Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

Authors: Jean Frazier, Michael O’Shea, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Inflammation is a normal part of the body’s defense to injury or infection. The investigators in this study wanted to find out whether factors known to be linked with inflammation during pregnancy (such as socioeconomic conditions, environmental exposures, and maternal infections) might be associated with emotional, cognitive, and behavioral dysregulation in children after birth. “Dysregulation” in this context refers to children’s attention, anxiety and depression, and aggression being measurably different from what is typically expected for children of their age.

What were the study results?

In this study, several maternal risk factors correlated with inflammation (lower education attainment, pre-pregnancy obesity, prenatal infections, and prenatal tobacco use) were strongly associated with dysregulation in offspring.

Researchers used a tool called the Child Behavior Checklist (CBCL) to measure aggressive behavior, anxiety/depression, and attention problems in children. Approximately 13.4 % of children and adolescents in the study met the criteria for the CBCL Dysregulation Profile. More youth with dysregulation (35%) were born to mothers with prenatal infections compared with 28% of youth without dysregulation.

Some additional maternal factors, including being overweight before pregnancy, lower education attainment, and smoking during pregnancy, were associated with higher likelihoods of childhood dysregulation. Children and adolescents who had a parent or sibling with a mental health disorder were more likely to experience dysregulation. Having a mother with gestational diabetes had no significant association with child dysregulation.

What was the study's impact?

By providing information about how maternal inflammation and relevant risk factors may be associated with dysregulation in a mother’s offspring, this study can help inform interventions to improve child health outcomes.

Who was involved?

This study included 4,595 children and adolescents (ages 6-18 years) from 18 ECHO research sites across the United States.

What happened during the study?

This study assessed perinatal factors known to be related to maternal and neonatal inflammation.

ECHO researchers collected data on maternal factors before and during pregnancy, including information about infections during pregnancy. They used the CBCL to collect parent-reported information about each child’s behavior. CBCL assessments were collected between 2009 and August 31, 2021, and researchers used these assessments to determine whether a child met criteria for the CBCL Dysregulation Profile based on their scores for aggression, anxiety/depression, and attention.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Future studies could focus on identifying the mechanisms that link maternal factors with childhood dysregulation. These studies could also look at whether certain interventions are able to reverse or partially reverse the mechanisms that contribute to the development of dysregulation.

Where can I learn more?

Access the full journal article, titled “Perinatal Factors and Emotional, Cognitive, and Behavioral Dysregulation in Childhood and Adolescence,” in the Journal of the American Academy of Child and Adolescent Psychiatry.

Published May 17, 2023

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Factors Linked to Pregnancy Inflammation May Be Associated With Dysregulation in Children

ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

Authors: Sarah Maylott, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

Why was this study needed?

Many studies in the past have been interested in how substance exposures during pregnancy affect childhood behavior. Most of these studies, however, have only focused on a single substance or have only assessed children aged 5 years or younger. The purpose of this study was to find out if types of substances affect a child’s behavior during middle childhood.

What were the study results?

Most children in the study were not exposed to any of the substances considered prior to birth, but those who were tended to be exposed to more than one. Children with substance exposures were more likely than their non-exposed peers to have certain behavior problems in middle childhood. Children exposed to tobacco and alcohol were more likely to display rule-breaking or aggressive behaviors, while children exposed to illegal drugs (cocaine, methamphetamine, heroin) were more likely to have higher rates of anxiety, depression, or withdrawn behaviors. However, not all children exposed to substances had behavioral problems, suggesting that some children may be more resilient than others.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

Two patterns of substance use during pregnancy were associated with childhood behavior problems. This finding is important because it suggests that researchers can identify children at risk for certain behavioral challenges based on the substances their mothers used during pregnancy. With more research, clinicians may be able to anticipate childhood behavior problems during or shortly after pregnancy based on the kinds of substances the child was exposed to and develop personalized interventions for these children.

Who was involved?

Researchers used data from approximately 2,000 women from 10 ECHO research sites which reported on their substance use during pregnancy. When their children were 6 to 11 years old, a caregiver reported on the child’s behavior. The average age of participating mothers at the time of pregnancy was 28 years old.

What happened during the study?

Using data from 2000 to 2020, the researchers grouped women based on the types of substances they used during pregnancy, including 1) low substance use, 2) mainly tobacco use (with moderate likelihood of using alcohol and marijuana), and 3) illicit use. They then compared children’s behaviors for each of these groups.

