Impact of COVID‐19 on Children's Attention Deficit Hyperactivity Disorder Symptomology, Daily Life, and Problem Behavior During Virtual Learning

ABSTRACT

To explore the impact of COVID‐19 on daily life and problem behavior during virtual learning, we created and administered a survey to 64 school‐aged children (in 2019, M = 9.84 years; SD = 0.55 years). Results indicated significant increases in hyperactivity (t = −2.259; p = .027) and inattention (t = −2.811; p = .007) from 2019 to 2020. Decreases in sleep were associated with increases in hyperactivity (B = −0.27; p = .04); increases in time exercising were associated with smaller increases in inattention (B = −0.34, p = .01); and higher levels of parent stress, specifically related to virtual learning, were associated with increases in child inattention (B = 0.57, p = .01). Furthermore, hyperactivity predicted problem behavior during virtual learning (B = 0.31, p = .03).

LAY ABSTRACT

To explore the impact of COVID‐19 on daily life and behavior during virtual learning, we created and administered a survey to 64 school‐aged children. Results indicated significant increases in hyperactivity and inattention from 2019 to 2020. Some factors protected against increases in attention deficit hyperactivity disorder symptomology, including adequate sleep and exercise. However, higher levels of parent stress specifically related to virtual learning were associated with increases in child inattention. Lastly, hyperactivity predicted problem behavior during virtual learning.

With over 78 million reported cases in the United States, COVID‐19 has impacted lives in a myriad of ways. Health concerns were often primary; however, the pandemic also caused changes to daily lifestyle habits like sleep, exercise, screen time, and behavior (Rosen et al., 2021). One clear change was the shift to virtual learning and other alterations to educational programming. With 94% of learners worldwide affected, the COVID‐19 pandemic has been the largest disruption of education in history (United Nations, 2020). In the United States, 93% of eligible households reported having some form of distance learning for their school‐aged children in the initial months of the pandemic (McElrath, 2020).

Virtual or distance learning has existed for decades; however, it was primarily used in higher education and completed both synchronously and asynchronously (Hay, Hodgkinson, Peltier, & Drago, 2004). Given its restricted use, the literature about virtual learning prior to the pandemic is limited and does not yet cover the vast range of K‐12 students who participated in COVID‐19‐related virtual learning. Even less is known about how students engaged in virtual learning and what behavioral problems may have impeded instruction. Only a few studies prior to the pandemic have investigated student behavior during virtual learning, and most have been conducted with adults (Bernard et al., 2004) to determine student engagement and virtual learning efficacy. For example, Regmi and Jones (2020) studied virtual learning with students in the medical field and reported poor engagement, lack of self‐discipline, and poor interactions between learners and facilitators. However, it is unknown how virtual disengagement presents for younger populations, particularly those with disabilities who are at high risk for virtual learning failure (Lamb et al., 2020). Such understanding is important in the context of a recent nationally representative survey of 3,338 households which revealed that more than half of parents reported that a child in their family struggled with distance learning. Importantly, those parents reported experiencing higher levels of stress and anxiety (Davis, Grooms, Ortega, Rubalcaba, & Vargas, 2021). A key consideration in the context of difficulty with virtual learning is the degree to which a child may exhibit attention deficit hyperactivity disorder (ADHD) symptomology. It is well established that children with elevated ADHD symptoms struggle with behavior during in‐person school (DuPaul & Stoner, 2014), thus highlighting the need to understand how ADHD symptomology relates to the virtual learning experiences during COVID‐19.

ADHD is the most common behavioral condition in children, with a prevalence of 9.4% in the United States (Wolraich et al., 2019). The ADHD diagnosis has three presentations: inattentive, hyperactive, and combined (Epstein & Loren, 2013; Willcutt et al., 2012). While the inattentive presentation is marked by difficulty with organization, sustaining attention, and mental effort, the hyperactive presentation is marked by excessive movement and difficulty inhibiting responses (Children and Adults with Attention‐Deficit/Hyperactivity Disorder, 2020). It is well documented that ADHD has adverse effects on children's lives including poor academic outcomes and difficulties with social, emotional, and adaptive functioning at school and home (Arnold, Hodgkins, Kahle, Madhoo, & Kewley, 2020; Colomer, Berenguer, Roselló, Baixauli, & Miranda, 2017; Wehmeier, Schacht, & Barkley, 2010). While medication is an effective ADHD treatment, some families seek to modify ADHD symptoms without medication or to use behavioral treatments like physical activity or sleep hygiene supports along with medication (Nikles et al., 2020; Schatz et al., 2015). Indeed, meta‐analyses report positive effects of exercise and sleep hygiene interventions on behavioral and emotional ADHD symptomology (Cornelius, Fedewa, & Ahn, 2017; Neudecker, Mewes, Reimers, & Woll, 2019; Nikles et al., 2020).

