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Pandemic Isolation Taking Toll on Kids’ Mental Health

Humans are social beings. History teaches us that even the early nomads moved together in tribes, finding strength, safety and security in numbers. We are wired for togetherness.

So what happens when we can’t be together? What does it do to our psyche when we can’t feel the warm hug of a loved one, experience the affirming smile of a teacher or get carried away with laughter while hanging with friends?

Over the past year we’ve lived a human experiment of virtual togetherness. While technology has certainly helped bridge some of the pandemic-induced connection gap, it has proven to be an inadequate replacement for the type of in-person interaction that breeds community—one that only exists in a 3-D world where a room full of people bustles with energy, engagement, relationship and life. As necessary as device-based interaction has been this year, one fact remains. Even in a virtual world, you’re still virtually isolated in a room all alone.

“I think, initially, social media took the place of one-on-one engagement and it was fun and nice to play with,” said Kathleen Powderly, M.D., a pediatrician at Cook Children’s Pediatrics Magnolia. “But as things went along, kids realized they’re not interacting or doing a lot of things so there’s not much to post. If you’re not going to the mall or playing baseball or not hanging out with friends, there’s not a lot to snap and share. So, all of a sudden it becomes more isolating.”

There is a difference between solitude and loneliness. Spending time alone doing something you enjoy without interruption can refresh your mind and body. Solitude can be good for the soul.

But loneliness is a different beast. It’s fueled by a longing to relate, engage and feel significance. It can cloud your point of reference for identity and your ability to discover and define your purpose. This past year, many children have spiraled into loneliness as their daily routines and social support frameworks of school, sports and time with friends came to a screeching halt. They miss the stability of predictability and the social outlets where they find common ground with others. They miss their tribe.

“Kids will usually tell me they miss school,” said Lisa Elliott, Ph.D, manager of the behavioral health clinic at Cook Children’s. “And I know what they are saying is they are missing two things—socialization and structure—because school is where they get both of those. Kids do well with structure, and now there is none.”

Kids In Crisis

The pandemic has been particularly impactful on adolescents.

“The normal developmental process for children entering the middle school years is to move away from their family,” Dr. Powderly said. “They’re starting to engage with non-parental adults and other peers their age in an independent fashion. As parents and teachers we are supposed to be supporters of them as they start to expand their world, but this pandemic basically said, ‘No. We’re not going to do that right now.’”

And the result is devastating.

Stress, anxiety, depression and feelings of hopelessness in children have emerged as a byproduct of COVID-19 restrictions. Between April and October of last year, at a time when most were avoiding the emergency department (ED) as much as possible, a significantly larger proportion of children that did visit the ED did so for emergency mental health intervention, according to the Centers for Disease Control and Prevention (CDC).

“I would say that, compared to last year, I have certainly experienced and seen a significant rise in the number of patients reporting anxiety, depression and even suicidal thoughts,” said Vida Amin, M.D., medical director of Cook Children’s Neighborhood Clinics. “I can estimate that I’ve seen at least a double to possibly triple increased rate of some degree of anxiety and depression among my patients. It sounds staggering and alarming to say that aloud, but truly nowadays it seems I’m more surprised if they don’t screen positive for anxiety and depression than if they do.”

Even more alarming, Cook Children’s Medical Center saw a tragic spike in children attempting suicide in late 2020. In January, 40 children were treated for suicide attempts, marking the worst month on record since at least 2015. A new record of 43 was set last month. The average age of these patients is 14.

It’s impossible to pinpoint one reason for a child’s suicide contemplation or attempt, as a number of internal and external factors may be at play. In some cases, COVID-19 has exacerbated problems already there. But, experts warn that the isolation generated by the pandemic is a breeding ground for depression, anxiety and suicide.

“Isolation is a huge driver, and it definitely makes other life stressors more complicated,” said Dayo Jolayemi, LCSW, a Cook Children’s Neighborhood Clinic family therapist. “It’s important to remember that, in addition to isolation, kids and teens have gone through traumatic experiences and big losses, and they are grieving. For them, activities like participating in sports, having birthday parties and going out with friends are a big deal and important milestones. Not getting to have those experiences is a loss, too.”

The Pandemic Plight

The issue is multi-faceted, according to Elliott.

