The Role of Family-Level Factors in Childhood Anxiety During the COVID-19 Pandemic

The COVID-19 pandemic has caused pervasive disruptions to family life. In light of the established role of parent-child dynamics in the maintenance of pediatric anxiety, we conducted a multilevel, multimodal study to examine how family-level factors moderate anxious youths’ responses to the COVID-19 pandemic. Prior to the pandemic (“pre-pandemic”), children with anxiety disorders (n = 28; ages 6-12) completed an fMRI task probing parental modulation of amygdala reactivity to fearful faces. During the first peak of the COVID-19 pandemic (“mid-pandemic”), parents completed questionnaires about their family’s exposure to COVID-19-related stress, their child’s COVID-19-related fears and behaviors, and their own (parental) functioning. Pre-pandemic parental modulation of amygdala reactivity moderated the association between children’s exposure to COVID-19-related stress and their COVID-19-related fears and behaviors. Furthermore, greater mid-pandemic parental assistance with their child’s use of venting and with their child’s use of expressive suppression as emotion regulation strategies exacerbated the effects of COVID-19-related stress on children’s COVID-19-related fears and behaviors, respectively. These results provide preliminary insight into the ways in which distinct family-level factors may buffer or exacerbate the effects of COVID-19-related stress on youth with a history of anxiety disorders.