobilize parent and family-focused intervention resources.¹⁸ However, these analyses relied on mothers' recall of pre-pandemic behavior. The current study adds to the nascent literature elucidating the impact of the pandemic on child development. The goal of the study was to compare children’s attention and self-regulation before and during the pandemic using data from a prospective cohort study in sample predominately comprised of Black families in Baltimore City, a group that has borne a disproportionate burden of pandemic hardship.¹⁹

METHOD

Study Sample

Participants in this study were parents of children ages 4-13 originally recruited when they participated in an intervention as first graders in Baltimore City Public Schools in 1993. The goal of the parent study, from which the current sample is drawn, is to evaluate potential cross-generational impacts of the intervention. The current study includes the subset of parents who completed study activities up to one year before the pandemic. Parents were re-contacted during the pandemic (April 30, 2020 – August 11, 2020, n = 45, response rate 74%). They completed a supplemental survey about their family’s experiences during the pandemic and their child’s self-regulation. Respondents and non-respondents were similar with respect to parent and child age, gender, race, number of children in the household, and parent mental health diagnoses.

Measures

Child Self-Regulation.

Before and during the pandemic, parents completed the Parent Observation of Child Adaptation (POCA).²⁰ The POCA assesses parents’ perceptions of child adaptation in the family context over the last three weeks including the frequency of cognitive and behavioral inhibition, attention, task engagement, and hyperactivity using a 6-point scale (1 = never to 6 = almost always), with higher scores indicating better self-regulation. Sample items include how often the child completes their work, concentrates, and waits for their turn. The POCA has fair to good internal consistency (α range = .54 - .85).²¹

Coronavirus-Related Disruptions.

The Coronavirus Impact Scale²² was used to rate the severity of pandemic impacts on family stress/dynamics, life/routine changes, food quantity/quality, and access to behavioral/physical health services using a 4-point Likert scale (0 = no change to 3 = severe change). Items were dichotomized (0 vs. 1-3) and summed (range = 0-9). The Coronavirus Impact Scale has good internal consistency (α range = .64 - .81).^22,23

Parenting Stress During Pandemic.

During the pandemic, parents completed the Parenting Stress Index (PSI-SF 4^th edition e.g., I feel trapped by responsibilities as a parent)²⁴ using a 5-point Likert scale (1 = strongly disagree to 5 = strongly agree). Items that were no longer relevant during times of social distancing (e.g., “when I go to a party, I usually expect not to enjoy myself”) and those not related to parenting directly (e.g., “I am unhappy with the last purchase of clothing I made for myself”) were omitted. The remaining 10 items were summed (range 10-50, α range = .88 - .91).

Covariates.

Child characteristics included gender, race (Black/African American vs. other), age, school participation (in school vs. not in school) and parent-reported diagnosis of attention deficit hyperactivity disorder (ADHD), collected pre-pandemic. Parent covariates included gender, race, and history of depression or anxiety diagnosis. Diagnoses (any diagnosis between 2006-2013) were reported at an earlier wave of parent data collection in 2013.

Statistical Analysis

Child behavior before and during the pandemic was compared using paired t-tests. Associations between child (gender, race, age, grade, ADHD diagnosis) and parent (gender, race, history of anxiety or depression) characteristics, and severity of Coronavirus impact on the family and children’s behavior were explored using Pearson correlation coefficients, paired t-tests and repeated measures ANOVA (RMANOVA). Covariates were evaluated for confounding and/or moderation.

RESULTS

Seventy-six percent (n = 34) of parents were mothers and twenty-four percent were fathers. On average, children were 7.5 years old (SD = 2.6) and 80% were Black/African American. 67% of families experienced 4 or more pandemic-related disruptions. Almost all children (95.2%) were attending school virtually and 76.2% of parents reported providing educational support for their child’s remote lessons (Table 1).

Table 1.

Parent Reported Sociodemographic Characteristics and COVID-19-Related Disruptions (n=45)

Variable	n	Mean (SD) or %
Mothers (%)	34	75.6
Parent Race (% Black)	39	86.7
Married (%)	12	26.7
Parent History of Depression (% yes)	6	13.3
Parent History of Anxiety (% yes)	2	4.4
Medicaid or Publicly Insured (%)	29	64.4
Child Age (years)	45	7.5 (2.6)
Female Child (%)	23	51.1
Child Race (% Black)	36	80.0
Child ADHD Diagnosis (% yes)	7	15.6
School Type (%)
Daycare, Pre-K or Kindergarten	15	33.3
Elementary (Grades 1-6)	29	64.5
Middle School (Grades 7-8)	1	2.2
Switched to Online Classes (%)	40	95.2
Coronavirus-Related Disruptions Endorsed
Family Routines	42	93.3
Food Access	24	53.3
Food Quantity	14	31.1
Food Quality	20	44.4
Medical Care	26	57.8
Mental Health Visits	13	28.9
Access to Social Support	33	73.3
Stress Related to Pandemic	34	75.6
Stress and Discord in Family	21	46.7
Number of Coronavirus-Related Disruptions
0 Disruptions	2	4.4
1-3 Disruptions	13	28.9
4-5 Disruptions	10	22.2
6+ Disruptions	21	44.4

