UNIVERSIDADE FEDERAL DO RIO GRANDE DO SUL

INSTITUTO DE PSICOLOGIA
PROGRAMA DE PÓS-GRADUAÇÃO EM PSICOLOGIA
DOUTORADO EM PSICOLOGIA

Impacts of the COVID-19 pandemic on early childhood development

Projeto de tese apresentado ao Programa

de Pós-Graduação em Psicologia do
Instituto de Psicologia da Universidade
Federal do Rio Grande do Sul (UFRGS),
como requisito parcial para a obtenção
do grau de Doutora em Psicologia.

Adriana Schütz

Profa. Dra. Denise Ruschel Bandeira

Orientadora

Porto Alegre, 12 de julho de 2023

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SUMÁRIO

1. INTRODUCTION 2
1.1 Early evidence of the effects of the pandemic on children 3
1.2 Socioeconomic impacts of the pandemic on children and their families 9
1.3 Pandemic context in Brazil and in the USA 10
1.4 Justification and objectives 11
2. METHOD 13
2.1 STUDY 1 - Longitudinal study of child development during the pandemic 13
2.1.1 Participants 13
2.1.2 Instruments 14
2.1.3 Procedures 15
2.1.4 Data Analysis 15
2.2 STUDY 2 - Comparative study of pre and post-pandemic child development 15
2.2.1 Participants 16
2.2.2 Instruments 17
2.2.3 Procedures 17
2.2.4 Data Analysis 18
2.3 STUDY 3 - Cross-cultural study between Brazil and the USA: child development in
the pandemic 19
2.3.1 Participants 19
2.3.2 Instruments 20
2.3.3 Procedures 20
2.3.4 Data Analysis 21
REFERENCES 22
PROJECT BUDGET 37
TIMETABLE 38
APPENDIX A - Research ethics committee approval 39
APPENDIX B - Informed Consent 43
APPENDIX C - Sociodemographic Questionnaire 45
APPENDIX D - COVID-19 Pandemic Impacts Questionnaire 48
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1. INTRODUCTION

The years 2020 and 2021 were marked by the COVID-19 pandemic, which hit the
entire world at both collective and individual levels. In order to control the virus' spread,
people had to socially isolate themselves, in addition to other security measures that had to be
taken, such as stay-at-home policies, recommendations for remote work and classes, and
closure of public services (Gato et al., 2021). Like adults, children were forced to distance
themselves from the school environment, and their interactions with other children and adults
outside their nuclear family were compromised (Benner & Mistry, 2020). It is not yet known,
however, the impact of such an event on children’s lives, since the literature relating
epidemics and other large-scale stressful events to child development outcomes is still very
scarce (Araújo et al., 2021).
On the other hand, it is known that the course of early childhood has a fundamental
role in development since it is characterized as a critical period, in which children are more
receptive to certain experiences, which, due to neuroplasticity, act on the process of brain
maturation (Glaser, 2000; Papalia & Feldman, 2013). Even during the gestational period, the
baby is sensitive to the intrauterine environment, which, in turn, when at risk, can affect
neurodevelopment (Papalia & Feldmas, 2013). Gestational exposure to SARS-CoV-2 itself
was negatively associated with fine motor development and problem-solving skills (Pinheiro
et al., 2023). ​Preschool-age children are especially sensitive to their environment as synapses
are at their peak of new formation during this period, but also going through a narrow
selection, in which important and reinforced connections are maintained, while underused
ones die away, through synaptic pruning (Tierney & Nelson III, 2009; National Scientific
Council on the Developing Child, 2007). This selection is directly influenced by social
determinants since they are responsible for the quality of the experiences children are
exposed to and the type of stimulation that is offered to them (Hertzman, 2010). The family's
socioeconomic and educational levels, for example, might influence children’s development,
as they affect aspects such as physical environment, resources, nutrition, stimulation, and
even the caregiver's mental health (Maggi et al., 2010).
Adverse experiences during early childhood have already been related to negative
developmental outcomes, such as detrimental effects directly on brain formation (especially
in cases of deprivation, bad nutrition, and toxin exposure) (Grossman et al., 2003),
internalizing and externalizing problem behaviors (Centers for Disease Control and
Prevention, 2013), poor academic and literacy skills (Jimenez et al. 2016), the emergence of
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socioemotional problems (Cooper et al., 2009), and poor cognitive performance (Guinosso et
al., 2016). In cases of cumulative and long-lasting adverse experiences, toxic stress has
emerged as a very common consequence, increasing cortisol levels and having brain
functions altered as a result, therefore, impacting children’s health and well-being (Miller et
al., 2011; Shonkoff et al., 2009). While COVID-19 was not considered of great risk for kids
(Bhopal et al., 2021), the indirect effects of the pandemic could be considered an adverse
experience, as it implied a complete change in the reality of children and their families,
generating the deprivation of several experiences considered essential for early childhood
(Green, 2020; Panda et al., 2021; Schiavo, 2020).

1.1 Early evidence of the effects of the pandemic on children

Even though infants and young children have not been able to really understand the
emergency of the pandemic and its implications, they have been either directly or indirectly
affected by it in all different areas (Comitê Científico do Núcleo Ciência Pela Infância, 2022).
Some studies already point out the important consequences of the pandemic on the
development and functioning of children and adolescents.

