**1. Introduction**

From 10 March to 17 May, 2020, the Italian government imposed a national lockdown to limit viral transmission of COVID-19. This period, lasting about 70 days, was characterized by severe social restriction measures, including domestic confinement, working from home, closure of non-essential businesses, and closure of all schools with distance learning. Immediate consequences were vast, i.e., the loss of freedom, the separation of elderly relatives from contradictory information surplus, the uncertainty about COVID-19 infection and health, and the increasing use of social networks. Other additional conditions included the lack of personal space at home and family uncertainty, concerning economic status or inadequate supplies (food, drugs, and safety devices) [1–4]. Following a break-down of borders between work and home, parents faced several pressing concerns, rearranging their work/children's schedules, as well as their children's education routines, because of school closures. In a complementary way, children were asked to re-arrange their routines by giving up all out-of-home and after-school activities, ranging from sports/recreational activities to social relationships with peers [5,6].

All of these factors, in addition to concerns about specific outbreaks, i.e., due to fears about COVID-19 and the use of measures to prevent it, acted as psychological stressors and accounted for detrimental effects on the global well-being and mental health of both adults and children [7]. Moreover, during the home confinement, stressful effects were intensified by "distress contagion" among family members through spillover or crossover mechanisms. The spillover mechanism refers to the impact in which exposure to distress in one area can have a ripple effect (i.e., in personal functioning) in another area (e.g., from

**Citation:** Polizzi, C.; Burgio, S.; Lavanco, G.; Alesi, M. Parental Distress and Perception of Children's Executive Functioning after the First COVID-19 Lockdown in Italy. *J. Clin. Med.* **2021**, *10*, 4170. https:// doi.org/10.3390/jcm10184170

Academic Editors: Michele Roccella and Erik Roj Larsen

Received: 2 July 2021 Accepted: 13 September 2021 Published: 15 September 2021

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**Copyright:** © 2021 by the authors. Licensee MDPI, Basel, Switzerland. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution (CC BY) license (https:// creativecommons.org/licenses/by/ 4.0/).

work or economic concerns to parenting skills), whilst the crossover mechanism refers to contagion from one member of the family to other family members [6].

Research on the psychological effects from previous epidemics and pandemics (e.g., SARS, MERS, H1N1, Ebola, equine influenza) corroborated with high rates of family distress, ranging from 30% in children to 25% in parents [8]. In particular, following a lockdown, to contrast severe acute respiratory syndrome (SARS) and Middle-East RES-PIRATORY SYNDROME (MERS), psychological (anxiety, depression, irritability, anger, emotional exhaustion, etc.) and behavioral (hyperactivity, sleep disorders, angry, conduct problems, externalizing problems, withdrawn, or clingy ... ) symptoms were reported [9–12].

Furthermore, it has been well documented how a long breakdown could enhance psychological distress, with a progressive appearance of despair during the first 9 days, anxiety from the 15th to the 19th day, and anger from the 20th to the 31st day, until a condition comparable to post-traumatic distress disorder (PTSD) occurs [10,13].

In a large Chinese survey involving 52,730 participants, the rate of psychological distress due to the COVID-19 outbreak was about 35%, with gender and age differences. Higher levels of distress were found in the female group and age range between 18 and 30 years or above 60 years [14]. An online survey carried out in Italy with 2766 respondents showed increased levels of frequency of anxiety, depression, and distress compared to the European epidemiological statistics. More in depth, higher levels of distress were reported by women, higher levels of depression were showed by individuals with a previous history of trauma or medical diseases, or having an acquaintance infected with COVID-19, higher levels of anxiety occurred in younger individuals and people who had an infected relative [15]. Of particular interest was the association between depression and the condition characterized by not having children. This is coherent with findings that highlighted how being a parent or living with children is a factor that enhances psychological distress during a lockdown or quarantine [16].

In particular, high psychological stress levels have been found in parents of children with special needs and exhibiting atypical patterns of development, due to a disability or a chronic medical condition [17–19]. Several studies pointed out the high prevalence of depressive symptoms and significant changes in strain observed among parents of special needs children during the COVID-19 outbreak; they demanded greater attention from mental health practitioners and rehabilitation care providers [20].

In light of the pandemic effects on psychological health, in particular for parents [13,21,22] during this critical period, there was an increase in requests for psychological support [4,23]. To respond to this emerging need, there has been a global proliferation of online psychological support services; these services were often free and promoted by government authorities, such as the Italian Ministry of Health [24]. In Italy, among the adults who asked for help from these services, many parents reported great difficulty in managing the relationships with their children, especially if they had some evolutionary fragility or special needs [24].

Almost all studies that analyzed the psychological conditions of parents indicated that specialist responses (psychological and psychotherapeutic) are fundamental for the support needs expressed by parents [25,26]. In other words, many parents during the pandemic needed the support of mental health specialists to cope with difficulties.

Higher levels of distress, negative emotions, such as anger or frustration, and negative cognitions, such as pessimism or perfectionism, were displayed by parents with personality profiles characterized by high neuroticism, with patterns of worrying, emotional variability, and feelings of insecurity [13].

In turn, parental distress negatively influenced the caregiver's ability to manage their children at home and to adopt proper disciplinary measures [13].

Petrocchi et al. [27] found that mothers with higher distress levels attributed more negative emotions to their children, with consequences on children's adaptive functioning [3].

