688 - The COVID-19 Pandemic’s Effects on Young Children’s Socio-Emotional Development

We hypothesized that COVID-19 pandemic-related isolation had negative effects on child socio-emotional development among families served by a home-visiting program.

Objective:

Determine if developmental screening scores (ASQ-3 and ASQ-SE) changed during the pandemic among families in Nurse-Family Partnership (NFP), a nurse-visiting program that enrolls birthing people during pregnancy and continues through child age 2 years.

Design/Methods:

We conducted a retrospective cohort study using national NFP data by identifying 76,423 families who were:1) enrolled in NFP, 2) had singleton children born from 1/1/15—12/31/21 at > 37 weeks gestation, and 3) had > 1 valid developmental screen. We created 4 cohorts (pre-pandemic, pandemic 1, 2, and 3) based on child’s pandemic exposure at time of screening (Figure 1). Outcomes were a positive screen ('refer' range per ASQ guidelines) on ASQ-3 sub-scales at 10 and 18 months and ASQ-SE at 12 and 18 months. Covariates included maternal race, marital status, income, age, and parity.  We used multiavariable logisitic regression models to generate adjusted relative risks (ARR) for positive screens compared to the pre-pandemic cohort. 

Results:

Table 1 shows demographic characteristics and rates of positive screens on the ASQ-3 and ASQ-SE by cohort. Pandemic cohorts had fewer teens and were more likely to be married and multiparous.  As shown in Table 2, compared to the pre-pandemic cohort, pandemic 2 (partly exposed to pandemic at 10-months and fully exposed at 18-months) was less likely to screen positive for gross-motor at 10-months (ARR 0.81; 95% CI 0.74, 0.90) and more likely to screen positive for communication and personal-social at 18-months (ARR 1.32; CI 1.14, 1.53 and ARR 1.45; CI 1.08, 1.95); pandemic 3 (fully exposed to pandemic at 10 and 18-month screens) was more likely to screen positive for fine motor at 10-months (ARR 1.09; CI 1.00, 1.18) and communication at 10 and 18-months (ARR 1.14; CI 1.01, 1.29 and ARR 1.16; CI 1.00, 1.35). All pandemic cohorts had higher risk for positive screens on the ASQ-SE at 12-months (pandemic 1 ARR 1.17; CI 1.03, 1.32, 2 ARR 1.25; CI 1.10, 1.43, 3 ARR 1.25; CI 1.12, 1.39) and 2 and 3 had higher risk at 18-months (2 ARR 1.50; CI 1.29, 1.75, 3 ARR 1.60; CI 1.39, 1.83).

Conclusion(s):

Exposure to the COVID-19 pandemic was associated with higher risk of a positive screen on the ASQ-SE indicating that isolation among families may have contributed to child socio-emotional delays. Next steps include analyses to elucidate potential causal pathways and evaluation of referrals to early intervention for those with positive screens.