Longitudinal Associations Between COVID-19 Stress and the Mental Health of Children With ADHD

Objective: To investigate the longitudinal associations between COVID-19 induced stress (related to COVID-19 restrictions/changes), attention-deficit/hyperactivity disorder (ADHD) symptoms, oppositional symptoms, and mental health outcomes (negative affect, anxiety, depression, and irritability) in children with ADHD during the COVID-19 pandemic. Method: Parents of 140 Australian children with ADHD (aged 5–17 years) completed an online survey in May 2020 during stay-at-home restrictions and 12-months later. Results: Baseline COVID-19 stress was associated with increased total ADHD symptom severity (β = .21, p = .007) and hyperactivity/impulsivity symptoms (β = .23, p = .002) at 12-months, after accounting for covariates (i.e., child age, gender, ADHD medication, socio-economic status, and baseline symptoms). Despite some indication of associations between baseline COVID-19 stress and 12-month oppositional symptoms and negative affect, these were attenuated when adjusting for baseline symptoms. Conclusions: The study provides initial evidence of the medium-term impacts of pandemic-related stress for children with ADHD.

Predicting the Trajectories of Parents' Relationship Well-Being During COVID-19 Lockdowns and Beyond: a Vulnerability, Stress and Adaptation Model Perspective.

Strict lockdowns have been employed by many of the world's nations as a public health response to COVID-19. However, concerns have been expressed as to how such public health responses disturb the human ecosystem. In this paper, we report on findings from a longitudinal study of Australian parents in which we investigated how state differences in government-mandated lockdowns affect the relationship well-being (i.e., relationship satisfaction and loneliness) of parents. We situated the study of the relational effects of strict lockdowns within the Vulnerability Stress Adaptation Model (VSAM, Karney & Bradbury, 1995) that considers the role of parents' pre-existing vulnerabilities (i.e., psychological distress and attachment insecurity), life stressors (pre-pandemic and COVID-19 stressors), and adaptive relationship processes (constructive communication and perceived partner support). A total of 1942 parents completed 14 waves of assessments of relationship satisfaction and loneliness over a 13.5-month period as well as baseline assessments of personal vulnerabilities, life stressors, and adaptive relationship processes. Parents with high relationship adaptations and low vulnerabilities evidenced the highest relationship well-being (i.e., high satisfaction and low loneliness) during changes in lockdown restrictions, while parents with moderate relationship adaptations and vulnerabilities experienced the poorest well-being. Differences in state lockdown restrictions (i.e., Victoria [long and strict lockdown policy] vs all other states) were associated with differences in relationship well-being for parents with high relationship adaptations. Specifically, Victorian parents experienced significant declines in relationship well-being compared to non-Victorian parents. Our findings provide novel insights into how government-mandated social restrictions can disrupt the relational ecology of parents.

Associations Between Anxiety and Home Learning Difficulties in Children and Adolescents with ADHD During the COVID-19 Pandemic.

The COVID-19 pandemic has markedly impacted functioning for children and adolescents including those with attention-deficit/hyperactivity disorder (ADHD). We explored home learning difficulties (HLD) during COVID-19 restrictions in Australian children (aged 5-17) with ADHD, aiming to: (1) describe home learning experiences, and (2) examine associations between child anxiety (i.e., concurrent anxiety symptoms and pre-existing anxiety disorder status) and HLD. Baseline data from the longitudinal ADHD COVID-19 Survey were used (n = 122). Parents reported on school factors and HLD; pre-existing anxiety and co-occurring difficulties; anxiety, ADHD, and oppositional symptoms; demographics; and medications. Parents retrospectively reported more children often looked forward to school pre-pandemic, than during the pandemic. Anxiety symptoms, but not pre-existing anxiety disorder status, were associated with HLD after accounting for covariates. ADHD inattention symptoms were also associated with HLD. Results support recommendations to continue pre-pandemic supports to assist with ADHD symptoms during home learning, and strategies/supports for families are discussed.

Child and Parent Physical Activity, Sleep, and Screen Time During COVID-19 and Associations With Mental Health: Implications for Future Psycho-Cardiological Disease?

The COVID-19 pandemic has afforded the opportunity for some to improve lifestyle behaviours, while for others it has presented key challenges. Adverse changes in global lifestyle behaviours, including physical activity, sleep, and screen time can affect proximal mental health and in turn distal cardiovascular outcomes. We investigated differences in physical activity, sleep, and screen time in parents and children during early stages of the COVID-19 pandemic in Australia compared to pre-COVID-19 national data; and estimated associations between these movement behaviours with parent and child mental health. Cross-sectional baseline data from the COVID-19 Pandemic Adjustment Study (CPAS; N = 2,365) were compared to nationally representative pre-pandemic data from the Longitudinal Study of Australian Children (LSAC; N = 9,438). Participants were parents of children aged ≤ 18 years, residing in Australia. Parents provided self-report measures of mental health, physical activity and sleep quality, and reported on child mental health, physical activity and screen time. Children in CPAS had significantly more sleep problems and more weekend screen time. Their parents had significantly poorer sleep quality, despite increased weekly physical activity. Children's sleep problems were significantly associated with increased mental health problems, after accounting for socioeconomic status, physical activity, and screen time. Poorer parent sleep quality and lower levels of physical activity were significantly associated with poorer mental health. Monitoring this cohort over time will be important to examine whether changes in movement behaviour are enduring or naturally improve with the easing of restrictions; and whether these changes have lasting effects on either parent or child mental health, and in turn, future risk for CVD.

