Parents' perception of their children's neurodevelopment during the COVID-19 pandemic and associated factors

Ibiapina, Sabrina Ribeiro; Werle, Taís Michele; Giongo, Milena Monticelli; Nunes, Magda Lahorgue

doi:10.1016/j.jped.2025.06.002

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Original article • J. Pediatr. (Rio J.) 101 (5) • 2025 • https://doi.org/10.1016/j.jped.2025.06.002 linkcopy

Parents' perception of their children's neurodevelopment during the COVID-19 pandemic and associated factors

Authorship SCIMAGO INSTITUTIONS RANKINGS

Abstract

Objective To verify parents’/caregivers’ perceptions of changes in their children’s development during the COVID-19 pandemic and factors associated with such perceptions.

Methods Cross-sectional study using an online survey made available to parents/caregivers of children between 0-7 years old, from September 2021 to March 2023 in two Brazilian states. Respondents answered questions about their perceptions regarding their children's neurodevelopment, and worsening of neurodevelopment during the COVID-19 pandemic. Validated questionnaires such as M-CHAT, “Swanson, Nolan and Pellham,” and “Strengths and Difficulties “were applied according to age. Comparisons were made using the chi-square test or Fisher's exact test, and Poisson regression was used in the univariate analysis and in the multivariate analysis.

Results Data from 589 children were obtained, 49.7% aged 0-3 years and 50.3% 4-7 years. Of the 0-3 age group, 50 (17.1%) were perceived as having abnormal neurodevelopment, and 79 (27.0%) as having worsened neurodevelopment during the pandemic. Of the 4-7 year group, 76 (25.7%) were perceived as having abnormal neurodevelopment, and 104 (35.1%) as having worsened their neurodevelopment. Significant risk factors associated with the perception of abnormal neurodevelopment were maternal schooling, the child's sex and age; for the perception of worsening neurodevelopment were the child's sex and age, low socioeconomic status, degree of social isolation, and death in the family due to COVID-19.

Conclusion Data from the present study showed that parents/ caregivers' perception of normal neurodevelopment was significantly higher than their recognition of abnormalities. In addition, a significant percentage perceived a worsening during the COVID-19 pandemic.

Keywords
COVID-19 pandemic; Children; Neurodevelopmental disorders; Parents; Perception

Variable	CE	RS	P
Respondents	(N = 276)	(N = 220)
Who answered the questionnaire, no. (%)			0.694
Mother	253 (91.7)	200 (90.9)
Dad	12 (4.3)	8 (3.6)
Other	11 (4.0)	12 (5.5)
Maternal age in years, no. (%)			0.173
< 18	5 (1.8)	9 (4.1)
≥ 18	271 (98.2)	211 (95.9)
Median (AIQ)	37 (32-40)	33 (25-38)	<0.001
Mother's schooling, number/total number (%)			<0.001
Elementary School	7/276 (2.5)	34/202 (16.8)
MS up to incomplete degree	52/276 (18.8)	82/202 (40.6)
Full degree and PG	217/276 (78.6)	86/202 (42.6)
Who the child lives with, no. (%)			<0.001
Responsible 1 and 2	214 (77.5)	152 (69.1)
Responsible 1 (father or mother)	31 (11.2)	11 (5.0)
Responsible 2 (father or mother)	25 (9.1)	46 (20.9)
Another family member	6 (2.2)	11 (5.0)
Family income in minimum wages, no. (%)			<0.001
Up to 1	30 (10.9)	68 (30.9)
Between 1 and 2	29 (10.5)	37 (16.8)
From 2 to 4	34 (12.3)	36 (16.4)
From 4 to 10	74 (26.8)	36 (16.4)
From 10 to 20	71 (25.7)	22 (10.0)
Above 20	38 (13.8)	21 (9.5)
Participates in Social Program, no. (%)	39 (14.1)	51 (23.3)	0.013
Did social isolation (*), number/total number (%)	255/275 (92.4)	186/218 (85.3)	0.011
COVID in the family, number/total number (%)	204/269 (73.9)	136/217 (62.7)	0.002
Death due to COVID in the family, no. (%)	31 (11.2)	13 (5.9)	0.040
Children	(N=318)	(N=271)
Sex, number (%)			0.001
Female	124 (39.0)	143 (52.8)
Male	194 (61.0)	128 (47.2)
Age group, number (%)			0.005
0-3 years	142 (44.7)	151 (55.7)
4-7 years	176 (55.3)	120 (44.3)
Schooling, number/total number (%)			<0.001
They don't study	60/316 (18.9)	110/271 (40.6)
Nursery	74/316 (23.3)	78/271 (28.8)
Pre-school	113/316 (35.5)	47/271 (17.3)
1st grade Elementary School	36/316 (11.3)	20/271 (7.4)
2nd grade Elementary School	26/316 (8.2)	15/271 (5.5)
3rd grade Elementary School	7/316 (2.2)	1/271 (0.4)

