COVID-19 and the Mental Health of Children and Adolescents
By Monika Ghosh
Published November 18, 2020
Being moody, or clingy, throwing tantrums, or experiencing breakdowns are symptoms of declining mental health. How is COVID-19 affecting children and what can parents do about it?
Social distancing, online learning, and remote work have become our ‘new normal.’ These disruptions in our daily routine and lifestyles have been stressful for everyone, but for children and adolescents, the inception of online learning can be nerve-wracking and sometimes even traumatic.
Several studies have shown that children’s mental health has worsened since the pandemic started. but the way deteriorating mental health manifests varies from child to child. On top of this, a recent study claims that the pandemic will have longer-term adverse consequences for children and adolescents compared to adults.
A qualitative interview study of children in Italy indicated that most of the respondents struggled to cope with quarantine measures. Interviewees reported difficulty in adjusting to online learning. Over 43% of participants reported dietary changes and increased proclivity for junk food. 28% of the interviewees reported difficulty sleeping. 78% and 43.9% reported symptoms of anxiety and mood swings respectively.
Another survey, conducted in China, listed out the major psychological problems observed among children since onset of the pandemic. These included poor sleep, nightmares, lack of appetite, physical discomfort, agitation, inattentiveness, clinginess, and separation anxiety.
Outside of pandemic-specific studies, anxiety, depression, and lethargy are some commonly-reported manifestations of poor mental health among children. Some studies suggest mental problems can even weaken the immune systems of children. This, in turn, can make them more vulnerable to the virus.
The impact of lockdowns on children’s mental wellness
Before the pandemic, interpersonal socialization at school formed a significant part of children’s daily lives. The upending of this crucial routine has led to anxiety and uncertainty among them. Lockdowns have also given rise to a sense of isolation and insecurity among children and adolescents.
“Routines are important, especially for young children. It gives them a sense of self-control, self-confidence, independence, reduces power struggle, and helps them cope with transitions. It also supports their learning and development,” says Jasmine Yeo, Clinical Supervisor at Singapore-based online-to-offline counseling startup Safe Space.
“For older children, routines help to establish expectations. It also offers stability during times of change or stress, especially in adolescents where they go through multiple transitions,” she adds.
COVID-19 related disruptions in the day-to-day routine, therefore, are likely to be to blame for general increases in anxiety among children. A recent study attributed changes in children’s psychological conditions to the disruption in education, physical activities, and socialization.
Another study suggested that disruptions in routine can lead to boredom and a lack of innovative ideas in academic and extracurricular activities. Some children have become clingy, attention-seeking, and more dependent on their parents, the study reported.
“Some of these children might also experience anxieties and worries related to returning to school, missing school, and the future,” says Yeo.
“The uncertainty of the situation, not knowing how long the situation would last, missing out on key defining experiences in their school life such as prom [or] graduation, accepting that things may never go back to being the same again can be hard and scary [for children],” she adds.
All these effects have been manifesting in various ways amongst children.
“Children and adolescents can get more depressed or anxious during this disruption,” Yeo says. “This can manifest in physical forms such as increased irritability, externalizing behavior such as being more argumentative, more antagonistic, reassurance-seeking by persistently inquiring about COVID-19, or internalizing behaviors such as being more withdrawn and inattentive.”
Moreover, when schools shut down indefinitely, several adolescents reported anxiety and stress regarding the cancelation of exams and other academic events. In a poll conducted by a Hong Kong student counseling group in March, 20% of respondents reported maximum stress levels even before the examinations were postponed.
The survey quoted a 17-year-old Diploma of Secondary Education (DSE) student saying, “I have a huge wave of fear that I might contract the virus and thus cannot make it to the exams. Staying healthy has become another stressor.”
The toll of social distancing on children’s mental health
The Greek philosopher Aristotle wrote the famous words, “Man by nature is a social animal.” Humans have an innate need for social interaction. And the social distancing measures implemented across the world to curb the spread of the virus have been difficult to adjust to, especially for children and adolescents. It has been especially challenging for children to cope with when family members, caregivers, or close relatives were infected.
“Children tend to be rather adaptable to new norms and new rules, more so than adults in fact,” Yeo says. However, she goes on to elaborate that younger children “… might not understand the need for remaining apart from their caregiver. This might affect their attachment security and be clingy or more emotional in the process.”
Amid the pandemic, older children are more susceptible to feelings of sadness, fear of death or parents’ death, and the dread of being isolated, says Yeo.
But most importantly, the mental health of children under quarantine is especially fragile and vulnerable. Due to separation from parents or primary caregivers, they may experience severe stress and anxiety. According to Yeo, there is an increased likelihood of PTSD symptoms in children who are quarantined. Overall, studies point to increased levels of distress, worry, and anxiety, she says.
