Be My Safe Haven: Parent-Child Relationships and Emotional Health During COVID-19

A longitudinal study of child adjustment during the COVID-19 pandemic: the protective role of the parent-child relationship in middle childhood

This longitudinal study assessed how parent-child relationship quality during the first COVID-19 lockdown was related to changes in internalizing, externalizing, and sleep problems during the first months of the pandemic: during lockdown, partial deconfinement, and total deconfinement. Participants included 167 children (9-12 year) and their parents recruited in the province of Quebec, Canada. Child behavior problems decreased between lockdown and the two deconfinement assessments, but more sleep and behavior problems were associated with lower levels of relationship quality (more conflict, less closeness, and more insecure attachment). Significant interaction effects showed that changes in externalizing and sleep problems varied as a function of parent-child relationship. Results support the critical importance of the parent-child relationship with regard to child adjustment in middle childhood in times of crisis such as a pandemic. They also highlight resilience in children aged 9 to 12, with a decrease in problems over time.

Maternal distress, parenting stress, maladaptive parenting and children's problematic media use in China: evidence from 2022 spring in Shanghai

The COVID-19 lockdown has forced young children to spend more time on media and significantly impacted their mothers' mental health. This study explored how mothers' individual distress influences children's problematic media use during the Shanghai citywide lockdown caused by COVID-19. Data were collected from 1889 Chinese mothers (Mage = 34.69 years, SD = 3.94 years) with preschoolers aged 3-6 years (Mage = 4.38 years, SD = 1.06 years; 49.0% boys) via an online survey. The statistical analyses relied on SPSS Statistics version 26.0 and macro-program PROCESS 3.3. to investigate the associations and mediation analysis among all the study variables. The results indicated a positive association between maternal distress and children's problematic media use, mediated by parenting stress and maladaptive parenting. Specifically, the serial mediation analysis revealed that high levels of maternal distress exacerbate parenting stress, which in turn leads to maladaptive parenting practices. These maladaptive practices subsequently increase problematic media use in preschool children. The findings highlighted that parents need to enhance their ability to manage risk and promote mental health during periods of significant stress and routine disruption to reduce children's problematic media use.

Trajectories and correlates of mental health among urban, school-age children during the COVID-19 pandemic: a longitudinal study

BACKGROUND

The COVID-19 pandemic posed numerous obstacles to psychosocial wellbeing for children. We conducted a longitudinal study to evaluate child mental health and social risks during the pandemic.

METHODS

Participants were 172 caregivers of children aged 6-11 years old who attended well child visits within 6 months before pandemic onset at an urban safety net hospital in the US. Prepandemic data was extracted from the electronic medical record, and surveys were administered at three time points between August 2020 and July 2021. We measured mental health symptoms with the Pediatric Symptom Checklist-17, social risks (e.g., food and housing insecurity) with the THRIVE questionnaire, and school modality (in-person, hybrid, remote).

RESULTS

Compared to pre-pandemic, children had significantly higher PSC-17 total scores (overall mental health symptoms) and THRIVE total scores (total burden of social risks) at all three mid-pandemic waves. Using longitudinal mixed models accounting for time, social risks, and school modality, both social risks (B = 0.37, SE = 0.14, p < 0.01) and school modality were significantly associated with PSC-17 scores (B = - 1.95, SE = 0.63, p < 0.01). Children attending in-person school had fewer mental health symptoms than those attending remote or hybrid school.

CONCLUSION

Mental health symptoms and social risks remained significantly higher fifteen months after the onset of the COVID-19 pandemic compared to prepandemic. In-person attendance at school appeared protective against persistently elevated mental health symptoms.

Short-term and long-term effects of the COVID-19 pandemic on child psychological well-being: a four-wave longitudinal study

As the COVID-19 pandemic further unfolds, it becomes a key theoretical and practical question to identify trajectories of child psychological well-being and to explore risk and resilience factors for developmental adjustment. The current study addressed this research gap by means of an ecological design: A (lockdown)-B (relaxation)-B (relaxation)-A (lockdown). We collected parental reports via online questionnaires over four measurement occasions during the COVID-19 pandemic in Germany (non-probabilistic sample): from the first lockdown (T1-spring 2020, N = 1769) to the following period of relaxation (T2-summer 2020, n = 873; T3-fall 2020, n = 729) on to the second lockdown (T4-winter 2020/21, n = 748). Key measures at T1-T4 were child emotional and behavioral problems as well as hyperactivity, child emotional and family-related well-being, parental strain, and parent-child relationship quality. We found evidence for quadratic growth models. While child problem behaviors (b = 0.32, p < 0.001) and emotional well-being (b = - 0.33, p < 0.001) improved after the first lockdown during subsequent periods of relaxation before worsening again in the second lockdown, child family-related well-being steadily decreased over all four measurement points (T1-T2: p < 0.001; T2-T3: p = 0.045; T3-T4: p = 0.030). Importantly, parental stress emerged as a strong risk factor (ps < 0.11) and the parent-child relationship quality constituted a resilience factor (p = 0.049) for child psychological well-being. These findings have major implications for policies aiming to further child health during the COVID-19 pandemic.