Mental Health
Experiences of fear were frequent during the pandemic and very intense among
children, which involved the concern of getting sick, but mainly of having a family member
infected and, consequently, losing them (Mangueira et al., 2020). Intense fear, in some cases,
led to acute somatization, with children presenting symptoms similar to SARS-CoV-2 itself
(Colizzi et al., 2020).
As pointed out by Chen et al. (2020), during the pandemic, children were also more
susceptible to mental disorders such as anxiety and depression. They evaluated 7866 Chinese
children and adolescents through a survey seeking to understand their mental health
conditions during this period. The study identified the following risk factors for symptoms of
anxiety and depression: higher school grade, female gender, family member infected with
COVID, and online studying. It has also been observed an increase in other risk factors such
as exposure to stress (Ezpeleta et al., 2020), changes in the circadian cycle and sleep pattern
changes (Türkoğlu et al., 2020), and social distancing (Oosterhoff & Palmer, 2020), which all
compromise mental health. Corroborating these data, in a systematic review, Elharake et al.
(2022) identified higher levels of anxiety, depression, fatigue, and stress among children and
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adolescents, and identified other risk factors such as living in rural areas, low socioeconomic
status and having a family member or friend as a healthcare worker.
Regarding sleep, a 2021 study identified that most parents noticed a worsening in
their children's sleep and that they associated this worsening with increased screen time,
anxiety, and a decrease in physical exercises (MacKenzie et al., 2021). In line with this, Zhao
and colleagues (2022) identified in their study with children and adolescents an association
between changes in sleep, such as shorter sleep duration and late-to-rise patterns, and mental
illness.
A study carried out with children aged 0 to 6 years also pointed out that there was a
significant decrease in their exposure to sunlight during social isolation, with a consequent
decrease in vitamin D levels, which indicated the need for supplementation (Yu et al., 2020).
As an essential hormone for regulating the circadian rhythm, vitamin D plays an important
role in mental health and well-being (Holick, 2001), so limiting sun exposure during the
lockdown period may have had direct consequences for children's mental health, and may
even have increased the risk for developing depression (de Figueiredo et al., 2021). The very
changes in eating, which have arisen as a result of increased stress levels, routine changes,
increased use of screens, and even food insecurity due to the economic crisis, as well as lack
of physical exercise also affect children's mental and general health (Mengin et al., 2020).
According to another study carried out with 2485 students, an increase in the
prevalence of Post-Traumatic Stress Disorder (PTSD) among young people was also
identified as a result of home confinement (Tang et al., 2020). This was even intensified in
cases where children went through a period of hospitalization in the intensive care unit (ICU)
due to the infection, with emotional and behavioral effects that, in some cases, progressed to
PTSD (Mangueira et al., 2020).
Children who already had some previous condition, such as neurodevelopmental
disorders, also presented problems and difficulties due to social isolation (Almeida & da
Silva Júnior, 2021). Türkoğlu et al. (2020) observed an intensification of symptoms in
children with autism, associated with sleep dysregulation. Confirming this finding, Amorim
et al. (2020) identified an increase in behavioral complaints from children with autism, such
as more significant irritability, anxiety, and hostility. Similarly, children with
Attention-deficit/hyperactivity disorder (ADHD) experienced a significant increase in
inattentive symptoms during the pandemic (Sasaki et al., 2020) and showed negative
changes across most areas of functioning (Sciberras et al., 2022).
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Learning
The closure of schools during lockdown forced educators to rethink their teaching
model so that they could adapt it according to the restrictions imposed by the pandemic,
making room for online classes. Thus, children and their families had to go through a rapid
transition to this new teaching modality (Andrew et al., 2020). Before the pandemic, they
spent a significant part of their day at school, an average of 30 hours a week, but with social
isolation, this scenario was modified with all their activities restricted to indoors (Cattan et
al., 2020).
Remote learning adaptations were applied to all educational levels, from primary
schools to higher education institutions (Vieira & Seco, 2020). A Chinese study indicated that
the main strategies used by teachers were interactive Q&A (questions and answers) and live
streaming, with one-to-one online tutoring being the least popular approach. However,
through interviews with principals, they also pointed out the difficulty in guaranteeing the
quality of web-based learning as their main obstacle (Song & Zhi, 2020). This difficulty can
be associated with the inadequate infrastructure of schools and the lack of preparation and
prior training of educators for remote teaching (Muñoz, 2020), in addition to possible
limitations of children and their families in relation to access to technology and connectivity
(Catalano et al., 2021).
In a study carried out in France and Italy, it was identified that both primary and
secondary school children had learning achievement difficulties, which were intensified in
cases of children who did not have access to remote teaching. Online studying, therefore, was
a protective factor for the learning process, except for kindergarten (Champeaux, 2020). Early
childhood care and education have been significantly compromised since it requires greater
responsiveness and emotional embracement from the caregiver, which is hampered in this
scenario (Britto et al., 2017). McCoy et al. (2021) found data suggesting that school closures
had negative consequences for children around the world, with an estimated 167 million
children losing access to early educational support. Their findings also indicate that those
closures represent a derail in the early development of more than 10 million children, which,
in turn, predicts important future income losses.
The quality of learning itself has dropped during remote teaching. Through a
systematic analysis, Donnelly and Patrinos (2021) identified that students experienced
learning losses in different subjects across different grades. These learning losses, however,
appear to be more prevalent among poorer children (Moscoviz & Evans, 2022). Children also
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had greater difficulty paying attention to online classes, especially the younger ones
(Scarpellini et al., 2021). For younger children, delays in the literacy process were also
observed (Feitosa & dos Santos, 2021). According to Strunk et al. (2023), school
achievement growth also had a significant decrease after the pandemic, especially in math.
In this scenario, parents played a much more active role in their children's education,
so they were responsible for supporting children in their home learning process. This,
however, was not an easy task and parents faced obstacles that were difficult to overcome
(Andrew et al., 2020). Abuhammad (2020) was able to identify these difficulties according to
four different spheres: (1) personal barriers, such as lack of preparation and qualification for
the task, lack of familiarity with technology, and lack of communication with educators to
better instruct them; (2) technical barriers, such as connectivity quality; (3) logistical barriers,
such as children's unpreparedness for distance learning, dissatisfaction with the online
teaching model and the lack of effectiveness of the methods used for the needs of children;
(4) financial barriers, such as lack of access to adequate technology and the difficulty of
paying for internet service. For parents of pre-school age children, it was even more difficult
to guide the learning process, since this group requires different, less standardized,
pedagogical strategies that demand greater creativity skills (Champeaux, 2020).
As pointed out by many authors (Azorín, 2020; Bayley et al., 2023; Chatterji & Li,
2021; Drane et al., 2002; Dorn et al., 2020), schools' closure, even if followed by the
implementation of remote teaching strategies, also increased the chances of school dropout as
it generates a general educational disengagement among students. The frequency of school
dropout is higher among adolescents, but still significant among children from initial grades
(Moscoviz & Evans, 2022).

Use of technology
With social isolation and remote teaching strategies, children and adolescents were
more exposed to screens and the excessive use of technology (Eidi & Delam, 2020), with a
significant increase in the use of smartphones, computers, tablets, and TVs (Montag & Elhai,
2020). The lack of opportunity for outdoor playing and social interactions had a direct impact
on their leisure routines, relying mostly on virtual entertainment options (Kourti et al., 2021).
Through a meta-analysis, Trott et al. (2022) identified an increase in the total time of daily
use of screens of 1.4 hours for children between 6 and 10 years old, 0.9 hours for adolescents
between 11 and 17 years old, and 0.6 hours for babies and toddlers aged 0 to 5. In addition,
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they also identified variables correlated with this increase, such as adverse dietary behaviors,
sleep, mental health, parental health, and eye health.
The use of social media also intensified among children and adolescents as an
alternative for maintaining interaction with peers (Nagata et al., 2020; Paschke et al., 2022).
This was positive from a socialization point of view, allowing them to maintain contact even
at a distance and obtain social support in the moment of crisis (Drouin et al., 2020), but
negative when we considered the effect that the excessive use of social media has on the
process of identity formation of young people (Richards et al., 2015). Likewise, there has also
been a rapid increase in the frequency of online gaming. A study with children and
adolescents aged 10 to 17 identified that the average time devoted to video games during the
week increased from 79.2 min to 138.6 min during the pandemic (DAK-Studie, 2020).
Although it can act as cognitive stimulation (Barr & Copeland-Stewart, 2022), gaming, when
excessive, can be harmful to children's mental health (Singh, 2019).
The overuse of technology also had effects on children's sleep patterns, since
prolonged exposure to blue light emanating from screens impairs the production of melatonin
and disrupts the biology of sleep (Becker & Gregory, 2020). The excessive use of technology
also negatively impacted eating and exercise habits (Trott et al., 2022). In addition, increased
screen time may pose a greater risk of developing depression and anxiety, in addition to
higher levels of inattention (Lissak, 2018).

