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. 2023 Dec 1;6(12):e2346106.
doi: 10.1001/jamanetworkopen.2023.46106.

Mental Health of Children With Special Educational Needs and the Return to In-Person Learning After the COVID-19 Pandemic

Winnie Wan Yee Tso  1   2 , Lok Kan Leung  1 , Mathew Siu Chun Chow  1 , Yuliang Wang  1 , Cuixin Li  1 , Ka Yi Hui  1 , Lawrence Ma  1 , Mei Wa Wong  1 , Michael Pak Kiu Lui  1 , Wilfred Hing Sang Wong  1 , So Lun Lee  1 , Tatia Mei Chun Lee  2 , Patrick Ip  1
Affiliations

Mental Health of Children With Special Educational Needs and the Return to In-Person Learning After the COVID-19 Pandemic

Winnie Wan Yee Tso et al. JAMA Netw Open. .

Abstract

Importance: There is limited evidence on whether the quality of life and behavior of children with special educational needs (SEN) have improved or worsened since schools reopened after COVID-19-related school closures.

Objective: To describe the changes in the mental well-being of children and adolescents with SEN during the initial 6 months of resuming in-person learning after COVID-19-related school closures.

Design, setting, and participants: This repeated cross-sectional study reported data from surveys completed by parents and caregivers of children and adolescents aged 3 to 18 years with SEN studying at special schools in Hong Kong. The first cohort was obtained during COVID-19-related school closure in April 2020 (wave 1) and the second cohort was obtained 6 months after school resumption with data collection between July and October 2021 (wave 2). Data analysis occurred from January to June 2022.

Exposure: Diagnosis of a disability or disorder that required school-based special educational programming.

Main outcomes and measures: Children's emotional and behavioral difficulties (measured with the Strengths and Difficulties Questionnaire [SDQ]), quality of life (measured with the Pediatric Quality of Life Inventory [PedsQL]), lifestyle habits, parental stress, and parental well-being (measured with the PedsQL Family Impact Module) were assessed. Cross-sectional comparisons of well-being between the 2 waves were conducted using analysis of covariance, and multiple regression analysis was performed to identify factors associated with mental health outcomes in wave 2.

Results: In wave 1, a total of 456 parents and caregivers of children with SEN (mean [SD] age, 7.44 [3.98] years; 315 boys [69.1%]; 141 girls [30.9%]) responded to the surveys. In wave 2, 519 parents and caregivers of children with SEN (mean [SD] age, 8.16 [4.47] years; 365 boys [70.3%]; 154 girls [29.7%]) responded. After school resumption, preschoolers aged 3 to 5 years with SEN had significantly fewer emotional difficulties (mean [SD] SDQ score, 3.26 [2.39] vs 2.68 [2.03]; standardized mean difference [SMD] = 0.26; 95% CI, 0.07-0.46; Bonferroni-corrected P = .04) and conduct difficulties (mean [SD] SDQ score, 2.88 [1.89] vs 2.41 [1.91]; SMD = 0.25; 95% CI, 0.05-0.44; Bonferroni-corrected P = .01), whereas adolescents had more conduct difficulties (mean [SD] SDQ score, 1.62 [1.50] vs 2.37 [3.02]; SMD = 0.41; 95% CI, 0.13-0.70; Bonferroni-corrected P = .049). The overall quality of life of school-aged children with SEN aged 6 to 11 years worsened after school resumption (mean [SD] PedsQL score, 67.52 [17.45] vs 60.57 [16.52]; SMD = 0.41; 95% CI, 0.19-0.62; Bonferroni-corrected P = .002).

Conclusions and relevance: The findings of this repeated cross-sectional study suggest that preschoolers with SEN had improved emotional and behavioral functioning when school resumed after COVID-19-related closures. School-aged children with SEN, adolescents with SEN, and children with intellectual disabilities were at risk of reduced quality of life, indicating that additional support should be offered to vulnerable groups as they return to schools.

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Conflict of interest statement

Conflict of Interest Disclosures: None reported.

Figures

Figure 1.
Figure 1.. Quality of Life of Children With Special Educational Needs Between 2 Waves by Age Group
The figure shows scores from various domains of the Pediatric Quality of Life Inventory (PedsQL) for children ages 3 to 5 years (A), 6 to 11 years (B), and 12 to 18 years (C). Scores on the PedsQL range from 0 to 100, with a higher score indicating a better quality of life. Wave 1 was conducted in April 2020 when schools were closed, and wave 2 was conducted July to October 2021 after in-person learning resumed. Error bars denote SEMs. aIndicates P < .01. bIndicates P < .001.
Figure 2.
Figure 2.. Serial Mediation Analysis Between Children’s Behavioral Outcomes and Quality of Life With Parental Worries and Emotional Functioning as Mediators in Wave 2
The diagram shows the mediation analysis of the association of children’s behavioral outcomes as measured by the Strengths and Difficulties Questionnaire (SDQ) with quality of life as measured by the Pediatric Quality of Life Inventory (PedsQL) in which parental worries and children’s emotional functioning serve as mediators of the association. The variable c′ indicates the direct association, and c indicates the total association. aIndicates P < .01. bIndicates P < .001.
See this image and copyright information in PMC

References

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