Globally, researchers saw the impact of the COVID‐19 pandemic on the symptomology of the pediatric ADHD population. Outside of the United States, studies report pandemic related increases in hyperactivity (Wendel et al., 2020), and hyperactivity and anxiety (Yousef, Sehlo, & Mohamed, 2021) of children ranging from four to 17 years of age, based on parent responses on behavior rating scales. In the United States, Breaux et al. (2021) found that adolescents (15–17‐year‐olds) with ADHD were more likely to experience increases in hyperactivity, inattention, and oppositional behaviors during the pandemic based on parent and self‐reports on behavior rating scales. Because ADHD symptomology is known to impact social, academic, and adaptive functioning during typical circumstances, it follows that ADHD symptomology would also have an impact on behavior during virtual learning during the pandemic. Recent studies from outside of the U.S. report that during the pandemic, children with ADHD ranging from four to 15 years old had a harder time with virtual learning than their typically developing peers based on parent surveys, interviews, and behavior rating scales (Ellala, AL‐Tkhayneh, & Abu‐Attiyeh, 2021; Tessarollo et al., 2021). Specifically, Tessarollo et al. (2021) found that reports of independence during virtual learning was significantly lower for parents of children with ADHD compared to ratings of typically developing children. While these studies either investigated changes in ADHD symptomology or difficulties with virtual learning for children with ADHD during the COVID‐19 pandemic, no studies have examined these topics with information prior to and during the pandemic within the same report. Critically, how ADHD symptomology predicts parental reports of problem behavior during virtual learning needs to be examined. As such, the purpose of this exploratory study was twofold: (1) to report on the impact of the pandemic on children's virtual learning and behavior, as well as changes in their stress and activity levels and (2) how children's ADHD symptomology related to parental reports of families' experiences during the pandemic. Specifically, we aimed to answer the following research questions:

• How did COVID‐19 affect the activities, behavior, and families' daily life?

• Were behavioral changes (indexed by ADHD symptomology) observed during the pandemic, and, if so, what factor(s) explained these changes?

• How did ADHD symptomology specifically affect problem behavior during virtual learning?

METHOD

Participants

The study was conducted in accordance with [Vanderbilt University]'s institutional review board and families gave their informed consent prior to participating in the study. This study asked children and their caregivers to complete a battery of behavioral assessments and surveys annually from the end of first grade to the end of fourth grade. Participants were recruited from previous studies, local schools, clinics, and doctors' offices in and around the [Nashville] area. Children were included in the study if they were Magnetic Resonance Imaging compatible, native speakers of American English, and had normal hearing, normal or corrected‐to‐normal vision, and no known history of neurological problems. Children were excluded if they had a developmental disability, autism spectrum disorder, or significant psychiatric disorders such as schizophrenia or bipolar disorder; however, ADHD diagnosis and medications for ADHD were allowed. Based on family reports in 2020, eight (12.5%) participants were taking medication for ADHD.

Sixty‐four families completed a COVID‐19 survey as part of their involvement in a larger neuroimaging longitudinal study. In 2019, children in this sample were on average 9.84 years old (SD = 0.55 years, min = 8.85 years, max = 10.98 years). See Table 1 for ages of participants in 2020 and 2021. This sample includes 26 (40.63%) males. The average Hollingshead composite couple status score of this sample is 4.48/5, which indicates that the majority of families in this sample are upper‐middle class (score = 4) or upper class (score = 5). The average Hollingshead parent educational score, which is the index of SES used in the models, is 6.39/7, which indicates that the majority of parents in the sample have graduated college (score = 6) and many have completed graduate/professional training (score = 7). Based on pre‐pandemic 2019 parent‐report SWAN scores, two unique participants (3.13% of the sample) presented with inattentive ADHD, two unique participants (3.13% of the sample) presented with hyperactive/impulsive ADHD, and four unique participants (6.25% of the sample) presented with combined inattentive and hyperactive/impulsive ADHD. There was an increase in ADHD diagnoses from prior to the pandemic to during the pandemic. Based on 2020 parent‐report SWAN scores, seven unique participants (10.94%) presented with inattentive ADHD, four unique participants (6.25%) presented with hyperactive/impulsive ADHD and four unique participants (6.25%) presented with combined inattentive and hyperactive/impulsive ADHD. See Table 2 for more demographic information on the sample, including race.

