Unravelling COVID-19's Psychological Effects on Children and Families

The COVID-19 pandemic has brought about an unprecedented global crisis that has significantly impacted various aspects of human life. While much attention has been focused on the physical health ramifications and the development of vaccines and treatments, it is crucial to recognise the profound psychological impact that the pandemic has had on individuals worldwide. The diverse ramifications of COVID-19 surpass mere health issues and interpersonal relationships, with profound impacts on individuals' cognition, emotions and behaviours. As of August 2024, COVID-19 has resulted in over 776 million confirmed cases globally, with more than 7 million deaths reported (WHO, 2024). The ongoing global vaccination effort has been pivotal in curbing transmission rates and reducing severe cases. However, the mental health toll of the pandemic remains profound across the global population, including children and families, as well as healthcare professionals.

This paper aims to explore these diverse impacts, drawing insights from psychological science to understand the nuances of these effects. Moreover, the implications of these findings will be discussed, with a particular focus on the Australian healthcare system and the role of counsellors in addressing such challenges. There will be a particular focus on the impact of COVID-19 on parenting, especially in families with children diagnosed with Attention Deficit Hyperactivity Disorder (ADHD), and the role of emotional dysregulation in the manifestation of this psychiatric disorder. By doing so, this paper will additionally seek to highlight the interconnectedness of physical and psychological health issues, thus underscoring the importance of an integrated approach to healthcare in the aftermath of COVID-19.

The cognitive effects of COVID-19 have been extensive, affecting a broad spectrum of cognitive functions, with one of the most notable impacts on attentional processes. The constant stream of pandemic-related information, often characterised by distressing statistics, has created an environment where attentional biases towards COVID-19 information are prevalent (Islam et al., 2020). This continuous exposure can lead to heightened levels of anxiety and distress, making it difficult for individuals to concentrate on tasks unrelated to the pandemic. The pervasive sense of threat and the need to stay informed can result in an overemphasis on pandemic-related news, detracting from cognitive resources that could otherwise be directed towards productive activities.

Moreover, the pandemic-induced stress has been linked to significant impairments in executive functions. These functions include critical cognitive processes such as decision-making, problem-solving, and cognitive flexibility (Pfefferbaum & North, 2020). The constant need to adapt to new routines, manage remote work or schooling, and navigate health-related decisions has contributed to cognitive overload. This can manifest as cognitive fatigue, reducing individuals' ability to perform optimally in various domains (Killgore et al., 2020). The prolonged stress and uncertainty associated with the pandemic have made it challenging for many to engage in effective decision-making and maintain cognitive flexibility, further complicating daily life.

The cognitive challenges faced by parents during the pandemic are particularly pronounced in families with children diagnosed with ADHD. ADHD is characterised by difficulties in maintaining attention, hyperactivity, and impulsive behaviour, which can be exacerbated by the additional stress and disrupted routines caused by the pandemic (Barkley, 2015; Sasaki et al., 2020). Parents of children with ADHD often need to provide a structured environment and consistent routines to manage their child's symptoms effectively. However, the pandemic has disrupted these routines, leading to increased cognitive demands on parents.

The increased cognitive load from juggling multiple roles, such as being a caregiver, educator, and employee, can lead to mental exhaustion. This exhaustion can make it harder for parents to provide the necessary support and structure that children with ADHD require (Tsai et al., 2024). The necessity for constant vigilance to manage a child's symptoms can further drain cognitive resources, leading to higher levels of parental stress and burnout. Indeed, Calvano et al., (2022) reported that parental stress increased significantly during the pandemic and that 12.3% and 9.7% of parents had very high levels of depressive symptoms and anxiety, respectively. Overall, the unique cognitive challenges faced by parents highlight the need for targeted support and interventions.

