April 2022|Volume 10, Issue 2
EVIDENCE IN ACTION
A quarterly research brief from the
Center on Trauma and Children
Special Edition: Review of Research from the Field
Glynn, L.M., Davis, E.P., Luby, J.L., Baram, T.Z., Sandman, C.A. (2021). A predictable home environment may protect child mental health during the COVID-19 pandemic. Neurobiology of Stress, 14:100291. https://doi.org/10.1016/j.ynstr.2020.100291. 
Prepared by Debbie Katz, M.D.
Introduction
Little is known about how the COVID-19 pandemic has affected the mental health of children, particularly preschoolers. Since young children’s mental health is so closely tied to the health and well-being of their caregivers, parental stress, depression and the loss of external supports and routines like daycare, school and social activities likely impact significantly on children. Data from early studies(1-3) reveal that the COVID-19 pandemic is associated with increases in child behavior problems and anxiety that were more pronounced in racial-ethnic minority families and in economically disadvantaged households and discuss ways of mitigating risk.
 
Because there is evidence that unpredictability in early life constitutes a source of stress and may contribute to psychopathology and disrupted neurodevelopment, the authors of this study wanted to look at the impact of a modifiable source of family stress, namely family routines. Family routines serve as protective factors in the face of adversity and stress and may predict child resilience. This study had two goals: (1) to investigate mental health symptoms in preschool children during the COVID pandemic, and (2) to evaluate the possible protective factor that maintenance of family routines has for children’s mental health during this pandemic. 
The Study

This study was part of an ongoing longitudinal study on early childhood development in Southern California. Child depressive symptoms were assessed through the Preschool Feelings Checklist (PFC), completed by mothers. Child externalizing symptoms were assessed using the Strengths and Difficulties Questionnaire (SDQ), and family routines were assessed through six items from the Family Routines Inventory (FRI). Maternal depressive symptoms and food insecurity were also assessed.
Findings
 
Participants included 169 mother-child pairs with a mean child age of 4.1 years. Approximately 83% of children were in dual parent households, and the majority of mothers were Latinx (46%). Most (61%) of the families were living below the estimated living wage for their county of residence. Nearly 30% had some food insecurity and 24% had at least one parent who was laid off or furloughed because of the pandemic.
 
On the PFC, approximately 40% of children scored above the cutoff for referral for further evaluation for depression. The proportion of children scoring above the cutoff was elevated compared to a pre-COVID population-based sample(4). Approximately 64% of mothers reported an increase in externalizing behaviors in at least one behavior category since the start of the pandemic. Bivariate correlations between family routines and child depressive symptoms showed that in households in which more routines were practiced, children had lower levels of both depressive symptoms (p < .01) and externalizing behaviors (p < .05). The association between family routines and child depressive symptoms remained statistically significant, controlling for covariates such as maternal depressive symptoms and perceived stress. Children who exhibited increased conduct problems since the start of the pandemic were more likely to have families practicing fewer routines. This correlation remained after adjusting for multiple factors (e.g., demographics, maternal depressive symptoms, perceived stress).
Translational Tips
  • The mental health of young children has been affected in negative ways by the pandemic, with the potential for long-term sequelae.
  • The impact of COVID on the mental health of preschoolers, particularly regarding depression and externalizing behaviors, may be ameliorated by the presence of family routines.
  • Family routines are important organizers of family life with the potential to protect families in times of adversity.
  • There are particular family routines these authors found important and screened for; these are measured by the Family Routine Inventory (FRI)(5):
  • Working parent(s) have a regular play time with the children after work.
  • Children do the same things each morning as soon as they wake up.
  • Family has certain ‘family time’ each week when they do things together at home.
  • Children have special things they do or ask for each night at bedtime (e.g., a story, a good night kiss, a drink of water).
  • Children go to bed at the same time.
  • The whole family eats dinner together.
  • Clinicians may also want to consider the PFC to screen for depression in young children(6): https://medicine.tulane.edu/sites/g/files/rdw761/f/pictures/Preschool%20feelings%20checklist.pdf
  • Clinicians may want to consider utilizing the CDC’s Parental Resources Kit (https://www.cdc.gov/mentalhealth/stress-coping/parental-resources/index.html) to help parents understand and address the impact of COVID on the emotional and social well-being of their child. 

References
(1) Center for Translational Neuroscience, 2020a. Why Households with Young Children Warrant Our Attention and Support during (And after) the COVID-19 Pandemic.
(2) Center for Translational Neuroscience, 2020b. Flattening the Other Curve: Trends for Young Children’s Mental Health Are Good for Some, but Concerning for Others. https://medium.com/rapid-ec-project/flattening-the-other-curve-7be1e574b340[DK1] .
(3) Yoshikawa, H., Wuermli, A. J., Britto, P. R., et al. 2020. Effects of the global coronavirus disease-2019 pandemic on early childhood development: short-and long-term risks and mitigating program and policy actions. The Journal of Pediatrics, 223, 188-193.
(4) Fuhrmann, P., Equit, M., Schmidt, K., von Gontard, A. 2014. Prevalence of depressive symptoms and associated developmental disorders in preschool children: a population-based study. Eur. Child Adolesc. Psychiatr. 23 (4), 219–224.
(5) Jensen, E.W., James, S.A., Boyce, W.T., Hartnett, S.A., 1983. The family routines inventory: development and validation. Soc. Sci. Med. 17 (4), 201–211.
(6) Luby, J.L., Heffelfinger, A., Koenig-McNaught, A.L., Brown, K., Spitznagel, E., 2004. The Preschool Feelings Checklist: a brief and sensitive screening measure for depression in young children. J. Am. Acad. Child Adolesc. Psychiatry 43 (6), 708–717.