Kids who have previous struggles with mental health are spiraling deeper into depression because access to their usual resources have been restricted. Children living in toxic home environments are feeling trapped and without a lifeline. High-performing students with lofty dreams are anxious because their ability to meet their goals in preparation for college have been stunted. Children without any previous struggle with anxiety or depression see no end to the pandemic or COVID-19 restrictions in sight and are feeling hopeless.

For those returning to school and other activities, pandemic isolation is giving way to social anxiety. Children have missed a year of social and emotional development where they learn to send, receive and fine tune social cues and skills. Teen members of Cook Children’s Youth Advisory Council shared in a recent meeting that kids emerging from isolation are struggling with feelings of awkwardness, insecurity and uneasiness as they readjust to engaging with friends in person.

“Having connection with others their own age allows children to learn social skills like sharing, communication and managing conflict,” said Traci Cocetti, LPC, a Cook Children’s Neighborhood Clinic family therapist. “These peer-to-peer connections allow kids to practice important social skills and build a level of confidence and independence. When that need for connection is not met, it can lead to lower self-esteem and feelings of depression. We know from research that social isolation in teens is one of the strongest predictors of suicidal contemplation.”

Hopeless to Hopeful

A child’s ability to cope is a matter of perspective and resilience, or lack thereof, according to Cook Children’s experts.

“Adults have reference points throughout their lifetime where they’ve gone through something for a period of time and then things get better,” Dr. Powderly said. “Adolescents don’t have as many of those points of reference to apply to our current circumstance. This leads to feelings of hopelessness that this is never going to end.”

Resilience is the ability to look for hope, regulate emotions and problem solve. These skills are driven by the frontal lobe function of the brain, which isn’t fully developed until the age of 25. That, coupled with a lack of experience bouncing back from a crisis, is why kids are reeling with mental and emotional stress right now, according to Elliott.

It’s important that parents and other caregivers take note of kids’ mental and emotional health, and bridge the gap between hopeless and hopeful for children in crisis. We do not have to be at the mercy of COVID-19 when it comes to protecting the mental health of our youth. Attention to these needs in our youngest generation is as critical as mask wearing, hand washing and social distancing.

Bridging the Gap

There are a number of ways parents and caregivers can monitor and help protect a child’s mental health. These can be done proactivity to help prevent issues and are useful supportive tools if you are waiting to see a therapist.

Pay attention. Children don’t always speak up when stress or isolation start taking a toll, so caregivers and parents can look to behavior for clues, Jolayemi cautions. Look for changes in patterns that are normal for your child. If your child stops doing something they otherwise enjoyed and prioritized pre-pandemic, that’s a red flag.

Get together. Dr. Powderly suggests that parents be intentional about spending time together as a family, even if it’s just watching TV together. Gather for family meals or activities outside of the child’s usual isolation space. Creating “social pods” with people who maintain your family’s same safety standards is an ideal way to foster healthy and safe socialization, Elliott proposes. Ideas for socially safe gatherings with your pods include picnics, flying kites, outdoor scavenger hunts or an outside movie night.

Structure the day. Kids need structure and the stability it provides. Help your children set a daily schedule that includes waking up, getting dressed, doing school work in a designated space, taking a break to do something they enjoy, getting some exercise, eating and getting plenty of rest.

Talk it out. Elliott says adults must model resilience for children and assure them this crisis won’t last forever. Share your past hardships with your kids, and tell them how things got better to help frame and anchor their perspective. Make your home a safe place for sharing hurts and hopes, and listen to what your kids are telling you they need. Don’t be afraid to talk to your child about depression, anxiety and struggles with suicidal thoughts. Listen for cues like, “I just wish I wasn’t here anymore” or “I can’t deal with this anymore,” to assess their state of mind and understand the help they may need. Cocetti suggests talking to your kids while doing an activity. Kids may be more comfortable talking if they don’t feel like they’re being grilled. The car is a great place to talk as kids may be more open if you’re not looking directly at them or sitting right across from them.

Get creative. Help your child find ways to channel their time and energy into something they love. Dr. Powderly advises parents and kids to find one thing to enjoy every day and make it a priority. This gives kids something to look forward to and provides an outlet for stress release.

Take one day at a time. Dr. Powderly’s goal with patients in crisis is to focus on one good thing for one day at a time. Looking any further ahead can be overwhelming. Find the joy in one day and then do the same the next day and the next.

Reach out. When things get too heavy, don’t be afraid to seek help. Talk to your child’s doctor, teacher or school counselor. They can all point you to resources for help. If you sense that a child is in danger of harming themselves, take immediate action for emergency intervention.

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