The emotional impact of COVID-19 has been profound and far-reaching, affecting individuals across all demographics. The pandemic has elicited a wide range of emotional responses, including fear, anxiety, grief, and loneliness. These emotions have permeated individuals' daily lives, influencing their overall mental health and well-being (Holmes et al., 2020). The fear of contracting the virus, witnessing its devastating consequences, and experiencing social isolation have contributed to a collective sense of emotional distress. The persistent uncertainty and unpredictability surrounding the pandemic have exacerbated feelings of anxiety and helplessness, leading to a significant increase in mood disorders such as depression and generalised anxiety disorder (Giallonardo et al., 2020).

Social distancing measures and restrictions on social gatherings, while necessary to curb the spread of the virus, have further amplified feelings of loneliness and social disconnectedness. These feelings are particularly acute among vulnerable populations such as the elderly and individuals with pre-existing mental health conditions (Loades et al., 2020). The loss of physical social interactions and the reduction in face-to-face contact have deprived many of essential emotional support systems, contributing to heightened emotional distress.

Emotional dysregulation, characterised by difficulties in managing and responding to emotional stimuli, is a common feature in children with ADHD (Shaw et al., 2014). Indeed, recent literature from Antony et al., (2022) has suggested that there are associations between ADHD symptoms, emotional dysregulation symptoms and internalising problems (including co-occurring depression and anxiety symptoms) during early childhood (i.e., ages 3, 5 and 7). During the COVID-19 pandemic, the disruptions to daily routines, lack of social interactions, and increased familial stress have exacerbated emotional dysregulation symptoms in these children. The challenges of adjusting to remote learning, changes in household dynamics, and the general uncertainty of the situation can lead to heightened emotional reactivity. Children with ADHD may struggle more with frustration, anxiety, and sadness, leading to increased behavioural issues (Gadow et al., 2004).

Parents of children with ADHD may find it particularly challenging to help their children manage these intense emotions. The lack of usual support structures, such as schools and extracurricular activities, can leave parents feeling overwhelmed and ill-equipped to handle their child's emotional needs. This can result in increased family conflict and stress, further complicating the emotional landscape of the household. This can also be understood as “extrinsic dysregulation”, a novel concept introduced by Antony (2024) whereby in this context, a child’s ADHD symptoms are “negatively impacted and affected” by the dysregulation experienced by others, including parents. Understanding the emotional challenges faced by these families, particularly parents with poor mental health, is crucial for providing effective support and interventions.

The behavioural ramifications of COVID-19 are manifold and have permeated various aspects of daily life. The implementation of lockdowns, social distancing measures, and quarantine protocols has necessitated significant changes in individuals' behavioural patterns, leading to disruptions in routines and social interactions (Brooks et al., 2020). The sudden and drastic changes to daily life have forced individuals to adapt to new ways of living, often without the usual support systems in place. This adaptation process has been associated with increased levels of stress and anxiety, which can manifest in various maladaptive behaviours.

One significant behavioural impact of the pandemic has been the increase in maladaptive coping behaviours. These behaviours include increased alcohol consumption, substance abuse, and unhealthy eating habits (Clay & Parker, 2020). The stress and uncertainty of the pandemic have led many individuals to seek comfort in these maladaptive behaviours, which can have long-term negative effects on physical and mental health. Additionally, the economic fallout of the pandemic has exacerbated socio-economic disparities, leading to disparities in access to healthcare, education, and employment opportunities (Purtle, 2020). These disparities can further perpetuate adverse behavioural outcomes, creating a cycle of disadvantage, particularly for families.

Parents have had to adapt to new roles as educators and caretakers, often without the usual support systems in place, such as schools and childcare services. This shift has led to increased parental stress and, in some cases, maladaptive parenting behaviours. For parents of children with ADHD, the need to maintain structure and consistency is paramount, yet the pandemic has made it difficult to uphold these routines (DuPaul et al., 2020). Behavioural interventions that were previously effective may no longer be feasible, leading to increased behavioural issues in children and heightened parental frustration.

The increased demands on parents during the pandemic have also led to changes in family routines. For instance, one study exploring changes in parenting during COVID-19 found that higher levels of maternal stress among mothers led to increased levels of sadness, compared to mothers that adopted positive parenting approaches (Vargas Rubilar et al., 2022). This suggests that stress management may need to be considered in future psychosocial interventions, which may focus on cultivating positive family environments. Indeed, Brown et al., (2020) study suggested that greater parental support during the pandemic can lead to lower perceived stress and lower child abuse potential. Overall, family interventions that focus on targeting parental stress and emotional instability may be key in fostering family wellbeing and positive parental involvement.

