Abstract
This paper offers a nuanced perspective of two families’ lockdown literacy journeys with their young children during the COVID 19 pandemic. We present informal home learning examples stimulated by play and by school-sanctioned synchronous and asynchronous activities from homes geographically miles apart yet close in terms of shared experience. In response to the catch-up and learning loss narrative which threatens to overshadow some of the positive learning experiences taking place at home, we redirect the ‘catch-up’ narrative towards a nuanced understanding of family learning at home by articulating the complexity of circumstance. Methodologically, drawing on Autoethnography, we present vignettes of lockdown life from Scotland and Michigan, USA. Throughout this paper we articulate challenges with the catch-up narrative and root our conclusions in the early childhood philosophy that learning extends beyond the mind to a whole body, holistic experience.
Introduction
When much of the world shut down in March 2020 in response to COVID-19 it felt as though this would be a temporary experience—a minor inconvenience for a handful of weeks. Yet the pandemic raged on for a further 2 years (with no firm end in sight), and while progress has been made in many areas, the lasting impact of multiple lockdowns, heightened anxiety, more or less convenience and increased or decreased family time as a result of working from home remains a source of debate.
In rather quick succession, publications pertaining to the pandemic materialised in almost every discipline. In Education, discussions of the field as a profession dominated: what online, blended or hybrid learning looked like (Teichert and Isidro, 2022); the impact of the digital divide on children’s learning (Azubuike et al., 2021); or how teachers and educators had to alter pedagogy while maintaining quality (Crawford et al., 2021). Fewer studies have captured the place of informal learning and the experiences of families, locked down in their homes, juggling educating, working and everyday living for survival to the best of their means.
We offer this nuanced perspective of two families locked down for several months in our homes in the first year of the COVID pandemic. As families we were geographically miles apart yet close in terms of shared experience as mothers, trained as early childhood educators, trying to navigate new working and learning arrangements for the whole family. We were both part of a two-parent home and both had two children. While we continued to work from home, and our children continued to learn at home, we were not considered keyworkers because our daily operational work could be achieved remotely. We were confined to our homes, except for 1 hour a day to buy essential supplies or for exercise, which had to be taken outside. As such, this paper does not represent a generalised population because we recognise that other families had to juggle decisions around sending their children to keyworker-only spaces at those few nurseries/schools that remained opened and would have had to weigh different challenges and opportunities. Furthermore, we explicitly recognise the privilege bestowed on our families, given our knowledge of pedagogy and play appropriate to support our children at this age and our knowledge of how that translates into home learning experiences.
Redirecting the ‘catch up’ debate
Education in early childhood is fraught with tensions about appropriate pedagogies and ways of learning across the spectrum of play versus structured learning experiences (Edwards, 2017) and the pandemic has only heightened these debates, causing unprecedented turmoil in the industry. Concerns are emerging about reduced staffing, reduced programmes and provision, lower enrolments which link to reduction in funding and key shifts in pedagogy, often to online platforms (Crawford et al., 2021). These industry level challenges cascade to fears around children’s learning and development, resulting in debated calls for ‘catch-up’ or recuperation of lost learning (BBC News, 2021).
Discourses penetrating education systems increasingly focus on “learning loss” (e.g. Dorn et al., 2020; Papineau, 2021; Major et al., 2021), catch-up narratives (Reform Scotland, 2021) and negative outcomes of remote learning (Andrew et al., 2020; Strunk et al., 2022). For example, Reimer and Schleicher (2020: 10), in their paper for OECD, emphasized learning loss and the need to “recover” it:
The majority of students were unable to learn what the curriculum expected them to learn during the first phase of the pandemic. Additional learning time will be necessary to minimise the long term impact of those losses. Creating expanded learning opportunities might involve extending the duration of the school day, extending the number of days of instruction per week, or work during the summer and other school holidays.
This propaganda around catch-up, speaks to a particular view of Education as academically driven and to a universal deficit perspective, where all children are assumed to have been negatively impacted academically by the pandemic. Throughout this paper, we use the term “academic” to denote a cognitive perspective of skill learning which focuses on individual development of knowledge, skills, and content assessed by government mandated curricula and privileged within schools. We follow Purcell-Gates et al.’s (2004: 66) description of school literacy as “academic literacy” and the skills associated with this as those “taught, measured, and valued in schools” (p.66).
Yet, the Early Childhood sector is guided by holistic experiences where pedagogies are responsive and relational (Hedges and Cooper, 2018); rooted in care and Professional Love (Page, 2014) and curriculum and policy guidance that is broad and flexible, not directive (Crichton et al., 2020). In this context, ‘catch-up’ related to academic subjects for the entire child population, is too narrow to capture children’s learning, development and progression in the heterogenous manner in which it likely manifested across lockdowns experiences.
This does not deflect from the reality that many challenges surfaced for families in this period, but the negative tone threatens to overshadow the positive experiences of students and families (e.g. Koskela et al., 2020; Midcalf and Boatwright, 2020; Schuh, 2021). Bubb and Jones (2020) described a school district in Norway where students (grades one through 10) reported more creative learning opportunities and cross-curricular opportunities. Teachers felt they had more time for lesson planning and feedback and this was noticed by students as they reported feedback “helped more than usual” (p. 215). Similarly, Brunt (2021) wrote about being an academic mom at home in Melbourne and described participating in a Teeny Tiny Stevies music video challenge with her family. This was as a positive experience which she described as ‘learning by doing while stuck at home” (p. 22). Souza et al. (2020) engaged in virtual culture circles with 10 children (seven to 9 years) in Brazil. While the children reported the loss of social gatherings and extra-curricular activities, they also highlighted many positive experiences about lockdowns, most notably the increased time and presence of parents, especially fathers, in day-to-day life. These children reported feeling that their families were more united as there was more time for joint activities.
Thus, we redirect the ‘catch-up’ narrative towards a nuanced understanding of family learning at home by articulating the complexity of circumstance. We argue children were constantly learning, albeit on a spectrum of multiliteracies where learning was not always bound by academic notions of progress or linearity and that the learning loss discourse focuses on narrow, discrete skills. With this stance we acknowledge the many ways meaning-making is embodied and expressed in everyday communication without one being more dominant than the other (Cope and Kalantzis, 2009). In doing so, we bring the story back to Early Childhood Education as concerned with learning beyond academic skills and development to include emotional literacy or experiential learning, for example. Despite the pandemic, this sense of broad learning outcomes in the field, beyond cognitive knowledge acquisition around hierarchical curricular subjects like literacy and numeracy, remains. In fact, the Early Childhood sector was particularly good at capturing the everyday learning opportunities available to children in the homes; albeit practitioners learned to facilitate and scaffold these experiences in new and uncertain ways.