Parent and child mental health trajectories April 2020 to May 2021: Strict lockdown versus no lockdown in Australia.

OBJECTIVE: To control a second-wave COVID-19 outbreak, the state of Victoria in Australia experienced one of the world's first long and strict lockdowns over July-October 2020, while the rest of Australia experienced 'COVID-normal' with minimal restrictions. We (1) investigate trajectories of parent/child mental health outcomes in Victoria vs non-Victoria and (2) identify baseline demographic, individual and COVID-19-related factors associated with mental health trajectories. METHODS: Online community sample of 2004 Australian parents with rapid repeated assessment over 14 time-points over April 2020 to May 2021. Measures assessed parent mental health (Depression, Anxiety and Stress Scales-21), child depression symptoms (13-item Short Mood and Feelings Questionnaire) and child anxiety symptoms (four items from Brief Spence Children's Anxiety Scale). RESULTS: Mental health trajectories shadowed COVID-19 infection rates. Victorians reported a peak in mental health symptoms at the time of the second-wave lockdown compared to other states. Key baseline predictors, including parent and child loneliness (standardized regression coefficient [ß] = 0.09-0.46), parent/child diagnoses (ß = 0.07-0.21), couple conflict (ß = 0.07-0.18) and COVID-19 stressors, such as worry/concern about COVID-19, illness and loss of job (ß = 0.12-0.15), predicted elevated trajectories. Effects of predictors on parent and child mental health trajectories are illustrated in an online interactive app for readers (https://lingtax.shinyapps.io/CPAS_trend/). CONCLUSION: Our findings provide evidence of worse trajectories of parent and child mental health symptoms at a time coinciding with a second COVID-19 outbreak involving strict lockdown in Victoria, compared to non-locked states in Australia. We identified several baseline factors that may be useful in detecting high-risk families who are likely to require additional support early on in future lockdowns.

Monitoring Australian parents' shifting receptiveness to digital mental health interventions during the COVID-19 pandemic.

BACKGROUND: Nascent evidence indicates that the mental health of parents and children has markedly declined during the COVID-19 pandemic. Considering disruptions to traditional face-to-face mental health services resultant from stay-at-home orders, the potential value of digital mental health interventions has become extremely apparent. Despite this, uptake of digital interventions remains poor, indicating that a better understanding is needed of factors that determine a willingness to use digital platforms. METHOD: The present multi-wave, longitudinal study of 2365 Australian parents explored between-person and within-person predictors of intentions to use digital interventions during the pandemic. RESULTS: More than one-third of parents reported likely use of a self-guided and therapist-guided digital intervention, with the most endorsed reason for use being to support their child's mental health. Between-person baseline predictors of higher intention ratings were parent's prior mental illness, not living with a partner and recent environmental stressors. Within-person predictors of higher intention ratings were endorsement of mindful parenting strategies, child access to the Internet, better perceived management of child's education, lower social support and financial hardship. CONCLUSION: Findings demonstrate that willingness to engage in digital interventions fluctuates in response to changing circumstances. Identifying novel ways to increase acceptance and uptake of digital interventions based on modifiable predictors established here is needed to realize the full potential of these modes of care in times of need.

Developmental gains and losses during parenthood.

The onset of parenthood irrevocably changes the landscape of adults' functioning, amplifying the potential for parents' experiences of both developmental losses and gains/growth, in context of increased responsibilities and more limited access to environmental resources/supports. In this article, we draw on dual theoretical lenses to integrate the frameworks of Baltes' lifespan development theory of gains and loss and Bronfenbrenner's bioecological model. We summarize empirical evidence in relation to a normative transition, exemplified by the transition to parenthood, and a non-normative event, the Coronavirus (COVID-19) pandemic, and show that parents' experiences of developmental loss and gains/growth are inextricably linked. Our findings illustrate how parents' losses/gains are influenced by a broad range of individual and environmental factors, with implications for parent prevention/intervention programs.

Subjective wellbeing in parents during the COVID-19 pandemic in Australia.