The influence of attachment style on support and feedback seeking and depression severity among mothers during the COVID-19 pandemic

OBJECTIVES

The ways that people seek support during times of stress influence their mental health outcomes, including depression. Insecure attachment is a risk factor for depression and may also interfere with adaptive support and feedback-seeking behaviour during stress. The purpose of the present study was to test theorized associations between insecure attachment, support and feedback seeking, and changes in depression symptoms over 1 year, in a sample of mothers of school-age children in the context of stress elicited by the COVID-19 pandemic.

METHODS

Participants (N = 70 mothers) completed self-report measures of anxious and avoidant attachment and depression severity at baseline in spring 2020 and then completed measures of past-year engagement in direct and indirect support seeking and excessive reassurance seeking (ERS), preference for negative feedback, and depression severity at a follow-up assessment in summer 2021.

RESULTS

Greater attachment anxiety at baseline predicted more frequent direct support seeking, indirect support seeking, and ERS during the 1-year follow-up period. In turn, greater indirect support seeking predicted greater increases in depression from baseline to follow-up. Greater attachment avoidance at baseline predicted less direct support seeking during the 1-year follow-up period. Greater attachment avoidance at baseline also predicted depression severity at follow-up, particularly among mothers with moderate to high levels of attachment anxiety, although none of the examined support and feedback-seeking behaviours mediated this association.

CONCLUSIONS

These results provide support for the role of activated attachment systems in determining support and feedback-seeking behaviour during stress, as well as the role of support and feedback-seeking behaviour in the maintenance and exacerbation of depression.

The Psychosocial Impact of the COVID-19 Pandemic on Families of Youth of Color: A Prospective Cohort Study

OBJECTIVE

Prospectively examine racial and ethnic disparities in exposure to COVID-19-related stressors and their impact on families.

METHODS

A racially, ethnically, and socioeconomically diverse cohort of caregivers of youth (n = 1,581) representative of the population served by a pediatric healthcare system completed the COVID-19 Exposure and Family Impact Scales in Oct/Nov 2020 and March/April 2021. Linear mixed-effects models were used to examine exposure to COVID-19-related events (Exposure), impact of the pandemic on family functioning and well-being (Impact), and child and parent distress (Distress) across time and as a function of race and ethnicity, adjusting for other sociodemographic variables.

RESULTS

Exposure and Distress increased over time for all participants. After adjusting for sociodemographic factors, caregivers of Black and Hispanic youth reported greater Exposure than caregivers of White youth and caregivers of Black youth had a greater increase in Exposure over time than caregivers of White youth. Caregivers of White youth reported greater Impact than caregivers of Black and Other race youth.

CONCLUSIONS

Exposure to and impact of the COVID-19 pandemic on family psychosocial functioning varied by race and ethnicity. Although exposure to COVID-19-related events was greater among Hispanic and non-Hispanic Black families, those of marginalized races reported less family impact than non-Hispanic White families, suggesting resiliency to the pandemic. Research should examine such responses to public health crises in communities of color, with a focus on understanding protective factors. These findings suggest the importance of culturally tailored interventions and policies that support universal psychosocial screenings during times of public health crises.

Children patients with COVID-19: How can parental and peer support lessen the psychological burden of isolation

AIM

To assess the effect of parental and peer support on children's self-esteem during the isolation period in COVID-19-infected children is the main objective of this study.

DESIGN

This is a descriptive cross-sectional study. One hundred ninety children with a confirmed diagnosis of COVID-19 were included.

METHODS

A survey questionnaire to assess family and children's demographic characteristics was used for this study. A 13-item scale to assess parental support during the isolation period and a 10-item scale to assess peers' support during the isolation period were evaluated. Along with it, a 10-item scale to assess self-esteem during the isolation period was also measured.

RESULTS

Home isolation was associated with higher parental and peer support scores than hospital isolation. The mean age of study participants was 13.23 ± 4.05 years; 52.6% were isolated at home versus 47.4% in hospital isolation. Phone calling and WhatsApp/messenger chat were methods of communication for 44.2% and 33.2% of patients, respectively. 6.3% of them had no method of communication. Child self-esteem was significantly affected by both parental and peer support during isolation. The increase in pronounced negative psychological effects such as disorientation, anger, low self-esteem and post-traumatic distress may be caused by a lack of parental care.

NO PATIENT OR PUBLIC CONTRIBUTION TO THIS STUDY

Patients or the general public were not involved in the design, analysis or interpretation of the data in this study. The study's aim and objectives were developed based on children's self-esteem, which was limited by questionnaire data information, so the researchers completed demographic and disease-related questionnaires by interviewing them.

Preschool Emotional Problems in the Post-Pandemic Era between Parental Risk and Protective Factors

The psychosocial adaptation of children born or experiencing their early years during the COVID-19 pandemic remains uncertain. In order to implement prevention strategies, it is, therefore, a priority to deeply analyze children's mental health in this post-pandemic phase and to identify family risk and protective factors. Indeed, recent studies reveal that children's emotional distress increased with the COVID-19 pandemic, especially in situations of high parental stress. The study investigates associations between some parental characteristics (coping strategies, parental burnout, resilience, perception of social support, and promotion of children's social-emotional competence) and children's emotional symptoms, considering gender differences. A total of 358 parents of children aged 2 to 6 years participated in this study. Regression analyses show that parental burnout is a predictor of emotional symptoms; moreover, for females, higher levels of emotional symptoms are associated with parental maladaptive coping strategies, whereas for males, the parent's ability to promote children's emotional competence is a protective factor. Results emphasize the importance of supporting parental well-being as a critical factor in shielding children from the repercussions of adverse situations.

