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Pandemics

COVID-19 Brief: Remote Learning and Children with Neurodevelopmental Disorders

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According to the United Nations, COVID-19 created the largest disruption to the education of children in history [1].


In the U.S. alone, nearly 60 million students abruptly transitioned to remote learning. The World Bank estimates that school closures will result in a loss of between three months to 1.1 years of schooling [2]. On average, children lost three months of mathematics education and 1.5 months of reading education. This translates to a loss in lifetime earnings per student of between $6,680 to $32,397.

Children with neurodevelopmental disabilities (NDDs) such as attention-deficit/hyperactivity disorder (ADHD), dyslexia, autism spectrum disorder (ASD), or intellectual disability (ID) found remote learning particularly challenging. These students require established routines, relationships, and professional support, as well as a range of inclusive and specialized educational services. These students also benefitted from non-academic school-based services that were sorely missing during the pandemic, such as food programs, childcare, mental health and disability support, and extracurricular activities. This paper explores remote learning’s impact on children with NDDs and what insurers can do to help.

Effect on Students with NDDs

The global prevalence of ADHD is estimated by various sources to be between 2% and 7% of the total population, with an average of 5% across all countries. In the U.K., a research survey of 10,438 children between the ages of 5 and 15 found that 3.62% of boys and 0.85% of girls had ADHD. In South Africa, ADHD affects approximately 1 in 20 youngsters, while in China a recent meta-analysis puts the prevalence of ADHD among children and adolescents at 6.26%. Boys are more likely to be diagnosed with ADHD than girls.

A study of adolescents with ADHD and their adaptation to remote learning during the initial stay-at-home order found that 31% of parents of students with an Individualized Education Program (IEP) or students receiving academic accommodations (504 Plan) reported remote learning to be very challenging. This compares to 18% of parents of adolescents with ADHD without an IEP/504 Plan and only 4% of parents of adolescents with neither ADHD nor an IEP/504 Plan.

The study also revealed that online schooling and video conferencing may not be an appropriate platform for children with preexisting attentional issues. Remote learning led to increased screen time, fewer routines, and diminished ability to concentrate. Students experienced increased restlessness, problems with sleep, eye impairment, and are at greater risk of obesity. Mental health symptoms included anxiety, depression, loneliness, difficulty in managing change, added stress, and an increase in suicidal thoughts. Parents reported their children having more emotional problems with anger and irritability, leading to more outbursts of aggression. Many found it difficult to cope with the ever-changing rules around mask wearing and social distancing.

Researchers in China asked 183 children diagnosed with ADHD to complete a questionnaire, after which subjects were divided into two groups: high difficulties during online learning (HDOL) and low difficulties during online learning (LDOL). The HDOL group experienced significant symptoms of inattention and hyperactivity as well as behavioral and emotional problems such as oppositional defiant disorder. The HDOL children also showed more inattention-related behaviors, more severe emotional problems, executive function (EF) impairment, and weaker learning motivation. They spent significantly more time on both video games and social software per day and less time on other activities.

Over 47.5% of parents in this study reported that the attention of their children became worse during online learning. Approximately 43% of parents reported the efficiency and completion of homework declined, possibly due to lack of ability to organize and plan (related to EF). In general, impaired self-control and behavioral inhibition from EF produced poor management of digital media usage by children with NDDs.

Insurance Considerations and Insurer Contributions

For all children, the longer-term impacts of remote learning on morbidity and mortality are largely unknown, but it is clear some could be significant. For example, a recent study found that children’s physical activity has decreased during the pandemic, ranging between −10.8 min/day up to −91 min/day [3]. A decrease in physical activity for children can lead to obesity or heart issues later in life. Ongoing monitoring of children’s mental and physical health challenges stemming from remote learning must therefore remain a priority. Insurers could potentially play an important role in this and help mitigate both short-term and long-term harm, via wellness support and expanded coverage, as well as community outreach initiatives.

For children with NDDs, who require additional developmental support that comes at significant educational and medical expense, insurance protection could be especially beneficial. Innovative insurance products could help families cover these costs. This is already happening in Asia, where lump sum payments are made upon diagnosis of various NDDs, including autism, intellectual disability, ADHD, and some learning disorders. Progress starts with wider recognition of NDDs from an insurance perspective with an emphasis early diagnosis and intervention. For more significant NDDs, the needs of the caregiver should also be acknowledged and supported. These protection gaps offer insurers an opportunity to help find meaningful solutions.

The insurance industry is already making a big impact through community engagement initiatives. Examples include the following:

  • Insurers have donated funds to campaigns such as BGL4Schools [4] in the U.K. and Donors Choose Keep Kids learning [5] in the U.S. to help struggling schools purchase technology to support remote learning. Vulnerable children need reliable access to this technology.
  • Insurers have also supported programs such as THRIVE (Together Helping Realize Inclusive Victories Everyday), which serves adults and children who are on the autism spectrum or have physical or cognitive disabilities.
  • The Sesame Workshop [6] and a large health insurer have launched bilingual resources that help children build their resilience to thrive in their communities.
  • One of the nation’s largest Medicaid managed care plans has partnered with insurtech Positiv.ly to create an online community that fosters resilience by giving teens a safe space to share their mental health stories and access mental health resources.
  • A large U.S. health insurer announced a partnership with GoNoodle, an interactive mindfulness and physical activity platform, to provide services to more than two million K-6th grade kids, their parents, and teachers.