Changing and challenging early childhood pedagogy: Making connections
The research emerging on COVID 19 and Education primarily explores the teaching profession and what lockdown meant for academic knowledge generation (Atiles et al., 2021; Steed and Leech, 2021). As a sector largely driven by hands-on, tactile and experiential play-based learning activities, the shift across the pandemic towards online learning or blended learning was a significant transition. Emerging research documents the fundamental challenges faced by educators. Mounting workloads, from juggling online and virtual education, and resulting extended workdays; rigorous and time-consuming cleaning regimes for toys utilised in physical play; learning new software and pedagogies, alongside managing the anxiety associated with the uncertainty of a global pandemic for both education and for children and families (Crawford et al., 2021) shaped the discussion. The feeling of helplessness in staff inability to support children’s wellbeing as much as they would like while children were at home (Dayal and Tiko, 2020) was also prevalent. In a sector where pedagogies are already debated, these additional challenges add to unrest about how to appropriately support young children’s learning and development.
One of the benefits to the Early Childhood sector in this regard, was the broad and responsive nature of the early childhood curriculum in many countries. In Scotland, the national practice guidance (Education Scotland, 2020) emphasises a focus on child-led learning and early child development in a broad sense spanning fine motor and gross motor development to attachment and relationships. In this context, the academic skills were broad and encompassing, extending beyond numeracy and literacy. A similar approach is employed in the Scandinavian countries where learning in nature in multidimensional ways is encouraged (Sandseter, 2014) or as part of Reggio Emilia in Italy, where environment and relationships facilitates and supports learning in holistic ways (Edwards et al., 2012). This unique approach to Education as a whole-body experience, not bound by textbooks or focused purely on the mind, created opportunities for learning in lockdown which could be easily translated into the home culture while not always having to be delivered synchronously online.
Dayal and Tiko (2020) detail some of these initiatives which allowed connections between the curriculum and home learning in tactile ways:
My term 2 theme is exploring and saving the nature in the garden – topics include plants and trees, vegetables, flowers, earthworms etc. For plants and trees, for example, we will ask the children to create a garden. If they are planting with their families, they can send a video or a picture of their practical work on planting, say, (for) example, planting your own vegetables. We have emailed the activity/worksheets/songs/practical hands-on activities to the parents (n.p.).
In this paper, we articulate how the complex nature of the home/school/nursery learning relationship evolved through the COVID 19 pandemic and specifically during periods of lockdown where schools and nurseries remained closed and educational support shifted to online learning. We draw on the home as a rich environment with potential to support young children’s literacy and we demonstrate how such learning transpired during a global pandemic.
Researcher positioning
The paper is punctuated by our positioning as two mothers whose training and past experiences as early childhood professionals with significant knowledge of early learning and development, informed educational decision making in the households during the various periods of lockdown.
In this context, it’s important to recognise our position not only as researchers but as families. Both families in this paper represent households with highly educated parents (two mothers with PhD qualifications and a father with a Masters qualification). This positions us as middle class, with stable incomes and secure home bases with gardens. It also facilitated the ability to purchase many home learning supplies and resources, which may have been needed throughout the lockdown period, and delivered directly to our homes without significant challenge. This in itself created a degree of security and privilege not afforded to some during this challenging time and offered the children in our homes a sense of security and safety amongst the anxiety of unpredictable outcomes.
Furthermore, we were not only educated but were specifically educated in the field of early childhood education and/or early literacy. This knowledge base significantly shifted our approach to home learning. In this sense, our knowledge of early childhood pedagogies bolstered confidence to creatively engage in educational activities while simultaneously causing anxiety over the effectiveness of our methods. Uncertainty materialised when our creative play-based and tactile hands-on experiential learning agendas, focused on broad curricular areas and advocated by our own philosophical worldview of good quality pedagogy, contrasted with more didactic, adult led and desk-based, task driven pedagogic home learning experiences suggested by the Schools.
This anxiety reflects the mindset of us as parents where our research training fosters a need for continual critical reflection and metacognition; reflection which is not bound only to our work but filters through into how we parent. As doctoral trained individuals, we are predisposed to analyse, reanalyse and critically reflect on what constitutes knowledge and reality, and what we have learned from that reflection, for our day jobs. This metacognitive state is engrained and, at times, over-analysis shapes how we see the wider world. It leads us to critically reflect on parenting decisions and family life, sometimes in a burdensome way because it creates as sense of uncertainty about whether the decisions we make could have been improved or transformed to offer an alternative, more desirable outcome. In doing so, it creates undue stress as we seek to navigate ideological theories of parenting, pedagogy and learning acquired from our research, alongside the practicalities of daily living and learning as a family.
We articulate our positioning in this way because we recognise that the stories that we present in the coming sections may not always reflect every Scottish or North American household, where knowledge of play and child development may be less engrained in the family life because, unlike the mothers in this paper, typical parents have not undergone significant training in this type of pedagogy. We also highlight the notion of anxiety because in what follows, we demonstrate that, despite our extensive training in a field that should have helped us cope and survive while home learning our children, uncertainty still crept in.