Parent psychological distress and parent-child relationships two years into the COVID-19 pandemic: Results from a Canadian cross-sectional study

BACKGROUND

Mental health impacts of the COVID-19 pandemic have not been felt equally within populations. Parents with children living at home were early on identified as a population at heightened mental health risk, with concerns about the potential long-term impacts of the pandemic on parents' mental health, family functioning, and children's well-being. This study investigates impacts of the pandemic on parents' psychological distress, contextual sources of distress, and associations with family functioning nearly two years into the pandemic.

METHODS AND FINDINGS

Data were drawn from a national cross-sectional survey of adults living in Canada in November and December 2021 that was representative by age, gender, household income, and region. Parents with children < 18 years old living at home (N = 553) reported their experiences of psychological distress, pandemic-related stressors, coping mechanisms, and family functioning (changes in parent-child interactions, children's anxiety). Chi-square tests, logistic regression, and linear regression analyses examined sociodemographic inequities in parents' levels of psychological distress, sources and mitigating mechanisms of distress, and associations between psychological distress and family functioning. Nearly two years into the pandemic, parents with children at home reported nearly double pre-pandemic population estimates of moderate to severe psychological distress. Psychological distress was more frequently reported among parents with pre-existing mental health conditions, disabilities, and financial stressors. Parents with greater psychological distress reported increases in negative parent-child interactions due to the pandemic and higher anxiety among their children.

CONCLUSIONS

This study identifies sustained negative impacts of the pandemic on parents' mental health and family functioning in Canada nearly two years into the pandemic, despite high vaccine uptake and declining infection rates. Disparities in financial stress, social support structures, and pre-existing mental health were identified as underlying sources of psychological distress. These results highlight that meaningful responses to promote mental health among parents and families must address social and structural inequities.

Using Nvivo to Analyze the Impact of Computer Simulation of Parent-Child Cooperative Art Activities on the Growth of Preschool Children

Psychology originally defined parent-child conflict in terms of interpersonal relationships, where parent-child conflict is a process of inconsistent attitudes between parents and children that occurs in a family setting. For this end, we aims to investigate the influence of parental awareness on preschoolers' perception of parent-child conflict and the mediating role of preschoolers' self-esteem. This paper proposes a dynamic parent-child relationship discovery algorithm based on the impact of parent-child cooperation activities on preschool children's development. We applied SPSS and Mplus statistical software for data processing and analysis, and Nvivo 11.0 qualitative software for validation and analysis. The reliability of preschool children's perceived parent-child conflict and sub-dimensions were: 0.901, 0.799, 0.791, 0.811, 0.729; the total scale and the retest reliability of each dimension were: 0.914, 0.837, 0.836, 0.792, 0.711. Validated factor analysis using Mplus: RMSEA = 0.075, TLI = 0.856, CFI = 0.876, SRMR = 0.064.

COVID-19-Related Stress and Resilience Resources: A Comparison Between Adoptive and non-Adoptive Mothers

Despite an increasing interest in how adoptive parents deal with situations appraised as stressful, there is a lack of research regarding adoptive parents' adjustment to the challenges posed by the prolonged COVID-19 pandemic. The current study explores similarities and differences between adoptive and non-adoptive mothers in terms of risks (i.e., COVID-19-related stress) and individual (i.e., sense of coherence [SOC]), couple (i.e., partner's support), parent-child (i.e., parent-child relationship satisfaction), and social (i.e., friends' support) resources in the face of the prolonged COVID-19 pandemic. Specifically, the present study was aimed at predicting which variables discriminate more effectively between the two groups. Participants were 445 Italian mothers (40.9% adoptive mothers), who were asked to fill in an anonymous online survey between May 2021 and October 2021. Results showed that adoptive and non-adoptive mothers reported different resilience resources to face the stressors posed by the health emergency. Specifically, COVID-19 traumatic stress symptoms, parent-child relationship satisfaction, and SOC were found to contribute most in discriminating between the two groups. Findings are discussed in relation to future research developments and practical implications.

Sometimes "we" can help: parents' pronoun use buffers fear and anxiety transmission

BACKGROUND AND OBJECTIVES

Parents' natural language when describing health-related threats reflects parents' cognitions that may shape their transmission of anxiety and fear. Parents' greater communal focus (i.e., higher we-talk) and less self-focus (i.e., lower I-talk) may buffer against intergenerational fear/anxiety transmission. The current study investigated whether the relation between parents' and children's anxiety and pandemic-related fear differed by parent we- and I-talk.

DESIGN AND METHODS

Parents of 114 children (2-19 years; M = 9.75, SD = 3.73) completed online measures assessing children's and parents' anxiety and COVID-19-related fears, and engaged in a written reflection on their early pandemic experiences. The proportion of parents' we-talk and I-talk during the reflection was obtained using Linguistic Inquiry Word Count software.

