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Children's Mental Health and the Pandemic

We have all changed because of the pandemic. Our children are no exception.

Key points

  • Children living through the pandemic are experiencing mental health disturbances at high levels.
  • Traditional forms of intervention, namely individual therapy sessions, may not be appropriate for every young client.
  • Parental and school involvement is critical in addressing the crisis of children's mental health head-on.
  • For children struggling to stay connected in online sessions, family therapy can be a valuable alternative.

Most of what is written about the emotional stresses of the pandemic focuses on adults; as a therapist who sees both children and adults, I think about the kids. Not only have they have suffered in their own unique ways during the pandemic, but they also suffer downstream effects of their parents’ strain during this time.

Surveys from pediatricians and child psychologists regularly document the special strain felt by children; these issues are showing up in my own practice, as well. The reports of added difficulty in school because of online classes; separation from peers and social anxiety, poor focus, and mental exhaustion; and loss of social skills. Collectively, this is what we might call a pandemic of mental health issues for children.

Defining the problems

In my practice, I have seen a number of things with my child clients:

Isolation. Kids who have transitioned to a new school because of a geographic move, or after they graduate from elementary school to middle school, have impoverished opportunities to meet and mingle with their peers. This results in isolation: an “imprisonment” in their home—even a good and loving home—where they are constrained to being with their parents or siblings day in and day out. The lessons we learn about the benefits of privacy—not the least of which is simply how to be alone—are going unlearned. Social media and screens only compound the problem.

Bullying. Online bullying was on the rise before the pandemic; now, without the respite of in-person peer interaction, online bullying (particularly via social media) is more common than many realize. These attacks often happen without the parents’ knowledge because their children, who may be deeply ashamed, try to keep things to themselves to avoid further shaming. We also see this with LGBTQ children, who are more prone to bullying in normal times. They are probably at even greater risk during the pandemic.

Stress. What we are seeing is an exacerbation in the children in what my colleague Jeffrey Taxman has called PTSE: Pandemic Trauma and Stress Experience. Taxman makes the point that, unlike PTSD, this is not a pathological condition; PTSE is a response to the ongoing stresses the pandemic imposes on all of us. Because children have immature coping mechanisms and ego development, they are less equipped to cope with the isolation, the sameness of daily experience, and the lack of social stimulation. This can manifest in a stress response that snowballs into other issues like depression or anxiety.

Pandemic fatigue. Most of all, children are poorly equipped to deal with the uncertainties of the pandemic era. Lacking the developmental stimulation of teachers, sports, peers, neighbors, and the daily practice of social interactions, children have less developed skills in dealing with pandemic problems. Children do not have the social or emotional experience to grapple with changing rules, constraints, and vaccination updates—much less politically charged messages that obfuscate how to see and evaluate threat. The same fears and uncertainties we all feel are being faced by children as well. The result is everything we see in ourselves but often more so: lethargy, foggy-headedness, lack of focus, and general malaise.

Parental neglect (or, at least, distraction). Some families do a wonderful job of protecting their children from the anxieties that attend the changing situations and recommendations—but many of these parents are also overwhelmed, anxious, and depressed themselves. Some may be out of work or have to work around the clock from home as the boundaries between work and home life dissolve. And, of course, many families face the stress of having to go to work in dangerously exposed times, or of having lost jobs and facing poverty or even homelessness.

Even in the most loving of families, economic uncertainties can leave kids feeling anxious, depressed, or even suicidal. Some experience an uptick of eating disorders, borne of the isolation and increased desperation to control something—anything—within their environment.

Addressing the problems

The reports keep coming: kids in crisis, colleagues swamped with more referrals than they can manage, and school counselors seeing more and more distressed children in their offices. What can be done?

In the “before times," therapy would have been my go-to answer—but nowadays, seeing children therapeutically online can only be one piece of the puzzle. Most of my adult patients do well with online therapy, but children are much more variable. Some do well, incorporating the online technology into their playful interaction with their therapist; if they are older, they may be able to speak more or less as well as they would in the office. Other children do not do well online. When distressed or even bored, they might simply wander off, turn off their camera, or just end the call. Others struggle focusing or responding to questions and are too disengaged to interact meaningfully.

What can we do in this situation? We need to do the best we can to figure this out because we can now see that fluctuations in the course of the pandemic are going to be with us for a long time, probably only gradually receding over a long trajectory. I can offer three suggestions:

Family therapy. With the children who seem difficult to treat online, I have moved to family therapy regularly. I have long been a proponent of family therapy as a good treatment for many children, but now I am having to invoke it when I might have preferred to see a child individually; parents seem to anchor the child to the here and now in a way that makes our sessions more valuable. For challenging child clients, this is a good option while we wait for a time when in-room therapy feels safer.

Parental involvement. Secondly, it is time to involve parents even more than usual in the care and management of their children. Parents need to be vigilant in engaging with their children in a meaningful way, even if it’s just cooking dinner together or going for a short walk after school. And, it goes without saying that parents must be checking in about their own emotional needs and seeking mental health counseling to diffuse the stress of this inherently stressful age.

Schools and care agency involvement. Finally, we are all in this together during this time of prolonged stress: this chronic Pandemic Trauma and Stress Experience that we share with our patients. School counseling programs must be used—and funded—to their fullest extent, and NGOs that work with kids should put children’s mental health front and center in their mission statements (if they haven’t already). The more third-party partners we can bring in, the more support we can leverage for each child. While we may need to be inventive and persistent in offering care to children in need, together we can hope for better times that will make our more traditional ways of offering therapy available once again.

To find a therapist, please visit the Psychology Today Therapy Directory.

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