Socialization
As a result of the closure of schools, children had their main context of socialization
ceased and restricted play and recreational activities with friends, which represents a loss for
the development of social skills. The social stimulation provided in the school environment is
also fundamental for the child's mental health and for the adequate progress of different areas
of child development. Furthermore, problems with socialization during childhood can have
detrimental consequences for adulthood (Lamana et al., 2023).
A study by Rodman et al. (2022) showed that there were significant changes in
children's social behavior after the pandemic, with a decline in in-person socialization. In the
same study, children reported moderate levels of isolation, which were correlated to an
increase in internalizing and externalizing symptoms. Some studies even point to a
relationship between reduced socialization as a result of the pandemic and mental health
problems among children and adolescents (Almeida et al., 2021; Loades et al., 2020 Paiva et
al., 2021). Parents reported worse emotional status of their children during the pandemic,
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particularly for younger children, which appears to be associated with limited interactions
with peers during this period. In the case of older children, this impact was mitigated by the
alternatives of virtual interactions (Champeaux, 2020).
Almeida et al. (2021) also point out that children in isolation tend to have higher
levels of cortisol, a stress related hormone. They also indicate that there may be a negative
effect on overall cognitive development. Social isolation and lack of interactions with peers
also had an effect on the development of aspects related to social cognition. Children who
had reduced contact with friends and adopted synchronous methods of communication over
text-based communication showed reduced positive bias in emotion recognition (Bland et al.,
2022).

Violence
Confined to the domestic environment during the pandemic, families had their
routines modified along with an increase in their members' stress levels (da Silva et al.,
2021). These factors, associated with a decrease in the accessibility of support, prevention
and reporting services for violence situations (Platt et al., 2020), led to a significant increase
in the rates of violence against children (de Oliveira et al., 2021; The Alliance for Child
Protection and Humanitarian Action, 2020; UNICEF, 2021). Although some sources indicate
a decrease in reports of violence against children, mainly in the United States (Kourti et al.,
2023; U.S. Department of Health and Human Services et al., 2021), it is understood that this
might be a consequence of the inaccessibility of protection services during the pandemic.
Besides children, women were also at greater risk of domestic violence during this
period (Mansi et al., 2020), thus exposing children to violence within the home between
parents. Children were victims of different types of violence: physical, verbal, emotional,
sexual, in addition to negligence. Regardless of the type of violence, however, parents or
regular caregivers were the most frequently reported perpetrators (Bourgault et al., 2021).
The closure of schools played an important role in this scenario, as it serves as a protective
factor against abuse and violence. Away from schools, children lost direct contact with
teachers, who usually receive and submit this type of report (U.S. Department of Health and
Human Services et al., 2020).
The effects of violence, added to the difficulties and limitations experienced by
children during the pandemic, represent a great danger to their physical and mental health, in
addition to putting their development at risk (Holt et al., 2008), especially since their
adjustment to stressful situations is directly related to parent's emotional state (Shorer &
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Leibovich, 2020). In this context, responses to stress are even more intense, as are the organic
reactions (Smith & Pollack, 2022). The development of a secure attachment is also impaired
(Levendosky et al., 2003), since, without contact with other adults, the child has the
perpetrator as the only figure of care.

1.2 Socioeconomic impacts of the pandemic on children and their families

It is also important to highlight that, in the midst of all the pandemic chaos, the world
economy has been heavily impacted due to the various government efforts to control the virus
spread (Auzan, 2020). Health systems were the main sector affected, but there were
repercussions in all economic sectors (Nicola et al., 2020). As a result of the various financial
losses worldwide, local economies ended up breaking, generating individual impacts on
workers and their families, who began to live in the face of financial instability. Those with
lower socioeconomic status (SES) had their financial difficulties aggravated, especially in
low-income countries (Josephson et al., 2021). These are extremely relevant data, as SES
disparities are known to be a very studied topic among the factors that can influence
differences in child development (Chaudry & Wimer, 2016; Letourneau et al., 2013; Walker
et al., 2011).
SES also had an effect on how children lived through the pandemic. One of the
biggest changes in their routines was school and childcare programs closure and the further
adaptation of education to online strategies (Gilliam et al., 2021). It is inaccurate, however, to
assume that all children had equal access to technology (Sahlberg, 2020). Many low SES
students had difficulties participating in online classes due to a lack of internet access or
adequate technological devices (Catalano et al., 2021). This distance from school, in turn,
represents a risk and possible delay in the learning process (Masonbrink, 2020). Furthermore,
high SES parents might have had more opportunities to work remotely from home in
comparison to parents of low SES (Bonaccorsi et al., 2020), which entails greater availability
to comfort children through this stressful experience and even support them through the
adaptation to remote education. In addition, parents of low SES had to deal with greater risks
of unemployment, which creates instability in the family environment and, consequently, in
the well-being of children (Terrier et al., 2021). Other socioeconomic factors (e.g. food
insecurity, scarce resources, and less healthcare access) also played a role in intensifying the
impairments in child development and mental health caused by disparities (Van Lancker &
Parolin, 2020).
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Li and colleagues (2021) observed that children from lower SES had been
disproportionally affected by the pandemic, showing more mental health problems.
Furthermore, social isolation, lockdowns, and the constant risk of COVID-19 contamination
have increased stress levels in the general population, especially children (Racine et al.,
2021). The combination of such a large-scale event with a prior condition of poverty (which
in itself is a stress trigger) has made the impact of recent events even greater at the
developmental level, including on executive functioning, academic performance, and emotion
regulation (George et al., 2021).

1.3 Pandemic context in Brazil and in the USA

In Brazil, there was a rapid spread of the virus associated with a high number of
deaths (Almeida et al., 2020). This, however, was not the biggest challenge for Brazilians, but
the health and economic crises that arose as a result (Werneck & Carvalho, 2020).
Unemployment levels have increased, aggravating the financial situation and generating
resource limitations for millions of Brazilian families (Costa, 2020). As a consequence of
unemployment and rising inflation, food insecurity levels increased drastically (Xavier et al.,
2021), which had a direct impact on children, that, before school closure, had at least one
meal guaranteed by the government at school lunches (Saluto & Rangel, 2022). In short,
socioeconomic disparities, which were already a hallmark of the Brazilian population, were
accentuated by the economic crisis (de Mendonça, 2020). Thus, all these factors, added to the
stress generated by the pandemic itself, can represent an important aggravation for the
development of Brazilian children.
Since environmental factors have such an important role in the ways children were
affected by the pandemic, different cultural and socio-economic settings are extremely
relevant variables to be considered when investigating the effects of recent global events
(UNESCO, 2020). The United States, despite also having been heavily affected by the
pandemic, both in terms of the number of deaths and economy (Altig et al., 2020), had
different impacts on its population in comparison to Brazil (Neiva et al., 2020), which may be
associated with both governments’ strategies to controlling the pandemic (Rocha et al.,
2021). As a first-world country with a better structure even prior to the pandemic, the levels
of social inequalities and direct economic impacts on North American citizens were not as
intense (Maia & Sakamoto, 2015), representing better conditions for children’s caregivers,
which directly impacts the quality of the care and support children received and,
consequently, their development context (Souza & Veríssimo, 2015).
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With regard specifically to children’s experiences, the reopening of schools was an

important milestone that had a significant time gap between the two countries. While North
American children were able to resume face-to-face school activities in the second half of
2020 (Marshall & Bradley-Dorsey, 2022), Brazilian children only returned to school in 2021
(Barberia et al., 2022). This difference in the time away from school, in turn, may have also
generated differences in the developmental patterns of Brazilian and North American children
since school plays a crucial role in this process.