Table 1.

Description of the Sample

Measurement	Year	N	Mean	SD	Minimum	Maximum
Age	2019	64	9.84	0.55	8.85	10.98
Age	2020	64	10.85	0.54	9.82	11.91
Age	2021	64	11.86	0.54	10.80	12.96
SES	2016	64	6.39	0.73	4	7
Hyperactivity	2019	64	51.31	11.03	40	85
Hyperactivity	2020	64	54.22	14.52	40	90
Inattention	2019	64	50.86	9.1	40	80
Inattention	2020	64	53.09	10.98	40	90
WJ‐IV Basic Reading	2019	60	109.15	11.9	86	136

Note. SES = socioeconomic status, as measured by the Hollingshead parent education score. Hyperactivity and inattention are measured with the Conners‐3; WJ‐IV = Woodcock Johnson‐IV.

Table 2.

Demographics of the Sample

Race	Number	Percentage
Asian	1	1.56
Black/African American	3	4.69
White	52	81.25
More than one race	7	10.94
Not reported	1	1.56
Total	64	100

Measures

Children completed subtests of the Woodcock‐Johnson IV (WJ‐IV; Schrank, Mather, & McGrew, 2014), which is an assessment that measures academic achievement in terms of language, reading, writing, and math skills. Given the known linkages between ADHD symptoms and reading (Arnold et al., 2020; Colomer et al., 2017), the Basic Reading score, which is a composite score of the Letter‐Word Identification (ability to recognize real words) and Word Attack (ability to decode nonwords) subtests, was used to control for differences in pre‐pandemic academic achievement. Reliability for this instrument is good (test–retest reliability is 0.92 for 10 year olds: McGrew, LaForte, & Schrank, 2014).

Caregivers completed batteries of questionnaires about their children's behaviors and their overall family lives. These batteries were completed at the beginning of the study (2016), before the pandemic (2019), during the pandemic (2020), and as the pandemic slowed (2021). Socioeconomic status (SES) was measured using the Hollingshead Four‐Factor Index of Socioeconomic Status. This instrument measures SES using four factors: marital status, employment status, educational attainment, and occupational prestige (Hollingshead, 1975). For ease of understanding, overall sample SES was reported with an overall composite score. However, only parent educational score specifically was used in the models, due to its known stability as an SES index (Davis‐Kean, 2005). Caregivers completed the Conners 3rd Edition (Conners‐3; Conners, 2008) to measure ADHD symptomology, specifically parsing hyperactive and inattentive behaviors, in the summers of 2019 and 2020. The Conners‐3 is a comprehensive evaluation of student behavior and has links to ADHD as defined by the DSM‐IV‐TR. We used the long parent form, which is 110 items and takes parents about 20 min to complete. The parent scale has an internal consistency Cronbach's alpha of 0.91 and test–retest reliability 0.85 (Gallant, 2008; Gallant et al., 2007). Caregivers completed the validated SWAN (SWAN; Swanson et al., 2001) to determine ADHD diagnosis. The SWAN contains 18 items on which parents rate their children as compared to their peers on skills including focusing attention, controlling anxiety, and inhibiting impulsive behavior. The parent‐report version of the SWAN is highly correlated (r = 0.75, p < .01 for inattention; r = 0.82, p < .01 for hyperactivity/impulsivity) with the Conners' continuous performance test (Cornish et al., 2005), which is considered a gold standard measure used to verify ADHD diagnoses (Kollins, Sparrow, & Conners, 2010). Caregivers also completed an in‐house survey designed to gather information about changes in stress, daily activities, sleep, and children's virtual learning due to the COVID‐19 pandemic. More information regarding the creation of the COVID‐19 survey is in Appendix A.

Analysis

We created histograms to depict caregivers' responses to the in‐house COVID‐19 survey and used the “stats” package in R (version 4.0.2) to perform paired sample t tests and run linear regressions to explore relations amongst the COVID‐19 survey responses and parent‐reported behavioral measures. Prior to entering variables into the regression models, data were centered and scaled. We created difference scores by subtracting 2020 Conners‐3 ratings from 2019 Conners‐3 ratings and explored relations between these difference scores and Child Activities (items 17–21; Appendix B) and Stress (items 22–25; Appendix B) in the COVID‐19 survey. For the regression models exploring problem behavior during virtual learning, only the 46 families that reported participating in virtual learning were included.

