January 09, 2024
3 min read
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Key takeaways:
- Infants and toddlers faced socio-emotional development delays during the COVID-19 pandemic.
- Referrals to early intervention services also seem to have decreased, according to the researchers.
Infants and toddlers faced socio-emotional development delays during the COVID-19 pandemic, according to a study published in JAMA Pediatrics.
The retrospective cohort study marked one of the latest in a line of research examining the development of infants and toddlers born and raised during the pandemic.
Infants and toddlers experienced socio-emotional development delays during the COVID-19 pandemic. Image: Adobe Stock
Larisa M. Kuehn, RN, a researcher at the Adult and Child Center for Outcomes Research and Delivery Science at the University of Colorado School of Medicine and one of the study’s authors, told Healio the idea for the study stemmed from her work as a nurse-home visitor for the national visiting nurse service Nurse-Family Partnership (NFP).
“I felt I was making more referrals to early childhood intervention programs during the pandemic than prior to the pandemic,” Kuehn said. “I was interested in seeing if the social isolation/lockdowns would affect child social-emotional development. We sought to determine if more positive screens indicated developmental concerns during the pandemic among families in NFP.”
Study design
Changes in two questionnaires — the Ages and Stages Questionnaire Social-Emotional, Second Edition (ASQ:SE-2), which measures development between age 10 and 18 months; and the Ages and Stages Questionnaire, Third Edition (ASQ-3), which measures development between age 12 and 18 months — were used to determine the impact of COVID-19 on children’s socioemotional development.
The study included 60,171 families enrolled in the NFP between 2015 to 2021. The researchers divided the families into four cohorts of pandemic exposure based on the child’s age: pre-pandemic, defined as those children who were aged 2 years at the start of the pandemic; pandemic 1, defined as those children who were aged 1 year when the pandemic began; pandemic 2, defined as infants at the start of the pandemic; and pandemic 3, defined as children born after the pandemic began.
The researchers used multivariable mixed-effects logistic regression models to determine odds ratios for the study’s main outcome of a positive screening in the ASQ:SE-2 or ASQ-3 between pandemic cohorts and the pre-pandemic cohort.
“We created cohorts with each cohort having differing pandemic exposure at the time of screening and then compared the amount of positive ASQ-3 and ASQ:SE-2 screenings in each cohort,” Kuehn said. “The outcome was a positive screen, ie, any score in the ‘refer’ range or above the cutoff on the ASQ-3 and ASQ:SE-2.”
Study findings
Kuehn and colleagues found that all pandemic cohorts had higher odds of positive screening on the ASQ-SE at age 12 months compared with the pre-pandemic cohort (pandemic 1: OR = 1.35; 95% CI, 1.09-1.66; pandemic 2: OR = 1.6; 95% CI, 1.30-1.96; pandemic 3: OR = 1.94; 95% CI, 1.61-2.33). They further found that pandemic 2 and 3 cohorts exhibited higher odds of a positive screening at age 18 months (pandemic 2: OR = 1.61; 95% CI, 1.29-2; pandemic 3: OR = 1.87; 95% CI, 1.50-2.32).
These ASQ-SE differences at 12 and 18 months continued after controlling for demographics, family risks and birth outcomes in the cohorts.
For the ASQ-3, pandemic cohorts 2 and 3 exhibited a higher likelihood than the pre-pandemic cohort to screen positive on the communication subscale at age 18 months (pandemic 2: OR = 1.39; 95% CI, 1.17-1.64; pandemic 3: OR = 1.28; 95% CI, 1.07-1.53). At age 10 months, pandemic 3 showed increased odds for a positive screening in problem-solving and fine motor domains in adjusted models, but this was not found in pandemic 2.
Conclusions, next steps
“Our hypothesis was correct that the odds of a positive ASQ:SE-2 at 12 and 18 months increased across pandemic cohorts,” Kuehn said. “We also examined referrals to early intervention for these cohorts, and while positive scores increased, referrals to [early intervention] seem to have decreased during the height of the pandemic, which we speculate could have been due to less access to services.”
Given these findings, Kuehn recommended primary care providers and physicians be aware that pandemic exposure during a child’s first year of life can be associated with an increased odds of a positive ASQ:SE-2 screening, and follow-up is important as these children may require additional support from early intervention and education.
“It would be interesting to know the continued effect of the pandemic on a child’s social-emotional development over time, as these children were exposed to the pandemic during crucial developmental years,” Kuehn said. “Knowing how this experience will continue to affect them by following these children over time would be beneficial.”
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