1.4 Justification and objectives

Studies, especially empirical ones, focused on understanding the impacts of the
COVID-19 pandemic on childhood are still quite scarce. Among those already published, the
majority target either the learning context and possible delays to the educational process or
the mental health perspective seeking to investigate possible mood and anxiety disorders
generated by the pandemic. Few, however, are oriented to the investigation of these factors in
younger children, and, therefore, do not address specific issues of early childhood and
developmental milestones. It is necessary to investigate possible damage to the development
of children who had part of their childhood affected by the pandemic. Added to this, it is also
critical to understand how specific environmental factors may have had an impact on this. By
identifying possible developmental delays generated by the pandemic, it will be possible, in
the future, to formulate and implement public policies aimed at childhood and education that
could reduce the effect of the damage caused, in addition to providing useful and practical
knowledge to face other large-scale events such as the COVID-19 pandemic.
In addition to that, as a still very recent and understudied subject, the impacts of the
pandemic on child development should address not only specific aspects of children’s health
and well-being but also possible effects caused by different cultural and socio-economic
aspects, which entails the conduction of a cross-cultural study. The employment of
cross-cultural analysis in developmental psychology is of great relevance since it allows for
developmental patterns to be relativized according to contextual variables and for researchers
to understand the role of these variables over possible encountered variations (Berry et al.,
2002; Gomes et al., 2018). Brislin (1983) even points out the crucial role of cross-cultural
research in expanding the knowledge about a given phenomenon by establishing a new range
of possible variations and obtaining new variables for theory development.
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Thus, the overall objective of this project is to investigate the impacts of the
COVID-19 pandemic on the early child development of Brazilian children. Furthermore,
three specific objectives were established:
● Investigating the developmental patterns of children born during or right before the
pandemic (who have also been subjected to social isolation during their first years of
life) through the assessment of all child development domains (cognition, motor
skills, communication and language, socio-emotional skills, and adaptive behavior);
● Analyzing sociodemographic and mental health variables as possible moderators of
child development outcomes, in order to understand how the impact of the pandemic
on households might have indirectly affected children;
● Exploring the difference between the developmental outcomes of Brazilian and North
American children as verified by child development assessment measures, relating
them to cultural and socioeconomic variables.
From these specific objectives, three studies were designed. The studies are presented
and described in the following section.
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2. METHOD

2.1 STUDY 1 - Longitudinal study of child development during the pandemic

This will be a quantitative longitudinal study that will involve the assessment of child
development milestones at two different times: during and after the pandemic. For this, the
study will rely on previously collected data by Vetor's (publisher of IDADI) online platform
(VOL) from the completion of IDADI by parents who agreed to disclose the data for
research, as well as new data collected with the same participants. Possible impacts of the
pandemic and social isolation on the progress of child development will be investigated. This
study will be conducted in accordance with the approval of the Research Ethics Committee of
the Institute of Psychology of the Federal University of Rio Grande do Sul (CEP-PSICO,
Appendix A).

2.1.1 Participants
VOL's current database has 5,372 cases that meet the requirements for this study and
that will be invited to participate in the research. With an expected acceptance rate of 20%,
the estimated sample size for this study is approximately 1,000 participants, which is in line
with the sample size suggested for the data analysis processes that will be conducted
(Maxwell, 2000). Participants will be parents or guardians of children born in all different
regions of Brazil aged between 36 and 72 months who have previously completed IDADI
between 2020 and 2021.

The inclusion of participants in the study will follow the following criteria:
a) The child must be Brazilian;
b) The child must have been born before March 2020 and aged less than or equal to 72
months at the time of data collection;
c) Parents or guardians must have previously completed the IDADI through VOL and
consented to the use of informed data for research.

The exclusion of participants in the study will follow the following criteria:
a) Parents or guardians who do not complete the IDADI and the COVID-related
questionnaire online survey will be excluded.
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2.1.2 Instruments
● Dimensional Inventory for Child Development Assessment (Inventário Dimensional
de Avaliação do Desenvolvimento Infantil, IDADI). IDADI is a multidimensional
instrument created to assess the development of Brazilian children aged between 4
and 72 months through parent reports. It is composed of five domains supported by
literature: Cognitive, Motor Skills (Gross and Fine subdomains), Communication and
Language (Receptive and Expressive subdomains), Socioemotional, and Adaptive
Behavior. The instrument consists of 524 items divided into five domains. Items were
designed to increase progressively in difficulty, cognitive competence, and age, so
inventory items were divided into seven age age-based forms (0 to 6 months, 7 to 12
months, 13 to 24 months, 25 to 36 months, 37 to 48 months, 49 to 60 months, and 61
to 72 months). The response options are established through a three-point Likert-type
scale regarding the performance of that specific skill (1=yes, 2=sometimes, and 3=not
yet) (Silva et al., 2020). The item's reliability index, obtained through Rasch model
analysis, was equal to 1 and the people reliability varied between 0.96 and 0.99
according to the domain (Mendonça Filho, 2017).
● Self-Reporting Questionnaire (SRQ-20). SRQ-20 is a psychiatric screening tool for
non-psychotic mental disorders, primarily aimed at symptoms of depression and
anxiety. It consists of 20 yes/no questions, four of which are about physical symptoms
and 16 about psycho-emotional disorders. It is divided into four scales: anxiety and
depression, somatic symptoms, reduced vital energy, and depressive thoughts. Each
affirmative answer is classified as "1" and the final score is obtained through the total
sum. The questionnaire also has a cutoff point of 8 for the clinical group, indicating
positive for mental disorders from this score (Beusenberg et al., 1994). The SRQ-20
has a Brazilian version that has an internal consistency of 0.86 (Gonçalves et al.,
2008). It will be used to investigate the parent or guardian's mental health, as a
relationship with child development is expected.
● Sociodemographic Questionnaire (Appendix C). This questionnaire covers questions
about the child's clinical and developmental characteristics, besides providing data on
relevant variables concerning the children’s family and socioeconomic context (e.g.,
social, cultural, economic, parental education, mother’s health during pregnancy,
child’s early development, child’s environment, and interactions with caregivers).
● COVID-19 Pandemic Impacts Questionnaire (Appendix D). This questionnaire was
developed to investigate specific impacts of the pandemic on the family (e.g. deaths
 15

caused by COVID, modality of work of providers during social isolation, possible

unemployment, changes in family income) and the child (e.g. time of absence of the
child from school, changes in sleep and hunger, behavior alterations, screen usage
time). Responses will be scored and, through their sum, will provide a pandemic
impact level score.

2.1.3 Procedures
As a first step, participants whose contacts are in VOL's database will be contacted
through e-mail and invited to participate in this study by accessing a link that will direct them
to the online application platform. All instruments will be attached to this platform's access
link. In addition to the aforementioned instruments, there will also be an informed consent
with information about the research that must be filled out and signed by the participant,
consenting to their participation in the research. A copy of this term will be later sent to the
participant for their own record.
All data collected via online survey will be directly exported to a database. The
collected data will be linked via the parent's or guardian's email to previous data acquired at
the time of initial completion of IDADI between 2020 and 2021.

2.1.4 Data Analysis

From the scores obtained through the two applications of IDADI, a mean comparison
test for paired samples will be carried out in order to identify possible differences in
developmental scores in each of the age bands. In addition, the delta (difference between the
pre-pandemic and the post-pandemic scores) will be used as the outcome of interest in a
multiple regression analysis, having the SRQ-20, the variables from Sociodemographic
Questionnaire, and the COVID-19 Pandemic Impacts Questionnaire as predictors. The
analysis will allow testing of the hypothesis that the period of social isolation had an impact
on the developmental pace of toddlers and, consequently, a decrease in their IDADI scores.