RESULTS

Table 2 contains descriptive information about the sample and measures for the 64 participants.

How COVID‐19 Affected the Activities, Behavior, and Families' Daily Life

To determine how COVID‐19 affected the activities, schooling, behavior, and daily life of families and their children, we reviewed the histograms of caregivers' responses to the in‐house COVID‐19 survey (see Appendix C, Figures C1, C2, C3, C4, C5, C6, C7, C8, C9, C10, C11, C12, C13, C14, C15, C16, C17, C18, C19, C20, C21, C22, C23, C24, C25). Highlights include that most children did not have confirmed cases of COVID‐19; most children participated in virtual learning; and virtual learning was somewhat worse than in‐person learning. Regarding behavior, most parents reported that their children's behavior during the pandemic was neither difficult nor easy to manage; their children's behavior specifically related to virtual learning was very easy to manage; their children's engagement during virtual learning was positive; and, their children did not engage in problem behavior during or before virtual learning. In terms of activities, parents generally reported that their children's daily screen time (unrelated to school) increased by 1–3 hr during the pandemic; that their children spent about the same amount of time as they did before the pandemic playing sports and sleeping; and that their children spent about the same or a bit less time socializing as they did before the pandemic. Regarding stress, parents reported that their stress levels had slightly increased due to their children's participation in virtual learning and due to the pandemic in general, and that their child's stress levels were about the same or slightly increased due to the pandemic.

ADHD Symptomology Increases and Explanations from COVID‐19 Survey

To test for behavioral changes (indexed by ADHD symptoms), we used paired sample t tests to compare pre‐ (2019) versus during (2020) pandemic parent‐reported behavior. Significant increases in both hyperactivity (t = −2.259; p = .027) and inattention (t = −2.811; p = .007) were observed from 2019 to 2020, meaning that parents reported a worsening of their children's ADHD symptomology. We note that it is possible that if parents were stressed during the pandemic, they might rate their children's hyperactivity and inattention as worsening. However, neither the relation between parent‐reported parent stress and parent‐reported child hyperactivity (B = 0.30; p = .181) or parent‐reported child inattention (B = 0.23, p = .313) were significant, suggesting that hyperactivity and inattentive increases were likely true and not artifacts of parental stress.

Linear regression models were used to explore potential reasons behind worsening ADHD symptomology. We postulated that COVID‐19 questionnaire items related to Child Activities (items 17–21) and Stress (items 22–25) could be responsible; therefore, we explored items in each of those two groups as potential predictors of hyperactivity and inattention changes, while controlling for pre‐pandemic ADHD symptomology. Two items from the Child Activities section were significantly related to increases in ADHD symptomology: (1) decreases in sleep during the pandemic were associated with increases in hyperactivity (B = −0.27; p = .0486); and (2) increases in time spent exercising or playing sports during the pandemic were associated with smaller increases in inattention (B = −0.34, p = .0177). One item from the Stress section was significantly related to increases in ADHD symptomology: (1) higher levels of parent stress specifically related to virtual learning during the pandemic were associated with increases in child inattention (B = 0.57, p = .0123). Other items from the Child Activities section of the survey, such as screentime and socialization, and other items from the Stress section of the survey, such as child stress, were not significantly related to ADHD symptomology.

Effects of ADHD Symptomology on Problem Behavior During Virtual Learning

Finally, we used two linear regression models to explore whether ADHD symptomology was linked to problem behavior observed during virtual learning while controlling for SES and basic reading skills. Results revealed that pre‐pandemic hyperactivity was associated with problem behavior during virtual learning (B = 0.35; p = .01) (see Model 1 in Table 3). However, pre‐pandemic inattention was not associated with problem behavior during virtual learning (B = 0.10; p = .51) (see Model 2 in Table 3).

Table 3.

Regression Results Predicting Child Problem Behavior Before or During Virtual Learning

	Estimate	Std Error	p	R 2
Model 1
Intercept	−0.01017	0.14295	.9436	0.2034
WJ‐IV Basic Reading	0.20481	0.14496	.1654
SES	0.08771	0.13961	.5334
2019 Hyperactivity	0.35891	0.13890	.0135
Model 2
Intercept	0.002048	0.153532	.989	0.0805
WJ‐IV Basic Reading	0.242436	0.154991	.126
SES	0.121988	0.149761	.420
2019 Inattention	0.100880	0.152686	.513

Note. SES = socioeconomic status, as measured by the Hollingshead parent education score. Model 1 uses hyperactivity to predict problem behavior during virtual learning. Model 2 uses inattention to predict problem behavior during virtual learning. Hyperactivity and Inattention are measured with the Conners‐3; WJ‐IV = Woodcock Johnson‐IV.