Paired t-tests showed significant within-child changes in self-regulation including poorer concentration, attention, task engagement and persistence, and greater impulsivity during the pandemic compared to pre-pandemic (Table 2). Sociodemographic characteristics were unrelated to these behaviors and/or changes in these behaviors (ps > .10). RMANOVA indicated main effects of a history of parental anxiety on children’s overall ability to concentrate, pay attention and eagerness to learn (see Table 3). Compared to children whose parent did not have a history of anxiety, children whose parent did (n = 2) were rated as having lower ability to concentrate (M (SD) = 4.01 (1.18) vs. 2.50 (.58), t (44) = 2.54, p = .01), pay attention (M (SD) = 4.16 (1.07) vs. 2.75 (0.5), t (44) = 2.61, p = .01) and eagerness to learn (M (SD) = 2.75 (.96) vs. 4.54 (1.30), t (44) = 2.73, p = .01). Parental history of depression was unrelated to self-regulatory behaviors. Parenting stress during the pandemic (M (SD) = 21.3 (8.9), range = 10 – 43) was inversely related to children’s concentration (r = −.40, p = .007), attention (r = −.45, p = .002), learning up to their ability (r = −.34, p = .03), eagerness to learn (r = −.49, p < .001), ability to work hard (r = −.52, p < .001) and wait their turn (r = −.36, p = .01). No interactions were detected between parent mental health history/pandemic parenting stress and changes in children’s behaviors pre-pandemic to during pandemic.

Table 2.

Children’s Attention and Behavior-Related Difficulties as Reported by Parents on the POCA (n = 45)

	Pre-Pandemic	During COVID-19 Pandemic
Variable	Mean (SD)	Mean (SD)	t a	p-value
Concentratesb	4.17 (1.2)	3.70 (1.1)	2.13	.04
Poor Effort	2.38 (.94)	2.53 (1.1)	−1.0	.32
Pays Attentionb	4.36 (1.2)	3.84 (.98)	2.69	.01
Learns up to Abilityb	5.09 (1.1)	4.56 (1.2)	2.70	.01
Easily Distracted	3.20 (1.3)	3.20 (1.2)	.00	1.00
Eager to Learnb	4.73 (1.3)	4.20 (1.4)	3.2	.003
Mind Wanders	2.89 (1.4)	2.89 (1.4)	.00	1.00
Works Hardb	4.82 (1.1)	4.18 (1.2)	3.02	.004
Stays on Taskb	3.98 (1.4)	3.76 (1.2)	.97	.34
Cannot Sit Still	3.00 (1.3)	3.11 (1.3)	−.49	.62
Runs Around	3.11 (1.4)	2.76 (1.6)	1.43	.16
On the Go	2.80 (1.6)	2.73 (1.4)	.24	.81
Waits for Turnb	4.43 (1.3)	3.73 (1.1)	3.05	.004

^adf = 44; paired t-tests used to examine differences in self-regulation pre-pandemic to during pandemic.

^b.lower scores on these items indicate worse behaviors. The question stem for the POCA items is: In the last three weeks, would you say your child never or almost never, sometimes, often, or almost always…

Table 3.

Repeated Measures ANOVA Results and Covariate Associations for Changes in Children’s Attention and Behavior-related Difficulties