Effective interventions for families with children with ADHD during the pandemic include behavioural parent training (BPT), which focuses on teaching parents’ skills to manage their child's behaviour effectively (Marquet-Doléac et al., 2024). BPT can help parents develop strategies for maintaining structure and consistency, even in the face of disrupted routines. Additionally, telehealth services have become a critical component in providing continued support to these families, offering flexibility and accessibility that traditional in-person services may not be able to match during lockdowns (Sibley et al., 2021).

The psychological ramifications of COVID-19 underscore the importance of integrating mental health services into primary healthcare systems, particularly in the Australian context. As the demand for mental health support continues to rise, counsellors play a pivotal role in providing accessible, culturally sensitive, and evidence-based interventions to individuals in need (Fisher et al., 2020). The pandemic has highlighted the need for a comprehensive approach to healthcare that includes mental health as a critical component.

Incorporating telehealth services and digital interventions can enhance the reach and accessibility of mental health services, particularly in rural and remote areas where access to in-person counselling may be limited (Hollander & Carr, 2020). Telehealth has the potential to bridge the gap between individuals and mental health services, ensuring that more people receive the support they need. Additionally, providing training and support for healthcare professionals to identify and address the psychological needs of patients is essential for ensuring holistic and integrated care (Wind et al., 2020).

Psychological science offers valuable insights into understanding and mitigating the psychological impact of COVID-19. One of the key lessons is the importance of fostering resilience and adaptive coping strategies. Resilience, the ability to adapt and recover from adversity, is crucial for maintaining psychological well-being in the face of the pandemic's challenges (Southwick & Charney, 2018). Interventions such as mindfulness-based stress reduction (MBSR) and resilience training can equip individuals with the tools to effectively navigate stress and uncertainty (Carl et al., 2020).

Furthermore, fostering social support networks and promoting social connectedness is essential for mitigating feelings of loneliness and isolation. Social support is a critical component of psychological well-being, providing individuals with emotional validation and a sense of belonging (Courtin & Knapp, 2017). Virtual support groups, online communities, and teletherapy platforms have emerged as valuable resources during the pandemic, offering individuals a way to connect and receive support despite physical distancing measures (Sood, 2020).

The COVID-19 pandemic has brought into sharp focus the interconnectedness of physical and psychological health and underscored the importance of prioritising mental health in healthcare systems worldwide. By drawing on insights from psychological science and adopting a holistic approach to care, counsellors and healthcare providers can effectively support individuals in coping with the psychological impact of the pandemic and promote resilience and well-being in the face of adversity. In the Australian context, integrating mental health services into primary healthcare systems and leveraging digital technologies can enhance the accessibility and effectiveness of mental health interventions, ensuring that no one is left behind in the aftermath of COVID-19. For parents, especially those with children that have ADHD, understanding and addressing the cognitive, emotional, and behavioural challenges brought on by the pandemic is critical. By providing targeted support and interventions, mental health professionals can help these families navigate the complexities of parenting during a global crisis, fostering resilience and promoting positive outcomes for both parents and children.

Evelyn Mary-Ann Antony is a PhD researcher in the School of Education at Durham University, UK. Her doctoral research focuses on conducting a multidimensional assessment of emotional dysregulation and its longitudinal associations with ADHD and parenting practices, across middle childhood (ages 6-12), leveraging data from two cohorts: the UK Millennium Cohort Study and the Zurich Project on Social Development from Childhood to Adulthood. She holds a MPhil in Education (Psychology) at the University of Cambridge and a MA (Honours) degree in Psychology at The University of Edinburgh.

Unravelling COVID-19's Psychological Effects on Children and Families: Insights from Psychological Science

Unravelling COVID-19's Psychological Effects on Children and Families:
Insights from Psychological Science