School Disengagement Increased Among U.S. Children with Mental Health Conditions During COVID-19 Pandemic

A nationally representative study analyzing data from the National Survey of Children’s Health (NSCH) found that school disengagement (SD) among U.S. children rose during the COVID-19 pandemic, with particularly high rates observed among those with mental health conditions (MHCs). The analysis included five years of data from 2018 to 2022 and examined trends before, during, and after the onset of the pandemic.

The sample included 136,576 children aged 6 to 17. SD was measured using parent responses to two NSCH questions about the child’s interest in school and completion of homework. Responses were categorized into “school engaged” and “school disengaged” based on standardized criteria. MHCs included parent-reported current diagnoses of attention-deficit/hyperactivity disorder (ADHD), anxiety, depression, or behavioral/conduct problems (BCPs).

Disengagement rates increased from 15.8% in 2018 and 14.7% in 2019 to 19.0%, 18.8%, and 19.1% in 2020, 2021, and 2022, respectively (P < .001). Among children with MHCs, SD rates were consistently higher than those without: in 2022, SD was reported for 63.2% of children with BCPs, 53.7% of those with depression, 50.7% of those with ADHD, and 41.3% of those with anxiety. For children without any of the four MHCs, SD was 12.3% in 2022.

Multivariate regression models showed increased odds of SD in all pandemic years compared to 2018. The adjusted odds ratios (aORs) for SD were 1.30 in 2020 (99% CI: 1.1–1.54), 1.27 in 2021 (99% CI: 1.08–1.49), and 1.28 in 2022 (99% CI: 1.1–1.49). Children with any of the four MHCs had significantly greater odds of SD compared to those without: ADHD (aOR: 2.02), depression (aOR: 1.84), BCPs (aOR: 3.33), and anxiety (aOR: 1.23).

Additional factors associated with increased SD odds included being male (aOR: 1.73), fair or poor general health (aOR: 2.90), having a special education plan (aOR: 2.04), missing 11 or more school days (aOR: 1.68), repeating a grade (aOR: 1.55), food insecurity (aOR: 1.70), and experiencing four or more lifetime residential moves (aOR: 1.41). Children in lone-parent or unmarried two-parent households also had higher SD odds than those in married-parent households.

The study identified a sustained increase in SD following the start of the pandemic, particularly among children with MHCs. Rates did not return to pre-pandemic levels by 2022. The authors note that while causal conclusions cannot be drawn due to the study’s cross-sectional design, the consistent methodology across years supports observations of temporal change. Limitations include reliance on caregiver report and a SD measure that may not reflect all dimensions of engagement or educational settings without homework practices.

The findings highlight patterns in school disengagement among children with MHCs during a period of widespread educational disruption, suggesting areas for further investigation and targeted support.