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July 27, 2020

How a Pandemic Could Advance the Science of Early Adversity

Author Affiliations
  • 1Department of Psychiatry, University of California, San Francisco, San Francisco
  • 2Department of Pediatrics, University of California, San Francisco, San Francisco
JAMA Pediatr. Published online July 27, 2020. doi:10.1001/jamapediatrics.2020.2354

The reach of the coronavirus disease 2019 (COVID-19) pandemic is global, a health crisis with a ubiquity never before experienced. While the physical health consequences of COVID-19 appear to affect proportionally fewer children compared with adults, its psychosocial consequences may be magnified within families who consistently weather a landscape of severe stressors or adverse childhood experiences (ACEs; eg, domestic violence, abuse, maltreatment, and parent mental health issues). Leveraging the scientific evidence of early childhood research can aid in developing and implementing evidence-based practices that reduce risk and promote resilience within vulnerable families.

For families with a history of severe stress exposure, the trauma and unpredictability of the COVID-19 pandemic will add to the types, intensity, and duration of ACEs in the short term and the months to follow. For example, risk factors for child maltreatment include parental unemployment, substance use, marital strain, and parent-child conflict,1 all of which may emerge as pandemic-associated sequelae. In vulnerable families, parents may be more likely to have underlying physical health conditions that lead to hospitalization or death as a result of COVID-19, disproportionally exposing such children to caregiver separation or loss. Children and parents with preexisting mental health conditions may struggle without access to their usual treatments or support. The pandemic is also likely to disrupt previously established protective family routines, creating greater disarray in the often chaotic family lives of vulnerable children.

Importantly, many families will also display resilience during this exceptionally difficult time, drawing on social support, religious/spiritual beliefs, and other coping strategies to maintain (or even increase) well-being during and after the pandemic.2 However, vulnerable families may be limited in their ability to cope given diminished resources that are amplified by inequities in the health and financial effect of COVID-19. For example, positive peer and teacher relationships are known protective factors in the association between stress exposure and adverse child outcomes3 but are not accessible as schools remain closed. The feasibility of video or “live stream” offerings with teachers and peers may be scarce within disadvantaged communities because of a lack of technology and limited internet availability in homes. Safe, walkable streets and recreational spaces where children can play (while maintaining appropriate social distance) are less available in under-resourced neighborhoods. Many disadvantaged families rely on multigenerational family structures to maintain order and support children.4 The pandemic and its lockdowns will present new impediments to allowing these cross-generational structures to work.

Health care clinicians on the front lines are providing vital services for children and families. We must continue to support their extraordinary efforts. Simultaneously, there is an important role for (nonclinician) scientists who conduct work in the field of early adversity. Researchers can study indirect pandemic associations with child health, as an unfortunate natural experiment, in ways that are supportive and nonintrusive to affected families and children. Recent advancements across disciplines relevant to early child development (eg, pediatrics, neuroscience, epigenetics, psychology, and public health) can be used to understand the consequences of this pandemic and develop and scale empirically supported interventions for adversity-exposed children and families.5 With this in mind, we offer the following recommendations for child development researchers to consider in the context of their current and future work.

Measure Pandemic Exposure and Disruptions

To optimally assess the consequences of COVID-19, careful measurement of pandemic exposure and disruptions is required. Researchers may consider asking parents/caregivers about the following:

  • The extent to which parents consumed COVID-19–associated news and attempted to limit children’s news exposure

  • Children’s fears that they or a family member could fall ill with or die of the disease

  • COVID-19–associated losses/strains, including the loss of jobs, income, childcare, and housing; an increase in family conflict, marital strain, and/or domestic violence; and separation from parent or death of a loved one

Children’s self-report of the effect of the pandemic is also important. Children may report on their unique experiences using validated, age-appropriate assessments, supplementing data collected from parents about children.

Conduct Longitudinal Assessments

The consequences of this pandemic will not be captured within a single point of data collection. In the context of ongoing economic challenges and the long-term sequelae of trauma exposure, repeated assessments of adjustment following the acute stage are crucial. Longitudinal studies with pre- and postpandemic measures are optimally positioned to help us understand the trajectories of risk and resilience that may inform prevention and intervention efforts.

Measure Resilience-Promoting Factors and Positive Adjustment

Studies often fail to assess indicators of positive adjustment or protective factors with the same level of detail as stress-associated negative consequences. The lack of maladjustment is not indicative of adaptive functioning; high levels of self-care, positive affect, life satisfaction, meaning and purpose, and healthy relationships are needed to draw such inferences. Examples of resilience-promoting factors include positive parenting, parent and child emotion regulation skills, strong school and community resources, and flexible employer family and medical leave programs. COVID-specific protective factors may include family access to supports, including contact with friends/family while out of school, time spent outdoors during the outbreak, and availability of parenting/childcare help.

