By Judy Koutsky and Diana Kelly Levey for Centennial Publishing’s ‘The Complete Guide to Mental Health’ magazine.
It’s hard enough for adults to wrap their heads around an invisible deadly disease that resulted in sheltering in place for months – now imagine being a child or teen and told that school will be conducted at home, activities are canceled, and you can’t see your friends or relatives for an undetermined amount of time. Chances are, most children are feeling out of sorts to say the least.
“The pandemic quarantine has affected children’s mental health in different ways, with some children thriving and some really struggling with feelings of worry and sadness,”
says Roseann Capanna-Hodge, Ed.D., LPC, BCN, LLC. “Parents might see that their kids are struggling with regulating their emotions, behavior, attention, or learning maybe for the first time or are realizing that issues they perceived as mild might really be impacting their learning.”
Adolescents are the hardest hit because they are shifting toward wanting to spend more time with their peers, so the social isolation is the most difficult for them, says Capanna-Hodge. “Teens are being creative about ways to connect, but they are missing their friends and some are feeling quite sad and even depressed.”
Every child goes through periods where he or she may seem out of sorts. Whether it’s a toddler’s temper tantrum or a tween’s rebellion, we expect our kids to have their ups and downs. But when should parents be concerned about their child being lonely, anxious or depressed due to these new circumstances?
The Centers for Disease Control and Prevention (CDC) describes mental disorders among children as “serious changes in the way children typically learn, behave or handle their emotions, which cause distress and problems getting through the day.”
Some experts say kids today are at a greater risk for a variety of mental health problems, including depression, anxiety and attention-deficit hyperactivity disorder (ADHD). Depression and anxiety symptoms in children can persist for an extended period, or frequently come and go, says Capanna-Hodge. Some emotional symptoms to be on the lookout for include excessive worry, sleep issues, difficulty concentrating, irritability, anger or rage, phobias, negative talk, perfectionist tendencies, and getting distracted by worried thoughts, to name a few.
“Children are prone to anxiety and depression, more so due to the exposure to social media, unrealistic social and image expectations, lack of creative play, the opportunity for real-life interactions and a subsequent delay in appropriate development,” says Sanam Hafeez, PsyD, a neuropsychologist and the director of Comprehensive Consultation Psychological Services, in New York.
The most common mental health issues facing kids today include ADHD, behavior problems, anxiety and depression, according to the CDC. Some of these issues work together. For example, about three in four children ages 3 to 17 with depression also have anxiety; almost half (47 percent) have behavior problems. Among those with anxiety, nearly 38 percent also have behavior problems and one in three has depression. The diagnoses of depression and anxiety are more common as children get older, but many mental, behavioral and developmental disorders begin in early childhood—one in six U.S. kids ages 2 to 8 has had a diagnosed mental, behavioral or developmental disorder.
The following is a look at some of the more common mental health concerns that kids are coping with during the coronavirus pandemic, as well as how these challenges differ from those of adults.
Children’s mental health disorders can be similar to those of adults, but they can also take on different forms. Take anxiety disorders: Most kids will outgrow typical childhood fears, like being alone in the dark or having to deal with strangers. But in some children, these fears can become so extreme that they interfere with their schoolwork, home or play. About 4.4 million children ages 3 to 17 have an anxiety disorder.
“Anxiety disorders are conditions that involve excessive amounts of worry, fear, anxiety or nervousness,” says Liz Harstad, MD, a developmental behavioral pediatrician at Boston Children’s Hospital (BCH) and expert at understood.org, a nonprofit organization for learning and attention issues. “While all kids may experience a little anxiety once in a while, a child with an anxiety disorder may experience anxiety on a daily basis, even when there is no threat.”
Childhood anxiety disorders can include separation anxiety (extreme fear when away from parents) or having an extreme fear about a specific thing or situation, such as dogs, insects or going to the doctor. General anxiety may manifest in a fear of bad things happening. These fears can be sudden, unexpected and intense, and may include symptoms like difficulty breathing, or feeling dizzy, shaky or sweaty. But children can also appear irritable or angry as well as, or instead of, seeming afraid. Other symptoms can include difficulty sleeping, fatigue, headaches and stomachaches. They may experience social anxiety and express hesitations about returning to school, parties, activities and social gatherings after this pandemic.
If your child expresses worries about their health or safety, do your best to reassure them that they and the rest of the family are okay. “That simple reassurance can be a powerful way to calm worries and kids often move on,” says Capanna-Hodge.
Every kid has their time to feel a little sad or even hopeless. But when a child feels persistent sadness and hopelessness, they may be suffering from depression. They may feel sad, disconsolate or uninterested in activities they used to enjoy. They may also seem irritable, eat more (or less) than usual, or sleep more (or less) than normal. Other symptoms of depression in kids include a change in energy (often being tired and sluggish or tense and restless), having a hard time paying attention, and feeling a sense of worthlessness, uselessness or guilt. Some may resort to self-harm or self-destructive behavior. About 1.9 million kids age 3 to 17 experience depression.
