Changes in social behavioral developmental risks in preschool children after the first COVID-19 wave: a prospective longitudinal cohort study

www.nature.com/scientificreports OPEN Changes in social behavioral developmental risks in preschool children after the first COVID‑19 wave: a prospective longitudinal cohort study Anika Kästner *, Vanessa Sophie Ernst , Wolfgang Hoffmann  & Marco Franze The impact of the COVID-19 pandemic on social-emotional developmental risks (SE-DR) of preschool children is largely unknown. Therefore, the aim of this prospective longitudinal dynamic cohort study was to assess changes in preschoolers’ SE-DR from before the pandemic to after the first COVID-19 wave. SE-DR were assessed annually with the instrument “Dortmund Developmental Screening for Preschools” (DESK). Longitudinal DESK data from 3- to 4-year-old children who participated both in survey wave (SW) three (DESK-SW3, 2019) and SW four (DESK-SW4, 2020) from August 1 to November 30 were used, respectively. Additionally, data from previous pre-pandemic SW were analyzed to contextualize the observed changes (SW1: 2017; SW2: 2018). A total of N = 786 children were included in the analysis. In the pre-pandemic DESK-SW3, the proportion of children with SE-DR was 18.2%, whereas in DESK-SW4 after the first COVID-19 wave, the proportion decreased to 12.4% (p = 0.001). Thus, the prevalence rate ratio (PRR) was 0.68. Compared to data from previous SW (SW1-SW2: PRR = 0.88; SW2-SW3: PRR = 0.82), this result represents a notable improvement. However, only short-term effects were described, and the study region had one of the highest preschool return rates in Germany. Further studies are needed to examine long-term effects of the pandemic on preschoolers’ SE-DR. Since the outbreak of the COVID-19 pandemic in March 2020, the lives of many people have drastically changed, with children in particular being affected in their daily lives by preschool and school closures and limited childcare options. In Germany, emergency child care services were offered to preschool children of parents with system-relevant occupations (e.g. medical staff, police, staff providing emergency daycare in preschools and schools)1. For instance in the German federal state Mecklenburg Western-Pomerania, the percentage of preschools that provided such services ranged between 0–15% (March until April 2020) and 15–77% (May until June 2020), r espectively2. Regular operation of preschools was not possible until August 2020. Several studies were initiated in Europe with a focus on transmission of SARS-CoV-2 and the impact of hygiene measures among children aged 0 to 19 years3,4. However, little is known about the impact of the pandemic on developmental risks in preschool children. In particular, the promotion of social-emotional competencies in preschools is crucial for later school success, mental health and contributes to the reduction of social inequalities5–8. Therefore, the loss of pedagogical promotion of children’s competencies in preschools might especially increase the prevalence of developmental risks in the social-emotional domain. When assessing the development of children’s social-emotional competencies, two general distinctions of social-emotional problems are made: Externalizing problem behavior refers to directing emotional responses away from the self and is characterized by disruptive behavior (e.g. aggression and rule-breaking behavior), whereas internalizing problem behavior implies that emotional responses are directed inward and is associated with anxiety, depression and psychosomatic p roblems9–11. Generally, social-emotional functioning can be considered a basic competency contributing to mental health and well-being. With regard to the effects of the lockdown on social-emotional competencies of preschool children, studies found that internalizing as well as externalizing problems significantly increased12. Interestingly, the subgroup of preschoolers who met the World Institute for Community Medicine, Section Epidemiology of Health Care and Community Health, University Medicine Greifswald, Ellernholzstr. 1‑2, 17487 Greifswald, Germany. *email: Scientific Reports | (2023) 13:5615 | https://doi.org/10.1038/s41598-023-32877-x 1 Vol.:(0123456789) www.nature.com/scientificreports/ Health Organization recommendations for physical activity had lower internalizing scores than non-active peers12. Most parents and children experienced lockdown-related stress and especially single parenthood and being an only child were associated with higher levels of child problems, e.g., more emotional s ymptoms13,14. Children and adolescents were more likely to experience higher rates of depression and anxiety symptoms during and after enforced isolation relative to before the p andemic15–18. Browne et al. showed that the mental health of Canadian preschool- to school-aged boys in early childhood education significantly deteriorated after the onset of the p andemic19. One study by Specht et al. showed a modest decrease in child-emotional behavioral functioning during the COVID-19 lockdown, potentially due to parental s tress20. One longitudinal study from Japan examined the social-emotional behavior with the Strengths and Difficulties Questionnaire (SDQ) of 4–6-year-old preschoolers during the first COVID-19 wave compared to after preschool closure and found no significant differences in preschoolers’ socio-emotional b ehavior21. Shum et al. longitudinally examined psychosocial difficulties in 2–5-year-old preschool children from North West England starting mid-April to July 2020 and found no significant differences one month l ater22. Interestingly, in another study applying the same study setting as Shum et al., the authors found an increase in socio-emotional difficulties in primary school aged children, and mixed results in secondary school-aged children: an increase in restlessness/attention difficulties, a decrease in emotional difficulties, and no change in behavioral d ifficulties23. When comparing the SDQ in preschoolers before (January 2020) versus during restrictions (May 2020), a Finnish study with a very small sample size (n = 22) showed no longitudinal changes in the scales emotional and behavioral difficulties, hyperactivity, and peer relationship problems, however, prosocial skills were significantly reduced24. Despite some lessons learned, most studies to date have not analyzed longitudinal data before the onset of the COVID-19 pandemic in preschool-aged children, or questionnaires were completed by parents o nly12,13. Most studies in Europe focusing on the impact of the first COVID-19 wave on mental health, health behavior, and well-being were restricted to adolescents and children of school a ge25–28. The main aim of this study is therefore to analyze changes in preschoolers´ social-emotional developmental risks by comparing child-specific data assessed in 2019 before the onset of the COVID-19 pandemic with data assessed in 2020 after the first COVID-19 wave. In addition, data from previous survey waves (2017/2018 and 2018/2019, respe (...truncated)