Perspectives of play literacy: Framing this paper
We drew from constructs of play theory from a sociocultural perspective. Play provides children with learning opportunities by allowing them to explore cultural symbol systems, including reading and writing. Vygotsky (1978) contended, that it is through play that “the child achieves a functional definition of concepts or objects” (p. 99). For example, a child uses a toy smartphone and imitates the behaviours of adults using the device in the real world. Play creates a Zone of Proximal Development (ZPD) because the child “always behaves beyond his average age” (Vygotsky, 1978: 101). When engaged in the ZPD, children learn complex concepts and develop psychological functions. Vygotsky categorized imagination as a psychological function, integral to children’s learning and noted the importance of play in engaging children’s imagination. Edwards (2011) expressed imagination as, “a way of interacting with the social and cultural world” (p. 198). Imagination is not fantasy. Imagination is a function that supports children’s connection with reality, not something that is “fundamentally abstracted from reality” (Edwards, 2011: 198). Imagination provides children with “something to play with and about” (Edwards, 2011: 200, emphasis in original). Children use their imagination to act on their ideas in play and use everyday objects as “pivots” (Vygotsky, 1978) and detach the actual meaning from the object, for example, using a banana to represent a telephone
In play, children develop understandings and competencies of the important cultural tools in their society. Wohlwend (2011) argued that play is a literacy because children are “creating and coordinating a live-action text among multiple players that invests materials with pretend meanings and slips the constraints of here-and-now realities” (p. 2). That is, multiple children work in coordination with in-the-moment texts and use pivots to remove the constraints of their current reality to invent new worlds. Wohlwend (2017), therefore, suggested play is a “printless literacy” that relies on “bodies, toys, props, and scenery rather than written with print on paper” (p. 66) and not only printed text. She described children’s worlds as “storied worlds” with texts filled with “vibrant dialogue, characters, and storylines” (Wohlwend, 2013: vii). Children make imaginary versions of “real-life or fantasy worlds”, but on their own terms, which allows them to “remake stories to fit their needs” (2013: vii). They “mediate print texts for themselves” and produce signs and “material objects or actions that represent and communicate ideas” (Wohlwend, 2011: 13). From this perspective our view of ‘literacy’ in this paper extends beyond traditional print media towards encompassing broad literacy development through play.
Methodology
While the pandemic was an unprecedented experience, we seek to describe the everyday nature of life during this 18-24 month period. The purpose of this study was to bring a nuanced understanding of family learning during the COVID-19 pandemic. With the focus of the study being ourselves and our families, we used autoethnography (Adams et al., 2014; Ellis and Bochner, 2000) to frame our inquiry and our “dual identities of academic and personal selves” (Ellis and Bochner, 2000: 740).
The aim of the personal ethnography is to describe the “practical contexts of everyday life” (Ellis and Bochner, 2000: 760) and to share a story that, in this case, may resonate with other parents navigating synchronous and asynchronous virtual schooling systems. We followed Ellis and Bochner (2000) and began with the researcher’s personal life, whereby the researcher pays attention to “physical feelings, thoughts, and emotions” (p. 737) and documented the “moment-to-moment details of a life” (p. 737). We focused on our attempts to sufficiently progress our children’s education within the constraints of our home lives—our need to work and our need to teach our children. We also drew from memory and hindsight (Adams et al., 2017) to reflectively review our individual experiences and then compared them to one another’s. We developed the following research questions in order to guide our autoethnographic reflections: 1. In what ways did the learning environments created and supported in our homes during the COVID-19 pandemic support children’s learning and literacy progression during lockdown? 2. In what ways did virtual connected learning and working environments help us to balance the multitude of responsibilities in our families (e.g. work, school, care) throughout government mandated lockdowns?
Data collection and analysis
Data were collected within our individual contexts and then brought together as a way to compare our families’ experiences. We held a virtual meeting to discuss our data collection and to share our similarities and differences in experience. We developed themes from the data as it related to our research questions (Frost, 2011) and organized our data within these themes (Creswell and Poth, 2018). We continued to share insights and our observations from the data through digital communication (i.e. email and Microsoft SharePoint). Autoethnography is not intended to generalize; however, we bring two accounts of lockdown life together as a means of describing what learning from home meant during the pandemic and to use our experiences to trouble the learning loss discourse.
Lorna’s context: Scotland
In Scotland, schools and early childcare settings closed 20th March 2020 and did not reopen until mid- August 2020. Schools and Early Learning and Childcare (ELC) settings returned with intense restrictions, strict distancing and bubbles between August 2020 and December 2020 before closing for a second time in January 2021. Primary Schools and early learning centres then reopened to children on 15th March 2021 and an online or blended learning approach for Secondary Schools remained for several more months. During this time, the structure of the schooling provision varied considerably with some schools utilising Google Classrooms and Teams spaces to offer synchronous lessons, even in early childhood. The first author’s school and nursery however, opted for an asynchronous approach, providing batches of work to be completed on school-based platforms.
The general philosophy in Scotland is that young children learn through play-based pedagogies and the curriculum documentation advocates for varied pace of learning and a significant focus on personalisation and choice. The curriculum bridges preschool provision (for children in Early Learning and Childcare settings from 3-5 years old) to the first years of Primary School. The ideological positioning of this bridging curriculum is to create curriculum continuity across settings to avoid problems with transition to formal schooling and to reduce the reliance on the ‘school readiness’ debate (Burns, 2018). Recent initiatives have taken this incentive further and have advocated for play based pedagogies in early Primaries, to mirror the experiences in pre-school (Realising the Ambition). Yet, this agenda was challenging to deliver during asynchronous teaching during the pandemic for the author’s school and in many cases (with the exception of art activities) the provision reverted back to ‘work’ focused tasks which centred around traditional academic subjects, such as English Language Arts and mathematics.
This novel period of time at home was documented inadvertently yet thoroughly, as I tracked our lockdown journey of supporting our children (4 years old and 6 years old at the beginning of the pandemic) and juggling home based working, on a daily basis. This process was not captured for the purposes of research, initially. I found myself posting our efforts on social media as a means of staying connected with families and friends who we were no longer able to see, as well as on the school-based platforms such as Class Dojo, Seesaw and Learning Journals, as evidence of completed home learning. A lockdown type diary bricolaged together across several media platforms, such as Facebook, WhatsApp or Twitter, emerged organically for our own purposes of self-reflection and to maintain digital connections with those outside our household. Throughout the full lockdown period, posts to social media were made daily. As a result, over these periods of full lockdown, I gathered extensive videos, images and written accounts of our time as a family while confined to our homes. Months later, as social media memories surfaced, it became clear that I had a thorough account of my family’s lockdown experiences. This documentation including anywhere between 5-30 photos recorded each day over several months, as well as remarks about interesting conversations or anecdotes from the children in the household which I thought family may find interesting. It become clear that this data set could be analysed for a qualitative research project.
Laura’s context: USA
On 31 August 2020, my son, C, began kindergarten online. Recognizing the novelty of his situation, I began documenting his learning experiences and my experiences supporting his learning on his first day of online kindergarten. The school district’s original plan was to remain online until the end of the first trimester (November, 2020). However, as cases of COVID-19 continued to rise in the state, schools remained virtual. In the end, C’s entire kindergarten year of schooling was online.
