Flattening the Other Curve

Trends for young children’s mental health are good for some but concerning for others

UOregon CTN
Jun 24, 2020 · 7 min read

In the early weeks of the pandemic, public health experts emphasized the need to “flatten the curve” of COVID-19 infection rates. The goal was to slow the pace at which new cases were occurring in order to avoid overwhelming the health care system. At that time, concerns were raised not only about physical illness, but also about mental health difficulties among those whose work and personal lives have been disrupted during the pandemic.

In prior posts, we took an early look at mental health difficulties among children and caregivers. In the first week of April, based on our very first survey, we reported that an increase in mental health difficulties was indeed occurring among households with young children. Specifically, we saw large increases from pre-pandemic levels in both caregiver stress and children’s emotional and behavioral difficulties. We noted the importance of policy measures to address these issues and mitigate related concerns that could potentially be driving mental health difficulties, such as delayed healthcare, lack of income for basic needs, and food insecurity.

Two weeks after the initial survey, we again reported on this topic, noting that although the reports of adult and young children’s mental health difficulties had begun to flatten and even diminish for middle and upper income households, among lower income households they were continuing to increase as the weeks went by. We expressed concern that the pandemic appeared to be negatively affecting mental health outcomes for households without necessary resources to buffer the stress of the pandemic — an issue that has subsequently been identified across American society on numerous indicators of wellbeing. We emphasized that looking out for the mental health needs of young children in lower income households is important to ensure healthy brain development. We also underscored the importance not only of young children’s psychological well-being, but also the well-being of parents and other caregivers whose nurturing care protects children from the negative effects of stress.

In weeks to come, we will be reporting on trends of adult and child mental health difficulties collected from the start of our survey up to the present.

This week we focus specifically on how we have seen children’s emotional difficulties and behavior problems change across the ten weeks of the RAPID survey.

Key Findings

Our analyses show that when looking at all of the families in the survey the trends are good — child mental health difficulties are down; however, when looking at specific subgroups, the picture changes and is cause for concern. In particular, for some subgroups such as lower income and single parent households, positive trends that were observed initially have actually reversed in recent weeks, and mental health difficulties are now on the rise. For other subgroups, initially high levels of mental health difficulties have never decreased and remain elevated. These findings require action from policy makers, early childhood educators, and mental health practitioners.

Trends in children’s well-being across all families in the survey

Children’s mental health difficulties were measured via two items on the survey, both of which were on a three point scale — not true, somewhat/sometimes true, often true/very true.

  • Children’s behavior problems was measured by asking caregivers the extent to which their child was “fussy or defiant” in the past week.
  • Children’s emotional difficulties was measured by asking caregivers the extent to which their child was “too fearful or anxious” in the past week.

In the overall sample, caregiver reports of both children’s emotional difficulties and behavior problems have diminished over time.

These positive trends suggest that many young children may be adjusting to life during the pandemic.

This is quite remarkable, given the many challenges most American households are experiencing in the face of the pandemic’s social distancing measures, changes in work and family life, and general uncertainty about the future.

With the data available from the survey, we are not able to explain these positive trends; however, it is possible that in households with sufficient financial resources and the flexibility to work from home, children have settled into a new routine.

But the curve in mental health difficulties isn’t flattening for everyone

Although the overall trends are positive, they mask different patterns in specific groups of households with young children. In order to examine how trends in specific subgroups differ, we compared the average weekly subgroup scores on children’s behavior problems and emotional difficulties to the average weekly scores for the overall sample.

We identified several subgroups in which there is not the consistent decrease that we see in the overall sample. Specifically:

  1. In recent weeks, a number of subgroups are experiencing significant increases in children’s behavior problems. We identified three subgroups in which children’s behavior problems decreased in the first six weeks of the survey, but have been on the rise in the subsequent six weeks. These groups are lower income households, single-parent households, and African American households.

We cannot discern from the data why trends have reversed so dramatically for these subgroups. We know from data analysis that it is not connected to caregiver stress. Certainly, as the pandemic drags on into the summer, life may be proving increasingly challenging for some households. As well, early childhood programs that run on academic school year calendars — even if they had shifted to remote delivery — have ended in recent weeks in many locations. In addition, recent events have raised both awareness and distress about institutional racism and discrimination in American society.

