The onset of the pandemic posed unprecedented challenges for everyone, especially the youngest members of our community. We talked with Dr. Whitney Herge, a pediatric psychologist at Scottish Rite for Children, about how the pandemic has changed the way we think about children’s mental health and what we can do to help our kids get through it.
What are some common misconceptions surrounding children’s mental health?
From my perspective, the most problematic misconception is the notion that children cannot experience genuine mental health concerns and, relatedly, that their mental health need not be taken seriously. This presents most acutely when youth express a desire to harm themselves or end their lives. Parents and caregivers sometimes express surprise or concern when their children are screened for mental health symptoms, including suicidality, in medical settings. Research indicates, however, that such screenings and assessments are critical. According to the 2016 National Survey of Children’s Health, approximately 7 percent of children aged 3 to 17 years have a diagnosed anxiety disorder. Similarly, approximately 3 percent of children aged 3 to 17 years meet criteria for depression. Furthermore, per the 2017 National Center for Health Statistics report, suicide was the second leading cause of death among youth and young adults aged 10 to 24 years. This indicates that youths’ mental health symptoms are not only real, they are prevalent and sometimes life threatening. Connecting children and adolescents in need with mental health support should be a priority for parents and caregivers, and this is especially true if a child may be at risk of harming themselves.
Many kids were struggling before the pandemic started. How are they faring now?
For many children and teens with mental health concerns, the pandemic has exacerbated their symptoms and possibly limited their access to intervention. Safety measures put in place to help control the spread of COVID-19 have resulted in significant changes to children’s daily lives, often including changes in their daily routine, participation in remote learning, and reduced socialization with friends and peers. Such changes have the potential to increase symptoms of social and school anxiety. Similarly, youth with preexisting anxiety related to overall health, germs, and/or contamination may have experienced an increase in their symptoms as they received confirming evidence that the world can indeed be a dangerous place. For youth with preexisting mood concerns, changes in daily schedules; disrupted health behaviors related to sleep, nutrition, and physical activity; reduced time with friends and peers; and decreased opportunities to engage in pleasant activities all have the potential to intensify symptoms. These changes also pose the risk for increased concentration and motivation difficulties, as well as increased feelings of boredom and irritability. Behavioral changes may also be evident, particularly in younger children.
What behavioral changes should parents watch out for?
In general, parents should look for changes in their children’s overall functioning. In younger children, symptoms of behavioral regression are often indicators of distress. For example, a child who is toilet trained suddenly having accidents again should be a warning sign to parents. Additionally, disruption in a young child’s sleeping or feeding routine, or increased fussiness, irritability, or behavioral acting out may be cause for concern. Increased difficulty separating from parents or caregivers may be another cue that a young child is struggling. With older children, parents and caregivers should attend to changes in a child or adolescent’s mood. If a child appears sad, down, moody, irritable, flat, or withdrawn, they may be struggling. Changes in sleeping habits and energy level (such as difficulty falling asleep, difficulty staying asleep, or sleeping more than usual) and eating habits (eating notably more or less than usual) are also warning signs of mental health difficulties. Withdrawal from social activities with family and friends or seemingly reduced interest in previously enjoyed activities are also clear indicators. Finally, if a child or adolescent ever expresses a wish to not be alive or a desire to harm themselves, an immediate mental health assessment may be required. Parents and caregivers should also be watchful for the development of any new, maladaptive coping strategies such as excessive technology use or alcohol and substance use. Behaviors that may put a youth’s safety at risk are a particularly clear indicator that mental health intervention is warranted.
In addition to straining teen mental reserves, the pandemic has strained the mental health profession. How are providers reaching kids in need?
The most significant change in the provision of mental health treatment has been the transition to telehealth, including care provided via videoconference and phone. Following the onset of COVID-19, Medicare, Medicaid, and private insurance companies, in conjunction with state and federal regulatory agencies, temporarily relaxed restrictions regarding telehealth, allowing many practitioners to pivot the way they deliver care to patients during the pandemic.
Telehealth has allowed mental health professionals to continue treating their patients in a safe manner, with patients typically participating in sessions from their home. Telehealth has also made intervention accessible for many patients new to therapy, who may previously have been impacted by factors such as a limited number of providers in their area, lack of transportation, or other logistical challenges such as provider schedule availability. Telehealth may represent a more appealing way to access care for those concerned with the potential stigma of visiting a mental health care office. Telehealth has also posed certain challenges. Most notably, a patient’s ability to participate in telehealth is dependent upon their access to technology. For patients with limited economic resources, telehealth may not be a viable treatment option, potentially leaving them vulnerable if their care is disrupted. Certain interventions, such as coaching parents through behavioral management techniques or providing intervention for children and teens on the autism spectrum may be difficult to deliver via telehealth.
What long-term consequences do you anticipate seeing in children and adolescents as a result of the pandemic?
It is difficult to predict the potential long-term consequences to youth mental health, in part due to the active rise of the COVID delta variant, reinstatement of certain safety restrictions, and overall uncertainty of the future. Generally, however, long-term outcomes will likely depend on a particular child’s age and current developmental stage. Young children may evidence sustained delays in their social skills due to limited opportunities to practice said skills with peers. This may include difficulty separating from caregivers, deficits in initiating and sustaining peer interactions, and challenges with back-and-forth social interactions and sharing.
Elementary-aged children may display prolonged irritability and behavioral difficulties as they navigate continuously shifting routines and expectations both at home and at school. Older children may show ongoing mood or anxiety symptoms, as well as grief for missed milestones such as birthdays, homecoming, prom, and graduation. Long-term mental health outcomes may also be indirectly influenced by other factors, such as the pandemic’s impact on a child’s community and their family’s financial and housing security. Certain vulnerable groups, such as youth with chronic medical conditions, youth without housing, or LGBTQ+ youth, may be particularly at risk for experiencing long-term symptoms.
What are some good practices to promote mental health for your family?
There are a variety of factors that contribute to an individual’s and a family’s mental health. General health behaviors, including sleep, nutrition, and physical activity, are critical pillars that support physical and mental health in both children and adults. Focusing on sleep hygiene, such as by adhering to a consistent sleep and wake schedule, discontinuing the use of electronics at least an hour prior to bed, and developing a calming evening routine, is very beneficial. Developing a consistent physical activity schedule is equally important and can be an enjoyable way to connect as a family. Attending to the family’s nutrition needs, such as meal planning, shopping, and cooking together, will help ensure youth receive adequate and appropriate nourishment to support their growth. Promoting engagement in safe hobbies, activities, and social activities is important in developing feelings of self-efficacy and social connection. Activities can vary widely, including individual hobbies (drawing, guitar), group activities (playing on a sports team, Scouts), and family and friend social events (hosting a dinner with neighbors, children inviting friends to sleep over). Finally, it is important to remember that children and adolescents learn, in part, by observing their caregivers’ behaviors. Parents and caregivers should model healthy mental health practices, as well as promote open discussion of emotions and model use of proactive coping skills, like positive reframing and relaxation. The most problematic misconception is the notion that children cannot experience genuine mental health concerns and, relatedly, that their mental health need not be taken seriously.