Hyperactivity is bolded because it is the only significant predictor.

DISCUSSION

The current study, while exploratory, provides intriguing findings regarding families' experiences during the COVID‐19 pandemic and the impacts that it had on children's behaviors. While most families reported that their children handled virtual learning relatively well, they also indicated that virtual learning was not as good as in‐person learning, and that parents and children were slightly more stressed. However, in addition to these broad questions about the impact of COVID‐19 on families, one key interest was in how elementary school students' ADHD symptomology might be linked to (and changed by) behaviors and virtual learning during the pandemic; prior studies have only examined this issue in adolescents (Becker et al., 2020). Consistent with previous findings, we observed significant increases in children's hyperactivity and inattention during the pandemic, and these findings did not appear to be artifacts of parent stress (Breaux et al., 2021; Wendel et al., 2020).

We next sought to better understand these increases in ADHD symptomology during the pandemic by determining if reported lifestyle changes (specifically stress and child activities) contributed to or alleviated the worsening of ADHD symptomology. Our most robust finding was that parent stress related to virtual learning was associated with an increase in child inattention. Perhaps parents noticed their child's inattention at home, particularly during virtual learning, which in turn, created a stress response in parents concerning virtual learning. Rosen et al. (2021) found several factors that protected against increases in externalizing and internalizing behavior for 7–15‐year‐olds, including getting adequate sleep and outdoor time. It is well‐documented that children with ADHD experience poorer quality and/or quantity of sleep, which in turn links to poorer academic performance and worse ADHD symptomology (e.g., Çetin et al., 2020; Hansen, Skirbekk, Oerbeck, Wentzel‐Larsen, & Kristensen, 2013). Our results showed that decreases in sleep were associated with increases in hyperactivity, which suggests that more sleep (or maintaining healthy sleep quantity and quality) may reduce hyperactivity, or at least prevent increases in hyperactivity. Moreover, there is growing literature that exercise has an acute and possibly long‐term effect on ADHD symptomology (Cornelius et al., 2017; Neudecker et al., 2019), which aligns with findings that children who exercised more or played more sports had a smaller increase in inattention symptoms during the pandemic. In terms of linkages between ADHD symptoms and virtual learning, we found that hyperactivity, but not inattention, was associated with problem behavior before and during virtual learning. These align with findings reporting that children with ADHD experience more difficulties with virtual learning as compared to their peers without ADHD (Becker et al., 2020).

Limitations

Overall, the present exploratory findings provide some understanding of how families experienced the pandemic and what impact the pandemic had on child behavior. However, the preliminary and exploratory nature of the study leads to two major limitations. First, we conducted multiple statistical tests to explore the origin of increases in ADHD symptomology without using any statistical corrections. This choice was made because our sample size was small (N = 64), which restricted our power for correcting for multiple comparisons. There is a paucity of theory currently available for understanding the effects of COVID‐19, thus we felt we needed to explore all potential explanations for increases in ADHD symptomology that were made available from our COVID‐19 survey. Second, we used a lab‐created survey to assess the impact of COVID‐19. We were unable to report reliability or validity information on the survey because the survey assesses a variety of changes to lifestyle during the pandemic (i.e., is not a single construct) and because there is no gold standard survey (or any validated published surveys) that assesses this information.

Future Directions

Future studies will need to consider more rigorous statistical tests and larger sample sizes. Moreover, future research should examine in greater depth how both hyperactivity and inattention impact academic success during virtual learning, as well as the role of sports participation on inattention to determine if there is an optimal type, frequency or duration that predicts decreased ADHD symptomology and specifically inattention. Last, as we move beyond the pandemic, we need to understand which behavioral strategies might support students with hyperactivity during virtual learning, especially because virtual learning continues to be an option for schooling, particularly for replacing previously missed days such as snow days (Dover, 2014). Therefore, future studies should consider what resources/services reduce stress for parents or caregivers supervising virtual learning of children with inattentive behavior. Emerging literature is investigating online interventions for college students with ADHD, including using self‐monitoring daily checklists, family contracts, and frequent check‐in meetings (Oddo, Garner, Novick, Meinzer, & Chronis‐Tuscano, 2021). Such strategies may prove fruitful as the world moves towards integrating at least some continued virtual learning (and work) within our lives.

Conflict of interest

The authors have stated explicitly that there are no conflicts of interest in connection with this article.

Appendix A.

