Kids, COVID-19, and Mental Health
Since the dawning of our 24 hour news cycle, researchers have been studying the effects of major disasters on children, including those whose only experience occurred remotely through news or social media. Common patterns of both short term reactions and longer term outcomes have been identified, leading to recommendations for how to handle these events and what symptoms may indicate the need for therapeutic intervention. In this article, we’ll explore how these reactions, recommendations, and danger signs relate to our kids, COVID-19, and mental health.
Summary
Common reactions to traumatic events like denial, fear, and reflection can be healthy.
Handling traumatic events by staying adequately informed and cautiously optimistic helps kids handle traumatic events well.
Dangerous reactions to traumatic events like drastic changes in sleep, weight, or outlook should be taken seriously and acted on immediately.
Common Reactions to Traumatic Events
Disasters are, unfortunately, an unavoidable part of life. While most adults have been accustomed to this, children may be experiencing this kind of situation for the first time and may have a more difficult time wrapping their heads around it. Below is a list of the most common reactions to trauma in healthy kids who have not been directly affected by the event. These signs are generally not a cause for concern, and we should expect to see these throughout the COVID-19 pandemic. Please note that these are the most common reactions, but there are many other healthy responses which are not on this list.
Denial. Denial is the most common, initial response to news of a crisis among children, adolescents, and adults. We can see this in statements like, “I can’t believe it!” and “No way… are you sure?” This is self-protective and perfectly healthy. Since the COVID-19 saga is not a single event and continues to unfold, it's likely we'll still see this response to new developments. However, a fraction of people will take this approach further and specifically avoid referring to or talking about the news for a time. This can also be a healthy initial response, unless it becomes prolonged.
Processing. “What if everyone got sick and we never went to school again?!” People have different ways of processing, or making sense of, a crisis. Young kids will fantasize about and even develop games or jokes around issues like COVID-19. Nightmares and replaying recent related memories are also common. Even if these reactions seem trivial, it helps to validate the child’s expressions and not dismiss them as distracting or irreverent.
Fear. Processing an event like COVID-19 will (and should!) arouse fear. Trauma-specific fears are common — eg, fear of illness, hospitalization, isolation — and children may express these fears verbally or, more commonly, in behaviors, such as an over-reaction to a cut finger or a scraped knee. Some kids may express this through nightmares or insomnia or through creative outlets like art or play. Often, these fears are temporary and are usually part of a healthy reaction to a crisis. Understanding and reassurance are the best responses when kids express fear.
Comfort. As the COVID-19 crisis and it’s associated fear continues to evolve, kids will turn to various sources for comfort, usually ones they’ve used before. They may engage in repetitive behaviors or insist more strongly on usual daily routines. Teenagers may seek a “reason” or some controlling “force” behind the pandemic. It is best to give kids space to find comfort in whatever way works best for them. If they’ve already developed negative patterns of coping with stress (eg, playing video games all night), this may be a good time to introduce some new stress management techniques.
Reflection. Adolescents and older kids who have a greater capacity to understand this crisis may change their attitudes about people, life, and the future. These attitudes usually don’t lead to mental illness or Posttraumatic Stress Disorder (PTSD), but are often persistent and have a long term impact on the person’s general impression of the world which may be negative. Kids and teenagers will soon be entering a post-COVID-19 world, and they’re going to think differently about it than we have thought about ours. It is important not to alienate them by dismissing or invalidating their opinions. Try to defend against helplessness, which can lead to depression, anxiety, and later mental health issues. Engaging them in realistic conversation and providing an underlying sense of hope may help them work out their opinions and guide future attitudes.
Tips to Handle Traumatic Events
Below are a few guidelines that may help reinforce a positive, healthy reaction to a stressful event like COVID-19. Please note that there are many forms of “healthy” response and many ways to get there, so even if you do not utilize any of the strategies below, your child may be just fine.
Model a Positive Response. All children respond to stress based on the way their parents or other trusted adults respond. In a crisis like COVID-19, one of the most stressful elements is uncertainty, which is unfortunately all too available in our 24 hour news feeds. The healthiest way to handle uncertainty is to moderate our reaction to the information we have and maintain an attitude of cautious optimism.