What happens next?

Similar large-scale studies are needed that look more closely at how the amount and timing of substance use during pregnancy affect the child’s risk for problem behavior, as well as how the child’s home environment contributes to that risk. Additionally, future studies are needed to identify factors that may increase resiliency in children with prenatal substance exposure.

Where can I learn more?

Access the full journal article, titled “Latent Class Analysis of Prenatal Substance Exposure and Child Behavioral Outcomes” in the Journal of Pediatrics.

The content is solely the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 12, 2023

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ECHO Study Suggests Substance Use During Pregnancy May Be Linked to Behavior Problems in Children

ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

Authors: Liz Conradt, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) program, Office of The Director, National Institutes of Health.

Why was this study needed?

Little is known about how a pregnant mother’s exposure to multiple substances, like tobacco, alcohol, or opioids, during pregnancy may be associated with outcomes for their children when they reach middle childhood. Most research looks at the effects of single-substance exposures or focuses on the effects of prenatal exposures on the child’s health exclusively during birth or early childhood. In this study, the research team evaluated the effects of prenatal exposure to multiple substances (alcohol, tobacco, marijuana, and opioids) on children’s reasoning skills and behavior during middle childhood.

What were the study results?

The team identified two groups of children based on their reasoning skills and problem behavior scores. Group 1 had average verbal reasoning skills, average spatial reasoning skills, and normal levels of problem behavior. Children in this group were exposed to fewer substances before birth. Group 2 included children with multiple substance exposures before birth. This group had below average verbal reasoning skills, but average spatial reasoning skills, and higher levels of problem behavior. Children in Group 2 were significantly more likely to be exposed to tobacco before birth. The effects of tobacco exposure on problem behavior and reasoning skills were stronger than expected.

What was the study's impact?

This study suggests that children exposed to tobacco and other substances before birth may be at increased risk for problem behaviors and lower verbal reasoning skill scores during middle childhood. These findings will help pediatricians identify children who are at risk for behavior problems and poorer reasoning skill scores. If replicated, this information might help pregnant women and their doctors to recognize how prenatal tobacco, especially in the context of other substance exposure, might affect their child’s verbal reasoning and behavior in middle childhood.

Who was involved?

This study involved pairs of mothers and their biological children. There were 256 mother-child pairs from two ECHO research sites with locations in Rhode Island, Minnesota, Washington, California, and New York. Children were ages six to 11 at the time of the behavioral and reasoning skills assessments.

What happened during the study?

Researchers collected data on prenatal exposure to substances including alcohol, tobacco, marijuana, and opioids. When the children were between six and 11 years old, their caregivers reported on the presence of problem behaviors such as aggression and anxiety. The researchers also collected data on problem solving skills with words, pictures, and diagrams (verbal and nonverbal reasoning).

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

Moving forward, the team wants to improve their measures of prenatal substance exposure and expand their sample size to include more ECHO participants. Grouping children that have been exposed to substances prenatally can help identify subgroups of children at risk for problem behaviors and low reasoning skill scores.

Where can I learn more?

The Center for Parenting and Opioids and National Institute on Drug Abuse have additional helpful resources.

The full journal article, titled “Prenatal Substance Exposure: Associations with Neurodevelopment in Middle Childhood” is published in the American Journal of Perinatology.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 10, 2023

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ECHO Study Suggests Prenatal Exposure to Tobacco, Other Substances Associated With Child Behavior, Reasoning

Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Authors: Lauren C. Shuffrey, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

Previous research has linked gestational diabetes (a type of diabetes mothers develop during pregnancy) to prenatal and postpartum depression in mothers. However, studies have not examined how the combination of gestational diabetes, prenatal depression, and postpartum depression affect early childhood behavior.

What were the study results?

The study found that gestational diabetes, prenatal maternal depressive symptoms, and postnatal maternal depressive symptoms were each associated with increased child externalizing (e.g., acting out, aggression, hyperactivity) and internalizing (e.g., anxiety, depression) behavior problems. This study also found that gestational diabetes was associated with increased autism behaviors only among children exposed to above average perinatal maternal depressive symptoms. Finally, the researchers observed gestational diabetes was only associated with child behavioral problems for male children, and not for female children.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the impact?

These findings suggest that children born to mothers who had both gestational diabetes and symptoms of depression during pregnancy should receive additional monitoring for behavioral problems during early childhood.

