SUMMARY/ABSTRACT The emergence of the COVID-19 global pandemic has had significant impact on the health and well-being of adults and children alike. In the United States, the COVID-19 pandemic has highlighted the fractures in many systems including education, the economy, housing, and healthcare, widening known racial disparities. This is of particular importance considering the criticality of the peripartum period on early neurodevelopment. Recent findings suggest that early maternal symptomatology can have lasting, and negative effects on parent-child interactions, infant/child development, and mental health of both women and children. Overall, these findings take on further importance when contextualizing the disparate exposure of Black children and their families to structural racism and the COIVD-19 pandemic. Although there is increasing knowledge of the impact of structural racism on child development beginning prenatally, mechanisms underpinning this transmission are still being investigated. Identifying women disproportionately impacted by the COVID-19 pandemic and endemic conditions (syndemic) during the peripartum period, provides an opportunity to understand the developing child’s environment, mother’s mental health, and parenting experience, with the long-term goal of improving infant/young child neurodevelopmental and mental health outcomes by ensuring appropriate, precise, culturally- informed interventions. The proposed multi-methods project consists of three aims that will longitudinally examine child neurodevelopmental outcomes by early identification of racially/ethnically diverse mothers with mental health challenges. The first aim implements extensive screening of postpartum Black and non-Latinx White (NLW) mothers using a battery of questionnaires and clinical psychiatric interviews to identify mothers currently experiencing distress and psychopathology, as well as determining resilience factors uncovering cross- cultural differences that may exist. Fathers/secondary caregivers will also complete similar questionnaires assessing levels of support. The second aim identifies maternal concern about their child’s development and mental health at two developmental time points (24 and 48-months) and assesses mother/child interactions on a series of dyadic tasks. The final aim consists of qualitative interviews with a sub-sample of Black women characterizing the impact of the syndemic on their mental health, parenting practices, perceptions of their child’s early development, and trust in the healthcare system. The overarching goal of this application is to deeply characterize the experiences of women and children impacted by the syndemic, filling the gap in the research by identifying specific maternal and environmental factors and mechanisms that critically influence early child development and mental health and allowing for future intervention development.

NARRATIVE SUMMARY Identifying the effects of a significant stressor, the COVID-19 pandemic, and underlying systemic conditions, defined together as a syndemic, on mothers and children is critically important, as impaired parenting impacts neonatal development and infant/early child mental health. This study aims to apply complementary methods to investigate maternal experiences of the syndemic, note differences between Black and non-Latinx White (NLW) women’s experiences, identify other stressors that may impact women’s mental health, and talk with Black women about their experiences with the syndemic and racism. We will observe early child development and parental interactions at ages 24 and 48 months, to identify how toddlers’/preschoolers’ environment and mothers’ mental health contribute to their development and well-being.