RESULTS

Results of multilevel structural equation models were partially consistent with expectations: The protective effect of we-talk was only observed for parents with lower fear/anxiety. For parents with higher fear/anxiety, higher I-talk was associated with lower child fear/anxiety. At higher levels of parent we-talk and at lower levels of I-talk, there was an unexpectedly positive association between parents' and children's fear/anxiety.

CONCLUSIONS

The concordance between parents' and their children's fear/anxiety differs depending on parents' natural language when reflecting on the pandemic.

Internalizing and externalizing symptoms in children during the COVID-19 pandemic: a systematic mixed studies review

Introduction

Given the vulnerability of children during the COVID-19 pandemic, paying close attention to their wellbeing at the time is warranted. The present protocol-based systematic mixed-studies review examines papers published during 2020-2022, focusing on the impact of the COVID-19 pandemic on children's internalizing/externalizing symptoms and the determinants thereof.

Method

PROSPERO: CRD42022385284. Five databases were searched and the PRISMA diagram was applied. The inclusion criteria were: papers published in English in peer-reviewed journals; papers published between January 2020 and October 2022 involving children aged 5-13 years; qualitative, quantitative, and mixed studies. The standardized Mixed Method Appraisal Tool protocol was used to appraise the quality of the studies.

Results

Thirty-four studies involving 40,976 participants in total were analyzed. Their principal characteristics were tabulated. The results showed that children's internalizing/externalizing symptoms increased during the pandemic, largely as a result of disengagement from play activities and excessive use of the internet. Girls showed more internalizing symptoms and boys more externalizing symptoms. Distress was the strongest parental factor mediating children's internalizing/externalizing symptoms. The quality of the studies was appraised as low (n = 12), medium (n = 12), and high (n = 10).

Conclusion

Gender-based interventions should be designed for children and parents. The studies reviewed were cross-sectional, so long-term patterns and outcomes could not be predicted. Future researchers might consider a longitudinal approach to determine the long-term effects of the pandemic on children's internalizing and externalizing symptoms.

Systematic review registration

https://www.crd.york.ac.uk/prospero/display_record.php?ID=CRD42022385284, identifier: CRD42022385284.

Safe haven in adolescence: Improving parental reflective functioning and youth attachment and mental health with the Connecting and Reflecting Experience

Attachment security provides a well-documented protective developmental function for children exposed to individual- and community-level trauma, yet the effectiveness of prevention and intervention efforts targeting attachment during adolescence has been relatively underexplored. The Connecting and Reflecting Experience (CARE) program is a transdiagnostic, bi-generational, group-based, mentalizing-focused parenting intervention developed to dismantle the intergenerational transmission of trauma and support secure attachment relationships across the developmental spectrum within an under-resourced community. This exploratory study evaluated outcomes among caregiver-adolescent dyads (N = 32) in the CARE condition of a nonrandomized clinical trial at an outpatient mental health clinic within a diverse, urban U.S. community with disproportionate trauma exposure exacerbated by COVID-19. Caregivers predominantly identified as Black/African/African American (47%), Hispanic/Latina (38%), and/or White (19%). At pre- and post-intervention, caregivers completed questionnaires regarding parental mentalizing and their adolescents' psychosocial functioning. Adolescents completed scales regarding attachment and psychosocial functioning. Results showed a significant decrease in caregivers' prementalizing on the Parental Reflective Functioning Questionnaire, improvement in adolescent psychosocial functioning on the Youth Outcomes Questionnaire, and an increase in adolescents' reports of attachment security on the Security Scale. These preliminary findings suggest that mentalizing-focused parenting interventions may be effective in fostering improved attachment security and psychosocial functioning during adolescence.

Positive experiences in the parent-child relationship during the COVID-19 lockdown in Poland: The role of emotion regulation, empathy, parenting self-efficacy, and social support

Despite the impact of the COVID-19 outbreak being largely negative on parents and children, for some families, lockdown could also bring about some positive effects, for example, increased emotional closeness, and more time for joint activity. The aim of the current study was to investigate cross-sectionally the most important correlates of the positive experiences in the parent-child relationship among Polish mothers and fathers during the lockdown in the initial phase of the COVID-19 outbreak. In May 2020, 228 mothers and 231 fathers completed the Brief version of the Empathic Sensitivity Questionnaire, Difficulties in Emotion Regulation Scale Short Form, Social Support Scale, Parenting Self-Agency Measure, and Scale of Positive Experiences in Parent-Child Relationship during the COVID-19 lockdown. Our results showed that parenting self-efficacy and social support were the strongest correlates of positive experiences in the parent-child relationship in both mothers and fathers during the lockdown. Perspective-taking was positively related to the positive experiences in mothers, whereas personal distress was positively associated with the positive experiences in the parent-child relationship in fathers. Our results point to factors of potential importance in designing preventive and therapeutic interventions for mothers and fathers to enhance positive experiences in the parent-child relationship during the pandemic.