2. For two subgroups, levels of mental health difficulties have remained higher across the duration of the survey. Specifically, among lower income households, children’s emotional difficulties have remained higher across the duration of the survey. Similarly, within households in which a young child has a disability, children’s behavior problems have remained higher across the duration of the survey.

What are the implications of these trends?

It is common for national household surveys to report on general trends for the population. If that was the extent of the reporting for the RAPID survey of households with young children, the picture would appear to be positive in terms of young children’s mental health difficulties; after an initial increase in behavior problems and emotional difficulties at the start of the pandemic, these issues appear to be decreasing.

However, this is clearly not the case for certain subgroups. As with prior postings from the survey, we identified a number of subgroups that have either shown a reversal of positive trends in recent weeks, or have never seen the improvements that are visible in the overall sample.

These subgroups, including lower-income and single parent households, African American households, and households in which a child has a disability, all warrant policy action that provides additional support and resources, in order to help mitigate barriers to access and other structural inequalities they are experiencing.


  1. Specifically, we recommend that policy makers should:
  • Increase funding for and access to services that support child and family health and mental health, including home visitation programs, early childhood special education programs, and evidence-based interventions. These resources need to be focused on and made immediately available to the subgroups showing the greatest levels of need. Notably, these are subgroups in which there have historically been gaps in access, and these gaps have only increased during the pandemic.
  • Pass legislation that provides financial supports for lower-income households in order to cover the costs of basic needs, including housing, food, and childcare, which is a major source of stress in these families.
  • Increase support to households in which a young child has a disability, via enhanced funding and innovative approaches for providing services.

2. Communities should focus on activities, in the context of re-opening, that maximize regaining or establishing new social supports, and minimize isolation; in addition, policy makers and communities should also look ahead to the possibility of the reinstatement of social distancing measures that could be necessary in the future, and be better prepared with prevention strategies to reduce caregiver stress and maintain supports while sheltering in place.

3. Public agencies at federal, state, and community levels must develop capacity to maintain real-time data and information on available childcare, social service, and mental health options for families, and increase efforts to make it easier for families to find and locate available, high quality services.

Suggestions for further reading

Coronavirus Pandemic Reveals Our Economic Inequality,” Forbes.

Flattening the mental health curve is the next big coronavirus challenge,” The Conversation.

Health care workers seek to flatten COVID-19’s ‘second curve’ — their rising mental anguish,” Science.

Coping With Stress,” Centers for Disease Control and Prevention.

Facing mental health fallout from the coronavirus pandemic,” World Health Organization.

Supporting Children’s Health During and After the COVID-19 Pandemic,” National Institute for Children’s Health Quality.

How we gathered this data

These analyses are based on responses collected from 4586 caregivers between the dates of April 06, 2020 and June 11, 2020. These caregivers represent a range of voices: 12.63% are Black/African American, 17.51% are LatinX, and 9.38% live at or below 1.5 times the federal poverty line. Proportions/percentages are calculated based on the item-level response rates, not out of the total sample size. The data for these analyses are not weighted.

About the project

When the COVID-19 pandemic emerged last winter, there were over 24 million children age five and under living in the United States. This period of early childhood is a critical window that sets the stage for health and well-being across the lifespan. As such, it is essential during the current health and economic crisis to listen to the voices of households with young children.

The weekly survey of households with children age five and under launched on April 6, 2020. Since then, we have been gathering weekly data about child and adult emotional well-being, financial and work circumstances, availability of healthcare, and access to child care/early childhood education.

We will continue to report on these issues as we learn more from each new weekly survey. We will also be producing policy briefs that make concrete recommendations about how to address the challenges we are seeing emerge from the family surveys.

Our goal is to use what we are hearing from families to improve the well-being of all households with young children, during the pandemic and beyond.

Suggested citation

Center for Translational Neuroscience (2020, June 24). Flattening The Other Curve: Trends For Young Children’s Mental Health Are Good For Some But Concerning For Others. Medium. https://medium.com/rapid-ec-project/flattening-the-other-curve-7be1e574b340

RAPID-EC Project

Rapid Assessment of Pandemic Impact on Development Early Childhood Household Survey Project