Play-based learning is not strongly defined within Michigan’s early learning context. Childcare centers and preschools may choose to operate using play-based pedagogies; however, it is not explicitly advocated for by the state. State documents emphasize learning expectations for three-to-four year old children as a method of measuring learning and development before they enter formal schooling (Michigan State Board of Education, 2013). Given the value I placed on play-based learning for young children, C was enrolled in a play-based preschool and attended 3 days a week before the lockdown was enforced in Michigan. His preschool did not attempt to offer remote learning during this time.
Also relevant within the Michigan context was the 2016 Read by Grade Three law passed by state legislators. The key purpose of this law was to increase student reading proficiency by the end of grade three (Rice, 2021) and students who could not read proficiently by third grade risked retention (Michigan Department of Education, 2016). March 2020 was the first year the law was to come into effect; but, in light of school closures retentions were not upheld. However, there has been strong concern about early elementary students’ learning loss during the lockdowns and the impact that loss will have on young Michigan children’s early literacy development as demonstrated on summative year-end assessments and benchmarks (Strunk et al., 2022).
Fieldnotes were created in two ways: key school-based milestones and emotional response to an activity/experience. School-based milestones were identified by C experiencing something for the first time, such as the first day of school, his first NWEA benchmark assessment, his first one-on-one formative assessment with his teacher, and so forth. C and I shared a work space while C attended online school. This afforded me the opportunity to record observations as fieldnotes while C was online. Emotional responses were recorded when C’s emotions were noticeably heightened, such as the joy he expressed when he read a sentence independently for the first time, or the frustration he showed when experiencing technical difficulties or the school content felt too challenging.
In addition to observation fieldnotes, I recorded my reflections on being C’s teacher during his first year of formal schooling. These reflections were recorded as fieldnotes and focused on my emotional responses to an activity or experience. For example, feelings of frustrations when C repeatedly stuck his tongue out at me while I tried to support his phonics knowledge, or excitement at witnessing C understand ‘silent e’ when reading. Reflections also included in-the-moment conversations. While these conversations were typically written down after the activity or experience, occasionally I made notes during the moment. For example, when C explained he wrote down all the vowel teams before starting Lexia so he would remember them, I recorded that statement as soon as C said it.
Photographs were also taken during key milestones (i.e. first day of school). Other photographs were taken simply to preserve a memory; however, those proved relevant during data analysis. Finally, photographs were also taken to document C’s learning for his teacher. These photographs occurred on days his teacher was not at school and unable to teach. On these days his teacher asked caregivers to complete activities she had prepared at home, such as listening to a read aloud through a website (e.g. Storyline Online) and create a drawing or write a sentence in response to the text. Photographs were the way caregivers could demonstrate the tasks had been completed. As with the memory photographs, these images were used in data analysis.
Ethics
Ethical practices for research are fundamental to the authors’ work and underpin all decisions made when conducting and disseminating research, particularly in relation to the involvement of young children (see Arnott et al., 2020). Decisions are always made to ensure the participants rights are respected and that involvement in research is fully informed. This paper takes a relational view of ethics; that is to say we negotiated directly with our families to ensure voluntary involvement with the paper and the submission of images to this journal. For example, Laura’s husband requested images of our children’s faces be blurred as a measure of confidentiality. Christensen and Prout (2002) described children as social actors who participate in, “change and become changed by the cultural world that they live in” (p. 481), and therefore research activities must be drawn from children’s “experiences, interests, values and everyday routines” (p. 482). In our research, we focused on the everyday routines within the ‘new normal’ of pandemic life. We attempted to understand their learning in the home during an unprecedented time. We took a consent-as-process (Schamroth Abrams et al., 2020) stance and asked our children and directly negotiated consent with them. This was essential to demonstrate an understanding of young children as ‘reliable, voluntary’ participants in research (Farrell, 2016: 226). Tensions in ethics collided with tensions related to online learning. These tensions tended to come from deciding whether or not to continue learning in a specific moment, such as needing to decide whether to close Lexia or to keep working during a challenging moment. Although it was not necessarily a research-based decision in those moments (i.e. do I collect this data), but upon reflection, did influence research decisions. For example, how to describe vulnerable moments between mother and son during a time of heightened stress. Critical reflection (Schamroth Abrams et al., 2020) required us to consider which emotional responses could be shared and those that needed to remain private. Given the emphasis we placed on our children’s autonomy in this process, our children had the ability to dissent or exclude pictures or vignettes and this was fully discussed and respected.
Findings and discussion
Through multiple qualitative vignettes we describe a pendulum swing of emotions as we navigated working and learning at home with our young children. In our reflections three themes emerged which appeared to offer commonality of experience for both families: 1. Fear versus joy 2. Structured versus playful home learning 3. Digital versus traditional analogue multisensory and tactile learning opportunities.
Across these themes we also articulate the role of the fathers in these households as key contributors to the daily survival, education and caring responsibilities during the pandemic. This may not be the norm and perhaps represents a unique dynamic in this data in comparison to other papers where it has explicitly been highlighted that the pandemic has deepened the gender divide in caring responsibilities (Manzo and Minello, 2020). In that paper they argued that “the couples who attempted to support each other between calls and deadlines, and tended to divide childcare equally, were few” (p. 121) but this was the position of the families in the current paper.
Fear versus joy
Firstly, we recount how we oscillated between crippling fear – for our families’ safety, but also our ability to sufficiently progress our children’s education to rebut concerns about learning loss - to moments of euphoric joy in experiencing unprecedented time and learning together. We fell somewhat into the category of many other parents identified in a large-scale survey in Italy (although we were based in other countries) where 60.4% of parents of preschoolers and 54% of parents of primary school children reported reasonable overall resilience [during lockdown] with ‘ups and downs’ (Mantovani et al., 2021: 40).
Euphoric joy
The ‘Ups’ were self- or community-made as new activities and experiences were designed as forms of distraction or education to support continued learning provision, as shown in Vignette 1. Vignette 1: The Silly Walk
In mid-Spring, we [Laura’s family] noticed new signs sprouting on lawns and the local neighbourhood Facebook page began advertising activities for the neighbourhood to participate in. For example, one neighbourhood activity involved a scavenger hunt for teddy bears people had strategically placed in window sills. However, the most cherished activity was the “silly walk zone” depicted in
Figure 1
Silly walk example.
