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Study finds increased emotional difficulties in children during the pandemic

Press release issued: 17 May 2021

The COVID-19 pandemic may be associated with continuing emotional and behavioural difficulties in children after the age of two, a new study out today [17 May] from researchers at the University of Bristol has found.

Please note this is a preprint, so it is a preliminary piece of research that has not yet been through peer review and has not been published in a scientific journal – so this is early data.

Whilst the rise in emotional problems in teenagers and young adults since the pandemic has become clearer, little is known about the emotional response of pre-school and primary school aged children. Using data tracking children's emotional development at multiple ages before and during the pandemic, the research team were able to explore differences in trajectories of emotional difficulties in children before and during the pandemic.  The study is published on the pre-print server

The researchers looked at data from 708 children who are part of the third generation of the health study Children of the 90s, based at the University of Bristol (also known as the Avon Longitudinal Study of Parents and Children). Due to the unique nature of the study, which first recruited pregnant women in the Avon area between 1991–92, researchers were able to compare data collected pre-pandemic with the data collected through a questionnaire conducted from 26 May and 5 July 2020, which focussed on the impact of the COVID-19 pandemic as restrictions were eased.

Dr Rebecca Pearson, Senior Lecturer in Psychiatric Epidemiology at the University of Bristol and senior author, explained: "Emotional problems usually peak around age two and then decline over childhood, but the peak of emotional problems at age two was lower during the pandemic than before the pandemic.  However, emotional problems usually reduce after the “terrible twos”, but during the pandemic we didn’t see the reduction we would expect. So older children in the pandemic had much higher levels of emotional difficulties than would be expected at their age. At the age of eight, their scores on the emotional difficulties measures are ten points higher in the pandemic sample than what we would expect based on pre-pandemic data.

"Our findings suggest that primary school children may have emotional difficulties at the level expected during the "terrible twos". This could reflect a delay in emotional development that, if not supported, may far outlive the pandemic and have long-term consequences for this generation of children. This age group should not be forgotten for health and educational resources and funding. The emotional consequences need to be understood and supported, in order to prevent a generation of children at greater risk of mental health problems."


Dr Helen Bould, Consultant and Senior Lecturer in Child and Adolescent Psychiatry at the University of Bristol, and a co-author on the study, added: "This work highlights the negative impact that Covid-19 and the lockdowns are having on the mental health of younger children. This is likely to have knock-on effects on their future mental health, so it is vital for the future of the country that we respond to this evidence with additional support for children and families. We need to invest more in high quality childcare, schools and social care, as well as increasing funding for our overstretched child and adolescent mental health services." 

Dr Elise Paul, Senior Research Fellow in Epidemiology at University College London and first author, said: "Our findings are in line with studies of older children and adults conducted during the pandemic and highlight the need for increased resources and attention to be paid to mental health, not only as the pandemic wears on, but also in its aftermath."

The team are now investigating factors that may be protective against or increase the risk of emotional difficulties in children during the pandemic and beyond, such as keeping to a routine, and the impact of parental anxiety.

This work was supported by the Elizabeth Blackwell Institute, University of Bristol and the European Research Council.

Preprint Paper

‘Trajectories of child emotional and behavioural difficulties before and during the COVID-19 pandemic in a longitudinal UK cohort’ by Elise Paul, Rebecca M. Pearson et al in medRxiv

Please note this is a preprint, so it is a preliminary piece of research that has not yet been through peer review and has not been published in a scientific journal – so this is early data

Further information

About Children of the 90s
Based at the University of Bristol, Children of the 90s, also known as the Avon Longitudinal Study of Parents and Children (ALSPAC), is a long-term health-research project that enrolled more than 14,000 pregnant women in 1991 and 1992. It has been following the health and development of the parents and their children in detail ever since and is currently recruiting the children and the siblings of the original children into the study.

The study has a huge catalogue of data and biosamples and continues to be used to collect new material. These resources can be used to quickly answer policy questions that arise given current conditions. Rapid response to important social and health questions has been a hallmark of the Children of the 90s’ contribution to COVID-19. Contributions have varied widely - from asking about the age of grandparents or the social and health effects of lockdown to finding out how long immunity lasts or how effective will vaccines be.

The study receives core funding from the Medical Research Council, the Wellcome Trust and the University of Bristol.

Find out more at

About Elizabeth Blackwell Institute
Nurturing research. Improving health.

The Elizabeth Blackwell Institute drives innovation in research to improve health for all. It nurtures interdisciplinary research to address the complex health challenges facing us today.

The institute focuses on:

  • Supporting the next generation of health researchers;
  • Connecting people to develop interdisciplinary research;
  • Including everyone in research so the research can benefit all.


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