How Did the First Covid Lockdown Affect Children with Mental Health Disorders?

What you need to know

• Children with autism spectrum disorder (ASD) and attention deficit hyperactivity disorder (ADHD) were most negatively impacted by lockdown restrictions compared to those with emotional disorders
• Poor parental mental health and challenges with remote education were strongly associated with worse emotional and behavioral outcomes in children across diagnoses
• Supporting parental mental health and helping children engage with education may help mitigate the impact of future pandemic restrictions on youth mental health

Background

The COVID-19 pandemic and associated lockdown measures significantly disrupted the lives of children and adolescents worldwide. While research has examined the mental health impacts on youth in general, less is known about how children with pre-existing mental health disorders were affected. This study aimed to investigate the emotional and behavioral outcomes of children and young people receiving mental health services during the first COVID-19 lockdown in England.

Study details

The researchers surveyed 1,741 parents of children aged 5-17 who were receiving outpatient mental health services in London before the pandemic. The online survey asked about children’s emotional and behavioral symptoms during lockdown compared to before, as well as pandemic-related circumstances like remote education experiences. This survey data was combined with demographic and clinical information from electronic health records.

The study compared outcomes across the three most common diagnostic groups in their clinical population:

1. Attention Deficit Hyperactivity Disorder (ADHD)
2. Autism Spectrum Disorder (ASD)
3. Emotional disorders (like anxiety and depression)

They examined factors associated with better or worse emotional and behavioral outcomes during lockdown.

Key findings

Neurodevelopmental disorders most impacted

Children with ADHD or ASD showed greater emotional and behavioral difficulties during lockdown compared to those with emotional disorders:

• Parents of children with ADHD or ASD reported more behavioral problems
• Children with ADHD or ASD showed greater worsening of both emotional and behavioral symptoms compared to before lockdown
• Those with ASD and emotional disorders had more emotional difficulties than the ADHD group

The researchers suggest children with neurodevelopmental disorders like ADHD and autism may have more trouble adapting to major disruptions in routines and support.

Factors associated with worse outcomes

Across all diagnostic groups, two factors were most strongly linked to poorer emotional and behavioral outcomes:

1. Poor parental mental health
2. Challenges with remote education

Other factors associated with worse outcomes included:

• Lack of family support
• Difficulty following social distancing measures
• Limited time spent outdoors
• Younger age (for behavioral problems)
• Older age (for emotional problems)

Education challenges

Children with ADHD and ASD struggled more with remote learning compared to those with emotional disorders. They showed lower enjoyment and engagement with online education.

For all groups, lower enjoyment and engagement with remote education was associated with greater worsening of emotional and behavioral symptoms during lockdown.

Implications

This study highlights that children with pre-existing neurodevelopmental disorders like ADHD and autism may be particularly vulnerable during pandemic restrictions. The findings suggest several key areas to focus on to support youth mental health during future pandemics or similar disruptions:

1. Provide additional support for children with ADHD and ASD to help them adapt to changes in routines and services

2. Support parental mental health, as this was strongly linked to child outcomes across diagnoses

3. Help children, especially those with ADHD and ASD, better engage with remote education when in-person schooling is not possible

4. Ensure children have opportunities for outdoor time and social connection within safety guidelines

5. Offer extra support to younger children for managing behavioral issues and older youth for emotional challenges

By identifying these risk factors and vulnerable groups, mental health services and policymakers can better target their efforts to mitigate the impact of pandemic measures on children’s wellbeing.

Limitations

The researchers note some limitations of the study:

• It focused only on the initial lockdown period, so longer-term impacts are unclear
• The survey response rate was relatively low at 32%, so results may not fully represent the entire clinical population
• The study did not include a comparison group of children without pre-existing mental health disorders
• It relied on parent reports rather than direct assessment of children

Despite these limitations, this large study offers valuable insights into how children already receiving mental health support fared during an unprecedented disruption to their care and daily lives. The findings can help inform strategies to protect the mental health of vulnerable youth during future pandemics or similar crises.

Conclusions

• Children with neurodevelopmental disorders like ADHD and autism may be most vulnerable to negative mental health impacts from pandemic restrictions
• Poor parental mental health and difficulties with remote education were key risk factors for worse outcomes across diagnoses
• Targeting support to at-risk groups and addressing parental wellbeing and educational engagement may help mitigate impacts in future pandemics