In some cases, the Ups materialised organically, driven by the children, circumstance and the new routine that emerged from new ways of living and learning. For example, in Michigan, halfway through the school year, when C’s whole class time online increased, his teacher provided a five-minute break at the mid-point of the lesson. C decided that it was “exercise time” and insisted Laura do push-ups with him (an example is provided in Figure 2) as shown in Vignette 2 Vignette 2: Physical Breaks Together
C challenged us to do 10 push-ups during his class break. Thus began a daily spurt of exercise while his class took a break. We moved from just push ups to adding wall sits, squats, planks, jumping jacks, and so forth. It led to plenty of laughter and competitiveness between us. But most importantly it was fun. This was not something we had previously done together.
We laughed while we did the activities and, more importantly, forced me to get out of my chair and move my body!
Joy was also experienced for C as he was able to bring treasured friends to class with him each day. In addition to push ups, Figure 2 offers a glimpse of “Razor Jaws” joining C at school that day.
Push ups with Mum.
In other cases, ‘ups’ required considerable thought and effort on behalf of the families to manufacture opportunities for ‘joy’. There was an overwhelming urge to generate joyful activities in an attempt to distract and protect children from the potential fear and anxiety that could ensue.
In Scotland, we planned home cinema experiences with bought in popcorn buckets and home projector to make it feel like we were going out to the cinema. We had family water balloon fights. We grew vegetables and fruit in the garden. We slept as a family in our living room on mattresses. We simulated camping experiences in the back garden. We created an ice cream sundae bar. We made what Lorna remembered as ‘school lunch cake’ and left slices on neighbours’ doorsteps before pressing the doorbell and running away. When our summer holiday to Spain was cancelled, but we were eventually allowed to visit family within a certain mile radius again, we created an airport at home and the children packed their cases, printed their boarding passes and the car became an imaginary aeroplane for the length of the journey. When we were semi-locked down over Christmas with visitors only allowed outside, we created a Santa’s Grotto in the garden, complete with artificial snow and Christmas dinner outdoors.
The general philosophy was to take a challenging situation and turn it into a new adventure which created lasting memories. We lived by the mantra that the children would look back on this time as a joyful period where we relished the additional family time together. Even if we as parents felt anxiety and stress around juggling work, home learning (and the learning loss discourse) and the general challenge of being confined to the house, that was not to be the lasting memory for our children as shown in the reflection below.
Vignette 3: Striving for positive memories in Scotland
During that first lockdown, the slightest glimmer of hope or essence of retaining control became central. My role as parent very quickly shifted towards creating a safe haven where my children did not feel scared. My job was to ease their anxiety (despite my own anxiety spiralling) and protect my girls from the fear of the outside world. My overriding concern throughout those early months was to protect not only their physical health but their mental health and that took precedence over all else. As I documented our crazy world for family on Facebook, my own Aunt sent me a poem she had seen, and told me that she could see that my girls would grow up remembering this pandemic the way that was described in the poem. The poem articulated how children would look back on the pandemic in years to come and hear about the horror of the situation in history lessons but in some families the children would not remember it in such bleak terms. They would remember family time and positivity.
The validation of reading that poem, with all the hope that it offered, and that to someone outside our bubble it appeared that we were doing a good job, propelled my motivation to keep moving forward and keep protecting. The way we did that was by overcompensating in the joyful moments and holding on to them as much as possible.
Crippling fear
Despite our best efforts to curtail fear and replace it with Joy, anxiety and sadness crept in from time to time. Children’s fear manifest in different ways. For Lorna’s family some fears were obvious, perhaps physical displays of emotion, such as a 4-year-old crying in their parents’ arms as they talk of ‘missing Nanna days [Nanna used to do weekly childcare before lockdown]’, or missing their friends at preschool. Similar reflections are heard from Michigan about why they could not visit Grandparents who were located in Canada. In other instances, children explicitly raised their concerns, expressing their sadness at the current situation: Vignette 4: Talking through the sadness
[Lorna’s]4 year old: When I go to big school will coronavirus be done?
Dad: Yeah, hope so!
4 yo: Because coronavirus is a bummer.
Dad: It is Darling.
4yo: Because we can’t see any of our friends
Dad: I know
4yo: Coronavirus is a bummer, but we just have to deal with it.
Dad: yeah, and it’s ok because we are dealing with it.
For the children, fear become pockets in time, punctuated by opportunities for joy to raise the spirits. But for parents, fear became an undertone which percolated throughout parents’ days as we tried to balance our children’s mental health needs and their learning and development requirements with their physical safety. We oscillated between moments of euphoric joy as we watched our children revel in the opportunities for fun and excitement. While at other times we simultaneously questioned our decision making and whether we were doing enough to keep our children safe or to progress learning. An example of this complexity is presented in Vignette 5. Vignette 5: Undertones of crippling fear during moments of joy. As parents [Laura and her husband], fear was discussed. As spring warmed the air, relief from long days inside the home became excitement to get outside. Yet, living on a street where other families with young children lived meant many children eagerly running towards each other to chase and play. This fear was a mix between concern about the virus and whether I was making the right decision in creating a small pod of friends for my children to play with. While this context began with fear, it culminated as a joy. My family moved from the west coast of Canada to the USA in August 2019—six months before the pandemic shut everything down. We were just beginning to build a life and routine in a new home. During this time, we were able to establish friendships with two families with young children.
For the Mothers in the families this fear was eased and the joy amplified by the support from the Fathers in the home. In both cases the Fathers played a central role in supporting family life. In Scotland we were fortunate with caring and compassionate employers, which meant that despite both parents working full-time at home, our employers facilitated flexible working to share the home learning and childcare duties. In Michigan, the Father took on the primary care role. In both scenarios, this offered an opportunity for children to have increased time with their male role models and was specifically exemplified in the reflection below: Vignette 6: Fathers’ Roles During the lockdown three dads were the primary parent—my [Laura’s] husband (because of visa restrictions) and another one (by choice) stayed home with their two children. The other dad was working from home, but the office he worked at had slowed down and he was taking on the primary parent role during this time. It was fun to look out the window and see three dads playing with five kids under five. That isn't the norm in Michigan.
Across the oscillating moments of joy and fear, learning prevailed. Perhaps not always specifically for academic subjects in standards-driven ways, but in terms of the broader curricular areas home learning and progression was expansive, inclusive and relational. This represented the tensions between balancing structured versus informal learning experiences (explored further in the next section) and how we sought to find balance in the process to ensure our children were not disadvantaged when they returned to school. For us, that disadvantage was not always evaluated around learning loss, but rather ensuring children’s mental health and emotional wellbeing remained positive to support their well-adjusted transition back to the classroom, when the time came.