2.2 STUDY 2 - Comparative study of pre and post-pandemic child development

This will be a cross-sectional study of a quantitative nature that will be conducted to
analyze the developmental pattern of children born during the COVID-19 pandemic. This
will allow the investigation of the possible effects of the pandemic and the consequent social
isolation on the expected development of each age group.
 16

2.2.1 Participants
The study will have a convenience sample of 300 participants according to theoretical
references that suggest more extensive samples for distribution analysis (Creswell, 2010;
Krithikadatta, 2014; Razali & Wah, 2011). The sample characteristics should resemble those
of the IDADI normative sample, as described in Table 1. Participants will be parents or
guardians of children born in all different regions of Brazil during the pandemic.

Table 1.
Descriptive characteristics of the parameterization sample of the IDADI's items

Child's sex
Total
Characteristics Female Male

N % N % N %

Birth weight

Under 1.000g 8 0.8 5 0.4 13 0.6

Between 1.000g and 1.500g 9 0.9 10 0.9 19 1.0

Between 1.500g and 2.500g 103 9.8 79 7.1 182 8.5

Between 2.500g and 3.000g 270 25.7 227 20.3 497 23.0

Between 3.000g and 3.500g 456 43.5 478 42.8 934 43.3

Between 3.500g and 4.000g 162 15.4 273 24.5 435 20.2

Over 4.000g 32 3.1 44 3.9 76 3.5

Clinical diagnoses

No 1004 95.7 1060 93.9 2064 94.6

Yes 45 4.3 69 6.1 114 5.3

Mother's education level

Illiterate 0 0 2 0.2 2 0.1

Elementary School I 5 0.5 17 1.5 22 1.1

Elementary School II 38 3.6 42 3.7 80 3.7

High School 217 20.9 200 18.2 417 19.7

Undergraduate 141 13.7 147 13.3 288 13.5

Graduate 228 21.8 249 22.1 477 21.9

Postgraduate 413 39.5 457 40.9 870 39.9

Source: IDADI instruction book (Silva et al., 2020).
 17

The inclusion of participants in the study will follow the following criteria:
a) The child must be Brazilian;
b) The child must have been born between March 2020 and December 2021.

The following criteria will be applied for the exclusion of participants from the study:
a) Parents or guardians who do not complete both the IDADI and the COVID-related
questionnaire online survey will be excluded;
b) Cases of children with extremely low scores or who have clinical conditions will be
excluded.

2.2.2 Instruments
For this study, the same instruments as those in Study 1 will be used, with the addition
of a new questionnaire.
● Dimensional Inventory for Child Development Assessment (IDADI);
● Self-Reporting Questionnaire (SRQ-20);
● Sociodemographic Questionnaire;
● COVID-19 Pandemic Impacts Questionnaire;
● Questionnaire on Parenting Practices during Social Isolation. This will be a qualitative
questionnaire to be elaborated during the conduction of the project through an open
interview with five parents. From this, a structured version will be designed to be used
in this study. The questionnaire will aim to investigate the handling of parents with
their children in the face of the difficulties and limitations imposed by the pandemic.

2.2.3 Procedures
Participants will be recruited through social media and e-mail (for those in the
research group's contact database from previous studies), as well as through partnerships with
preschools. For this, schools will be contacted and invited to disseminate the research among
the students' parents. The first five parents who accept to participate in the research through
an in-person meeting will be submitted to an open interview, in addition to the application of
the other instruments, concerning their parenting experiences during the pandemic, such as
possible handling difficulties in the handling of their children’s behavior or emotional issues
or even school demands. From the topics brought up during the interview, a questionnaire
will be elaborated for the investigation of those aspects with the subsequent participants.
 18

Those interested in participating may choose to answer the survey online or be

interviewed, either by video or phone call or in person.
a) Online survey: The participants who choose the online survey option will receive a
link to fill in the instruments, as provided by VOL. All instruments will be attached to
this platform's access link. In addition to the aforementioned instruments, there will
also be an Informed Consent (Appendix B) with information about the research that
must be filled out by the participant, consenting to their participation in the research.
b) Interview: The participants who choose to be interviewed will be offered different
appointment options for a video or phone call or an in-person meeting at the school,
as they choose, with a researcher from our team. The researcher will either have
access to the same VOL link with all the questionnaires available for the online
survey or a printed version of all the same instruments. All the items will be passed on
to the participant during the interview, while the researcher fills out the information.
The participant will also have to consent to their participation through the FICT,
which will be directly given to them for signing, in the case of an in-person meeting,
or read to them, in the case of a video or phone call. In this case, the researcher will
mark their consent on the form.
All data collected via online survey or interview will later be exported to a database.

2.2.4 Data Analysis

The collected and digitized data will undergo an initial distribution analysis in order
to compare the sample distribution pattern of the study participants' scores in relation to the
scores of IDADI’s normative sample. Mean comparison tests will also be carried out for each
of the age bands in order to identify possible differences between the mean scores of the
sample of this study and those of the normative sample from the instrument’s manual. As a
second step in the data analysis process, a multiple linear regression analysis will be
performed, with the pandemic impact level score, the caregiver's mental health (SRQ-20
score), and the child’s socioeconomic context as the predictor variables and the IDADI score
as the outcome variable. Through this, it is intended to test the hypothesis that children born
during the pandemic may have developmental delays, with scores lower than expected for
their age group when compared to the normative sample. Furthermore, in relation to
sociodemographic characteristics, it is hypothesized that children in higher socioeconomic
conditions, with access to school (remotely or in person) and parents with high education had
less impact on the development process. Likewise, it is understood that fewer experiences of
 19

infected family members or losses due to COVID and good mental health of the caregiver are
protective factors for the child's development.

2.3 STUDY 3 - Cross-cultural study between Brazil and the USA: child development in
the pandemic
This cross-cultural study between Brazilian and North American children will identify
possible differences in the impacts on child development caused by the pandemic in both
countries. In addition, through the assessment of caregivers, it will be possible to understand
how the effects of the pandemic on those who care for children may have indirectly impacted
their development.
​The study will have the support of Fulbright Brasil, which will fund the doctoral stay
at the Child Study Center at Yale University. The doctoral stay, which will last 9 months, will
be supervised and guided by professors Walter Gilliam and James McPartland, who will
assist in the data collection process with the North-American population. In addition, during
the period in the US, the researcher will take classes and courses, have assistance in the data
analysis process and will be involved in other activities of the North American laboratory that
will support the elaboration of the dissertation.

2.3.1 Participants
This study will have a convenience sample composed by two groups: one of 600
parents (300 Brazilian and 300 North American) and another of 50 care providers (25
Brazilian and 25 North American) from public and private institutions. The Brazilian sample
of this study will be composed of the same participants as the sample of Study 2.
The inclusion of participants in the study will follow the following criteria:
a) Parents or guardians and care providers must accept to participate in the study by
signing the Informed Consent;
b) Parents must have children who have been born between March 2020 and December
2021.