Who was involved?

This study included 2,379 children from ECHO cohorts located in Colorado, Massachusetts, New York, Pennsylvania, and Tennessee. More than half of participants were male, and 216 participants were born to mothers with gestational diabetes during pregnancy.

More than half of maternal participants were from an underrepresented minority group with 32% self-identifying as Black, 23% as Hispanic, 15% as mixed race, and 4% as Asian.

What happened during the study?

ECHO researchers used the Preschool Child Behavior Checklist (CBCL) to examine the behavior of children ages 2 to 5. They also collected information from the mothers including gestational diabetes diagnosis and self-assessments of depression symptoms during and after pregnancy. The study evaluated how gestational diabetes, prenatal depression, and postpartum depression affected children’s behavioral outcomes using the CBCL.

What happens next?

ECHO researchers are currently analyzing blood samples collected during pregnancy to investigate potential inflammatory mechanisms that may influence the associations between gestational diabetes, maternal depression, and early childhood behavior.

Where can I learn more?

Access the full journal article titled, “Gestational Diabetes Mellitus, Perinatal Maternal Depression, and Early Childhood Behavioral Problems: An Environmental Influences on Child Health Outcomes (ECHO) Study” in Child Development.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published May 2, 2023

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Gestational Diabetes and Postpartum Depression May Be Linked With Early Childhood Behavior Problems

Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

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Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Authors: Julie A. Hofheimer, Monica McGrath, Rashelle Musci, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

Why was this study needed?

Emotional and behavioral difficulties during early childhood can predict later problems such as anxiety, depression, attention deficits, and aggression. This study aims to describe children’s behavioral development from 18 to 72 months of age, examining risk factors for continuing behavioral problems that can inform early interventions to improve behavioral and emotional regulation.

What were the study results?

Children born preterm, males, and those exposed to more family hardships had more behavioral difficulties that persisted over time, including anxiety/depression, attention deficits, and aggression. Other factors that increased the risk for behavioral difficulties in children were prenatal substance exposure and higher maternal psychosocial and economic difficulties during pregnancy. Some children who experienced fewer family hardships showed improved behavior over time when receiving early support. The researchers were able to identify early life factors that may increase a child’s risk for experiencing behavioral and emotional difficulties later in childhood.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study suggested that support and services for families to help them cope with newborn health challenges and other family hardships may help improve young children’s behavioral and emotional difficulties. Specifically, preterm births and prenatal substance exposures may be used to identify children who may benefit from early support. Individualized support to meet the specific needs of children may prevent later behavioral problems and improve future outcomes for vulnerable children and their families.

Who was involved?

The study included 3,934 children born between 1990 and 2019 and their mothers from 20 ECHO cohorts across the United States. About 80% of the children were born at term (at or beyond 37 weeks of gestation), and about 20% were born preterm (before 37 weeks of gestation).

What happened during the study?

The researchers collected caregiver self-reports, demographics, and medical and social environment information about the mothers and children before and during pregnancy and from infancy through age 6. Caregivers also completed the Child Behavior Checklist at multiple study visits to describe their child’s behavior at different ages. Researchers compared the trajectory of children’s scores for dysregulation behaviors (anxiety, depression, attention, and aggression) across the first six years of life. Researchers described three patterns of behavioral trajectories observed in these children 1) high and increased dysregulation (2.3%); 2) borderline and stable dysregulation (12.3%); and 3) low and decreasing dysregulation (85.6%).

What happens next?

Future ECHO studies may examine how the behavior of children continues to develop after six years of age. These new studies could focus on identifying additional risk and protective factors for emotional and behavioral well-being and patterns across middle childhood and adolescence.

Where can I learn more?

Access the full journal article, titled “Psychosocial and Neonatal Risk Factors Associated with Behavioral Dysregulation Trajectories Among Young Children from 18 through 72 Months of Age,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published April 26, 2023

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Preterm Birth and Family Hardship May Associated With Childhood Behavior Problems

Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

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Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

Authors: Aaron Kaat, Kristen Lyall, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

Why was this study needed?

Prior research has developed and examined shortened versions of the SRS questionnaire, but this has been mostly done with school-age participants with autism and their family members. Researchers haven’t been able to evaluate the reliability of shortened versions of the SRS for capturing broader traits in the general population or for preschool-age participants. In addition, prior studies have not developed a shortened version of the questionnaire that uses computer-adaptive testing to select relevant questions based on a participants existing answers.

