Kids Born in COVID Lockdown May Have Diminished Executive Function

Children born during England’s COVID lockdown appeared to have markedly lower executive function than expected for their age, interim results of a cross-sectional observational study showed.

Among more than 200 4-year-olds born from March to June 2020, executive function was lower than pre-pandemic norms on two caregiver-reported scales (Global Executive Composite [GEC], Cohen’s d=-0.47; Emergent Metacognition Index [EMI], d=-0.36), according to Nicola Botting, PhD, of City St. George’s University of London, in the U.K., and colleagues.

In further analyses, when benchmarked against non-verbal reasoning ability, scores on both scales were significantly below cognitive potential, they added. And about a third of children were one or two standard deviations away from published norms for both of those scales, they reported in the Archives of Disease in Childhood.

“Executive functioning is very educationally relevant, because children need to settle. They need to keep on with whatever tasks they’re doing in school,” co-author Lucy A. Henry, DPhil, DClinPsych, also of City St. George’s University of London, told MedPage Today.

Other developmental characteristics — including non-verbal reasoning (d=0.42), expressive vocabulary (d=0.24), and receptive vocabulary (d=0.49) — were actually better than pre-pandemic norms, the researchers found.

The picture for language skills, however, was less clear, they noted. While the measurement of receptive language (matching a spoken word to a picture) was higher than expected (d=0.59), the measure of expressive language (naming objects and actions) was lower (d=0.01), they reported.

“The current preliminary findings suggest that expressive language is somewhat more vulnerable to pandemic impacts than receptive language, possibly due to the loss of rich and varied interactions with less familiar people, which in turn may impact expressive semantic and syntactic development,” the researchers wrote.

All told, the “relatively weaker expressive language and lower [executive function] could be the result of more limited social opportunities experienced in the first year,” they wrote. “For example, learning to communicate and manage behavior in public spaces was absent during lockdown periods. In contrast, receptive language may have been somewhat protected by increased familial attention and communication. These possible associations need further research.”

Botting told MedPage Today the “good news is that most children born in lockdown are doing well at [age] 4 on their language and their executive function.”

However, she added, “for a significant group of those children, they’re finding subtle problems with language, with talking and speaking. And for a larger group, they’re finding it difficult to stay on task, follow instructions, [and] self-regulate in the classroom.”

The study, an interim analysis of a subsample of the Born in COVID Year — Core Lockdown Effects (BICYCLE) study, focused on children who were born from March 23, 2020 through June 23, 2020, the initial COVID lockdown in England. Children born “very preterm” (<32 weeks) and those with developmental delays were excluded.

Of the 205 participants, 58.5% were male; 81% were white; 78.5% of participants’ mothers had an undergraduate or postgraduate degree; and 54.2% of participants annual household income was $95,000 or higher. About two-thirds (66.8%) were either diagnosed with or suspected of having COVID and recovered.

The study was limited because families had higher educational levels than the general English population, and by the use of some remote testing. They also noted that executive function was measured by caregivers and not directly assessed. However, direct measures of executive function will be conducted later in the study, they noted.

Nonetheless, they concluded that their findings “are in line with emerging evidence for [executive function] support needs in children born before or during the pandemic.”

“The present results imply the need for additional classroom scaffolding for behavioural regulation, [executive function]-focused approaches and more explicit strategies for expressive language, rather than individual screening or specialist support,” they added.