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Neurodevelopmental Diagnoses Before, During, and After the COVID-19 Pandemic

Sloane J Freeman^1,2,3, Rosane Nisenbaum^4,5, Michael D Sgro^1,2,3

¹Women and Children's Health Program, St Michael's Hospital, Unity Health Toronto, Toronto, Ontario, Canada.

JAMA Network Open

|April 8, 2026

Insights

COVID-19 lockdowns did not significantly alter neurodevelopmental diagnosis rates in young children. Virtual care likely supported continued access to diagnoses during and after the pandemic.

Area of Science:

Pediatric Health
Neurodevelopmental Disorders
Epidemiology

Background:

The COVID-19 pandemic and associated lockdowns impacted children's learning, development, and healthcare access.
Understanding the pandemic's effect on neurodevelopmental diagnoses is crucial for pediatric care.

Purpose of the Study:

To evaluate changes in the rates and trends of new neurodevelopmental diagnoses in children before, during, and after the COVID-19 pandemic in Ontario, Canada.
To assess the pandemic's impact on the diagnosis of neurodevelopmental disorders in children aged 6 years or younger.

Main Methods:

A population-based retrospective cohort study utilized administrative data from ICES.
The study analyzed new neurodevelopmental diagnoses for 291,896 children aged 6 years or younger in Ontario from March 14, 2015, to December 31, 2024.
Interrupted time series analysis was employed to compare diagnosis rates across prepandemic, pandemic, and postpandemic periods.

Main Results:

While diagnosis rates initially decreased at the onset of the pandemic, they recovered and stabilized.
No statistically significant differences in the rate trends of new neurodevelopmental diagnoses were observed between the prepandemic, pandemic, and postpandemic periods.
A total of 130,418 diagnoses were recorded in the prepandemic, 86,383 during the pandemic, and 75,095 in the postpandemic period.

Conclusions:

This study found no significant long-term changes in the rates of new neurodevelopmental diagnoses among young children due to the COVID-19 pandemic.
The widespread adoption of virtual care may have mitigated disruptions in healthcare access, ensuring continued diagnosis of neurodevelopmental conditions.
Findings suggest the healthcare system adapted effectively to maintain essential diagnostic services for children during the pandemic.

Read full analysis

Abstract

Importance:

The COVID-19 pandemic and associated lockdowns resulted in changes to the way children learned, developed, and accessed health care.

Objective:

To evaluate changes in rates and rate trends of new neurodevelopmental diagnoses for children in Ontario, Canada, before, during, and after the COVID-19 pandemic.

Design, Setting, And Participants:

This population-based retrospective cohort study used administrative data from ICES to assess new neurodevelopmental diagnoses from March 14, 2015, to December 31, 2024, among 291 896 children aged 6 years or younger in Ontario.

Exposures:

The COVID-19 pandemic period, defined as March 14, 2020, to November 30, 2022, and the postpandemic period, defined as December 1, 2022, to December 31, 2024.

Main Outcomes And Measures:

Monthly rate of new neurodevelopmental diagnoses per 1000 child-months, defined as the total number of children with a neurodevelopmental diagnosis divided by the total number of child-months. Interrupted time series analysis using data before, during, and after the pandemic was performed to evaluate changes in rate levels or slopes between study periods.

Results:

A total of 291 896 children received a neurodevelopmental diagnosis during the study period. Of 1 481 844 children at risk, 130 418 received a diagnosis in the prepandemic period (mean [SD] age, 2.5 [1.6] years; 79 573 boys [61.0%]); of 1 115 791 children at risk, 86 383 received a diagnosis during the pandemic period (mean [SD] age, 2.4 [1.6] years; 52 943 boys [61.3%]); and of 1 014 792 children at risk, 75 095 received a diagnosis in the postpandemic period (mean [SD] age, 2.7 [1.6] years; 45 030 boys [60.0%]). In the prepandemic period, rates of neurodevelopmental diagnoses increased monthly (slope = 0.04; 95% CI, 0.03-0.05; P < .001). In the first month of the pandemic, rates of neurodevelopmental diagnoses decreased by 0.91 per 1000 child-months (95% CI, -1.56 to -0.25 per 1000 child-months; P = .01) compared with the expected rate in the absence of the pandemic. Rates recovered and remained stable, with no statistically significant differences in slopes between the prepandemic period and either during or after the pandemic.

Conclusions And Relevance:

This population-based cohort study showed no significant differences in rates of new neurodevelopmental diagnoses among children aged 6 years or younger from prepandemic rates in the pandemic and postpandemic periods. The rapid deployment of virtual care may have helped maintain health care access, facilitating diagnoses during the pandemic and postpandemic periods.

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