Limit Exposure to Media Coverage. Studies have shown that children who have been exposed to the most media coverage of disasters tend to be the ones who later have the most difficulties. There may be many mitigating factors, of course, and this is not universally true. Nevertheless, it's not helpful to expose children to overly graphic images or media reports that continuously repeat the same message without adding new information. In general, this is not helpful for people of any age. Young children, in particular, however, may misunderstand what they are seeing or hearing and may be needlessly frightened. Limit information to what they actually need to know to be safe, such as appropriate contact precautions.
Don’t Push Discussion. “Are you okay? Are you feeling worried or anxious?” These questions are sure to make someone feel worried or anxious. It is important to be available if your kids want to talk, of course, but there is no need to push them into discussions they are not ready to have. Besides, if they sense your anxiety, they may just tell you what they think you want to hear — which, ironically, isn’t what you want to hear. Feelings are abstract, and discussion of them is difficult for many kids. They may prefer nonverbal forms of expression and will usually find a way to tell us what we need to know, if we know how to “listen.” It is best to allow them to direct the conversation about how afraid they are or aren’t.
Maintain Normal Routines. Furloughs, working from home, schedule changes, empty shelves at the grocery store… the effects of COVID-19 are no doubt a challenge for all of us. Some changes is unavoidable, but most individuals stay healthiest when they can maintain their daily rhythms as much as possible. Do your best to establish the routines and habits that make the most sense for your family. Preferably, as soon as possible, before your teenager is sleeping from 3 to 3.
Dangerous Reactions to Traumatic Events
This list includes signs that almost always indicate a need for clinical intervention; it's by no means comprehensive. As a parent or caregiver, you may notice signs that are equally alarming, even if they are not listed below.
Change in Outlook. Persistent pessimism about the future, a “premonition” or expectation of early death, preoccupation with death, significant depression, or a general sense of hopelessness are not common and should be viewed with concern. Similarly, suicidal thoughts, violent thoughts, and substance abuse should always be taken seriously. Seek professional help right away.
Change in Sleep or Weight. If your child experiences persistent insomnia (more than 1 or 2 weeks) or recurring/frequent nightmares (more than 1 or 2 months), this may indicate a need for clinical intervention. Also, any major increase or decrease in appetite/weight is likely a sign of difficulty. Of course, eating and sleeping habits are bound to change as schedules change, but major fluctuations — more than 5-10 pounds in a child and more than 10-20 pounds in an adolescent — are concerning.
Dramatic Drop in Grades. There is likely to be some change in your child’s usual grades during this abrupt transition from face-to-face learning to a virtual classroom. However, a dramatic drop is usually a sign of major distress. For example, a B-student dropping to C-student might be okay from a trauma perspective, but a B-student dropping to an F-student is most likely a problem.
Obsessive-Compulsive Symptoms. Given the COVID-19 recommendations for intensive contact precautions, a child predisposed to Obsessive-Compulsive Disorder (OCD) will likely not know where to stop and is likely to take these to an extreme. Although it may be difficult for all of us now to differentiate between appropriate and “excessive” precautions, if you think your child may have OCD, it is best to seek treatment as early as possible.
If you notice any of the above danger signs or if you have specific concerns about yourself or your child, please talk to your provider or feel free to schedule a 30 minute consultation by phone or video consultation. Questions or comments? Let me know!
Sources:
Media Coverage of Traumatic Events: Research on Effects, by Jessica Hamblen, PhD. Dart Center for Journalism and Trauma (dartcenter.org). Quoted from National Center for PTSD, Department of Veterans Affairs (ptsd.va.gov).
Large-Group Preventive Treatment Techniques for Use After Disaster, by Lenore C. Terr MD found in Chapter 5 of Responding to Disaster: A Guide for Mental Healths Professionals, edited by Linda S. Austin MD. Washington DC: American Psychiatric Press, Inc., 1995
Children’s Thinking in the Wake of Challenger, by Lenore C. Terr, MD; Daniel A. Bloch, PhD; Beat A. Michel, MD; Hong Shi, MS; John A. Reinhardt, PhD.; and SuzAnne Metayer. Am J Psychiatry. 1997 Jun; 154(6): 744-51.
Childhood Traumas: An Outline and Overview, by Lenore C Terr MD. Am J. Psychiatry. 1991 Jan; 148(1): 10-20.