What were the study results?

The Social Responsiveness Scale (SRS) is frequently used to measure autism-related traits and social impairments. The full 65-question SRS can create more burden for participants, so many researchers have attempted to shorten the questionnaire. In this study, ECHO researchers evaluated the SRS questionnaire across two different versions for preschool and school-age groups, comparing the questions used on each and developing a comparable scoring method for both forms. They then used computer-adaptive testing, where a computer program tailors the questionnaire in real-time to each participant, and found that a median of 14 questions was sufficient to reach a reliable score.

What was the study's impact?

The results of this work suggest opportunities to reduce the amount of time participants spend completing questionnaires like the SRS without sacrificing accuracy. Additionally, the results suggest computer-adaptive questionnaires can be used to evaluate autism-related traits in a way that is comparable to standard fixed questionnaires, improving testing efficiency and reducing participant burden.

Who was involved?

This study included 7,030 children from multiple ECHO research sites and other large studies across the United States. Participants included children ranging from ages 2.5-18 years, most of whom did not have an autism diagnosis.

What happened during the study?

The researchers collected data on the preschool and school-age SRS forms from multiple different sources. They then conducted several analyses to assess a variety of factors that may affect how the full SRS and shortened versions of the SRS are scored. The researchers then used these data to simulate how computer-adaptive testing would score each individual after completing the minimum number of questions required to reach a comparable result.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What happens next?

The researchers’ follow-up analyses to this work compared the computerized version developed in this study to other versions of the questionnaire. Future research is needed to examine how these different questionnaires perform in different groups of people, and if results differ when captured according to self vs parent report.

Where can I learn more?

Access the full journal article, titled “Modifying the Social Responsiveness Scale for Adaptive Administration,” in Quality of Life Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published March 21, 2023

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Shorter Questionnaire Shown Effective for Measuring Autism-Related Traits in Children

ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

Authors: Marie Camerota, et al.

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health, and a career development award from the National Institute of Mental Health.

What were the study results?

ECHO researchers used the neurobehavioral scores to classify babies into one of six groups based on different patterns of behavior. While each group exhibited different characteristics, 4 of these groups contained infants with normal patterns of behavior. Only two of the six groups were characterized as poorly regulated. The first of these groups was hyper-aroused, or too excitable. The other group was hypo-aroused, or slow to respond.

Babies with poorly regulated behavior were more likely to be male, have younger mothers, and have mothers who were depressed or used tobacco during pregnancy. Babies born at all different gestational ages were found in each of the six groups.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study describes a possible link between demographic and health characteristics of mothers and babies with patterns of behavior in newborns. Previous studies conducted in single cohorts have described similar patterns of poorly regulated behavior in infants. The current study replicated those findings using a larger and more diverse population. If these patterns of behavior continue to be found in other large studies, this might suggest that these patterns could generalize to babies outside these studies. This information could be used to identify babies at risk for poorly regulated behavior who might benefit from early interventions and prevention services to help promote positive health outcomes for children.

Why was the study needed?

Behavior patterns in newborns can be used as indicators of long-term developmental outcomes. Previous studies have looked at the link between demographic and medical characteristics of mothers and their infant’s behavior shortly after birth, but these studies were conducted with smaller groups of babies who were very similar to one another (e.g., studies with babies who were all born full term). There is a need for studies that include a larger sample representing more diverse pairs of mothers and their babies, including babies who were born all across the gestational age spectrum.

Who was involved?

This study included 1,112 mother-infant pairs from 5 ECHO cohorts across the United States. Infants were born at gestational ages from 22 to 42 weeks.

What happened during the study?

The babies received a neurobehavioral exam shortly after they were born to test their responses to objects and people, their reflexes, and their movement. Either mothers reported information about their own and their babies’ demographic characteristics and health information or it was collected from their medical records. ECHO researchers looked at how the mothers’ demographic characteristics and health during pregnancy were related to their newborns’ behavior patterns.

What happens next?

More research is needed to determine which of the characteristics studied are stronger predictors of babies’ neurobehavior patterns, and whether the impact of these factors changes in babies born at different gestational ages. Further research is also needed to learn more about how babies’ neurobehavior shortly after birth is related to their health and development later in childhood.

Where can I learn more?