Not every child who is depressed talks about their thoughts, and some may not even appear sad—rather, they may come off as unmotivated, or act out. “This can continue for weeks or even months at a time,” warns Harstad. “They may have a hard time enjoying activities or feeling happy.”
More than 6 million kids in the U.S. have been diagnosed with ADHD, making this one of the most common neurodevelopmental disorders of childhood. Kids with ADHD may have trouble paying attention, often daydreaming or forgetting or losing things. They may have difficulty sitting still, squirm or fidget a lot, talk too much, or have difficulty controlling impulsive behaviors or being overly active. Symptoms usually don’t just go away as the kids get older—they can start to interfere with schoolwork, home life or with friends. The disorder can start early: About 2 million children have received an ADHD diagnosis between the ages of 2 and 5.
“Common signs of ADHD include forgetfulness, being easily distracted, making careless mistakes, rushing through tasks, frequently losing items, getting into other people’s personal space, difficulty waiting their turn, and restlessness or hyperactivity,” says Harstad. There’s no single test to diagnose ADHD, and other mental health concerns (including anxiety, depression, sleep issues and certain types of learning disability) can create similar symptoms. Doctors may do a medical exam to rule out other problems that can cause these symptoms, including hearing and vision tests. They may also complete a checklist that rates ADHD symptoms. The American Academy of Pediatrics recommends healthcare professionals ask about a child’s behavior in different settings, including home, school and with peers.
The Toll of Social Distancing
The long-term effect of social distancing for children could mean that children will have a difficult time when we return to physical distancing. “Keeping away from other children while playing will be a challenge for both younger children who don’t fully understand the concept of personal space, as well as teens who developmentally want to be physically close to their peers,” says Capanna-Hodge.
Kids of all ages will be challenged by physical distancing guidelines and – just like adults – might even be afraid to be next to other kids. “While rejoining their peers is super exciting for most kids, some may have a level of panic,” says Capanna-Hodge. “They might even have Re-Entry Panic Syndrome and parents need to support their child’s anxiety at the emotional, behavioral, and social level.”
Kids may also have a harder time connecting socially with other children in large group activities, as they lost the rhythm of playing with others, especially if they weren’t interacting with siblings at home. It will be important for parents and teachers to prepare children for returning to play on playgrounds and group sports, Capanna-Hodge suggests. “That means talking about what that activity looks like and maybe practicing before they rejoin to help ease worries or simply help them re-engage.”
“The best thing parents can do is to be connected with their children through activities and conversations and watch for those behavioral signs of emotional distress,” says Capanna-Hodge.
How Tech Helps with Connection
Right now, the only connection kids – and adults – have to others is via technology, so parents need to feel okay about letting their kids use their technology more than they normally do, Capanna-Hodge suggests. “The need to be socially connected trumps worries about too much technology right now. Parents can lessen their concerns by setting an example of a balanced approach of technology usage and time doing physical activities, as well as insisting kids join them.”
If teens are just surfing the Internet and not interacting with their peers, then the research demonstrates that passive online usage like watching YouTube videos versus interacting online was linked to higher levels of depression.
While some older kids and teens might connect to friends through video games or social media messaging apps, you can help younger kids see their friends and extended family through Facebook Messenger Kids, JusTalk Kids, FaceTime, Zoom and Skype. Arrange “play dates” with younger children’s friends’ parents so they can chat and play together remotely during this crisis. It’s not a replacement for in-person quality time socializing with friends but it might help your child feel less lonely at times to connect this way.
As parents, we all want to help our children get the care they need to thrive. Being alert to shifts in behavior and demeanor is key, since you likely know your child better than almost anyone.
Talk to your child about their worries. “It’s important to listen and not ‘grill’ your child, so you can better understand what they are feeling,” says Capanna-Hodge. “Sometimes children’s worries are valid and other times it can be based on false information, so talking about it helps a parent to know what your kid is really feeling. For your child, their fears are real and they need support around them and some TLC from a parent can help to mitigate fears about the coronavirus.”
“Some signs are subtle, so don’t ignore changes in sleep, eating and refusal to play,” says Hafeez. And keep the conversations going, even if your children are young. “Spending quality time—even if it’s just a half hour a day—playing, eating dinner together, doing an activity outside of homework—allows children to communicate their thoughts, feelings› and events at school or otherwise.”
Taking time every day to do calming activities, such as meditation, yoga, or art helps children develop lifelong skills to manage their own stress, says Capanna-Hodge.
“When children have worries about the coronavirus or anything else where they are exhibiting behaviors that aren’t resolving, then seeking support from a licensed mental health provider is always a good idea,” she advises.
“Ultimately, children are very resilient and their mental health is largely tied to how we role model stress management,” Capanna-Hodge says. Children look to us to learn ways to not just cope with stress but how we view it. “If your role model a ‘glass half empty’ mentality and negative verbiage, your child is more likely to have difficulty managing stress.”
When you use positive language and show your kids not to sweat the small stuff – like a spotty Wi-Fi connection during a call — they learn to not be as affected by those small irritants in life, too. “That means that kids learn to build frustration tolerance and that will serve them in this crisis and throughout adulthood,” says Capanna-Hodge.
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