Structured versus playful home learning
While much of our day was encapsulated with tailored attempts to reduce anxiety and increase joy, we were still faced with the realities of home learning and juggling work. The vignettes attempt to trouble the discourse around learning loss, as we articulate the broad cross-curricular and interdisciplinary opportunities that our children embraced. We unpick how playful experiences strengthened literacy skills in a broad sense, not only including academics but also in terms of emotional and digital literacies.
Home learning in Scotland: Broad literacies instead of learning loss
In Scotland and pre-COVID our children regularly watched YouTube Vloggers whose Mothers’ home school their children. These Vloggers document their home learning journey offering insights into their daily routines and the kinds of learning activities that are experienced by their children. Thus, continuing our attempt to create adventure despite the pandemic, when lockdown became imminent in Scotland our children immediately saw this as an opportunity to replicate the ‘Home School’ experience they had so often coveted from YouTube. Before the shops closed, we raced to clear the shelves of fun stationary, folders, papers and we bought a printer. Homemade signs were created which indicated that a certain area of the house was ‘Home School’ and the children took it upon themselves to write their own Home School timetable including Physical Education, Numeracy, Literacy and Snacks, mimicking the timetables they had watched on YouTube. School closure for the children was filled with a sense of excitement and new possibilities, at first. It became an imaginary game of playing Home School. Vignette 7: Playing Home School
In those moments of structured learning, play still featured. My [Lorna’s] children would dress up in school uniform (my youngest wasn’t even yet at school) and role play teachers and students. We had to open the front door, let them walk a short way down the road and play a school bell sound on our phones and they would come running in to make sure they weren’t late, before sitting at a formal table reading books in pairs (see
Figure 3
Playing home school and reading.
This structured approach to home learning aligned well with the kinds of experiences sent home from the school where most of the learning was asynchronous and provided via a series of worksheets to be completed, mostly around literacy skills (e.g. handwriting practice, phonics) and numeracy. For the first 2 weeks, the children were excited to complete these tasks and stick to their self-devised timetable. But this engagement quickly waned and before long we had to adapt many of the activities sent home to foster engagement as shown in Vignette 8. Vignette 8: Transforming worksheets to tactile activities
In other situations, we [Lorna] had to transform the structured-school based worksheets that were sent home to foster engagement. Tactile resources become key. Such as magnetic letters/numbers (See
Figure 4
Practicing hundreds, tens and units with physical manipulatives. Marshmallow division.
The physical, hands-on approach was vital when there were two children at home. Activities sent home by the school which were solely tailored at one child became problematic, when we as parents had to juggle work, helping with school activities and support a younger sibling. The times when the school sent home activities which could be completed by both children easily were a joy and a relief.
For example, Lorna’s School sent home a weekly art challenge directed at the entire school community and therefore suited multiple age ranges. This meant the younger sibling could help or complete her own version of the task, creating a sense of achievement for everyone. One such task was to create a self-portrait in any medium allowing teamwork between both siblings to construct a giant outdoor sculpture (again moving us away from the desk and allowing embodied or experiential learning (See Figure 6). Alternatively, they were asked to paint a Picasso inspired abstract portrait which allowed younger sibling to create her own art impression (Figure 7). Self portrait. Picasso self portrait.
In other cases, there was a distinct need to switch off from home learning, of any sort, in order to maintain the ‘ups’ (moments of joy) described in the previous section. We did not complete all the activities sent home from School as our focus on mental health, wellbeing and emotional literacy in an uncertain time took precedence in those moments. Lorna recounted how her children watched movies several times and vented to Facebook friends for reassurance that in a global pandemic, some relaxing of rules was necessary:
My girls have watched this film (Alvin and the Chipmunks), maybe 8 times in the last fortnight! Have I failed at home learning??
In reality, on the whole as the months progressed, a very small portion of the day ended up being allocated to school-structured learning but given my experience with early childhood education, I felt confident (most of the time) that although children were not ‘working’ they were still learning and concerns expressed in the media about children’s learning loss were strategically pushed far from my mind. In this sense, much of the day was consumed with role play activities, construction and Lego, home science play by making slime or homemade playdough, baking cakes, scavenger hunts and playing board games. These activities were tailored to allow problem solving and challenge. For example, my eldest daughter was given written and pictorial instructions of how to make slime and she was tasked with teaching her sister how to make the slime while I remained close by, working. In many cases images of board game play, like Scrabble, were submitted to the School as evidence of learning and replaced many of the more standards-based learning tasks like rote learning spelling activities that were sent home. Reading was carried out at bedtime each night but this was not considered a ‘School’ task because it was a defined bedtime routine pre-pandemic; we didn’t always read the School mandated books and opted for children’s choice of books.
The School accepted these substitutions without challenge, although at times we received whole school emails encouraging everyone to keep up with the ‘work’ sent home which increased the sense of pressure and duty on our family. In these scenarios, I drew on my confidence in play pedagogy and reflected on my children’s general dispositions towards the tasks allocated by the schools to make carefully considered judgments about whether to follow these instructions. This required a significant degree of self-reflection and when I felt the school mandated tasks were not achievable and I decided to maintain the path towards a focus on broader literacy learning experiences. This required great courage to advocate for why we had taken a different approach to that set by the schools.
This process was challenging, however, and the sense of fear re-emerged. Despite my faith in play as a vehicle for learning, we were deviating from the School’s set activities and we worried about the long-term impact this may have in how our children were viewed by the School. We were not, like our peers, spending 6 hours per day on School assigned work. Yet, we made the decision to favour mental health, wellbeing and emotional literacy and took the risk that perhaps our children may academically fall behind the curve as a result. When they returned to school and nursery, both children had maintained their skills and the teachers were delighted with their progress; there was no ‘learning loss’.