Access the full journal article, titled “Prenatal and perinatal factors associated with neonatal neurobehavioral profiles in the ECHO Program," in Pediatric Research.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 25, 2023

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ECHO Study Links Younger Pregnancies, Tobacco Use During Pregnancy, and Depression During Pregnancy With Poorly Regulated Behavior in Newborns

ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

Authors: Claudia Buss, Nora K. Moog

Who sponsored this study?

This research was supported by the Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health.

What were the study results?

Results from this study suggest that mothers’ maltreatment experience as children may influence their own children’s future health. Children of mothers who were neglected or abused during childhood were more likely to have diagnoses of asthma, ADHD, and ASD. These children were also more likely to demonstrate symptoms and behaviors linked to depression (i.e., internalizing behaviors). Additionally, girls whose mothers experienced maltreatment during childhood were more likely to have obesity. Children with mothers who experienced childhood maltreatment were also more likely to develop several of these health outcomes at once. Furthermore, exposure to several different forms of maternal childhood maltreatment was associated with highest risk increases for most offspring health outcomes suggesting the more severe the maternal childhood experiences were, the higher the risk for adverse health outcomes in her child.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study highlights the impact of maternal childhood maltreatment experiences as a major determinant of health across generations. While not all children of mothers who experienced abuse or neglect during childhood develop health problems, those who do are at higher risk for developing more than one condition. Results from this study suggest that screening and identifying these children early on, can allow the opportunity to direct targeted interventions to interrupt the intergenerational impact of adversity.

Why was the study needed?

Childhood maltreatment increases the risk for adverse health outcomes, and this risk can be transmitted from one generation to the next. Previous studies have investigated single health outcomes in children of mothers that were exposed to childhood abuse or neglect. However, health outcomes can often be connected to one another and affected by the same factors. This study investigated six health outcomes simultaneously and investigated whether a mother’s own exposure to maltreatment affects a child’s risk for experiencing more than one of these health outcomes.

Who was involved?

This study included over 4,000 mothers and their children from 21 ECHO cohorts. About 44% of mothers who participated in the study reported experiencing some form of abuse or neglect during their own childhood.

What happened during the study?

Mothers self-reported on their childhood experiences, and researchers used this information to assign mothers to one of two groups: 1) exposed to childhood maltreatment and 2) not exposed to childhood maltreatment. The researchers compared the risk for physical and mental conditions, including asthma, internalizing behaviors (e.g., social withdrawal, trouble sleeping, symptoms of anxiety or depression), autism spectrum disorder (ASD), attention-deficit/hyperactivity disorder (ADHD), and obesity, between the children in the two groups. They also examined whether multiple health outcomes co-occur in the same child.

What happens next?

Follow-up studies will investigate the pathways between maternal childhood maltreatment experiences and child health outcomes. Other studies may also investigate if other forms of negative childhood experiences are linked to different consequences of childhood maltreatment in the next generation.

Where can I learn more?

Access the full journal article, titled “Intergenerational transmission of the consequences of maternal exposure to childhood maltreatment – a United States nationwide study of multiple cohorts in the ECHO program” in The Lancet Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published February 23, 2023

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ECHO Study Suggests Childhood Maltreatment of Mothers Linked to Asthma, ADHD, and Autism Spectrum Disorder in Their Children

ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

Authors: Sara Nozadi, Johnnye Lewis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of the Director, National Institutes of Health supported this research.

What were the study results?

In this study, up to 15% of infants and toddlers who were developmentally on track prior to the COVID-19 pandemic showed signs of developmental delays during the pandemic. Male children showed more delays than female children, and language was the most affected developmental area. Families from minority communities and those with lower socioeconomic status were more likely to experience pandemic-related hardships. However, financial and social pandemic-related hardships were not associated with the individual changes observed in children’s developmental progress.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

What was the study's impact?

This study highlights the importance of early developmental screening during times of adversity, such as pandemics, in order to identify delays and connect children to supportive services. Previous studies have shown negative impacts of the pandemic on overall child development but have not looked at the effects of the pandemic on individual children’s development over time.

Why was this study needed?

Many studies have focused on the COVID-19 pandemic’s effects on the development of school-aged children, evaluating the effects of the pandemic on academic performance and behavior problems. Fewer studies have examined the pandemic’s effects on the developmental progress of infants and toddlers, whose needs are different than those of school-aged children. During this study, researchers examined whether the negative developmental effects observed in school-aged children over the course of the pandemic could also be seen in infants and toddlers.