The following criteria will be applied for the exclusion of participants from the study:
a) Parents whose children have a nationality other than Brazilian or North American will
be excluded;
b) Parents or guardians who do not complete the IDADI and the COVID-related
questionnaire online survey will be excluded;
 20

c) Care providers who did not work directly with the care of children who have been
born between March 2020 and December 2021 will be excluded.

2.3.2 Instruments
● Dimensional Inventory for Child Development Assessment (IDADI): IDADI will be
used to assess Brazilian children’s development;
● Self-Reporting Questionnaire (SRQ-20): This questionnaire will be used to assess
North American and Brazilian parents and care providers.
● Sociodemographic Questionnaire: This questionnaire will be used to assess North
American and Brazilian families;
● Care providers questionnaire: This questionnaire will be prepared during a doctoral
stay in the U.S., under the guidance of a professor who is already conducting similiar
research;
● Child Development Inventory (CDI): The CDI is a parent report assessment measure
of child development. It was developed for the assessment of children aged between
15 months and 6 years. The item pool includes 270 items across 8 different domains:
Social, Self-Help, Gross Motor, Fine Motor, Expressive Language, Language
Comprehension, Letters, and Numbers. It also includes 30 additional items describing
children’s symptoms and behavior problems. Parents should indicate whether the
child has reached a certain developmental milestone by checking "yes" or "no" for
each statement. The instrument presents a good internal consistency index, with a
Cronbach’s alpha ranging from 0.70 and 0.90. As validity evidence, the instrument’s
relationship to age was assessed through the correlation between children’s age and
each of the domains, which ranged from 0.70 to 0.89. The cutoff point for significant
delays is defined by scores that are lower than the average scores of children who are
30% younger, which is equivalent to performance two or more standard deviations
below the mean (Ireton & Glascoe, 1995). The CDI will be used to assess North
American children’s development.

2.3.3 Procedures
Care providers from public and private institutions of education and childcare
programs in both Brazil and in the United States will be invited to complete a questionnaire,
providing information about the potential socio-economic and mental health impacts of the
COVID-19 pandemic on their lives. Through these care providers, parents or guardians of
 21

children aged between 15 and 72 months, which are cared for by these professionals, will be
contacted and invited to fill out a questionnaire to assess their children's development. In
addition to this, parents will also be asked to complete a sociodemographic survey protocol,
providing information about their families and the potential socio-economic impacts of the
pandemic.
All participants will be informed about the research procedures and must consent to
their participation in the research. The child development assessment instruments will be
scored according to their manuals and the scores will be digitized and organized in a data set,
as well as the sociodemographic data collected.

2.3.4 Data Analysis

The first step of data analysis will be done through the scores obtained in measures of
child development. American children will have their results obtained through CDI and
Brazilian children through IDADI. Their scores will be compared with the respective
instrument’s normative sample in order to identify possible deviations from the norm for a
given age group, as assessed by the number of standard deviations. Based on this, a statistical
analysis will be carried out to compare the group of American and Brazilian children, who
will be divided according to age group, in order to identify possible differences in
developmental patterns. This comparison will be made through the average standard
deviation of the two cultural groups in each age group using the Student’s T-test.
In addition, from the sociodemographic data collected, descriptive analysis will be
carried out to make it possible to draw a profile of the research participants and the difference
between the two cultural groups. These data, both from parents and care providers, will later
be submitted to regression analysis with the scores obtained through the IDADI and the CDI
in order to investigate the possible effects of these variables on child development scores.
Structural equation modeling will be used to test specific subhypothesis. It is presumed that
COVID-related trauma experienced by parents and care providers, such as direct infections or
losses due to COVID or even financial or emotional losses arising from the lockdown, might
moderate changes in child development, both as individual moderators and in interaction with
each other. Thus, the hypothesis is that such experiences have negatively affected children’s
development and that, when combined (experiences of both parents and care providers), the
negative impact has been even greater.
 22

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 30

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 38

PROJECT BUDGET

Expenses Units Unit rate Cost

IDADI
computerized 1000 R$28,00 R$28.000,00
applications1

Article submission
3 R$600,00 R$1.800,00
fee2

Statistical consulting
15 hours R$300,00 R$4.500,00
services2

Translation review2 100 pages R$30,00 R$3.000,00

Airplane tickets to
2 R$5.000,00 R$10.000,00
the U.S.3

U.S. stay3 9 months R$10.000 R$90.000,00

TOTAL R$ 137.300,00

Research costs will be covered by Editora Vetor1, the National Council for Scientific and
Technological Development (CNPq)2, and Fulbright Brasil3.
 39

TIMETABLE

2022
Activities
J F M A M J J A S O N D

Literature review

Project planning

Project pre-qualification

Submission to the ethics committee

2023

J F M A M J J A S O N D

Study 1 data collection

Project qualification

Doctoral stay in the U.S.

Study 3 data collection

2024

J F M A M J J A S O N D

Doctoral stay in the U.S.

Treatment of the Studies 1/3 databases

Study 2 data collection

Treatment of the Study 2 database

Studies 1/3 data analysis

2025

J F M A M J J A S O N D

Study 2 data analysis

Paper writing - Study 1

Paper writing - Study 3

Paper writing - Study 2

2026

J F M A M J J A S O N D

Dissertation structuring

Dissertation defense
 40

APPENDIX A - Research ethics committee approval

41
42
43
 44

APPENDIX B - Informed Consent

Termo de Consentimento Livre e Esclarecido

(Pais)
___________________________________________________________________________________
Dados sobre a pesquisa:

1. Título: Construção e estudo de evidências de validade de um Inventário Multidimensional de Marcos

do Desenvolvimento Infantil
2. Pesquisadora Responsável: Drª. Denise Ruschel Bandeira (Professora do Instituto de Psicologia da
Universidade Federal do Rio Grande do Sul)
3. Pesquisador Executante: Me. Adriana Martino Schütz Lopes (Doutoranda do Programa de Pós-
Graduação em Psicologia da Universidade Federal do Rio Grande do Sul)
4. Avaliação do risco da pesquisa: ( x ) Mínimo ( ) Baixo ( ) Médio ( ) Maior
5. Riscos e inconveniências: Os procedimentos desta pesquisa têm risco mínimo. Os inconvenientes que
podem acontecer são você ter que dispor de tempo para responder aos questionários ou sentir algum tipo de
cansaço, ansiedade ou emoção ao participar da atividade. Contudo, para minimizar estes inconveniente,
escolhemos colaboradores com formação para responder suas dúvidas e auxiliar no que for necessário. Para
além disso, em se tratando de uma pesquisa online, aponta-se o risco de vazamento do dados fornecidos por
meio de malwares ou devido a falhas de configurações de segurança das plataformas utilizadas. Para
minimizar esses riscos, seus dados serão armazenados de forma segura e protegida sob acesso apenas das
pesquisadoras responsáveis, conforme a Lei Geral de Proteção de Dados (LGPD, Lei nº 13.709).
6. Duração da pesquisa: A pesquisa será realizada até julho de 2023. Contudo, a sua participação
consistirá em responder a quatro questionários que avaliam tanto o desenvolvimento do seu filho(a) como
questões relativas à família. Trata-se de uma entrevista remota ou preenchimento de Survey online com
duração aproximada de uma hora e trinta minutos.
7. Justificativa e objetivo: Os vários domínios que constituem o desenvolvimento infantil são complexos
e inter-relacionados. O atraso no alcance dos marcos do desenvolvimento em um ou mais domínios pode
representar um risco ao desenvolvimento infantil e ser sugestivo de vários transtornos. A detecção precoce
dos atrasos é fundamental, já que a criança pode ter uma recuperação significativa dos prejuízos do
desenvolvimento quando estes são identificados e tratados precocemente. O objetivo desta pesquisa é
investigar possíveis impactos diretos e indiretos da pandemia por meio de um instrumento de avaliação dos
marcos do desenvolvimento infantil que visa auxiliar na identificação de atrasos, além da correlação com
variáveis socioeconômicas e de saúde mental do cuidador. Para isso, estamos contando com a colaboração
de várias mães de crianças, com e sem problemas de desenvolvimento. Entende-se ainda que o período da
pandemia de COVID-19 pode ter impactado o processo desenvolvimental devido ao papel de fatores
contextuais para o desenvolvimento infantil. Por isso, estamos realizando essa reavaliação.
8. Procedimentos: Caso concorde em participar desta pesquisa, você será convidado a responder a
quatro questionários: dois sobre o desenvolvimento do seu filho, um sobre a sua saúde mental e um sobre
como a sua família passou o período da pandemia de COVID-19. Se você tiver mais de um filho, você
deverá pensar apenas naquele que for por nós indicado. O preenchimento dos questionários tem duração
prevista de, no máximo, uma hora e trinta minutos e será realizado de acordo com sua disponibilidade.
9. Potenciais benefícios: A sua participação nesta pesquisa beneficiará o desenvolvimento da ciência e a
prática de profissionais de saúde no nosso país com a realização de um estudo específico para a compreensão
dos impactos da pandemia no desenvolvimento infantil por meio de um instrumento padronizado. Seu
filho(a) e outras crianças poderão se beneficiar de avaliações sistemáticas utilizando o instrumento em
questão, ajudando na avaliação do desenvolvimento esperado e de possíveis atrasos de desenvolvimento.

_________________________________________________________________________________
Como participante, você terá assegurado os seguintes direitos:
 45

1. Participação voluntária: Sua participação na pesquisa é voluntária e você só precisa assinar este
termo caso deseje participar.
2. Direito de não participar ou interromper sua participação no estudo: Você pode interromper a sua
participação a qualquer momento sem qualquer prejuízo para você.
3. Sigilo e privacidade: O material produzido na avaliação (questionários preenchidos) ficará arquivado
em local seguro na sede do Grupo de Estudo, Aplicação e Pesquisa em Avaliação Psicológica (GEAPAP), na
Universidade Federal do Rio Grande do Sul, por um período mínimo de cinco anos. Os dados coletados
serão publicados em periódicos científicos, e garantimos que seu anonimato e de seu filho(a) serão
assegurados. A identificação de vocês poderá ser realizada somente pela equipe envolvida diretamente com a
pesquisa.
4. Direito à informação: Você receberá uma via deste documento por email e, em qualquer momento do
estudo, você poderá obter mais informações e esclarecer possíveis dúvidas com a Profª. Drª. Denise Bandeira
ou com a pesquisadora Me. Adriana Martino Schütz Lopes (0xx51) 99152-1293 ou ainda pelo e-mail
geapap@ufrgs.br.
5. Direito de informação sobre aspectos éticos da pesquisa: Se você tiver alguma consideração ou
dúvida sobre a ética desta pesquisa, você pode entrar em contato com o Comitê de Ética em Pesquisa do
Instituto de Psicologia da Universidade Federal do Rio Grande do Sul pelo telefone (0xx51) 3308-5698, ou
e-mail cep-psico@ufrgs.br, localizado à Rua Ramiro Barcelos, 2.600. A presente pesquisa foi aprovada por
este Comitê de Ética, que está à disposição para esclarecimentos.
6. Despesas e compensações: Você não terá despesas ou compensações financeiras ao participar da
pesquisa.
7. Garantia de assistência: Caso, durante a participação na pesquisa, entendamos que você ou seu filho
necessite de algum tipo de atendimento e assim você desejar, nós lhe informaremos acerca de locais de
assistência. Em caso de complicações e/ou danos decorrentes, direta ou indiretamente, da pesquisa, será
oferecida assistência integral.
8. Indenização: Se houver algum dano, comprovadamente decorrente da presente pesquisa, você terá
direito à indenização, através das vias judiciais, como dispõe o Código Civil, o Código de Processo Civil, na
Resolução nº 466/2012 e na Resolução nº 510/2016), do Conselho Nacional de Saúde (CNS).
___________________________________________________________________________________
Informações do participante

Nome do participante: ____________________________________________

Telefone: (__)________-___________

E-mail: _________________________________

Consentimento: Confirme o aceite de sua participação na pesquisa marcando a opção abaixo

□ Acredito ter sido suficientemente informado a respeito das informações que li (ou que foram lidas
para mim) sobre o estudo “Impactos da pandemia de COVID-19 no desenvolvimento infantil”. Concordo
voluntariamente com a minha participação e poderei retirar o meu consentimento a qualquer momento, antes
ou durante o mesmo, sem penalidades ou prejuízo
 46

APPENDIX C - Sociodemographic Questionnaire

Dados de identificação do participante

1. Nome: __________________________________________________________________

2. Idade: __________________________ 3. Data de nascimento:____/____/______

4. Cidade: ______________ 5. Estado: _______________ 6. CEP:________________

7. Você se considera: rsz 8. Estado civil:

Branco Casado
Negro Solteiro
Amarelo Divorciado / Separado
Pardo Viúvo
Outro: ______________________ Outro:______________________

9. Qual a categoria que melhor descreve:

Menor que um salário mínimo (menor que R$1.212,00)
Entre 1 e 2 salários mínimos (entre R$1.212,00 e R$2.424,00)
Entre 2 e 3 salários mínimos (entre R$2.424,00 e R$3.636,00)
Entre 3 e 4 salários mínimos (entre R$3.636,00 e R$4.848,00)
Entre 4 e 5 salários mínimos (entre R$4.848,00 e R$6.060,00)
Entre 5 e 10 salários mínimos (entre R$6.060,00 e R$12.120,00)
Entre 10 e 15 salários mínimos (entre R$12.120,00 e R$18.180,00)
Acima de 15 salários mínimos (acima de R$18.180,00)

10. Quantas pessoas vivem dessa renda, incluindo você? _________

11. Qual a sua escolaridade?

Nunca estudou 9º ano
1º ano 1º ano do ensino médio
2º ano 2º ano do ensino médio
3º ano 3º ano do ensino médio
4º ano Ensino superior incompleto
5º ano Ensino superior completo
6º ano Especialização
7º ano Mestrado
8º ano Doutorado

12. Qual a sua ocupação atual?

Trabalho Aposentado / licença saúde
Estudo Do lar
Trabalho e estudo Outro: ______________________
Desempregado
 47

Dados da criança

13. Data de nascimento:____/____/_____ 14. Sexo: feminino masculino

15.Qual a sua relacão com a criança? 16. Você considera a criança:

Mãe Branco
Pai Negro
Irmã(o) Amarelo
Avó(ô) Pardo
Outro: ______________________ Outro:_____________________

17. Qual foi o peso ao nascer?

Abaixo de 1.000 g 18. Qual foi o tipo de parto?
Entre 1.000 e 1.500 g Natural
Entre 1.500 e 2.500 g Humanizado
Entre 2.500 e 3.000 g Normal
Entre 3.000 e 3.500 g Normal com uso de fórceps
Entre 3.500 e 4.000 g Cesariana
Acima de 4.000 g