The impact of COVID-19 on mental health of children with pre-existing mental health conditions
Children with special educational needs like autism and other pre-existing mental health conditions have felt the impact of COVID-19 most prominently.
For instance, children with depression may have struggled to go to school prior to the pandemic. But with schools shut, symptoms of depression can easily become amplified. Some children are isolating themselves, refusing to eat, shower, or socialize for weeks, according to Zanonia Chiu, a registered clinical psychologist working with children and adolescents in Hong Kong.
On the other hand, children with autism, attention deficit hyperactivity disorder (ADHD), cerebral palsy, learning disability, developmental delays, and other behavioral and emotional difficulties can become frustrated and short-tempered with disruptions in their routine. The conditions can also lead to outbursts of temper, and cause conflict between parents and adolescents.
“If these children and adolescents used schools as a means of a distraction, a way of coping or a safe space where they feel good about themselves, the lockdown has definitely affected them,” Yeo says. “The lockdown can also affect them more if [their] home is the source of their distress and disharmony.”
COVID-19 era mental wellness in underprivileged children
It is important to bear in mind that children with abusive family dynamics may suffer from disproportionately worsening mental health in the absence of outside contact. With friends and teachers physically out of reach, they may find it difficult to cope, raise objections, report abuse, or seek help. According to UNICEF, children are at heightened risk of exploitation, violence, and abuse amid the pandemic.
“Children and adolescents from disadvantaged backgrounds can face overcrowding issues in their house, [be] exposed to more violence or witness [more] conflicts which can affect their overall mental health,” says Yeo.
On the other hand, children from poor families face more stress and have access to fewer resources, including requisite Internet connections for online education. Amid a struggle to maintain daily routines – and in many families, to get food on the table – providing access to education and intellectually stimulating children in the absence of school is exponentially more difficult.
How has overexposure to technology impacted mental health among children and adolescents?
Technology was indispensable even prior to the pandemic. But with lockdowns and social distancing, they are now our primary source of contact with the outside world. Children are not only using mobile phones, laptops, tablets, or computers for attending classes but also to maintain social relationships. This has led to a drastic increase in screen time and exposure to the Internet, social media, and technology.
Moreover, children who spent over seven hours a day looking at screens experienced thinning of the brain’s cortex – the area of the brain that is related to critical thinking and reasoning, the study also found.
Because of being confined at home, children are increasingly turning to the Internet for entertainment and socialization. This increase in exposure to the Internet and social media has increased the tendency to use the Internet compulsively.
Besides, since parents may not be around all the time, children are likely to access objectionable content and expose themselves to cyberbullying, sexual predators, or other abuse. All this contributes to deteriorating mental health.
According to the American Academy of Child and Adolescent Psychiatry, exposure to violent TV shows, movies, video games, and music can desensitize children to the gravity of such things. This means that such children could be more likely to resort to violence to solve their own issues, as they imitate what they see.
The above notwithstanding, Yeo adds that prolonged screen time, though necessitated by the times, is “only detrimental when children engage in screen time at the expense of outdoor play or social interaction with their family members or friends, [which] affects their social skills or development.”
“However, using technology to communicate with others or to carry out lessons is not likely to have the same adverse effects [provided] they take frequent breaks to rest their eyes from staring at the screen,” she adds.
How parents can ensure the mental well-being of children
Yeo recommends a few ways in which parents can ensure the mental well-being of children and adolescents amidst the pandemic.
Social interaction is the key to mental health. Therefore, Yeo suggests caregivers and close relatives, even those who are infected, remain in touch with children and adolescents through video calls and online games.
To protect children from the adverse effects of overexposure to technology, Yeo suggests parental controls, monitoring, and supervision. Setting boundaries around screen time can help limit and curate the content they are exposed to, she says. Besides, Yeo recommends co-viewing content to increase dialogue and discussions between parents and children.
Moreover, parents could focus more on “what to do rather than what not to do,” says Yeo. “Keep the line of communication and conversation open,” she adds.
Yeo recommends activities that promote family bonding and interaction like family cookouts or board games. Parents can try doing a home improvement project, baking, or cooking as a family bonding exercise. These activities are the best way for parents to stay connected with their children and understand what they are going through, she says.
To assuage fears of going back to school, Yeo recommends having honest and open discussions and being sensitive rather than dismissive.
“Name their fears to tame their fears. Help them identify their concerns or worries. Listen, validate their feelings, stay factual, and help them problem-solve. Focus on the things they might look forward to or might go well,” says Yeo.
In the end, it is important for parents to ensure a healthy lifestyle for their kids, even amid the lockdowns. Children and adolescents should, therefore, try to follow a reasonable routine. Yeo recommends activities that channel kids’ energy creatively like art, music, writing a story, and dancing. Doing a home improvement project together, baking, cooking as a family, writing a story.
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