Who was involved?

The study included 684 children between the ages of 2 months and 4 years from 8 ECHO cohort research sites across the United States. Researchers included children whose parents had filled out the Ages and Stages Questionnaire (ASQ), which uses parent-reported information to pinpoint a child’s developmental progress, within the 18-month period before and after March 2020. Parents of participating children were also asked about financial hardship, defined as at least one parent experiencing job loss or change, or social hardships, defined as families’ quarantining from household members or extended family and friends, during the pandemic.

What happened during the study?

Parents answered 30 questions before and during the pandemic to determine whether their child had achieved developmental milestones in language, motor, cognitive or problem solving, and socioemotional development. Researchers also used the ECHO COVID-19 survey that was developed in April 2020 to gauge pandemic-related financial and social stress on families.

What happens next?

Future research can follow the developmental patterns in these children over time to determine if COVID-19 related delays are lasting or reversible. Studies may also focus on pandemic-related stressors that could particularly effect infants and toddlers, such as family dynamics, parent-child interactions and parental stress.

Where can I learn more?

Access the full journal article, titled “Effects of COVID-19 financial and social hardships on infants’ and toddlers’ development in the ECHO program,” in the International Journal of Environmental Research and Public Health.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published January 5, 2023

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ECHO Study Suggests COVID-19 Pandemic Contributed to Developmental Delays in Infants, Toddlers

Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress

Authors: Tracy Bastain, Amy Margolis, et al.

Who sponsored this study?

The Environmental influences on Child Health Outcomes (ECHO) Program, Office of The Director, National Institutes of Health supported this research.

What were the study results?

The study identified two groups of mothers based on their pandemic experiences. One of these groups experienced more changes to their daily life routines, more isolation from friends and family, and more changes to their health behaviors, when compared to the other group who experienced fewer pandemic-related changes in their lives.

Mothers who reported more life changes also reported more symptoms of traumatic stress due to the pandemic. The mothers who fell into the group that experienced more changes and reported more symptoms of traumatic stress tended to be women with higher incomes and higher education. Sixty-six percent of the women in the high change group were white. The women in the high change group were more likely to report financial concerns as a cause of stress. They were also more likely to report that the pandemic affected their healthcare.

In contrast, the group that reported fewer changes tended to have lower education and lower income. The women in this group were primarily Black and Native American. Hispanic women were split evenly between the two groups.

Both groups reported similar rates of COVID-19 infection in the household and similar work changes.

Footnote: Results reported here are for a single study. Other or future studies may provide new information or different results. You should not make changes to your health without first consulting your healthcare professional.

Impact

As compared to fathers, during the COVID-19 pandemic more mothers have been affected by job and income losses, taken on more childcare burdens related to remote schooling, and have made major adjustments to their daily routines. This study found that mothers who had the most changes to their work, health, and social support systems also reported the highest amounts of traumatic stress due to the pandemic. These findings suggest that the association between sociodemographic, stressful life events, and mental health should be considered in future studies examining the long-term outcomes of the COVID-19 pandemic.

Why was this study needed?

The goal of this study was to better understand the mental health impacts of the COVID-19 pandemic on mothers in the United States and Puerto Rico.

Who was involved?

This study included 11,473 mothers from 62 ECHO cohorts across the U.S. and Puerto Rico.

What happened during the study?

ECHO researchers investigated the potential impacts of the COVID-19 pandemic on maternal mental health, from April 2020 through August 2021. The researchers looked for patterns of pandemic-related changes in maternal health and health behaviors, healthcare visits, work and finances, and coping strategies. They then used these data to group the mothers by those who had more or fewer pandemic-related changes to examine whether these groups reported higher or lower symptoms of traumatic stress related to the pandemic.

What happens next?

Future studies could examine how changes over the course of the pandemic affect mothers’ stress and well-being.

Where can I learn more?

Access the full journal article, titled “COVID-19 Pandemic Experiences and Symptoms of Pandemic-Associated Traumatic Stress Among Mothers in the US,” in JAMA Network Open.

The content is the responsibility of the authors and does not necessarily represent the official views of the National Institutes of Health.

Published December 16, 2022

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Mothers Who Experience More Life Changes Due to the COVID-19 Pandemic Reported More Symptoms of Traumatic Stress