Parent-Child Relationships, Digital Media Use and Parents' Well-Being during COVID-19 Home Confinement: The Role of Family Resilience

Research has provided substantial evidence on the role of parents' well-being in the quality of parent-child relationships and children's adjustment. Parents' stress and parental couple conflict have been linked to children's adverse developmental outcomes. However, little is known about the factors that affect parents' well-being when coping with multiple stressors such as those brought by the recent COVID-19 global pandemic. Our study intended to examine the predictors of parental well-being by looking at the contextual factors of COVID-19 home confinement, i.e., the use of digital media and parents' domestic workload, and family resilience in two countries: Ireland and Italy. Additionally, the age and number of children were controlled as potential variables impacting parents' well-being. A three-step hierarchical regression analysis was applied. The results showed that family resilience was a very strong predictor of parents' well-being after controlling for any other variable. Parental couples' conflict over the use of technology predicted lower levels of parents' well-being, while, notably, parent child-conflict and domestic workload were not associated with parents' well-being. Additionally, the age of children did play a role: the higher the mean age of children in the family the better the parents' well-being. The findings are discussed in the light of cross-country differences and their implications for research and practice.

Impacts of COVID-19 on children and adolescents: A systematic review analyzing its psychiatric effects

OBJECTIVE

To summarize the most relevant data from a systematic review on the impact of COVID-19 on children and adolescents, particularly analyzing its psychiatric effects.

METHODS

This review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-analyses (PRISMA) guidelines and included experimental studies (randomized-individually or pooled-and non-randomized controlled trials), observational studies with a group for internal comparison (cohort studies-prospective and retrospective-and case-control) and qualitative studies in the period from 2021 to 2022.

RESULTS

The search identified 325 articles; we removed 125 duplicates. We selected 200 manuscripts, chosen by title and selected abstracts. We excluded 50 records after screening titles and abstracts, as they did not meet the inclusion criteria. We retrieved 150 records selected for a full reading. We excluded 90 text articles and we selected 25 records for the (n) final. Limitations: Due to the short period of data collection, from 2021 to 2022, there is a possibility of lack of relevant studies related to the mental health care of children and adolescents. In addition, there is the possibility of publication bias, such as only significant findings being published.

CONCLUSION

The impact of COVID-19 on the mental health of children and adolescents is of great concern to child and youth psychiatry. Situations such as fear, anxiety, panic, depression, sleep and appetite disorders, as well as impairment in social interactions caused by psychic stress, are punctual markers of pain and psychic suffering, which have increasing impacts on the mental health panorama of children and adolescents globally, particularly in vulnerable and socially at-risk populations.

Behavioral, Affective, and Cognitive Parenting Mechanisms of Child Internalizing and Externalizing Problems during the COVID-19 Pandemic

The COVID-19 pandemic has led to increased mental health concerns, including depression and anxiety among parents and internalizing and externalizing problems among youth. To better understand the mechanisms and moderators of child mental health during the pandemic, the current study tested two moderated mediation models in which parent depression and anxiety indirectly impacted child internalizing and externalizing problems through negative effects on multiple parenting variables, with these associations moderated by families' exposure to COVID-19-stressors. A national sample representative of U.S. parents (N = 796, 48.2% female, Mage = 38.87 years, 60.3% Non-Hispanic white, 18.1% Hispanic/Latinx, 13.2% Non-Hispanic Black/African-American, 5.7% Asian, 2.8% Other Race) completed a cross-sectional online survey in February-April 2021. Children ranged from 5-16 years old (Mage = 10.35 years, 59.8% Non-Hispanic white, 17.2% Hispanic/Latinx, 13.7% Non-Hispanic Black/African-American, 4.5% Asian, 4.8% Other Race). Parent depression/anxiety was directly and indirectly associated with child internalizing and externalizing problems. For both internalizing and externalizing problems, indirect associations occurred by means of increased parent hostility and inconsistent discipline and decreased routines and parent supportiveness. There were also specific indirect effects through decreased monitoring (internalizing problems) and parenting self-efficacy (externalizing problems). Multiple indirect effects were moderated by number of COVID-19-stressors experienced. Notably, COVID-19-stressors did not have direct effects on child mental health when other variables were considered. Findings highlight the buffering effects of parents for child mental health, the need to address parent depression/anxiety in child interventions, the utility of existing evidence-based parent interventions during the pandemic, and the need to assess families' level of exposure to COVID-19-stressors.

Emotional and Behavioral Health among Portuguese Toddlers during the COVID-19 Crisis: The Impact of Social Isolation and Caregiving Distress

The COVID-19 pandemic has led to significant changes in the lives of families with young children. The present study aimed to explore whether child social isolation due to the COVID-19 crisis was associated with toddlers' emotional and behavioral health (EBH) and whether this association was moderated by caregiving distress, during the second mandatory lockdown in Portugal. Participants included 315 toddlers and their primary caregivers. Caregivers were invited to complete a set of questionnaires in order to report about toddlers' social isolation from other significant family members, other children, and activities outside the house, and to provide ratings of caregiving distress and toddlers' EBH. Family socioeconomic factors, including stressors resulted from the pandemic, were also measured. Significant interaction effects, independent of child sex and sociodemographic factors, between COVID-19-related social isolation and caregiving distress emerged in the prediction of toddlers' EBH: COVID-19-related social isolation was found to be a significant predictor of both emotional/behavioral competencies and problems, but only among toddlers exposed to higher levels of caregiving distress. This study evidences the negative impact of the COVID-19 crisis on the functioning of Portuguese families and toddlers' EBH. It emphasizes the importance for policies to consider the implications of the COVID-19 crisis for young children, and to provide psychosocial support to families in order to reduce caregiving distress and, thus, prevent children's mental health problems.

