Report: Depression, mental health in children worsened during pandemic

Depression, mental health in children worsened during pandemic

Anxiety and depression are increasing among children, and it’s not just the pandemic causing the uptick.

According to the State of the World’s Children report published by UNICEF, more than 40% of children ages 10-19 across the globe suffer from a mental health illness. In the United States, depression among 12- to 17-year-olds has increased from 8.5% to 13.2% in the past 12 months.

The White House also reported earlier this month that emergency department visits among children with moderate to severe anxiety and depression increased in 2020. During that year, there was a 24% increase in emergency room visits for mental health reasons in children ages 5 to 11 and a more than 30% increase among 12- to 17-year-olds. Suicide, alarmingly, remains the second leading cause of death among people ages 10 to 24.

The problem has increased so much that school districts have taken advantage of House Bill 323, which provides funding to place licensed mental health therapists directly inside the schools.

“These issues have risen significantly since the onset of COVID-19. I believe these numbers are higher since many kids likely do not get diagnosed if they are not taken to a professional,” said Whitney Hebbert, clinical director of Meadowbrook Counseling of Utah and clinical director of Utah Ketamine Therapies in Provo. “In addition to the pandemic, life is much faster paced today and very competitive. This puts a lot of pressure on children to excel and be successful.”

Hebbert said many children are involved in numerous activities and don’t get enough time to just be a kid. She said another contributor to increasing anxiety and depression is the high use of electronics.

“Kids can learn so much online and can understand more at a younger age, but that doesn’t mean they can handle more in life or the big feelings they have,” she said. “Many adults tend to expect more from children when they appear to be smarter or more capable. That can also add more stress to kids.”

Hebbert added that screen time means kids are playing less outside and with parents, siblings and friends. That can have an effect on their mental and emotional health if they are not getting the social engagement they need to thrive.

Natalie Sergent, a licensed psychologist with Intermountain Primary Children’s Medical Center, said by the time she sees children for a mental illness, they are having pretty bad symptoms. She also said she has seen an increase with the pandemic, but agrees there are other combinations as well.

“A big driver is kids are now exposed to a lot more adult topics and issues than in the past,” Sergent said. “Social media and internet kids are learning about news due to online presence. They’re just exposed more and more to real world stuff.”

Not only are more children suffering from anxiety and depression, they’re suffering from other mental illnesses like obsessive compulsive disorder and bipolar disorder.

“OCD is a commonly seen disorder and it can vary widely,” Sergent said. “Some people will count and check things over and over. Other people will worry excessively and ask for reassurance.”

Other OCD symptoms include fear of contamination, a need for order and symmetry, religious obsessions, lucky and unlucky numbers, fear of harming oneself or relatives, and sexual or aggressive thoughts, Hebbert said.

AAP: Healthy relationships can help offset toxic stress

Healthy relationships can help offset toxic stress

Toxic stress can have lifelong negative effects. A new policy statement from the American Academy of Pediatrics (AAP) examines how healthy relationships may serve as a buffer.

It isn’t enough to try and prevent traumatic events in childhood. Supporting healthy growth also means helping children identify stable and supportive relationships in their life. These relationships can buffer bad experiences and promote resiliency, according to a recent policy statement from the American Academy of Pediatrics (AAP).

The policy statement updates previous data on the lifelong effects of toxic stress in children with information on the value of a nurturing relationship with at least 1 stable adult.

“Childhood toxic stress is a public health crisis that demands an integrated public health response. With a social isolating pandemic, a widening of disparities, and a reckoning with centuries of systemic racism, the concept of toxic stress has never been more relevant,” said Andrew Garner, MD, PhD, FAAP, a pediatrician from Westlake, Ohio, and clinical professor of pediatrics at Case Western Reserve University in Cleveland.

Garner, a member of the AAP committee that developed the report, explained that toxic stress can permanently remodel a child’s brain at the cellular level, resulting in behavioral changes that become biologically embedded. Addressing these stresses is 1 step to helping children at risk, but Garner said the policy focuses on what pediatricians can do to be proactive.

“Toxic stress is a deficits-based model in that it defines the problem. Toxic stress explains how many of our society’s most intractable problems—disparities in health, education and economic stability—are rooted in our shared biology but divergent experiences and opportunities,” he explained. “Conversely, relational health is a strengths-based model in that it defines the solution. Relational health explains how the individual, family, and community capacities that support the development and maintenance of safe, stable, and nurturing relationships also buffer adversity and build resilience across the life course.”

In 2012, the AAP outlined the dangers of toxic stresses—early childhood experiences that become biologically embedded and impact life-long development—in a policy statement. The recent policy statement updates the lessons from that report, focusing on how relational health can be used to buffer and support growth and resiliency in spite of toxic stress.1

Toxic stress refers to a wide range of childhood experiences that have physical, behavioral, and even cellular impacts on a developing child. Many of these experiences are the result of relationship challenges like the lack of a nurturing support system, and things like homelessness or insecurity over food and housing. These stresses can damage the entire trajectory of a child’s life, according to the policy statement, and may be to blame for some of the most challenging disparities that develop in adulthood.

The statement outlines new research that suggests that positive childhood experiences can have a protective effect against toxic stress, even working to reverse the effects of damaging experiences.

Safe, stable, and nurturing relationships are key to promoting relational health, according to the paper, because they not only buffer toxic stresses but they also help build resiliency. The policy statement therefore advocates for a new focus on not just preventing toxic stress, but also on promoting relational health.

“Promoting relational health and preventing toxic stress are 2 sides of the same coin. Toxic stress is a deficits-based model that describes what goes wrong in the absence of nurturing relationships,” Garner wrote in a summary of the new policy statement for AAP.2 “Conversely, relational health is a strengths-based model that describes what goes right when children are afforded safe, stable, and nurturing relationships and positive early experiences.”

