The Impact of COVID-19 Quarantine on Children‘s Behaviors and Language

Sana M Kamal1, Ali Al-Samydai*2, Rudaina Othman Yousif3, Talal Aburjai4 1Department of Hearing and Speech Sciences, the University of Jordan, Amman, 11942, Jordan 2Pharmacological and Diagnostic Research Centre, Faculty of Pharmacy, Al-Ahliyya Amman University, Amman, 19328, Jordan 3Founding commission member, Al-Zahrawi university college, Karbala, 56001, Iraq 4Department of Pharmaceutical Sciences, Faculty of Pharmacy, University of Jordan, Amman, 11942, Jordan


INTRODUCTION
COVID-19 is a global pandemic. Until now, COVID-19 has affected more than 22.6 million people worldwide, resulting in over 792,000 reported deaths (Worldometers, 2020). Several preventative strategies and non-pharmaceutical interventions have been used to slow down the spread of COVID-19, including; applying quarantine, social distancing, careful infection control, and the isolation of patients (Nicola et al., 2020). In early 2020 many counties apply quarantine to stop the spreading of viruses between people, and these counties succeed in stopping a pandemic from affecting a large number of people. Additionally, several countries request people who have potentially come into contact with the infection to isolate themselves at home or in a dedicated quarantine facility. Mainly reviewed studies reported negative psychological effects, including post-traumatic stress, confusion, and anger between isolated people (Brooks et al., 2020). The family's life suddenly and extremely changed. At home, the role of parents in children's education has become more essential than before. Just parents around Children, provide them support in homework, and promote a positive development and new learning experiences for toddlers and preschoolers (Wang et al., 2020). Parents became alone not only in taking care of their children's school-assignments but also in the management of their children at the home environment.
All educational faculties are closed, no babysitters and some families no available grandparents, and contact with neighbors is not allowed. Many parents also must do smart-working. Handling time and space to work with children around may be very problematic as they are called to take an educational role while also trying to live their own lives and get on with their everyday job commitments. This situation has signi icantly increased the risk of experiencing stress and negative emotions in parents, with a potential cascading effect on children's wellbeing (Sprang and Silman, 2013). All these conditions affect Children's Psychological, affecting the results of children's mental health (language delay, memory de icits, aggressiveness, attention defects and telling events/storytelling) (Loades and Mastroyannopoulou, 2010;Anderson and Olson, 2006). Behavior is affected by an overabundance of information received every day through which shown sequence of physical activity, mental and emotional done by humans in selecting . Due to quarantine the role of community pharmacists in mental health has been increasing and go much further, from encounter individuals with mental health problems to play an important role in giving parents advice and information. The majority of studies conducted during COVID-19 pandemics examined the psychological impact on the general population, leaving the study of effects on children mainly unexplored. The present study aims to drop light on COVID-19 impact on children's behavior and language and highlight the important role of community pharmacists in helping families.

Study Design
This study was conducted from April to august 2020.
Google form surveys, were used to ensure the safety of participants (Al-Samydai et al., 2020). A simple random sampling strategy was used to collect data. All subjects reported their demographic data and completed a standardized questionnaire that studied the impact of COVID 19 quarantine on Children's Behaviors and Language. To ensure the quality of the survey, we set the response range of some items (e.g., the age range was limited to parents. Finally, a total of 469 participants who completed the questionnaires (contained 36 question as represented on APPENDIX, Table 6) were included in the analysis (Al-Samydai et al., 2020).

Study model
The ( Figure 1) represents the study model which put to study research problem, objectives and hypotheses Al-Samydai et al., 2019).

Statistical analysis
The study aimed to document the impact of COVID-19 quarantine on Children's Behaviors and Language. Therefore, bivariate correlation analysis, linear regression, two-sample t-test, one-way ANOVAs were conduct throw SPSS ® software used, Version 21 was used (Aburjai et al., 2019).