Structure in the USA
The structure of Laura’s son’s online school required 60 min of whole class instruction Monday through Friday (increased to 70 min after December holiday break) and 30-min small group sessions three times a week. Families were tasked with additional screen-based learning through Lexia—a systematic phonemic awareness and phonics program—and Dreambox—a mathematics program. Students were to spend 20 min each night on Lexia and 10 min on Dreambox (increased to 30 min and 20 min as the year progressed). The programs allowed teachers to track student progress. C and I diligently followed the school’s structured learning schedule and worked together for approximately an hour each evening on Lexia and Dreambox. As we progressed through both programs, I found myself becoming a de facto second teacher as I had to explicitly teach content, rather than reinforce or support his in-class learning. Vignette 9: de facto teacher
As a means of transitioning to Dreambox and Lexia, I have begun referring to the activities as “computer game time.” C has now progressed far enough in Dreambox that he is tasked with activities that he has not been exposed to in school and are first grade standards (per his state’s mathematics curriculum standards). Therefore, in order to fulfil his Dreambox expectations (i.e., 10 minutes per night), I now need to explicitly teach him skills above grade level and without the tools available in a classroom ... The shift in more challenging activities, combined with zero introduction to them, has created tension for him and for me.
C was resistant to my instruction—I was Mom, not his teacher, and he was reluctant to listen to my instructions or explanations. For example, fixing his writing hand grip was a nightmare. No amount of encouragement or correction would convince him that he needed to hold his white board marker in his fingers and not his fist. He began to fight “computer time” because it “was boring” or he “hated it.” It became a nightly battle and some nights I simply turned it off. The anger and resentment we both felt was not worth the effort for the potential of school-sanctioned learning.
These experiences brought guilt and frustration for me. I wanted to be a ‘good mother’ (Smythe, 2006) and follow his school’s expectations. At the same time, my literacy researcher hat and elementary teacher hat told me he was learning and meeting his grade-level expectations. He had not “lost” learning opportunities. It was just not school-sanctioned. For example, a bird chose to nest in a bedroom window sill on our house (see Figure 8). This provided C an up-close view of a bird’s life cycle: egg, to baby, to eventually leaving the nest. We checked the eggs daily and recorded our predictions on when it would hatch. Once the eggs hatched, when we were careful enough, we could watch the mother bird feed and tend to her babies. We also, unfortunately, talked about nature and how some baby birds do not survive as one baby died in the nest. Bird’s nest.
Like the serendipity of the bird’s nest, much of C’s lockdown learning took on an inquiry-based learning approach. He expressed an interest in a topic and we explored said interest in books and in online resources. At the time the photograph (Figure 9) was taken, C was really interested in marine creatures. We read books about whales, sharks, and other sea creatures. We watched YouTube videos and documentaries on Disney+. Most importantly, with my teacher hat on, this inquiry provided C an authentic way into drawing and writing. He had always been a reluctant artist and writer, yet he became motivated to draw the largest whales (in order to compare) and label the drawings, “like in [his] book.” Drawing whales.
Across Scotland and the US, and despite different approaches to online-learning, commonalities in experience emerged. The children’s own agency in departing from the School sanctioned learning, for example, materialised. Similarly, as parents we toiled with balancing school expectations and our children’s reluctance to engage over time. For us, this became an interesting point of reflection when considering the wider society home learning experience; if we as early childhood educated professionals struggled to find balance, what challenges must have been faced by those parents with no knowledge of educating children?
Digital versus traditional analogue
The switch to online learning caused concern around increased screen time for young children’s engaging in synchronous time with practitioners and teachers online. Yet, while research is beginning to show that children’s interactions with digital devices shifted somewhat during the pandemic, with more children accessing online resources, this was countered by reduced time watching television because engagement transitioned to using more mobile technologies (Koran et al., 2021). The reality appears to be much more dynamic than first posited with blended opportunities for synchronous and asynchronous online learning experiences being common.
In response, we describe the affective elements of entangled digital learning (e.g. connections to relatives and friends) alongside multisensory, tactile and informal learning experiences that sustained our children’s joy as we sought to create safe spaces and build lasting positive memories that with time would override any fear.
Michigan: C’s Multimodal letter play
C’s ‘screen time’ increased dramatically during the pandemic. In addition to the typical screen-based activities from his day (e.g. TV watching in the morning), two-hours of tablet time were permitted in the afternoon while his younger brother napped. This served to keep the house quiet for brother to sleep and provide two exhausted parents time to recharge. All weekly communication with grandparents was done through video-chat. This was on top of the virtual learning time assigned by his school (i.e. 60 min of whole class instruction, 30 min of small group instruction, 60 min of nightly Lexia and Dreambox). Sufficed to say, C was consuming more than the recommended amount of screen time (American Academy of Pediatrics, 2016).
As I reflected upon his digital engagement, however, what struck me was the interplay between digital and analogue in real time. Rarely was C’s use of digital tools limited to that tool. He moved between digital and non-digital in most of the activities he did. For example, when engaged with Lexia (see Figure 10 for a screenshot of his learning activity), he moved away from the screen to write down what he was learning. Lexia screen.
He began writing his sight words, vowel teams, and r-controlled vowels on the white board before starting the Lexia activity (Figure 11 shows an example of his vowel team work). He explained, ““I’m writing them so I can remember.” Writing what he had learned.
On another occasion, he decided to create letters and sight words with play dough instead of writing them down, as evidenced in Figure 12. Playdough letters.
As has been documented elsewhere (Kumpulainen et al., 2020; Marsh, 2004; Stephen et al., 2008), children are not simply passive users of digital technology; rather, they move between spaces as they play. This held true for C not only as he played but during school-sanctioned activities too.
Scotland: Sharing devices and asynchronous experience
Unlike C’s case in Michigan, in Scotland the learning tasks sent home from school were asynchronous, sent in batches on a weekly basis so there was greater flexibility in how to manage work versus play time. This was also fundamental because as a family we do not own a family computer. Both parents have a work laptop and the family shared a singular iPad, but with both parents juggling working and two children at home, it would have been almost impossible to logically manage synchronous teaching across multiple devices and platforms alongside work. Activities which were sent home via the online learning platforms were either printed or written on a whiteboard so the children ended up with hard copies of tasks to complete. In this sense, there was not much focus on digital screen time increase due to schoolwork.
The exception to this was increased video calls throughout various points in lockdown. For example, Grandparents phoned to coach the children through some of the activities sent home. Mobile phones were used to arrange calls to allow the children to read to grandparents when parents were both occupied on work calls of their own. Similarly, a large family Easter celebration was typical, but while in lockdown the Easter Egg hunt happened while all the cousins were on Zoom. At Christmas, the tradition of baking minced pies with Grandparents was transferred to Zoom with both children and Grandparents making their own mince pies in their own homes simultaneously. Similarly, extra-curricular out of school activities like ‘Rainbows’ or ‘Brownies’ transitioned to online events in the evening via video call. Digital literacy learning in this context materialised as the children become confident navigating video conferencing software that had previously not be used.