	Time		Main Effect			Interaction
Outcome Variable	F (dfa, dfb)	p	Covariate	F (dfa, dfb)	p	Time x Covariate	F (dfa, dfb)	p
Concentrates	4.54 (1, 44)	.04	Parent Anxiety	5.56 (1, 43)	.02	Time x Parent Anxiety	.21 (1, 43)	.65
			Parent Stress	.16 (1, 42)	.69	Time x Parent Stress	.98 (1, 42)	.33
			Child ADHD	07 (1, 43)	.79	Time x Child ADHD	.83 (1, 43)	.37
			Pandemic disruptions	.05 (1, 43)	.82	Time x Pandemic disruptions	.18 (1, 43)	.67
Pays Attention	7.26 (1, 44)	.01	Parent Anxiety	5.76 (1, 43)	.02	Time x Parent Anxiety	.00 (1, 43)	.99
			Parent Stress	.24 (1, 42)	.63	Time x Parent Stress	.20 (1, 42)	.64
			Child ADHD	.33 (1, 43)	.57	Time x Child ADHD	4.92 (1, 43)	.03
			Pandemic disruptions	.85 (1, 43)	.36	Time x Pandemic disruptions	.83 (1, 43)	.37
Learns up to Ability	7.30 (1, 44)	.01	Parent Anxiety	1.71 (1, 43)	.20	Time x Parent Anxiety	.33 (1, 43)	.57
			Parent Stress	1.09 (1, 42)	.30	Time x Parent Stress	.29 (1, 42)	.59
			Child ADHD	1.02 (1, 43)	.32	Time x Child ADHD	15 (1, 43)	.70
			Pandemic disruptions	.84 (1, 43)	.36	Time x Pandemic disruptions	2.10 (1, 43)	.15
Eager to Learn	10.20 (1, 44)	.003	Parent Anxiety	4.73 (1, 43)	.03	Time x Parent Anxiety	1.81 (1, 43)	.18
			Parent Stress	1.09 (1, 42)	.30	Time x Parent Stress	.29 (1, 42)	.59
			Child ADHD	.07 (1, 43)	.79	Time x Child ADHD	1.01 (1, 43)	.32
			Pandemic disruptions	.44 (1, 43)	.51	Time x Pandemic disruptions	.71 (1, 43)	.40
Works Hard	9.10 (1, 43)	.004	Parent Anxiety	1.27 (1, 43)	.26	Time x Parent Anxiety	.39 (1, 42)	.24
			Parent Stress	.16 (1, 41)	.69	Time x Parent Stress	4.00 (1, 41)	.52
			Child ADHD	.05 (1, 43)	.83	Time x Child ADHD	1.75 (1, 43)	.20
			Pandemic disruptions	.25 (1, 43)	.62	Time x Pandemic disruptions	1.61 (1, 43)	.21
Waits for Turn	9.28 (1, 43)	.004	Parent Anxiety	1.84 (1, 43)	.18	Time x Parent Anxiety	0.56 (1, 42)	.46
			Parent Stress	2.58 (1, 42)	.11	Time x Parent Stress	4.01 (1, 41)	.52
			Child ADHD	.36 (1, 43)	.55	Time x Child ADHD	1.48 (1, 42)	.23
			Pandemic disruptions	5.06 (1, 43)	.03	Time x Pandemic disruptions	5.28 (1, 42)	.03

Note. df_a indicates degrees of freedom numerator. df_b indicates degrees of freedom denominator. Separate repeated measures ANOVAs were run to examine impact of each covariate (i.e., parent anxiety) on child behaviors that changed pre-pandemic to during pandemic.

Child ADHD diagnosis was significantly related to changes in ability to pay attention (F (1, 43) = 4.92, p = .032). Children without ADHD had a decrease in their ability to pay attention from pre-pandemic to pandemic ratings (M (SD) = 4.47 (1.16) vs. 3.79 (.93), t (37) = 3.62, p < .001) while children with ADHD (n = 7) did not have a significant change in ability to pay attention (M (SD) = 3.71 (.95) vs. 4.14 (1.21), t (6) = −.75, p = .48). There were no differences in pre-pandemic ability to pay attention comparing children with and without ADHD (M (SD) = 3.71 (.95) vs. 4.47 (1.16), t (43) = 1.63, p = .11).

Total number of Coronavirus-related family disruptions was unrelated to child and parent characteristics, child ADHD and parent mental health, but correlated with higher parenting stress (r = .45, p < .001). Children from families reporting more disruptions were less able to wait their turn during the pandemic (r = −.48, p < .001) and at a trend level, were less able pay attention during the pandemic (r = −.29, p = .055); no other associations were detected with child self-regulatory behaviors during the pandemic. Families were categorized into households having four or more pandemic-related disruptions (67.4%) versus fewer than four (32.6%). There was a significant main effect of Coronavirus-related disruptions on children’s ability to wait their turn and changes in ability to wait their turn (Table 3). Children in households that experienced 4 or more disruptions had a significant decrease in ability to wait their turn comparing pre-pandemic to pandemic ratings (M (SD) = 4.41 (1.21) vs. 3.34 (.93), t (28) = 3.93, p < .001); there was no change among children in households with fewer than 4 disruptions (M (SD) = 4.46 (1.41) vs. 4.46 (.91)). There were no differences in children’s pre-pandemic ability to wait their turn by pandemic-related disruption group (M (SD) = 4.46 (1.4) vs. 4.41 (1.2), t (42) = .13, p = .89).