Summary

All children faced challenges during the pandemic with the sudden switch to remote learning, but children with NDDs appeared to have suffered more and continue to do so. Pre-existing attentional and perception issues were exacerbated by increased screen time and a suspension of needed support services. Life and health insurers can play a meaningful role in meeting the needs of these children and adolescents moving forward – via community outreach, wellness initiatives, and innovative product development. Though the pandemic may have passed its peak, its ripple effects will continue to impact people’s health and wellbeing, especially among the most vulnerable.


References

  1. https://www.un.org/development/desa/dspd/wp-content/uploads/sites/22/2020/08/sg_policy_brief_covid-19_and_education_august_2020.pdf
  2. Azevedo JP, Hasan A, Goldemberg D, Geven K, Iqbal SA. Simulating the Potential Impacts of COVID-19 School Closures on Schooling and Learning Outcomes: A Set of Global Estimates. World Bank Res Obs. 2021;lkab003. Published 2021 Mar 17. doi:10.1093/wbro/lkab003
  3. Physical Activity of Children and Adolescents during the COVID-19 Pandemic—A Scoping Review Lea Rossi, Nick Behme and Christopher Brewer
  4. https://www.bglinsurance.co.uk/media/press-releases/february-2021-(1)/bgl-launches-major-national
  5. https://equitable.com/news/2020/equitable-expands-commitment-to-donorschoose-through-matching-gift-program
  6. Sesame Workshop Launches New Resources to Help Children and Families Build a Lifelong Foundation of Resilience | Sesame Workshop: https://www.sesameworkshop.org/press-room/press-releases/sesame-workshop-launches-new-resources-help-children-and-families-build

 Additional Resources

  • Becker SP, Breaux R, Cusick CN, et al. Remote Learning During COVID-19: Examining School Practices, Service Continuation, and Difficulties for Adolescents With and Without Attention-Deficit/Hyperactivity Disorder. J Adolesc Health. 2020;67(6):769-777. doi:10.1016/j.jadohealth.2020.09.002
  • Colizzi M, Sironi E, Antonini F, Ciceri ML, Bovo C, Zoccante L. Psychosocial and behavioral impact of COVID-19 in autism spectrum disorder: an online parent survey. Brain Sci. 2020;10(6):341. doi: 10.3390/brainsci10060341. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7349059
  • De Giacomo A, Pedaci C, Palmieri R, Simone M, Costabile A, Craig F. Psychological impact of the SARS-CoV-2 pandemic in children with neurodevelopmental disorders and their families: evaluation before and during covid-19 outbreak among an Italian sample. Riv Psichiatr. 2021 Jul-Aug;56(4):205-210. doi: 10.1708/3654.36348. PMID: 34310578.
  • Panagouli E, Stavridou A, Savvidi C, et al. School Performance among Children and Adolescents during COVID-19 Pandemic: A Systematic Review. Children (Basel). 2021;8(12):1134. Published 2021 Dec 4. doi:10.3390/children8121134
  • Roy AK, Breaux R, Sciberras E, Patel P, Ferrara E, Shroff DM, Cash AR, Dvorsky MR, Langberg JM, Quach J, Melvin G, Jackson A, Becker SP. A preliminary examination of key strategies, challenges, and benefits of remote learning expressed by parents during the COVID-19 pandemic. Sch Psychol. 2022 Mar;37(2):147-159. doi: 10.1037/spq0000465. PMID: 35266770.
  • Online Learning Performances of Children and Adolescents With Attention Deficit Hyperactivity Disorder During the COVID-19 Pandemic Shan He, MD1,2, Lan Shuai, PhD1,2, Zhouye Wang, MD1,2, Meihui Qiu, MD1,2, Amanda Wilson, PhD3 , Weiping Xia, MD1,2, Xuan Cao, MD1 , Lu Lu, MD1 , and Jinsong Zhang, PhD, MD1,
  • Jess Whitley, Miriam H. Beauchamp, and Curtis Brown. The impact of COVID-19 on the learning and achievement of vulnerable Canadian children and youth. FACETS6(): 1693-1713. https://doi.org/10.1139/facets-2021-0096
  • Zhang J, Shuai L, Yu H, Wang Z, Qiu M, Lu L, Cao X, Xia W, Wang Y, Chen R. Acute stress, behavioural symptoms and mood states among school-age children with attention-deficit/hyperactive disorder during the COVID-19 outbreak. Asian J Psychiatry. 2020;51:102077. doi: 10.1016/j.ajp.2020.102077. https://www.ncbi.nlm.nih.gov/pmc/articles/PMC7195413/

The Author

  • Diana Bosworth
    Senior Research Analyst
    Strategic Research

Summary

All children faced challenges during the pandemic with the sudden switch to remote learning, but children with neurodevelopmental disorders (NDDs) appeared to have suffered more and continue to do so. In this article, RGA's Diana Bosworth explores this notable ripple effect of COVID-19.