BACKGROUND: The COVID-19 pandemic had a major impact on the mental health and well-being of children with neurodevelopmental conditions (NDCs) and of their families worldwide. However, there is insufficient evidence to understand how different factors (e.g., individual, family, country, children) have impacted on anxiety levels of families and their children with NDCs developed over time. METHODS: We used data from a global survey assessing the experience of 8043 families and their children with NDCs (mean of age (m) = 13.18 years, 37% female) and their typically developing siblings (m = 12.9 years, 45% female) in combination with data from the European Centre for Disease Prevention and Control, the University of Oxford, and the Central Intelligence Agency (CIA) World Factbook, to create a multilevel data set. Using stepwise multilevel modelling, we generated child-, family- and country-related factors that may have contributed to the anxiety levels of children with NDCs, their siblings if they had any, and their parents. All data were reported by parents. RESULTS: Our results suggest that parental anxiety was best explained by family-related factors such as concerns about COVID-19 and illness. Children's anxiety was best explained by child-related factors such as children's concerns about loss of routine, family conflict, and safety in general, as well as concerns about COVID-19. In addition, anxiety levels were linked to the presence of pre-existing anxiety conditions for both children with NDCs and their parents. CONCLUSIONS: The present study shows that across the globe there was a raise in anxiety levels for both parents and their children with NDCs because of COVID-19 and that country-level factors had little or no impact on explaining differences in this increase, once family and child factors were considered. Our findings also highlight that certain groups of children with NDCs were at higher risk for anxiety than others and had specific concerns. Together, these results show that anxiety of families and their children with NDCs during the COVID-19 pandemic were predicted by very specific concerns and worries which inform the development of future toolkits and policy. Future studies should investigate how country factors can play a protective role during future crises.

Aspect Research Centre for Autism Practice Autism Spectrum Australia Frenchs Forest New South Wales Australia

Autism Center of Excellence Riyadh Kingdom of Saudi Arabia

Cabinet office London UK

Center of Neurodevelopmental Disorders at Karolinska Institutet Center for Psychiatry Research Department of Women's and Children's Health Stockholm Sweden

Centre de Génétique et Centre de Référence Anomalies du Développement et Syndromes Malformatifs FHU TRANSLAD INSERM UMR1231 Hôpital d'Enfants CHU Dijon Dijon Cedex France

Centre for Clinical Brain Sciences University of Edinburgh Edinburgh UK

Child and Adolescents Neuropsychiatry Unit Bambino Gesù Children's Hospital Rome Italy

Cognitive and Behavioural Neuroscience Laboratory Department of Humanities and Social Sciences Indian Institute of Technology Bombay Mumbai Powai Maharashtra India

Comprehensive Health Research Centre Departamento de Desporto e Saúde Escola de Saúde e Desenvolvimento Humano Universidade de Évora Évora Portugal

Department of Basic Psychology Faculty of Psychology Universidad Autónoma de Madrid Madrid Spain

Department of Behavioural and Cognitive Sciences University of Luxembourg Luxembourg

Department of Child and Adolescent Psychiatry and Psychotherapy University Medical Centre Göttingen Göttingen Germany

Department of Child and Adolescent Psychiatry Medical University of Vienna Vienna Austria

Department of Cognitive Modeling Institute for Cognitive and Brain Sciences Shahid Beheshti University Tehran Iran

Department of Cognitive Psychology Institute for Cognitive and Brain Sciences Shahid Beheshti University Tehran Iran

Department of Counselling Educational Psychology and Special Education Michigan State University East Lansing Michigan USA

Department of Developmental and Educational Psychology Universidad Nacional de Educación a Distancia Madrid Spain

Department of Early Childhood Education Faculty of Education East China Normal University Shanghai China

Department of Education Sao Paulo State University Rio Claro Brazil

Department of Education Studies Faculty of Social Sciences University of Warwick Warwick UK

Department of Genetics APHP NUP Robert DEBRE University Hospital Paris France

Department of Life Sciences and Public Health Catholic University Rome Italy

Department of Microscopic Morphology Genetics Center of Genomic Medicine University of Medicine and Pharmacy Victor Babes Timisoara Timisoara Romania

Department of Psychiatry and Behavioural Sciences Stanford University Stanford California USA

Department of Psychology and Human Development IOE UCL's Faculty of Education and Society London UK

Department of Psychology Centre for Neurodiversity and Development Durham University Durham UK

Department of Psychology Marquette University Milwaukee Wisconsin USA

Department of Psychology University of Miami Coral Gables Florida USA

Department of Special and Inclusive Education Faculty of Education Masaryk University Brno Czech Republic

eMbrace New Delhi India

Faculty of Education Mary Immaculate College Limerick Ireland

Faculty of Psychology UniDistance Suisse Brig Switzerland

Faculty of Social Sciences University of Applied Sciences Zittau Görlitz Görlitz Germany

Genetics Department Reference Centre for Developmental Disorders Centre East Bron France

Independent researcher

Institute for Research in Social Communication Slovak Academy of Sciences Bratislava Slovakia

Institute for Social Sciences of Religions University of Lausanne Lausanne Switzerland

Institute of Special Education University of Fribourg Fribourg Switzerland

Laboratory CLLE University of Toulouse CNRS Toulouse France

Laboratory of Brain and Cognitive Development Institute of Psychology University of Lausanne Lausanne Switzerland

Laboratory of Sensori Motor Affective and Social Development Faculty of Psychology and Educational Sciences University of Geneva Geneva Switzerland

Medical Genetics University of Siena Siena Italy

National Reference Center for Intellectual Disabilities of Rare causes Lyon University Hospital France

Penn Center for Mental Health University of Pennsylvania Perelman School of Medicine Philadelphia Pennsylvania USA

Service de génétique HCL INSERM U1028 CNRS UMR5292 CRNL GENDEV Team UCBL1 Bron France

Swiss Center for Affective Sciences University of Geneva Geneva Switzerland

University of Wisconsin Milwaukee Milwaukee Wisconsin USA

Williams Syndrome Association Troy Michigan USA

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