Prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders during the COVID-19 pandemic: A meta-analysis and systematic review.
Half of caregivers of kids with neurodevelopmental disorders hit clinical stress levels during COVID-19, and the damage lingered even after lockdowns ended.
01Research in Context
What this study did
Gu et al. (2023) pooled 20 studies that asked caregivers how they felt during COVID-19. All studies included parents of kids with autism, ADHD, or other neurodevelopmental disorders.
The team looked for rates of anxiety, depression, and stress. Surveys came from many countries and covered the first two years of the pandemic.
What they found
About half of caregivers scored above the clinical cutoff for stress. Roughly four in ten reached the cutoff for anxiety or depression.
The numbers stayed high across different cultures and lockdown rules. The review shows the crisis hit parents hard and kept them there.
How this fits with other research
Hochman et al. (2025) seems to disagree at first. Their UK sample showed carer stress dropped from 2020 to 2022 as schools reopened. The key difference is timing: Xuan captured a frozen moment of peak distress, while Yael tracked the same families over time and saw recovery once services returned.
Lu et al. (2026) fills in the middle. Their three-wave study in China found parent anxiety and depression kept worsening even after lockdowns eased. Together the papers tell one story: stress soared early, stayed high while services were shut, then slowly fell only where supports came back.
Greene et al. (2019) gives the before picture. Pre-COVID, maladaptive coping and unmet service needs already predicted poorer caregiver mental health. The pandemic simply turned up the volume on an existing problem.
Why it matters
Screen every caregiver at intake, not just the child. A quick anxiety or depression checklist takes two minutes and flags the families who need extra help. When you see high scores, offer telehealth parent groups, flexible session times, or a simple referral list. Reducing parent stress makes your behavioral plan stick better and keeps the whole family in service.
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02At a glance
03Original abstract
BACKGROUND: The COVID-19 pandemic impacted children and adolescents with neurodevelopmental disorders, which caused difficulties and increased caregivers' burden. AIM: The objective of this study was to assess the prevalence of psychological problems among caregivers of children and adolescents with neurodevelopmental disorders. Methods and procedures We searched the PubMed, Embase and Web of Science databases for relevant studies published from December 2019 to March 2023. Random effects models were used to calculate the pooled prevalence of psychological problems among caregivers. Subgroup analyses were used to detect potential heterogeneity and sensitivity analyses were performed to evaluate the robustness of the included studies. Egger's and Begg's tests were used to examine publication bias. Outcomes and results Twenty studies involving 14,743 participants were included in this systematic review and meta-analysis. The main psychological problems among caregivers were anxiety (36.6%, 95% confidence interval [CI] 19.6-53.7%), depression (41.1%, 95%CI 35.4-46.8%), and stress (58.9%, 95%CI 45.1-72.7%). There were differences in prevalence by study year, national economic level, continent, and sample size. Conclusions and implications Our study showed that caregivers of children and adolescents with neurodevelopmental disorders had a high prevalence of anxiety, depression, and stress during the COVID-19 pandemic. Therefore, the psychological problems of these caregivers should not be overlooked. We recommend that the government should provide caregivers with more medical and financial assistance. What this paper adds? The current study is the first systematic review and meta-analysis focusing on parents whose children have neurodevelopmental disorders during the COVID-19 pandemic. The results show that the prevalence of psychological problems among caregivers of children with neurodevelopmental disorders is particularly prevalent, which suggests that we should attach importance to the parenting pressure and mental health of this special group.
Research in developmental disabilities, 2023 · doi:10.1016/j.ridd.2023.104632