A Pediatrician's Guide to Working with Children on the Autism Spectrum in Coronavirus Disease 2019 and Beyond: Retrospect and Prospect

The COVID-19 pandemic is an unprecedented event with devastating effects on children and families, highlighting and broadening disparities in the care of children with developmental disabilities, while simultaneously catalyzing innovation. Children are vulnerable to the impacts of COVID-19, resulting in increased stress, anxiety, isolation, and health challenges, further amplified in autistic children and children with other neurodevelopmental disabilities. These children are uniquely vulnerable due to communication impairments, comorbid medical disorders, reduced adaptability, and reliance on therapeutic interventions. Abrupt reduction in services and access to care during the pandemic compromised physical and mental health and led to missed intervention opportunities at critical times. It is important to examine the effects that the pandemic triggered, address deficiencies, and recognize new opportunities to improve systems of care to prepare for unforeseen futures.

COVID-19 distress, negative parenting, and child behavioral problems: The moderating role of parent adverse childhood experiences

BACKGROUND

Heightened familial stress and distress during the COVID-19 pandemic may lead to increased negative parenting practices, particularly for parents with substantial adverse childhood experiences (ACES).

OBJECTIVE

To determine whether families' COVID-19-related distress is associated with young children's emotional/behavioral functioning via negative parenting, and whether these relationships vary based on parents' ACEs.

PARTICIPANTS AND SETTING

Participants were 267 parents of children ages 1.5-5 years recruited from five primary care sites across the United States.

METHODS

Participants completed internet questionnaires including measures of demographics, parent ACES, negative parenting, parent mental health, and COVID-19 distress. We used regression analyses to test a moderated mediation model in which the relationship between COVID-19 distress and child emotional/behavioral problems is mediated by negative parenting, and both the direct and indirect effects of COVID-19 distress on child emotional/behavioral problems is moderated by parents' ACEs.

RESULTS

Negative parenting significantly mediated the relationship between COVID-19 distress and child emotional/behavioral problems (indirect effect β = 0.07). Parents' ACEs moderated the associations between COVID-19 distress and both negative parenting and child emotional/behavioral problems, such that each relationship was stronger in the context of higher parental ACEs. The model accounted for 42% of the variance in child emotional/behavioral problems.

CONCLUSIONS

Findings have implications for managing risk and promoting well-being in young children during periods of significant stress and routine disruption. This study advances understanding of factors influencing negative outcomes in children during the pandemic's acute phase and may have implications for the development of targeted interventions to improve families' adjustment in the future.

The voices of parents in child protective services: A qualitative analysis of families' struggles with COVID-19

The pandemic of the Coronavirus disease 2019 (COVID-19) has affected children and families worldwide, disrupting their daily lives and well-being. A small-scale study involving 13 parents in Child Protective Services in Estonia was conducted using in-depth, semi-structured interviews to explore parents' experiences with COVID-19 and its impact on their families' well-being. The findings indicated that one of the areas most impacted by the COVID-19 pandemic was schooling, as the implementation of remote schooling often created tensions and conflicts at home. Parents reported regression in daily functioning, attributing this to the lack of supportive services during lockdown and additional distress resulting from increased workload at home and problems with balancing home and work life. Parents were exhausted by the various problems caused by the pandemic and questioned their ability to provide their children the support they needed. Discontinuation of services intensified existing challenges for both parents and children. Furthermore, a lack of trust in Child Protective Services was identified, serving as a barrier to asking for help in times of crisis.

COVID-19 Pandemic-Related Restrictions: Factors That May Affect Perinatal Maternal Mental Health and Implications for Infant Development

This review aims to discuss the factors that may affect maternal mental health and infant development in COVID-19 pandemic condition. Toward this direction, the two objectives of this review are the following: (a) to discuss possible factors that may have affected negatively perinatal mental health through the pandemic-related restrictions; and (b) to present the implications of adversely affected maternal emotional wellbeing on infant development. We conclude that the pandemic may has affected maternal mental health with possible detrimental effects for the infants of the COVID-19 generation. We highlight the need for evidence-based interventions to be integrated within the health system for prenatal and postpartum care in an effort to promote maternal mental health and infant development.