DISCUSSION

Using prospective measures of child attention and self-regulatory behavior prior to and during the COVID-19 pandemic, we highlight the disruptive impact of the COVID-19 pandemic on families and pandemic-related decrements in child attention, task persistence, and task engagement in tandem with increases in impulsivity. More than two-thirds of households reported four or more disruptions in routines, social supports, family dynamics, and access to behavioral and physical health services attributable to the pandemic. The pandemic may impact child development by increasing exposure to chronic stressors as well as reducing critical buffers.

Children from households that experienced more disruptions were more likely to exhibit increases in impulsive behaviors during the pandemic compared to their pre-pandemic baseline. There were no pre-pandemic differences in baseline impulsivity between households that eventually experienced a higher number of pandemic-related disruptions compared to those who did not, suggesting that the pandemic-related impact on children’s impulsivity is not solely a function of baseline differences in self-regulation. Notably, family disruptions were associated only with children’s impulsivity. It is possible that disruptions may have also impacted internalizing or mood-related symptoms, which we did not measure.

Interestingly, children without a pre-pandemic diagnosis of ADHD showed decreases in their ability to pay attention pre-pandemic to pandemic, whereas children with ADHD had no notable changes. It is possible that children with ADHD already had some family, classroom, and/or medication supports in place that helped buffer them or that we were unable to detect these changes with our small sample of children with ADHD (n = 7). Children without ADHD could have had other mood-related or internalizing symptoms (i.e., depression, anxiety) that affected their attention as well.

Attention and self-regulatory behaviors are of particular importance as children transition back to in-person school following remote learning. Prior work has linked exposure to stressful life events and early life adversities to increased risk of ADHD and related symptomology.^25-27 As children return to the classroom, adapt to new routines and expectations, and navigate social relationships and interactions after many months, anticipating these challenges can guide student supports. The fact that many, if not most, children may present with some level of pandemic-induced self-regulatory challenge requires proactive planning.

Study results suggest that parent mental health and distress during the pandemic may impact children’s self-regulatory behaviors. Pre-pandemic, children whose parent had a history of anxiety had more difficulties with concentration, paying attention and eagerness to learn than children whose parent did not. Parents with higher levels of parenting stress during the pandemic also reported their children as having lower concentration, attention, task engagement/persistence and higher impulsivity during the pandemic only. Impacts of parent mental health on children’s emotional and behavioral difficulties are well documented,²⁸ often attributed to shared genetic factors,²⁹ parental distress inflating reports of child difficulties,³⁰ and/or variation in parent-child interactions.³¹ In our study, parental mental health and parenting distress during the pandemic were unrelated to pandemic-related changes in children’s self-regulation, however. This could be due to the low prevalence of diagnosed depression and anxiety disorders in the sample and/or insufficient power to detect moderating effects.

Overall, we observed modest changes in children’s self-regulatory behaviors and attention providing preliminary evidence for the impact of the COVID-19 pandemic on children’s emotional and behavioral well-being. Parent perceptions of child well-being and changes in behavior are one critical way children are identified as needing mental health and educational services.³² As such, parents’ perceptions of changes in their child’s well-being may result in additional requests for educational services at school, and/or parents seeking clinical mental health/ADHD evaluations and referrals.

This study leveraged a subgroup of participants who completed study activities before the pandemic. The small sample likely reduced our ability to detect some associations, particularly those between child self-regulation and parent mental health/distress and children’s ADHD diagnosis. We also had limited data on children’s comorbidities (i.e., depression or anxiety). Children’s self-regulation was measured using a non-diagnostic assessment focused on externalizing behaviors, therefore, we may have missed changes in internalizing behaviors and mood. Additionally, children’s behaviors were assessed early in the pandemic and could have shifted over the course of pandemic. Most children in this study were not in in-person school, thus the results of this study may not generalize to children who remained in in-person school. Moreover, this study over-represents socioeconomically marginalized and Black families who have been disproportionately affected by the pandemic.

CONCLUSION

The COVID-19 pandemic has transformed family life, with impacts of the pandemic disproportionately affecting families of color and those living in economic precarity.⁴ The results of this study highlight the prevalence of pandemic-related family disruptions. Children showed modest decreases in self-regulation compared to their pre-pandemic functioning. Although we did not find evidence of broad or severe impacts, we note that decrements in children’s self-regulation may be an early signal for worsening behavioral and emotional problems. Children whose families have been disproportionately impacted by the pandemic may need focused support at home and at school in the post-pandemic period to avoid widening pre-pandemic health and educational disparities.