In regard to the children, as found by the first studies carried out in China, behavioral problems due to COVID-19 lockdowns, ranged from 4.7% to 10.3% in childhood [28].

Psychological consequences varied from anxiety to depression, regression symptoms, panic attacks, irritability, restlessness, and feelings of loneliness [3,29–32]. Indeed, vulnerability factors, such as developmental age, educational, and socioeconomic status, previous special needs, or mental health disease, seemed to moderate the appearance of psychological problems [33].

Clinginess and the fear of contagion were more frequent in younger children aged, approximately, 3 to 6 years; inattention and inquiry persistence were more frequent in older children aged 6 to 18 years [34].

However, despite the increasing research on parental distress effects, to the best of our knowledge, minor research has been produced to investigate the interplay between parental distress and children's executive functions (EF) during a lockdown period.

Executive functioning (EF) is a set of core cognitive processes for development that consist of a variety of higher-order cognitive processes; it plays a key role in mental and physical health. Moreover, EF is involved in a wide range of "long-life" aspects, ranging from school readiness to job success, marital harmony, and public safety [35].

Executive functions involve a network of frontal-parietal areas, are greatly heritable, and are supposed to be polygenic. Three main components were identified as being potentially important: inhibition, switching, and working memory [36]. Inhibition is the ability to control and repress a prevailing response in support of another response or no response. Switching is the ability to switch from one task or mindset to another. Finally, working memory is the capacity to monitor and manipulate items and mental representations in the mind [35]. These three components are theoretically described as a model of "unity and diversity" because they refer to distinct but inter-correlated cognitive functions. As demonstrated by structural equation modeling, the three functions contribute in a different way to allow a successful performance on tasks, tapping memory, inhibition, fluency, and attentional shifting; therefore, the need to recognize the unity and diversity of executive functions is suggested [37].

Moreover, these main components are closely related to other processes, such as fluency and planning. Fluency denotes the ability to produce, in a given amount of time, as many items as possible (e.g., words, colors, etc.), and planning is the ability to identify, employ, and monitor a sequence of thoughts or actions to achieve a specific goal [38].

An inadequate family context, lacking both material and psychosocial supports, is considered to be a risk condition that hampers a child's development of EF [39,40]. Family functioning explains up to 20% of the variance of a child's performance in working memory and EF tasks [41].

Following an ecological perspective, previous research demonstrated that EFs, for their long development, are very sensitive to macro-contextual (e.g., cultural contexts or SES) and micro-contextual (e.g., family members psychological variables, language, parent-child relationships, parenting skills) factors [42]. Adverse environments characterized by high levels of parental distress account for increasing parental control strategies and limit the use of scaffolding measures to support the gradual increase of children's autonomy in decision-making processes, behavioral, and emotional management, and the use of strategies to cope with distress events. The extreme consequence could be an impairment or delay in long-term EF development [43]. Children with poorer EFs had a higher level of salivary cortisol, which is the distress hormone [44]. Moreover, parents' mental health factors, such as acute distress, depression, and anxiety, can impair parenting skills and children's later development of working memory, inhibition, and cognitive flexibility [43,45,46]. Parents with experiences of daily distress and worries about life goals can feel less connected to their children, engage less in cognitively challenging tasks, produce a distressful or chaotic family context and, as a consequence, can have behavior and parent–infant interaction that obstructs the development of a child's self-regulatory skills, which ends up influencing cognitive development [47–49]. On the other hand, a lack (or a

break) from school learning is a risk factor for the increased distress of a child, reduced inhibitory control, and cognitive flexibility, as well as concerns surrounding planning, attention, or decision making [50]. Contemporary research has documented how, during the lockdown, children's self-regulation capacities and inhibitory controls seem to have been negatively influenced by an increase of the mother's negative emotions, by changes in the mother's sleep quality and in the perception of time, by the breakdown of daily routines and after-schools habits [51]. Furthermore, attention deficit hyperactivity disorder (ADHD) symptoms in children worsened following the lack of daily routines, extra-familiar social relationships, and the increase of family distress [12].

In light of the literature reviewed above, the present study assessed the relationships between parental distress and children's EF, as perceived and reported by their parents. In regard to parental distress, this study assumed the balances between risks and resources theory [52,53] that explains parental distress as a condition of parental burnout, resulting from an imbalance between parental risks and protective factors. Parental burnout develops when parental resources are insufficient to meet the demands/risk factors that significantly increase parental distress levels (e.g., parental low emotional intelligence, perfectionism, poor childrearing practices, lack of support from the co-parent, lack of social support).

An online cross-sectional survey was performed to measure the above-mentioned variables immediately after the end of the first spring Italian lockdown (from March to May 2020) and prior to the following autumn (partial) lockdown (since October 2020). This period was selected because critical questions remain to be answered about the short-term effects of pandemic events on cognitive development whilst pandemic long-term effects on mental health have been well-documented in previous pandemic conditions.

Given these concerns the following goals were investigated:

Goal 1: parental distress following first COVID-19 lockdown would be influenced by parental variables (age, education, job or working condition, couples' conditions, support needs during the lockdown) and the child's typical/atypical patterns of development.

Goal 2: parental perception of children's EF would be influenced by specific parental variables (age, education, job or working condition, couples' conditions, support needs during the lockdown), and the child's typical/atypical patterns of development.

Goal 3: parental distress following the first COVID-19 lockdown would be related to the perception of children's EF. Higher levels of parental distress would be associated with their perception of worse EFs in their children.