RESULTS AND DISCUSSION
The coronavirus disease 2019 (COVID-19) pandemic and the resulting economic recession may have negatively affected people to be stressed, fear, and anxiety about what could happen, which re lects strongly on emotions and mental health of adults and children (WHO, 2020). Imposed mass quarantine applied by nationwide lockdown programs and applying and social distancing, However, these actions are very necessary to reduce the spread of COVID-19, but they could make people feel isolated and lonely (Yousif, 2019).    Table 1 shown demography distribution of study sample.
The general opinion of people in Jordan toward the impact of COVID-19 quarantine on children's behaviors and language was tested based on data collected from a random sample and Table 2 shown the multiple regressions between the stress of children, social relation impact on children, children, demand during quarantine, and children isolationism during quarantine on them behaviors and language. Table 2 shown the research dependent variables (children's behaviors and language) are signi icant because F signi icant is (0.00), which is less than (0.05), and the calculated F value (39.408) is more than the F table (2.89). Therefore, we reject the null hypothesis and accept the alternative one which states that there is a statistically signi icant effect at the level of (α≤0.05) of the (Stress, Social rela-  tion, Children demand, and Isolationism) on the children's behaviors and language during quarantine and its refracted a negative impact on children.
The relationship between the dependent and independent variables is strong and positive. It is more than (0.5) (Cohen, 1988), R= 0.504. Also, the R2 = 0.254, which means that the contribution of the independent variables strongly affects the dependent variables with a percentage of 25.4%.
Since the value of the calculated t value for the variables (Stress: 4.902, children demand 2.176, and isolationism 4.957), are more than the t value table (1.96). This means they have a statistically signi icant effect on the children's behaviors and language. While social relation t value was 1.209, which was less than the t value table (1.96), which mean social relation don't have a statistically signi icant effect on the children's behaviors and language. Stress consider one of the main factors that could develop language delay (the type of communication disorder) in children which play a critical role in emotional and health of children (Long et al., 2008;Leung and Kao, 1999) , increasing demand of children's in above the expected norm for age could be considered to be challenging behaviors (Ogundele, 2018), challenging behaviors becomes a worry as it is frequent, unexpected and leads to trouble at home. Additionally, some literature has been shown that the COVID-19 outbreak has undoubtedly resulted in increased dif iculties among Autism individuals (Colizzi et al., 2020).  Table 3, Multiple comparisons were performed using the LSD at α0.05, data shown that the families with income of "More than 2000 monthly" was signi icantly less change in the children's behaviors and language in compari The quarantine played a big role in having behavioral disorders for children -2 The quarantine affected children's thinking which made them exhausted 3 The quarantine played a role in increasing anxiety for children which affected their behavior 4 The quarantine played a role in increasing children's fear 5 The quarantine played a role in increasing children's nervousness 6 The quarantine played a role in making children feel lonely 7 The quarantine played a role in making children having fears to be affected by Covid-19 8 The quarantine played a role in making children feel depressed 9 The quarantine played a role in making children feel tensed

Second dimension social relation
Continued on next page Table 6 continued Demography data and general questions Very agree agree Neither agree or nor disagree disagree Very disagree 10 The social distancing due to quarantine may increase the feeling of isolation 11 The social distancing due to quarantine may increase the feeling of longing for friends which may affect their behavior negatively 12 The social distancing due to quarantine may increase family interaction which may affect children's behavior positively 13 The social distancing due to quarantine may increase the pressure on parents which may create psychological problems for children 14 The quarantine may be considered an opportunity to increase the bonds among family members 15 Children have a great ability in discovering the features of fear and anxiety for their parents and this may affect their behaviors negatively Continued on next page  Table 4.
Additionally, when we applied person correction The results showed that we had a strong negative correlation as monthly income increases in value, the change in children's behaviors and language were decreases in value with P value (2-tailed) was 0.007 and Pearson Correlation -0.542.which mean we have a reverse relationship between Economic level amount and change the children's behaviors and language as shown in Table 5.
One of the main recommendations that could be applied to help parents protect and improve children's behaviors and language in quarantine condition based on simple opinion is increasing the role of community pharmacies inpatient counseling and especially towards children after giving courses to pharmacists in child psychology and behavior. This could help the family protect them, children, from any changing in their behaviors and language in such conditions in the future if the world reface's such the same problem as community pharmacies showed successful results in many ields of disease management. In Belgium, for example, asthma patients prescribed inhaled corticosteroids were given two follow up appointments with a community pharmacistTable 6 . This program showed to bene it up to Thirty-six thousand patients, with the service potentially expanding to other chronic conditions. Another example is in Ireland, where community pharmacists gave over 50,000 patients (a tenth of people vaccinated) the lu vaccine in 2014.
In 2015, owing to the scheme's success, the pharmacist remit was increased to include pneumococcal and shingles vaccines (Blair and Menon, 2018).

CONCLUSIONS
COVID-19 has become a global crisis. It shows a negative impact on the health care system and economy of many countries besides a large number of people infected worldwide and died due to this pandemic. The COVID-19 also showed a negative impact on healthy people in the psychological and social area. Our results showed clearly that the COVID-19 pandemic has a negative impact on children's behaviors and language, where stress and isolationism has a higher effect and economic level (monthly Income) of families have signi icant impact.
The recommendation of this work is to increase the role of community pharmacies inpatient counseling and especially towards children, after giving courses to the pharmacist in child psychology and behavior, This could be helpful to family to protect them, children, from any changing in them behaviors and lan-guage in such condition in future if world reface such a same problem.
The COVID-19 pandemic show clearly how simple organisms "virus" could produce a negative impact on our lives even we live in a highly developed century (Technology age).