Associations between Parental Educational Attainment, Children's 24-h Behaviors and Children's Hyperactivity Behavior in the COVID-19 Pandemic

Abstract

Background: Parental Educational Attainment and children's 24-h behaviors significantly influenced children's hyperactivity symptoms. This study aimed to examine the mediating role of children's 24-h behavior changes due to the COVID-19 pandemic between Parental Educational Attainment and children's hyperactivity index. It also aimed to investigate the associations between Children's Physical Activity, digital media use, sleep, and hyperactivity index between two clusters of Parental Educational Attainments. The goal was to provide targeted behavioral optimization recommendations for caregivers to reduce the risk of children's hyperactivity.

Methods: The study was a collaborative extension of the International iPreschooler Surveillance Study Among Asians and otheRs project and the Chinese Children and Adolescent Sports Health Promotion Action Project. The Parent-Surveillance of Digital Media in Childhood Questionnaire^® and the Abbreviated Rating Scales from the Conners Parent Symptom Questionnaire were used to measure Parental Educational Attainment, children's behavior changes during the COVID-19 pandemic, and hyperactivity indexes. A total of 11,190 parents of 6-to-12-year-old children completed the online surveys in mainland China. A structural equation model was established by using Smart-PLS, and the linear regression model, and isotemporal substitution models were established by using a Compositional Data Analysis package with R program to achieve the research objectives.

Results: Changes in children's 24-h behaviors due to the COVID-19 pandemic had a significant mediation effect on the negative associations between Parental Educational Attainment and children's hyperactivity index (β = 0.018, T = 4.521, p < 0.001) with a total effect (β = -0.046, T = 4.521, p < 0.001) and a direct effect (β = -0.064, T = 6.330, p < 0.001). Children's Digital Media use was significantly and negatively associated with hyperactivity index among all children. Reallocated time from digital media use to both sleep and physical activity decreased the hyperactivity index, and vice-versa. For parents without tertiary education (R² = 0.09, p < 0.001), sleep was significantly and negatively associated with the hyperactivity index (β_ilr-CSL = -0.06, p < 0.001); for parents with tertiary education (R² = 0.07, p < 0.001), physical activity was significantly and negatively associated with the hyperactivity index (β_ilr-CPA = -0.05, p < 0.001), and sleep was significantly and positively associated with the hyperactivity index (β_ilr-CSL = 0.03, p < 0.001). A significant increase in the hyperactivity index was detected when physical activity time was reallocated to sleep, with a significant decrease in the opposite direction.

Conclusions: Parental Educational Attainment and children's 24-h behaviors directly influenced children's hyperactivity index. However, a purposeful and targeted optimization of children's 24-h behaviors-namely, physical activity, digital media use, and sleep-could assist parents with different educational attainments to reduce their children's hyperactivity index and mitigate the risk of hyperactivity.

Keywords: Children’s 24-h behaviors; Children’s hyperactivity behavior; Parental educational attainment.

Figure 1

The numbers below the different cities represent the number of participants, and the numbers below the different geographic areas represent a combination of the total number and percentage of participants in the corresponding city.

Figure 2

The numbers across the lines represent the coefficients and significance, and the numbers in the blue circle represent the R² of the constructs; PEA = Parental Educational Attainment; C19 = a change because of the COVID-19 pandemic; CDM = Children’s Digital Media use; CSL = Children’s Sleep; CPA = Children’s Physical Activity; CHI = Children’s Hyperactivity Index.

Figure 3

The graphs show the trends in CHI changes after the isotemporal substitution of children’s PA, SL, and DM for PWTE and PTE. Models were controlled for differences in age, gender, and geography. The shaded portions of the images depict the 95% confidence intervals for the respective child behaviors; DM = Digital Media use; PA = Physical Activity; SL = Sleep.