As an alternative to continuous video call, while still wishing to maintain contact with missed loved ones, the children found joy in writing letters to Grandparents and cousins. On several occasions, they would make crafts, cycle to the nearby post box and post these crafts to the family, which created yet another sense of adventure as they waited for their reply in the mail (Figures 13 and 14). Crafting for cousins. posting crafts.
In this sense, the pandemic created opportunities for meaningful analogue literacy engagement, which would not have been necessary had we continued to see cousins on a regular basis. It provided a purpose for this writing in context.
In both countries the blurring of online and offline learning became central as children fluidly transitioned from digital and analogue play and learning.
Conclusion
These everyday lived experiences, and the cultures from which they were grounded, shaped our lives from moment-to-moment across our complex embodied and virtual worlds to describe how our children’s lockdown literacies advanced, evolved and deepened by an enriched, yet challenging, period at home.
What became clear as we spent increased time at home with our children was the sense of contrast between home learning and school learning, from our perspective. Local government policies influenced schools’ online/learn from home structure and requirements, which typically focused on desk-based tasks or standards-based skills. This contrasted our early learning philosophies that were more active and play-based, which guided our decision making as parents and educators. It seems reasonable to assume that schools were as concerned about ‘learning loss’ as we were, and that this concern informed school’s decisions throughout the pandemic. For us, parents on the receiving end of those decisions, there was a desire to demonstrate our commitment to the school by completing tasks, even when these tasks did not align with the everyday activities in our homes. In some cases, we worked with our children to complete assigned tasks and photographed children’s activities to show the school we had done the work. Yet, we were also in positions to take liberties on this work and to justify our decisions throughout educational and professional backgrounds. In the face of the learning loss discourse, which continues to permeate news and social media (i.e. Ojiambo and Reynolds Lewis, 2022), we offer this small study as counter evidence to the claim that all children lost learning opportunities while schools were locked down. While we acknowledge our privileged positions in supporting our children’s learning at home, we also ponder what conversations might look like if the discourse focused on the overwhelming conditions schools, teachers, and caregivers were under, and acknowledged the unprecedented nature of this moment in time.
The sense of duty from parents was contextually bound but the fear over progressing our children’s learning adequately was shared across continents. In Scotland, where testing is less prevalent, there appeared to be no problem with Lorna’s children’s formal progress in learning, although on return to School, communication made reference to how much children had missed and the need to catch up. In the second instance of lockdown, we also received direct communication from the school, perhaps fuelled by local Government agendas and instruction, that indicated that non-completion of home learning tasks would result in children being marked as absent and justification for the lack of involvement was required by parents. Consequently, as a family we still felt somewhat bound by the School’s agenda and where we digressed, we felt needed to explain to teachers how our children engaged in alternative learning processes and as a way to justify actions and demonstrate that children were not falling behind. From a family perspective, it created a perceived indirect hierarchy where the school became the vehicle to structure lockdown experience in accordance to the wider political learning loss agenda set by local governance or perpetuated in the media.
In Michigan, where testing was evident, the need to demonstrate learning and progression was more conspicuous and testing occurred more formally at home. This testing process appeared problematic in capturing the learning and development children experienced at home, as shown in Vignette 11. Vignette 11: The Notion of Loss
In the fall of 2020, the school district decided it would administer the NWEA online assessment and families were tasked with administering the assessment from their homes. To establish literacy and numeracy benchmarks, C had to complete two tests on consecutive days. C had never written a test before, much less one on a laptop. Families had been instructed to stay silent during the test and to only offer technological support. Here was my reflection:
It struck me that the scores were just numerical, in other words, just scores. There was no formative context. C had to find the /j/ sound and complete /jog/. He was to tap the /j/ from a row of letters to indicate which was the /j/ sound.
C knew /j/ made the sound he was looking for—and said so out loud—however, Lexia and Dreambox had conditioned him to expect immediate confirmation of his answer, whether correct or not. When nothing happened on screen, he started tapping other letters. I reminded him to “tap the arrow to move on with the test” (i.e., technical support). He took my prompt but did not ‘check’ whether he had the correct letter. He just tapped the arrow to move on. His final answer ended up being /h/ and therefore wrong, despite initially identifying the correct answer.
It was clear he lacked testing experience. He struggled to know where to put his answers when he tapped them and how to get the narrator to repeat the question. Therefore, I questioned the accuracy of the scores. The NWEA was administered again in May 2021 as a method of comparison. However, the digital element and home environment were still present. Although C’s digital competence had increased by May and he now had online testing experience, he made similar digital errors as the Fall NWEA assessment—he rushed to change his answer when it did not provide him with positive feedback (i.e. that he was correct in his answer).
While C’s scores were not concerning and he saw gains on the test between October and May, the notion of loss has often sat with me as I considered his testing experience compared to the playful learning experiences he was having in the home. My literacy background tells me he reads with fluency and accuracy beyond “kindergarten.” I base this claim on the many mornings I sat at my desk working and heard whispers coming from his bedroom. To my surprise, he had been waking up and reading to himself early in the morning. So, while I struggled to fulfil the 20-30 min of Lexia and school-sanctioned reading, he was eagerly waking to read books of his choice and on his time. I acknowledge C is privileged with at-home learning because of his mom but I suspect other children saw learning growth too. It is just whether it is school-sanctioned or not.
This process highlights a significant problem with the catch-up narrative, which fails to capture that children are learning in different ways than the standard. As we have demonstrated in this paper, our children were constantly learning and that learning covers a broad spectrum of multiliteracies and was not always bound by academic notions of progress.
It is important to recognize the privileged spaces in which our lockdowns occurred. Both of us possess insider knowledge and skills about early learning which afforded our children opportunities other families may not have had. We were in a position to push back on ‘learning loss’ discourses because we have expertise unique to this field. However, that did not protect us from uncertainty and doubt and we had to make brave spaces to follow through with our agenda, particularly as we continued to question whether we were adequately educating our children because in many cases, our pedagogies did not align with school-sanctioned ways.
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Supplemental Material - Family learning and working in lockdown: Navigating crippling fear and euphoric joy to support children’s literacy
Supplemental Material for Family learning and working in lockdown: Navigating crippling fear and euphoric joy to support children’s literacy by Lorna Arnott and Laura Teichert in Journal of Early Childhood Literacy
Footnotes
Declaration of conflicting interests
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