COVID‐19 Survey

We administered a lab‐created survey to caregivers that measured families' experiences and changes in lifestyle, as a result of the COVID‐19 pandemic. The survey consisted of 25 questions that were inspired by items found on recently published questionnaires (Aucejo, French, Araya, & Zafar, 2020; Oliver, Barber, Roomp, & Roomp, 2020; Salon et al., 2021; Schlenz, Schmidt, Wöstmann, Krämer, & Schulz‐Weidner, 2020) and original items that asked questions directly related to children's virtual learning experiences. Most items used Likert scale responses; a few items were categorical. To the authors' knowledge, there are no validated surveys that provide information about how families' lives changed as a result of COVID‐19 that could have been used in place of this in‐house survey. Furthermore, since the survey is not assessing a single construct and was only administered once to one sample, measures of reliability are unavailable.

Appendix B.

COVID‐19 Impact Survey

Family

1. How many people live in your home (including you)?

   1. 2
   2. 3
   3. 4
   4. 5 or more
2. What kind of support system or resources are you able to readily access? (Select all that apply)

   1. Free emotional support (e.g., friends, family, community)
   2. Paid emotional support (e.g., counseling)
   3. Free physical support (e.g., childcare, food delivery)
   4. Paid physical support (e.g., childcare, food delivery)
   5. I do not feel that I have a local support system
   6. Even outside of my local area, I do not feel that I have a support system
3. Since the COVID‐19 pandemic began, my household income is:

   1. Much less
   2. Somewhat less
   3. About the same
   4. Somewhat more
   5. Much more
4. What kind of economic impact has COVID‐19 had on you or your family? (Select all that apply)

   1. Little or no impact
   2. My partner or I lost a job
   3. My partner or I lost savings
   4. I am unable to pay my mortgage anymore
   5. I have greater food insecurity
   6. I am more cautious about spending for entertainment
   7. I have more economic security
5. Has your child had a confirmed case of COVID‐19?

   1. Yes, they are feeling 100% better now
   2. Yes, they have some lingering symptoms
   3. No
   4. Prefer not to answer

Virtual Learning and Child Academics

• 6
  During the last 12 months, how long did your child participate in virtual learning (in any capacity)?

  1. Did not participate in virtual learning
  2. A few weeks
  3. 1–3 months
  4. 4–7 months
  5. 8–12 months
• 7
  How would you compare your child's learning in virtual classes now to their learning in face‐to‐face classes?

  1. Much worse
  2. Somewhat worse
  3. About the same
  4. Somewhat better
  5. Much better
  6. In some ways it is better and in some ways it is worse
  7. Not applicable
• 8
  For my child, I do not think that virtual learning was useful and would have preferred in‐person learning or a gap in learning.

  1. Strongly disagree
  2. Disagree
  3. Neutral
  4. Agree
  5. Strongly agree
  6. Not Applicable.
• 9
  I know more about what my child is learning in school than I did prior to the COVID‐19 pandemic.

  1. Strongly disagree
  2. Disagree
  3. Neutral
  4. Agree
  5. Strongly agree
• 10
  Compared to “face to face” learning, virtual learning is, in general:

  1. Much worse
  2. Somewhat worse
  3. About the same
  4. Somewhat better
  5. Much better
  6. Not applicable
• 11
  Due to the COVID‐19 pandemic, my child's academics have been:

  1. Very negatively affected
  2. Somewhat negatively affected
  3. About the same
  4. Somewhat positively affected
  5. Very positively affected
• 12
  Have you found an academic tutor for your child during the COVID‐19 pandemic?

  1. Yes, but my child was already using a tutor prior to the pandemic
  2. Yes, my child started working with a tutor during the pandemic
  3. No, my child did not need a tutor
  4. No, because of cost restraints and/or COVID‐19 infection concerns

Child Behaviors

• 13
  During the COVID‐19 pandemic, my child's behavior has been:

  1. Very difficult to manage
  2. Somewhat difficult to manage
  3. Neither difficult nor easy to manage
  4. Somewhat easy to manage
  5. Very easy to manage
• 14
  Specifically related to virtual learning, my child's behavior has been:

  1. Very difficult to manage
  2. Somewhat difficult to manage
  3. Neither difficult nor easy to manage
  4. Somewhat easy to manage
  5. Very easy to manage
  6. Not Applicable
• 15
  My child's engagement during virtual learning is:

  1. Very poor
  2. Poor
  3. Fair
  4. Good
  5. Very good
  6. Not applicable
• 16
  My child engages in problem behavior during virtual learning or before having to participate in virtual learning.