Assess Biological Factors

As many traumatic events are internalized in a manner not readily observed in short-term health and behavior outcomes, it is important to capture the biological embedding of these adverse exposures6 within already vulnerable populations. Measuring biological markers of resilience or recovery can also help understand the propensity toward chronic disease and evidence of its diversion.7

Consider the Complexity of Pandemic-Induced Consequences

Simple correlations or main effects may fail to fully capture the consequences of the pandemic, as individuals may be differentially susceptible to the negative consequences of COVID-19 depending on preexisting risk and protective factors. We encourage researchers to consider more complex modeling of factors that mediate or moderate the association of the pandemic with parent, child, and overall family functioning.

Measure Caregiver Mental Health and Functioning

Parent/caregiver and child mental health are associated with each other in a transactional framework. Measuring parent/caregiver depression, anxiety, posttraumatic stress disorder, and other symptoms is essential for evaluating children’s response to the pandemic.

Collect Data That Foster the Recognition and Discussion of Health Disparities

Emerging data highlight inequalities in the physical, economic, and psychosocial toll of COVID-19. Researchers are encouraged to examine disparities in the social determinants of health across racial/ethnic groups (including xenophobia and racism) and across urban and rural areas that preclude effective intervention for COVID-19 and its broad effects. While the refrain to address health disparities in vulnerable communities is certainly not new, such data may enhance the impetus for policy changes.

Evaluate Prevention and Intervention Efforts

Many in academia are adapting ongoing prevention and treatment programs to continue despite pandemic-associated disruptions, and the National Institutes of Health is allocating emergency funding to study how to meet COVID-associated mental health needs, particularly among at-risk populations. New local or state policies are also being enacted to support families. Applying evidence-based programs and examining policy effects, ideally with a comparison group, will inform future efforts to mitigate the consequences of severe adversities and their sequelae.

Foster Collaborations Within the Research Community

A network of studies within this domain will advance knowledge more and have a stronger public health effect than any single study. Thus, collaboration and harmonized data collection across studies are vital.

Consider Feasible, Sensitive, and Nonintrusive Data Collection Methods

Access to high-speed, high-quality internet may be limited in less resourced communities, precluding the use of video visits or other livestream services. Resources to improve internet quality/speed (eg, hot spots) and other data collection methods (eg, telephone interviews and mail-in surveys with prepaid postage) should be considered to enhance the representation of those most in need of research and support.

In sum, lessons from COVID-19 have the potential to deepen rather than diminish the research agenda on adverse early experiences among children and families. The current global pandemic is an international tragedy; however, the greatest burden of morbidity, mortality, and misfortune will be borne by those with the fewest resources. Our purpose is not to turn this tragedy into academic gain but rather to promote advancement in the science of child development as a means to reduce the chasm between advantaged and vulnerable families.

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Article Information

Corresponding Author: Danielle Roubinov, PhD, 3333 California Ave, Ste 465, San Francisco, CA 94118 (danielle.roubinov@ucsf.edu).

Published Online: July 27, 2020. doi:10.1001/jamapediatrics.2020.2354

Conflict of Interest Disclosures: None reported.

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    1 Comment for this article
    EXPAND ALL
    More than an Education, a Healthy Future Should be Every Child’s Right
    Frank Sterle, Jr. | None
    A passage from the book Childhood Disrupted (Donna Jackson Nakazawa, page 24), about the devastating effects of chronic adverse childhood experiences, in part reads: “Well-meaning and loving parents can unintentionally do harm to a child if they are not well informed about human development …”

    Yet society generally treats human procreative rights as though we’ll somehow, in blind anticipation, be innately inclined to sufficiently understand and appropriately nurture our children’s naturally developing minds and needs.

    I strongly believe that a psychologically sound as well as a physically healthy future be every child’s foremost
    right, and therefore basic child development science and rearing should be learned long before the average person has their first child.

    By not teaching this to high school students, is it not as though societally we’re implying that anyone can comfortably enough go forth with unconditionally bearing children with whatever minute amount, if any at all, of such vital knowledge they happen to have acquired over time?

    Perhaps foremost to consider is that during their first three to six years of life (depending on which expert one asks) children have particularly malleable minds (like a dry sponge squeezed and released under water), thus they’re exceptionally vulnerable to whatever rearing environment in which they happened to have been placed by fate.

    I frequently wonder how many instances there are wherein immense long-term suffering by children of dysfunctional rearing might have been prevented had the parent(s) received some crucial parenting instruction by way of mandatory high school curriculum.
    CONFLICT OF INTEREST: None Reported
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