Being a Parent during COVID-19: Risk for Psychological Distress in the United States and Italy

The COVID-19 pandemic has had significant effects on people worldwide, yet the psychological impact of collective traumas may differ at the individual and societal level. Parents may be exposed to greater pandemic-related stressors, yet also are more likely than non-parents to have social interactions during social distancing mandates. Furthermore, varying degrees of pandemic severity in countries may alter the adverse outcomes of pandemic stressors on psychopathology across nations. The purpose of this investigation was to cross-nationally explore how COVID-19 stress exposure relates to psychological distress and whether the association differed by parental status and nationality. Individuals from the United States (n = 2449) and Italy (n = 579) completed assessments measuring traumatic stress, depressive symptoms, and COVID-19-related stressors. COVID-19-related stressors were positively associated with traumatic stress and depressive symptoms. The association between COVID-19-related stressors and psychological distress did not differ by parental status or nationality. We also found that being a young adult, having a lower educational status, not being a parent, and being Italian were related to exposure to COVID-19-related stressors. We discuss these findings and their implications for our understanding of unique contexts that may pose as risk or resiliency factors during a global collective trauma, particularly on parental psychological distress as a way of promoting whole-family wellness.

Pandémie de COVID-19: attachement, anxiété, régulation émotionnelle et stratégies de coping chez les enfants d’âge scolaire

Introduction

Un impact de la pandémie de COVID-19 sur les émotions et comportements des enfants a été retrouvé dans plusieurs études. Cependant, cet impact n’a pas été retrouvé dans toutes les études. L’attachement pourrait être lié à des réactions et des niveaux d’anxiété différents.

Objectif

L’objectif principal de cette étude était d’analyser les liens entre l’attachement insécure des enfants et les variables liées à l’anxiété et à la gestion émotionnelle et comportementale des enfants pendant la pandémie.

Méthode

Les participants de l’étude (n = 83 parents et leur enfant âgé de 6 à 12 ans) ont complété de façon anonyme des questionnaires en ligne évaluant l’insécurité d’attachement, l’anxiété-état, les stratégies de coping et la régulation émotionnelle. Ils ont également répondu à des questions sociodémographiques et liées à leur contexte de vie et vécu de la pandémie.

Résultats

L’anxiété-état est liée de façon significative à la dysrégulation émotionnelle des enfants mais pas à la stratégie de coping tourné vers l’émotion. Des liens significatifs ont été observés entre l’insécurité d’attachement, d’une part, et l’anxiété-état des enfants, la stratégie de coping tourné vers l’émotion et la dysrégulation émotionnelle des enfants, d’autre part. La dysrégulation émotionnelle médiatiserait le lien entre attachement désorganisé et anxiété-état.

Conclusion

Les liens entre l’insécurité d’attachement et l’anxiété-état des enfants, d’une part, et la stratégie de coping tourné vers l’émotion, d’autre part, montrent l’importance de prendre en compte les facteurs individuels et interactionnels dans les manifestations socio-émotionnelles des enfants pendant la pandémie de COVID-19.

Lipid Nanoparticle Delivery Systems to Enable mRNA-Based Therapeutics

The world raced to develop vaccines to protect against the rapid spread of SARS-CoV-2 infection upon the recognition of COVID-19 as a global pandemic. A broad spectrum of candidates was evaluated, with mRNA-based vaccines emerging as leaders due to how quickly they were available for emergency use while providing a high level of efficacy. As a modular technology, the mRNA-based vaccines benefitted from decades of advancements in both mRNA and delivery technology prior to the current global pandemic. The fundamental lessons of the utility of mRNA as a therapeutic were pioneered by Dr. Katalin Kariko and her colleagues, perhaps most notably in collaboration with Drew Weissman at University of Pennsylvania, and this foundational work paved the way for the development of the first ever mRNA-based therapeutic authorized for human use, COMIRNATY^®. In this Special Issue of Pharmaceutics, we will be honoring Dr. Kariko for her great contributions to the mRNA technology to treat diseases with unmet needs. In this review article, we will focus on the delivery platform, the lipid nanoparticle (LNP) carrier, which allowed the potential of mRNA therapeutics to be realized. Similar to the mRNA technology, the development of LNP systems has been ongoing for decades before culminating in the success of the first clinically approved siRNA-LNP product, ONPATTRO^®, a treatment for an otherwise fatal genetic disease called transthyretin amyloidosis. Lessons learned from the siRNA-LNP experience enabled the translation into the mRNA platform with the eventual authorization and approval of the mRNA-LNP vaccines against COVID-19. This marks the beginning of mRNA-LNP as a pharmaceutical option to treat genetic diseases.

In their own words: Child and adolescent perceptions of caregiver stress during early COVID-19

BACKGROUND

The coronavirus disease 2019 (COVID-19) pandemic has exacerbated multiple stressors for caregivers of children in the United States, raising concern for increased family conflict, harsh parenting, and child maltreatment. Little is known regarding children's perceptions and experiences of caregiver stress during the COVID-19 pandemic.

OBJECTIVE

To examine how children and adolescents identify and experience caregiver stress during the early COVID-19 pandemic.

METHODS

We analyzed 105 de-identified helpline text and online chat transcripts from children under age 18 who submitted inquiries to the Childhelp National Child Abuse Hotline from March to June of 2020, with COVID-19 as a presenting issue. Inductive, thematic analysis was used to identify how child helpline users: 1) perceived and experienced drivers of caregiver stress and 2) used words to describe manifestations of caregiver stress during the COVID-19 pandemic.