  1. Strongly disagree
  2. Disagree
  3. Neutral
  4. Agree
  5. Strongly agree
  6. Not applicable

Child Activities

• 17
  Approximately how much screen time does your child have currently per day for non‐school related activities?

  1. Less than 1 hr
  2. Between 1 and 2 hr
  3. Between 2 and 3 hr
  4. Between 4 and 5 hr
  5. Between 5 and 6 hr
  6. More than 6 hr
• 18
  Compared to prior to the COVID‐19 pandemic, approximately how much has your child's screen time increased per day for non‐school related activities?

  1. No change or decreased.
  2. Increased less than 1 hr
  3. Increased 1–2 hr
  4. Increased 2–3 hr
  5. Increased 4–5 hr
  6. Increased 5–6 hr
  7. Increased more than 6 hr
• 19
  Compared to prior to the COVID‐19 pandemic, the amount of time my child spends exercising and/or playing sports is:

  1. Much less
  2. Somewhat less
  3. About the same
  4. Somewhat more
  5. Much more
• 20
  Compared to prior to the COVID‐19 pandemic, the amount of time my child spends sleeping:

  1. Much less
  2. Somewhat less
  3. About the same
  4. Somewhat more
  5. Much more
• 21
  Compared to prior to the COVID‐19 pandemic, the amount of time my child spends socializing:

  1. Much less
  2. Somewhat less
  3. About the same
  4. Somewhat more
  5. Much more

Stress

• 22
  As a parent of a child participating in virtual learning, my stress levels have:

  1. Significantly decreased
  2. Slightly decreased
  3. Stayed the same
  4. Slightly increased
  5. Significantly increased
  6. Not applicable
• 23
  As a result of the COVID‐19 pandemic, my stress levels have:

  1. Significantly decreased
  2. Slightly decreased
  3. Stayed the same
  4. Slightly increased
  5. Significantly increased
• 24
  As a result of the COVID‐19 pandemic, my child's stress levels have:

  1. Significantly decreased
  2. Slightly decreased
  3. Stayed the same
  4. Slightly increased
  5. Significantly increased
• 25
  Compared to prior to the COVID‐19 pandemic, my work–life balance now is:

  1. Much worse
  2. Somewhat worse
  3. About the same
  4. Somewhat better
  5. Much better

Appendix C.

Appendix C includes 25 histograms depicting parents' answers to the 25 questions included in the COVID‐19 survey. Most questions were answered with a Likert scale where parents could only select one answer. Answers of “NA” were removed from the dataset and so are not included in the histograms below.

Fig. C1.

Histogram depicting household sizes of families. Scale is as follows: (2) two people live in the home; (3) three people; (4) four people; (5) five or more people.

Fig. C2.

Histogram depicting support systems of families. Scale is as follows: (0) free emotional support (e.g., friends, family, community); (1) paid emotional support (e.g., counseling, community); (2) free physical support (e.g., childcare, food delivery, community); (3) paid physical support (e.g., childcare, food delivery, community); (4) I do not feel that I have a local support system; (5) even outside of my local area, I do not feel that I have a support system. Parents were able to select all options that applied to them.

Fig. C3.

Histogram depicting changes in household income during the pandemic. Scale is as follows: (0) much less income since the pandemic began; (1) somewhat less; (2) about the same; (3) somewhat more; (4) much more.

Fig. C4.

Histogram depicting economic impacts of COVID‐19 on families. Scale is as follows: (0) little or no impact on families due to COVID‐19; (1) my partner/I lost a job; (2) my partner/I lost savings; (3) I am unable to pay my mortgage anymore; (4) I have greater food insecurity; (5) I am more cautious about spending for entertainment; (6) I have more economic security. Parents were able to select all options that applied to them.

Fig. C5.

Histogram depicting children's COVID‐19 cases. Scale is as follows: (0) yes, they did have a confirmed case of COVID‐19, and they are feeling 100% better now; (1) yes, they have some lingering symptoms; (2) no.

Fig. C6.

Histogram depicting children's participation in virtual learning. Scale is as follows: (0) they did not participate in virtual learning; (1) a few weeks; (2) 1–3 months; (3) 4–7 months; (4) 8–12 months.

Fig. C7.

Histogram depicting comparison between parents' opinions of virtual learning as compared to in‐person learning. Scale is as follows: (0) virtual classes are much worse than face to face classes; (1) somewhat worse; (2) about the same; (3) somewhat better; (4) much better; (5) in some ways it is better and in some ways it is worse.