19. Qual foi o número de semanas de gestação?

Menos de 28 semanas De 38 a 40 semanas
De 28 a 32 semanas De 41 a 42 semanas
De 33 a 37 semanas Mais de 42 semanas

20. A criança frequenta a escola de educação 21. Se sim, a instituição é:

infantil ou creche? Pública
Sim Privada
Não

22. Se sim, há quanto tempo frequenta?

0-5
6-11
1 ano
2 anos
3 anos ou mais

23. A criança apresenta algum desses diagnósticos?

Transtorno do Espectro Autista
Síndrome de Down
Paralisia Cerebral
Deficiência Intelectual (antigo Retardo Mental)
Transtorno do desenvolvimento da coordenação motora
Transtorno do desenvolvimento da linguagem
 48

Outros: ______________________________________
Não, nenhum diagnóstico

24. A criança está em acompanhamento atual com algum profissional da saúde?

Psicólogo
Fonoaudiólogo
Neurologista
Psiquiatra
Terapeuta ocupacional
Outro: ________________________________________

25. A criança tem ou já teve algum problema de saúde grave?

Sim. Qual? ____________________________________
Não

26. A criança já teve alguma internação hospitalar, desde o nascimento até o momento atual?
Sim
Não
 49

APPENDIX D - COVID-19 Pandemic Impacts Questionnaire

QUESTIONÁRIO DE IMPACTOS DA PANDEMIA DE COVID-19

Família

O período da pandemia foi difícil para todos. Queremos investigar as experiências pelas quais
você e a sua família (pessoas que moram com você) podem ter passado durante essa época.
Por isso, pedimos que você relembre esse período e pense nas vivências do início da
pandemia até o momento atual.

1. Você contraiu COVID-19?

□ Sim □ Não

2. A mãe da criança teve COVID-19 durante a gravidez?

□ Sim □ Não

3. Se sim, em qual trimestre da gestação?

□ Primeiro trimestre (0 a 13 semanas)
□ Segundo trimestre (14 a 26 semanas)
□ Terceiro trimestre (27 a 41 semanas)
□ Não se aplica

4. Algum outro membro da sua família contraiu COVID-19?

□ Sim □ Não

5. Você ou algum membro da sua família foi hospitalizado devido ao COVID-19?

□ Sim □ Não

6. Algum membro da sua família faleceu devido ao COVID-19?

□ Sim □ Não

7. Você e sua família realizaram isolamento social?

□ Sim □ Parcialmente □ Não

8. Você ou algum membro de sua família teve que ficar em quarentena devido à possível
exposição ao vírus ou após viajar?
□ Sim □ Não

9. Você ou algum membro de sua família trabalhou de forma remota?

□ Sim □ Parcialmente □ Não
 50

10. Você ou algum membro de sua família continuou trabalhando fora de casa (serviço
essencial)?
□ Sim □ Parcialmente □ Não

11. Você ou algum membro de sua família perdeu o emprego?

□ Sim □ Não

12. Você teve que ficar separado de algum membro de sua família por questões de saúde,
segurança ou trabalho?
□ Sim □ Parcialmente □ Não

14. A renda familiar diminuiu?

□ Sim □ Parcialmente □ Não

15. Você e sua família tiveram dificuldade em conseguir comprar comida?

□ Sim □ Parcialmente □ Não

16. Você e sua família tiveram dificuldade em conseguir comprar medicamentos?

□ Sim □ Parcialmente □ Não

17. Você e sua família tiveram dificuldade em obter cuidados de saúde quando precisavam?
□ Sim □ Parcialmente □ Não

18. Você e sua família tiveram dificuldade em obter outros itens essenciais, como produtos de
higiene ou limpeza?
□ Sim □ Parcialmente □ Não

19. Você e sua família perderam um evento familiar importante devido ao isolamento social
(ex. casamento, formatura, nascimento, funeral)?
□ Sim □ Não

20. Você e sua família tiveram outras pessoas com quem podiam contar para ajudá-los com
problemas?
□ Sim □ Parcialmente □ Não

21. Você sentiu maior dificuldade de dar conta das demandas da criança?
□ Sim □ Parcialmente □ Não

22. Você teve dificuldade nas suas práticas parentais (como os pais educam e se relacionam
com os filhos)?
□ Sim □ Parcialmente □ Não
 51

Criança

Relembre o período da pandemia e responda as perguntas que dizem respeito a experiências

pelas quais a criança pode ter passado durante essa época. Considere o período do início da
pandemia até o momento atual.

1. Contraiu COVID-19?
□ Sim □ Não

2. Foi hospitalizada devido ao COVID-19?

□ Sim □ Não

3. Teve a sua escola ou creche fechada temporariamente?

□ Sim □ Não

4. Se sim, por quanto tempo?

□ 0-3 meses
□ 4-6 meses
□ 7-9 meses
□ 10 ou mais meses

5. Teve aulas online?

□ Sim □ Parcialmente □ Não

6. Apresentou dificuldades de aprendizagem?

□ Sim □ Não

7. Teve sua rotina drasticamente alterada?

□ Sim □ Não

8. Teve dificuldades de se adaptar às mudanças geradas pela pandemia?

□ Sim □ Parcialmente □ Não

9. Ficou afastada de algum familiar próximo?

□ Sim □ Parcialmente □ Não

10. Teve oportunidade de interagir com outras crianças de sua idade?

□ Sim □ Parcialmente □ Não

11. Teve problemas ou dificuldade de interagir com outras crianças de sua idade?
□ Sim □ Parcialmente □ Não

12. Passou a brincar menos?

□ Sim □ Parcialmente □ Não
 52

13. Pareceu ficar mais agitada?

□ Sim □ Parcialmente □ Não

14. Passou a apresentar mais medos?

□ Sim □ Parcialmente □ Não

15. Pareceu ficar mais ansiosa ou preocupada?

□ Sim □ Parcialmente □ Não

16. Pareceu ficar mais irritada do que o normal?

□ Sim □ Parcialmente □ Não

17. Expressou angústia ou preocupação específica com o COVID-19 (em relação a si mesma
ou a pessoas próximas)?
□ Sim □ Parcialmente □ Não

18. Teve problemas para dormir?

□ Sim □ Parcialmente □ Não

19. Ficou fisicamente menos ativa do que o normal?

□ Sim □ Parcialmente □ Não

20. Passou a comer mais ou menos do que o normal?

□ Sim □ Parcialmente □ Não

21. Começou a apresentar comportamentos repetitivos (ex. lavar as mãos, limpar, arrumar as
coisas em uma certa ordem)?
□ Sim □ Parcialmente □ Não

22. Aumentou o tempo gasto na frente das telas (sem considerar aulas online)?
□ Sim □ Parcialmente □ Não

23. Passou a solicitar mais ajuda dos adultos?

□ Sim □ Parcialmente □ Não

24. Apresentou alterações nos seus hábitos de higiene?

□ Sim □ Parcialmente □ Não

25. Teve que ser acompanhada por algum profissional de saúde mental (como psicólogo ou
psiquiatra) devido a alterações no comportamento que começaram a ser observadas durante a
pandemia?
□ Sim □ Não