RESULTS

Children experienced multiple drivers of caregiver stress during COVID-19, including intrapersonal (e.g. caregiver health concerns), interpersonal (e.g. parental discord, perceived dislike of child), and extrapersonal (e.g. financial insecurity, sheltering in place) stressors. Regardless of the driver, caregivers' stress was internalized by children. "Anger," "control," and "blame" were most commonly used to label manifestations of caregiver stress, which were often externalizing behaviors, including yelling, name calling, and blaming of others.

CONCLUSION

In text and online chat inquiries to a national child helpline during the COVID-19 pandemic, children described multiple drivers of caregiver stress, often feeling as though they were to blame. Providers serving children should address household stress spillover effects by including caregivers and directly acknowledging children's concerns using their own words.

Impact of the COVID-19 pandemic on children's mental health: A systematic review

BACKGROUND

The outbreak of COVID-19 in December 2019 has caused unprecedented disruption to the structure of children's daily lives due to school closures, online learning, strict social distancing measures, limited access to outdoor activities and many other restrictions. Since children are more susceptible to stress than adults and there is a growing concern about the potential debilitating consequences of COVID-19 for children's mental health, the present review aims to provide empirical evidence on the groups who are most at risk of mental health problems and uncover the risk and protective factors of children's mental health.

METHODS

A systematic search was performed, in accordance with PRISMA guidelines, in the electronic databases Web of Science (including SSCI and A&HI) and EBSCOhost (including ERIC, MEDLINE and APA PsycArticles and APA PsycINFO), for any empirical studies published between January 2020 and February 2022 that focused on children ≤ 12 years old.

RESULTS

An initial search identified 2,133 studies. A total of 30 studies fulfilled the inclusion criteria and were analyzed. The evidence showed that many children were affected by the COVID-19 pandemic and experienced internalizing and externalizing behaviors. Worsened child mental health outcomes reflected socioeconomic inequalities as most at-risk children had parents with low educational attainment, were from families of low socioeconomic status and lived in small homes. Key risk factors were identified, including unhealthy lifestyle behaviors (extended screen time, sleep disturbances and less physical activity), increased pandemic-related stressors among parents and deteriorated mental health of parents, which were directly or indirectly associated with the pandemic safety measures, such as home confinement or social distancing. Protective factors including parents' resilience, positive parent-child relationship and school connectedness in relation to children's mental health were reported.

CONCLUSION

The overall results highlight the urgent need for the implementation of tailor-made interventions for children with signs of internalizing and externalizing behaviors. Health promotion and prevention strategies by the government to maintain the mental health of children, particularly those from lower SES families who are at higher risk of worsened mental health are essential for post-pandemic policies.

Psychological Distress and Adolescents' Cyberbullying under Floods and the COVID-19 Pandemic: Parent-Child Relationships and Negotiable Fate as Moderators

Since the outbreak of coronavirus disease 2019 (COVID-19), adolescents in 70 countries have suffered the COVID-19 pandemic and flood disasters simultaneously. Although antecedent cyberbullying variables have attracted significant research attention, the effects of psychological distress and the potential mechanisms of cyberbullying among adolescents under multiple disasters remains unclear. Based on social-ecological system theory, this study examines the moderating effects of parent-child relationships and the negotiable fate on the relationship between psychological distress and cyberbullying. A total of 1204 middle school students (52.4% boys) who suffered from floods and the COVID-19 pandemic from Zhengzhou City, China, are the participants. The results reveal that psychological distress was positively related to adolescent cyberbullying during a disaster. Parent-child relationships and negotiable fate significantly moderate the relationship between psychological distress and cyberbullying. Specifically, high parent-child relationships and a high negotiable fate could protect adolescents from the negative effects of psychological distress of cyberbullying. For adolescents with low or high parent-child relationships and low negotiable fate, the links between psychological distress and cyberbullying are stronger. These findings underline the significance of considering the interaction of psychological distress, parent-child relationships, and negotiable fate when examining adolescents' cyberbullying during disasters.

COVID-19 mental health impact among children with early brain injury and associated conditions

This study describes the impact of COVID-19 among a clinical research sample of children with early brain injury and associated conditions. Between March 2020 and March 2021, 64 children and their parents participated. Children ranged in age between 3 and 14 years (M = 6 years, 3 months; SD = 2 years, 4 months) with a range of diagnoses (i.e., neonatal stroke, hypoxic ischemic encephalopathy (HIE), congenital heart disease (CHD) and preterm birth (<32 weeks)). The abbreviated CoRonavIrus Health Impact Survey (CRISIS) was completed by parents as part of their child's routine intake for neuropsychological services. Questions included COVID-19 specific ratings of child mental health impact, child, and parent stressors, with open-ended questions regarding negative and positive COVID-19 related changes. Over 40% of parents described moderate to extreme influence of COVID-19 on their child's mental health. Common child stressors reported included restrictions on leaving the home and social isolation. Among parents, the most common stress reported was caring for their child's education and daily activities. Children's mental health impact was associated with social isolation, parent mental health, COVID-19 economic concern, and number of siblings in the home. Child's age, sex, brain injury severity, or intellectual functioning were not associated with reported COVID-19 mental health impact. Some COVID-19 positives were identified, namely increased quality family time. Findings reflect the significant pandemic mental health impact among neurologically at-risk children and their families. Implications to future clinical needs and considerations for neuropsychological practice are discussed.