Fig. C8.

Histogram depicting parents' opinions of virtual learning as compared to in‐person learning or a gap in learning. Scale is as follows: (0) strongly disagree that virtual learning was useful; (1) disagree; (2) neutral; (3) agree; (4) strongly agree.

Fig. C9.

Histogram depicting parents' knowledge of their children's learning as compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) strongly disagree that they know more now than they did before the pandemic; (1) disagree; (2) neutral; (3) agree; (4) strongly agree.

Fig. C10.

Histogram depicting parents' opinions of face to face learning as compared to virtual learning. Scale is as follows: (0) virtual learning is much worse than face to face learning; (1) somewhat worse; (2) about the same; (3) somewhat better; (4) much better.

Fig. C11.

Histogram depicting the impacts of COVID‐19 on children's academics. Scale is as follows: (0) academics were very negative affected; (1) somewhat negatively affected; (2) about the same; (3) somewhat positively affected; (4) very positively affected.

Fig. C12.

Histogram depicting use of tutors during the COVID‐19 pandemic. Scale is as follows: (0) yes, I did find a tutor, but my child was already using a tutor prior to the pandemic; (1) yes, but my child started working with a tutor during the pandemic; (2) no, my child did not need a tutor; (3) no, because of cost restraints and/or COVID‐19 concerns.

Fig. C13.

Histogram depicting parents' opinions of children's behavior during the COVID‐19 pandemic. Scale is as follows: (0) my child's behavior has been very difficult to manage; (1) somewhat difficult to manage; (2) neither difficult nor easy to manage; (3) somewhat easy to manage; (4) very easy to manage.

Fig. C14.

Histogram depicting parents' opinions of children's behavior related to virtual learning. Scale is as follows: (0) my child's behavior has been very difficult to manage; (1) somewhat difficult to manage; (2) neither difficult nor easy to manage; (3) somewhat easy to manage; (4) very easy to manage.

Fig. C15.

Histogram depicting children's engagement during virtual learning. Scale is as follows: (0) my child's engagement is very poor; (1) poor; (2) fair; (3) good; (4) very good.

Fig. C16.

Histogram depicting children's problem behavior during and before virtual learning. Scale is as follows: (0) strongly disagree that my child engages in problem behavior before or during virtual learning; (1) disagree; (2) neutral; (3) agree; (4) strongly agree.

Fig. C17.

Histogram depicting children's screen time (not related to school) per day. Scale is as follows: (0) less than 1 hr of screen time for non‐school related activities; (1) between 1–2 hr; (2) between 2–3 hr; (3) between 4–5 hr; (4) between 5–6 hr; (5) more than 6 hr.

Fig. C18.

Histogram depicting increases in children's screen time (not related to school) per day as compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) no change in screen time (not related to school) or it has decreased; (1) increased by less than 1 hr; (2) increased by 1–2 hr; (3) increased by 2–3 hr; (4) increased by 4–5 hr; (5) increased by 5–6 hr; (6) increased by more than 6 hr.

Fig. C19.

Histogram depicting changes in time children spend exercising/playing sports compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) much less time exercising/playing sports; (1) somewhat less; (2) about the same; (3) somewhat more; (4) much more.

Fig. C20.

Histogram depicting changes in time children spend sleeping compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) much less time sleeping; (1) somewhat less; (2) about the same; (3) somewhat more; (4) much more.

Fig. C21.

Histogram depicting changes in time children spend socializing compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) much less time socializing; (1) somewhat less; (2) about the same; (3) somewhat more; (4) much more.

Fig. C22.

Histogram depicting parents' stress levels related to virtual learning. Scale is as follows: (0) stress levels have significantly decreased; (1) slightly decreased; (2) stayed the same; (3) slightly increased; (4) significantly increased.

Fig. C23.

Histogram depicting parents' stress levels as a result of the COVID‐19 pandemic. Scale is as follows: (0) stress levels have significantly decreased; (1) slightly decreased; (2) stayed the same; (3) slightly increased; (4) significantly increased.

Fig. C24.

Histogram depicting children's stress levels as a result of the COVID‐19 pandemic. Scale is as follows: (0) stress levels have significantly decreased; (1) slightly decreased; (2) stayed the same; (3) slightly increased; (4) significantly increased.

Fig. C25.

Histogram depicting parents' work‐life balances as compared to prior to the COVID‐19 pandemic. Scale is as follows: (0) work‐life balance is much worse; (1) somewhat worse; (2) about the same; (3) somewhat better; (4) much better.