The physical impacts of the covid-19 pandemic were both visible and measurable, and thus, universally understood, appreciated, and perhaps even addressed. However, the invisible impacts went largely unnoticed and continue to linger and wreak havoc.
The pandemic brought together a confluence of unnatural events in the lives of children: Being cooped up indoors with no physical activity, an absence of peer interaction, and online learning to name a few. This coupled with familial stress and the general morbidity set in motion a silent mental health disaster. While the long-term effects on the mental health of children continue to be studied, a few glaring trends have come to light. What is emerging is that the pandemic has affected children differently across age groups.
Predictability and consistency in care is very critical for children who are less than six years of age. This helps them develop a sense of trust and safety and eventually allows them to function independently and have healthy boundaries. The pandemic created a fair share of overwhelmed and unavailable parents. Even though they were home, they were preoccupied with competing priorities like work, household chores, illness, and uncertainty. This inhibited their ability to be truly available for their children. ‘Care’ suddenly became less predictable. To compensate, children looked to attract parental attention. And in many cases the manifestation came in the form of regression. Children regressed on old habits and milestones they had achieved earlier. For example, bed wetting at night, losing toilet training habits, not eating by themselves or not changing their clothes without help or difficulty separating from their parents as they transitioned to school.
Several children became needy and clingy, many reacted to inconsistently available parents by becoming aloof. This was part of their coping mechanism. Many were also exposed to high levels of screen time at an age when this can play havoc with normal brain development. In cases where children had pre-existing developmental difficulties or cognitive delays, these deficits became larger and more concerning. Once normalcy resumed with school, many children caught up on their developmental journey. But many did not. The effects stayed and created delayed milestones and we are seeing this manifest in various forms—delayed language development, lack of social skills and difficulties in transitioning to school.
Children between 6 and 12 years need to feel protected and develop a sense of competence e.g. “I can do this!”, “I am good at this!”. Competence is achieved by succeeding in one or many areas which may be skill based (arts and sports), academics or social skills. This sense of competence allows a healthy self-esteem to develop, which is necessary to progress to the next stage of development—identity.
The pandemic robbed children of the opportunity to build these areas of competence—academic rigour took a back seat and there was no sports or social interaction. In fact, many children in this age group started playing the role of adults. If parents were busy, they took on the role of parenting their younger siblings, or in some cases tried to resolve marital conflict between their parents. Moreover, constant proximity with parents meant they were part of or overheard many more adult conversations than before. The need for competence building was being met by playing adult roles—what we call adultification.
What exacerbated this was un-regulated screen time, resulting in children consuming information that was age-inappropriate. School librarians are observing that readers have used the downtime during the lockdown to consume age-inappropriate content and moved on to books meant for older kids.
Over the long term, for children who are unable to regain this balance, there may be implications on substance use, problems of anger and emotional regulation, higher rates of depression, anxiety and eating disorders as they try to straddle concepts and difficulties beyond their age.
It is endearing to see your “mature kid” as reflection of good parenting. However, awareness that this does not always lead to positive outcomes is crucial.
Executive function is the brain’s ability to plan, organise and initiate tasks. Executive function is at the core of making choices and building the “skill” of self-regulation. Accountability structures like school, non-academic spaces, friends help build executive functioning skills of an adolescent and hence their ability to self-regulate. The pandemic stole this opportunity.
Adolescents stuck at home did not get a chance to build their executive functioning skills. Online schooling could not provide the rigor or discipline teens needed. During the lockdown there was no space for teens to learn how to do simple things like packing a bag, planning a day or figuring out what was an acceptable time to stay out till at a party. As executive function skills depleted self-regulation steadily fell. Binge-watching shows, poor sleep cycles were all a manifestation of this.
It is a difficult time to be a teenager. While the teenager has moved to a higher grade, the skills to cope with the increased academic pressure never developed. Adolescents and teachers are left holding the pieces. For teenagers in higher grades who have now gone to college there is an even greater loss. College systems, unlike school, are not designed to teach executive function and self-regulation. It is assumed you have already mastered these skills as you enter college. Executive function and self-regulation form the bedrock of adult roles. Being successful at work, managing a house, making healthy choices and controlling impulses by seeing the consequences of choices. Teenagers with poor executive functioning are more likely to indulge in high-risk behaviours, substance abuse and have unhealthy boundaries. Over the long term this leads to poor self-esteem and sense of self.
Mental health problems often have very miss-able symptoms. Which is why they are ignored. Parents must be vigilant and spend time listening to their children, observing out of character behaviour. If your child says “I don’t feel good about myself” or “I can’t concentrate in class” or “I am having thoughts that I can’t control” they may be asking for help. Children are sensitive. If they find that their concerns are not met or being dismissed, they may not reach out again for a long time. This, in many cases, complicates treatment and prolongs recovery.
Difficulties in children present themselves in different ways. Some common indicators (by age) are:
●Zero to six years: Delayed milestones of speech, reading, writing. Not playing with friends or being reluctant to go to school
●Six years to twelve years: Physical aggression (of any kind), significant academic difficulties (persistent feedback from school) or social isolation.
●Thirteen years to eighteen years: High risk behaviours, very few friends, extreme academic difficulties or self-harm (e.g. superficial cutting).
●Across age groups: Complaining of inexplicable body aches, have difficulty sleeping or performing repetitive rituals (e.g. handwashing, checking door locks at home).
These symptoms might emanate from biological or psychological difficulties and need to be referred to a professional for evaluation and treatment.
For children who are already receiving mental health care it is of vital importance that parents stay closely engaged with their provider. To understand their child’s struggles and the role they need to play as a supportive family.
The journey to healing can be slow and frustrating. But it is necessary. We may not have chosen to be a part of the pandemic, but we can choose to do something about its consequences.
A child and adolescent psychiatrist, Dr Pramit Rastogi is the Medical Director at STEPS Center for Mental Health and works extensively with families to help navigate child and teenage mental health struggles.