Pandemic Tied to Developmental Changes in Kindergarteners

The COVID-19 pandemic was associated with some negative and some positive developmental health outcomes in kindergarteners, a cross-sectional cohort study of almost half a million US pupils found, and most of the developmental issues already existed before the pandemic.

Compared with an immediate pre-pandemic-onset cohort (2018-2020), mean Early Development Instrument (EDI) scores in the post-pandemic-onset cohort (2021-2023) were lowest in language and cognitive development, social competence, and communication and general knowledge — likely the result of school closures and home virtual learning. Scores were highest in emotional maturity, whereas scores for physical health and well-being did not differ.

Reporting results in JAMA Pediatrics, researchers led by Judith L. Perrigo, PhD, LCSW, an assistant professor in the Department of Social Welfare, UCLA Luskin School of Public Affairs, University of California, Los Angeles, said the negative developmental trends in young children were small and most of the pre-existing issues persisted after COVID struck.

“Most social studies on the pandemic’s impact focus on older children’s academic outcomes, particularly in math and literacy, with some qualitative research examining the perceptions of parents or teachers,” Perrigo told Medscape Medical News. “In contrast, our study is unique in its focus on the holistic development of kindergarteners.”

Additionally, while several studies have explored socioemotional development, this research distinguished between social competence and emotional maturity, uncovering important distinctions. “Notably, while social-emotional development declined during the pandemic onset, emotional maturity improved,” Perrigo said.

She acknowledged that the results were somewhat surprising because the authors anticipated that all five domains of developmental health would deteriorate. “However, our findings revealed that only three domains significantly declined and, interestingly, one domain, physical health and well-being, did not experience significant changes, while another domain, emotional maturity, actually improved,” Perrigo said.

The slight increase in emotional maturity may be linked to greater exposure to adult stressors during the pandemic — for example, rising casualties, financial strain, health anxiety, and news coverage, she said. Accelerated maturity may have been required for young children similar to maturation observed in children facing life challenges such as family separation or poverty, the authors conjectured.

Overall, the results “highlight troubling trends in kindergarteners’ development, both before and during the pandemic, and more information is needed to understand why developmental outcomes are worsening over time,” Perrigo’s group wrote.

The 14-year study period also revealed that EDI scores in US kindergarteners were already significantly decreasing across all domains in the immediate pre-pandemic period, an observation that aligns with other literature highlighting negative national trends in the health and well-being of US children.

Since kindergarteners’ developmental health is an indicator of outcomes from birth to age 5 years, it is a factor in future health trajectories. Children’s developmental health is also very susceptible to environmental influences, such as school disruptions during the COVID-19 pandemic. “Our results identify public health prevention domains for kindergarten populations with important implications for school and health policies as the pandemic persists,” Perrigo’s group wrote.

The Study

The investigators examined trends among 475,740 US kindergarteners from 390 school districts in 19 states during the period 2010-2023.

In the cohort, 51.1% were men, 11.4% were African American or Black individuals, 55.5% were Hispanic or Latin individuals, and 20.1% were White individuals. The mean age was 6 years (SD, 0.4; range, 4.0-8.0). By state, 38.8% came from Texas and 38.6% from California.

Among the statistical findings:

•Compared with the immediate pre-pandemic period, the rate of change in EDI scores was significantly lowerafter the pandemic set in for the following measures: Language and cognitive development (mean change, −0.45; 95% CI, −0.48 to −0.43); social competence (mean change, −0.03; 95% CI, −0.06 to −0.01); and communication and general knowledge (mean change, −0.18; 95% CI, −0.22 to −0.15).

• EDI scores were significantly higher in emotional maturity (mean change, 0.05; 95% CI, 0.03-0.07).

• No significant change was observed in the physical health and well-being domain (mean change, 0; 95% CI, −0.01 to 0.02).

Offering an outside perspective on the study, Dipesh Navsaria, MPH, MSLIS, MD, a professor of pediatrics and human development and family studies at University of Wisconsin–Madison and chair of the American Academy of Pediatrics’ Council on Early Childhood, said the observed changes were significant because they were tracked across a very large pediatric population.

“The general narrative other work often lays out is that pandemic factors, ­for example, lack of in-person schooling, lockdowns, have been developmentally negative for children,” Navsaria said. “While these data do not generally dispute that, the study broadens the time period and notes, critically, that young children were having declines well before the pandemic occurred.”

He added that while the focus on pandemic measures is a reasonable one, “we should be looking at the larger context­ — being worried about ‘what the pandemic did to children’ should be accompanied by being worried about ‘why things were worsening years before the pandemic occurred.’”

He also asked if other measures taken during the pandemic may have had a partially protective effect: “Did a range of child- and family-facing measures such as tax credits and other social supports keep things from being even worse? We declined to continue those measures, so might this study, if repeated with an additional 2 or 3 years of data, show a difference from that?”

Navsaria’s key takeaway is that while the pandemic was challenging, it was so in the context of already concerning changes in the kindergarten-age population. “Further research and policy work should be examining these broader societal trends and not focusing solely on the pandemic itself. Measures that mitigate child and family challenges either during or outside of a global pandemic are likely to have benefit broadly.”

The researchers said their results could apply to future pandemics or collective crises that force children out of school, such as mass shootings, terrorist attacks, and natural disasters. “The initial and ongoing responses of leaders to crises can offer lessons for the future, which is particularly important for vulnerable populations (eg, low socioeconomic status) with fewer resources to buffer against potential hardships,” they wrote.

Perrigo said the findings highlight an urgent need for early childhood policies that not only address preexisting challenges but also account for the additional stressors introduced by the pandemic. “By implementing targeted interventions and support systems, we can mitigate the long-term effects on young children’s development and ensure a more resilient and equitable future.”

Her group is exploring related questions to identify which groups of children have been most affected, as well as the regions that may require additional supports.

This paper received no specific funding but used data collected by the Data Informed Futures team at the UCLA Center for Healthier Children, Families, and Communities. Coauthor Halfon reported grants from Health Resources Services Administration Funding for the Life Course Intervention Research Network during the conduct of the study. Navsaria disclosed no relevant conflicts of interest.

Diana Swift is an independent medical journalist based in Toronto, Ontario, Canada.