OBJECTIVES: To examine (1) the subjective wellbeing of Australian parents raising children and adolescents (0-18 years) during April 2020 'stage three' COVID-19 restrictions, in comparison with parents assessed over 18-years prior to the pandemic; and (2) socio-demographic and COVID-19 predictors of subjective wellbeing during the pandemic. METHODS: Cross-sectional data were from the COVID-19 Pandemic Adjustment Survey (CPAS, N = 2365 parents of a child 0-18 years, 8-28th April 2020); and a pre-pandemic national database containing 18 years of annual surveys collected in 2002-2019 (N = 17,529 parents). RESULTS: Levels of subjective wellbeing during the pandemic were considerably lower than ratings prior to the pandemic (Personal Wellbeing Index, mean[SD] = 65.3 [17.0]; compared to [SD] = 75.8 [11.9], p < 0.001). During the pandemic, lower subjective wellbeing was associated with low education (adjusted regression coefficient, 95% confidence interval [95% CI] = -5.19, -0.93), language other-than-English (95% CI = -7.22, -1.30), government benefit (95% CI = -6.99, -0.96), single parents (95% CI = -8.84, -4.59), child neurodevelopmental condition (95% CI = -3.44, -0.76), parent physical/mental health problems (95% CI = -3.23, -0.67), COVID-environmental stressors (95% CI = -3.48, -2.44), and fear/worry about COVID-19 (95% CI = -8.13, -5.96). Unexpectedly, parent engagement with news media about the pandemic was associated with higher subjective wellbeing (95% CI = 0.35, 1.61). CONCLUSION: Subjective wellbeing in parents raising children aged 0-18 years appears to be disproportionately impacted by the COVID-19 pandemic and restrictions in Australia. Specific at-risk groups, for which government intervention may be warranted, include parents in socially disadvantaged contexts, parents with pre-existing mental health difficulties, and parents facing significant COVID-19-related work changes.

From "It Has Stopped Our Lives" to "Spending More Time Together Has Strengthened Bonds": The Varied Experiences of Australian Families During COVID-19.

The present study uses a qualitative approach to understand the impact of COVID-19 on family life. Australian parents of children aged 0-18 years were recruited via social media between April 8 and April 28, 2020, when Australians were experiencing social distancing/isolation measures for the first time. As part of a larger survey, participants were asked to respond via an open-ended question about how COVID-19 had impacted their family. A total of 2,130 parents were included and represented a diverse range of family backgrounds. Inductive template thematic analysis was used to understand patterns of meaning across the texts. Six themes were derived from the data, including "Boredom, depression and suicide: A spectrum of emotion," "Families are missing the things that keep them healthy," "Changing family relationships: The push pull of intimacy," "The unprecedented demands of parenthood," "The unequal burden of COVID-19," and "Holding on to positivity." Overall, the findings demonstrated a breadth of responses. Messages around loss and challenge were predominant, with many families reporting mental health difficulties and strained family relationships. However, not all families were negatively impacted by the restrictions, with some families reporting positive benefits and meaning, including opportunities for strengthening relationships, finding new hobbies, and developing positive characteristics such as appreciation, gratitude, and tolerance.

Study Protocol for the COVID-19 Pandemic Adjustment Survey (CPAS): A Longitudinal Study of Australian Parents of a Child 0-18 Years.

BACKGROUND: The COVID-19 pandemic presents significant risks to the mental health and wellbeing of Australian families. Employment and economic uncertainty, chronic stress, anxiety, and social isolation are likely to have negative impacts on parent mental health, couple and family relationships, as well as child health and development. OBJECTIVE: This study aims to: (1) provide timely information on the mental health impacts of the emerging COVID-19 crisis in a close to representative sample of Australian parents and children (0-18 years), (2) identify adults and families most at risk of poor mental health outcomes, and (3) identify factors to target through clinical and public health intervention to reduce risk. Specifically, this study will investigate the extent to which the COVID-19 pandemic is associated with increased risk for parents' mental health, lower well-being, loneliness, and alcohol use; parent-parent and parent-child relationships (both verbal and physical); and child and adolescent mental health problems. METHODS: The study aims to recruit a close to representative sample of at least 2,000 adults aged 18 years and over living in Australia who are parents of a child 0-4 years (early childhood, N = 400), 5-12 years (primary school N = 800), and 13-18 years (secondary school, N = 800). The design will be a longitudinal cohort study using an online recruitment methodology. Participants will be invited to complete an online baseline self-report survey (20 min) followed by a series of shorter online surveys (10 min) scheduled every 2 weeks for the duration of the COVID-19 pandemic (i.e., estimated to be 14 surveys over 6 months). RESULTS: The study will employ post stratification weights to address differences between the final sample and the national population in geographic communities across Australia. Associations will be analyzed using multilevel modeling with time-variant and time-invariant predictors of change in trajectory over the testing period. CONCLUSIONS: This study will provide timely information on the mental health impacts of the COVID-19 crisis on parents and children in Australia; identify communities, parents, families, and children most at risk of poor outcomes; and identify potential factors to address in clinical and public health interventions to reduce risk.