Importance: Coronavirus disease 2019 (COVID-19) containment measures such as school closure have been implemented to curb the spread of the virus among children. Subsequent changes in children’s participation in daily activities may exacerbate the risk of mental health problems among them.

Objective: To examine the relationship between children’s activity participation and mental health before and during the pandemic.

Design: Pretest–posttest design.

Setting: Communities in Hong Kong.

Participants: Children (N = 114; 60 boys, 54 girls; M age 11 yr, 4 mo) who participated in a previous school-based study.

Outcomes and Measures: Parents completed the Participation and Environment Measure for Children and Youth and the Strengths and Difficulties Questionnaire for their children.

Results: Parents completed the questionnaires before and during the pandemic. They reported a significant increase in their children’s externalizing problems and a decrease in prosocial behaviors during the pandemic. Increased externalizing problems were found to be significantly associated with less frequency and involvement in school activities and less involvement in community activities. Significant associations were found between decreased prosocial behaviors and reduced participation in all types of activities.

Conclusions and Relevance: Pandemic-related restrictions on children’s participation were unfavorably related to their mental health. Strategies and services that promote children’s involvement in daily activities are needed to decrease the risk of mental health problems during the COVID-19 pandemic.

What This Article Adds: Pandemic-related restrictions (e.g., school closure or social distancing) on activity participation unfavorably affect children’s mental health. Occupational therapy practitioners can play an important role in promoting children’s involvement in daily activities so as to prevent mental health problems among children.

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