				Univariate analysis			Multivariable analysis*
Features	N	no.	%	PR	95% CI	P	PR	95% CI	P
Family income
up to 2 MW	202	54	26.7	Ref.	-	-	Ref.	-	-
2 to 10 MW	207	64	30.9	1.14	0.83 - 1.56	0.412	0.76	0.50 - 1.15	0.198
> 10 MW	180	65	36.1	1.31	0.96 - 1.79	0.086	0.76	0.48 - 1.21	0.248
Education
Fundamental	50	9	18.0	Ref.	-	-	Ref.	-	-
Up to incomplete degree	172	48	27.9	1.51	0.76 - 2.99	0.236	1.51	0.78 - 2.93	0.224
Undergraduate and PG	344	124	36.0	1.92	1.00 - 3.68	0.050	2.22	1.05 - 4.69	0.036
Maternal age
up to 18 years old	16	4	25.0	0.84	0.36 - 2.00	0.701
> 18 years	573	179	31.2	Ref.	-	-
Sex of the child
Female	267	69	25.8	0.75	0.59 - 0.96	0.022	0.74	0.58 - 0.94	0.013
Male	322	114	35.4	Ref.	-	-	Ref.	-	-
Child's age group
0 to 3 years	293	79	27.0	Ref.	-	-	Ref.	-	-
4 to 7 years	296	104	35.1	1.36	1.07 - 1.74	0.012	1.34	1.05 - 1.72	0.020
Participation Social program
Yes	113	36	31.9	1.04	0.76 - 1.43	0.800
No	476	147	30.9	Ref.	-	-
Social isolation
Yes	522	169	32.4	1.59	0.94 - 2.70	0.085	1.36	0.81 - 2.28	0.241
No	67	14	20.9	Ref.	-	-	Ref.	-	-
COVID-19 in the family
Yes	397	127	32.0	1.08	0.82 - 1.41	0.596
No	192	56	29.2	Ref.	-	-
Death from COVID-19 in the family
Yes	49	20	40.8	1.29	0.88 - 1.89	0.185	1.35	0.92 - 1.99	0.121
No	540	163	30.2	Ref.	-	-	Ref.	-	-

				Univariate analysis			Multivariable analysis*
Features	N	no.	(%)	PR	95% CI	P	PR	95% CI	P
Family income
up to 2 MW	202	52	25.7	Ref.	-	-	Ref.	-	-
2 to 10 MW	207	32	15.5	0.60	0.41 - 0.89	0.011	0.86	0.56 - 1.34	0.514
> 10 MW	180	42	23.3	0.91	0.63 - 1.30	0.589	1.32	0.83 - 2.09	0.247
Education
Fundamental	50	9	18.0	Ref.	-	-
Up to incomplete degree	172	40	23.3	1.27	0.63 - 2.59	0.507
Undergraduate and PG	344	74	21.5	1.19	0.60 - 2.36	0.626
Maternal age
up to 18 years old	16	4	25.0	1.18	0.48 - 2.89	0.714
> 18 years	573	122	21.3	Ref.	-	-
Sex of the child
Female	267	37	13.9	0.50	0.35 - 0.71	<0.001	0.51	0.36 - 0.71	<0.001
Male	322	89	27.6	Ref.	-	-	Ref.	-	-
Child's age group
0 to 3 years	293	50	17.1	Ref.	-	-	Ref.	-	-
4 to 7 years	296	76	25.7	1.51	1.09 - 2.08	0.013	1.50	1.10 - 2.05	0.012
Participation Social program
Yes	113	40	35.4	1.96	1.43 - 2.69	<0.001	2.06	1.35 - 3.13	0.001
No	476	86	18.1	Ref.	-	-	Ref.	-	-
Social isolation
Yes	67	8	11.9	1.89	0.98 - 3.64	0.056	1.93	1.04 - 3.60	0.039
No	522	118	22.6	Ref.	-	-	Ref.	-	-
COVID-19 in the family
Yes	397	79	19.9	0.81	0.59 - 1.12	0.200
No	192	47	24.5	Ref.	-	-
Death from COVID-19 in the family
Yes	49	17	34.7	1.72	1.14 - 2.60	0.009	1.89	1.28 - 2.79	0.001
No	540	109	20.2	Ref.	-	-	Ref.	-	-

Perceptions - Scales	Total
Perceptions - M-CHAT, no./total no. (%)	(N = 79)
Abnormality - Moderate, hight risk	8/31 (25.8)
Normality - Low risk	44/48 (91.7)
Worsening in the pandemic - Moderate, hight risk	10/31 (32.3)
Perceptions - SDQ, no./total no. (%)	(N=296)
Abnormality - Abnormal	52/153 (34.0)
Normality - Normal, boderline	119/143 (83.2)
Worsening in the pandemic - Abnormal	64/153 (41.8)
Perceptions - SNAP (Inattention), no./total no. (%)	(N=296)
Abnormality - Moderate, severe	24/35 (68.6)
Normality - No signs, mild signs	209/261 (80.1)
Worsening in the pandemic - Moderate, severe	27/35 (77.1)
Perceptions - SNAP (Hyperactivity, impulsivity), no./total no. (%)	(N=296)
Abnormality - Moderate, severe	14/39 (35.9)
Normality - No signs, mild signs	195/257 (75.9)
Worsening in the pandemic - Moderate, severe	19/39 (48.7)
Perceptions - SNAP (Oppositional, challenging behavior), no./total no. (%)	(N=296)
Abnormality - Moderate, severe	5/23 (21.7)
Normality - No signs, mild signs	202/273 (74.0)
Worsening in the pandemic - Moderate, severe	6/23 (26.1)

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