Building relational health is a process that can take at least 2 generations, he added, noting that it takes multiple layers of family and community effort to support a child’s emotional needs. When a child’s support system functions in “survival mode” because of their own stresses, they aren’t able to provide a positive childhood experience or a background of supportive relational health for future generations.

“Understanding that process allows us to see how many ‘adult-onset’ diseases are actually ‘adult-manifest’ diseases with their origins in childhood,” he added.

Addressing these issues, which Garner called a public health crisis, requires both vertically and horizontally integrated efforts. Vertical efforts are rooted in a public health approach that supports stable relationships throughout childhood. Horizontal efforts can include policy and societal changes designed to support families and community health.

Garner said pediatricians are uniquely positioned to universally promote relational health; identify and address potential barriers to relational health; and utilize the common factors approach and refer to evidence-based therapies when relationships are strained. Some examples of universal promotions include educating parents about development, promoting lots of developmentally appropriate play, and supporting emotional intelligence by helping kids tap into their passions when distressed or bored.

“Potential barriers to relational health that the pediatrician might identify and address include: parental adversity as a child; parental mental illness or substance abuse; or the child’s exposure to poverty, violence, or racism,” Garner added. “Attachment and Biobehavioral Catch-up, Parent Child Interaction Therapy, and Child Parent Psychotherapy are all evidence-based interventions to support relational health, and pediatricians are well placed to advocate for the local development of these services.”

According to the report, another challenge is the fact that our society as a whole is moving toward increased division and social isolation, leading to even more barriers to the formation of stable, healthy relationships that can support relational health. AAP is working to develop practices and policies that can help support healthy relationships despite these challenges. A few starting points that have been identifies include:

  • Support nurturing relationships. This is a core function of the family-centered pediatric medical home and a focus of the statement. How to promote relational health in families is a hot topic in pediatric research, and pediatric primary practices may be the perfect place to focus intervention efforts.
  • Reduce external stress on families. Addressing family stressors such as financial circumstances or ill family members—even in adult members who are not normally included in the pediatric care spectrum—can go a long way toward overcoming barriers that increase toxic stress and make it more difficult to promote relational health. Clinicians can suggest programs that could help either ameliorate or solve such stress points.
  • Strengthen core life skills. Offering support for core life skills like executive function and self-regulation is something pediatricians are used to doing for children, but not other members of their families. Including parents and caregivers in these efforts by doing things like providing education on basic child-rearing and the importance of establishing daily routines.

How to help ease your child's fears and anxiety about returning to class

How to help ease your child’s fears and anxiety about returning to class

“Asking your kid things like, ‘What was the most challenging part of your day, what was the best part of your day, what do you need help with tomorrow,” Sell said. “It gives them opportunities and prompts them to express what’s going on inside of them.”

Dr. Sell says children who are anxious about school tend to procrastinate, may begin fighting with parents over doing homework and often have problems sleeping.

To begin helping them, it’s important for both parents and teachers to recognize more of those typical warning signs, such as a disengaged child.

“Someone who might be tying their shoes too long and might not want to participate in reading or math,” Sell said. “Or a chatty person because those are all types of disengagement.”

Some of these things may sound familiar because we tend to do the same, but we have to remember that a child isn’t yet equipped to handle the same problems as adults.

“We allow ourselves maybe the freedom and opportunity to call into work if we don’t want to go,” Dr. Sell says. “But our kids, when they don’t want to go we say, ‘You have to go.’ We’re pushing them to do something they don’t want to do, which is OK, but if it’s bigger than that, then we have a problem.”

Here are Dr. Sell’s top six tips to help keep the stress at bay so you and your child can have a successful school year:

Tip #1: Keep a consistent sleep-wake schedule even on the weekends

Well before the start of the school year, you should be transitioning away from staying up late and sleeping in. A child and teen’s body relies on adequate sleep to maintain alertness and the ability to retain new information. Many times parents allow their children to change their sleep habits on the weekend which negatively impacts their sleep for the following week. Stay consistent with their schedule and with your own.

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Tip #4: Take the heat off of grades

Parents, did you know that your child’s grades in elementary, middle and even high school do not define the potential of the person they will become. Too often I hear parents pushing their kids to get A’s and take advanced placement courses when they really aren’t necessary. Don’t pay your kids for grades, instead pay attention to your kids. Have evening talks about the best parts of the day, the challenges they are having and what they are looking forward to instead of only worrying about grades.

“Look at things like resiliency.” Dr. Sell says, “How is your kid bouncing back from a poor grade on a test? How are they doing how are they emotionally doing, how can they do better to prepare. that type of thing.”

Tip #5: Don’t overcommit

Kids need breaks too. If you have them signed up for every single after school activity, you are likely just introducing stress on the entire family. Instead pick one or two things to participate in for the entire year. That will reduce your kids stress load as well, and reduce your own.

Tip #6: Don’t be a hypocrite

Yes, you are the adult, but you are also setting the example for your kids. If you expect them to put their electronics down, eat differently before bed and have a set bedtime and wake time, you do the same. Instead of arguing about why you can do it differently, do it with them. Ultimately it will help your sleep too.

Remember, kids feed off of your emotional energy, so If we’re stressed, they’ll be stressed; and Dr. Sell says the best way to help them is to stay calm ourselves.

“We are way better at maintaining these things for our kids then we are for ourselves, but if we’re all happy and healthy, chances of that emotional problem keeping in is going to be less.”

Children’s brains on stress

Children’s brains on stress

Gabriel was always an “angsty” child, his mother, Camille, remembers. This story also appeared in The Seattle Times As a toddler, he was bright and curious — by nine months he was intuitive enough to test out the strength of a cardboard box before climbing onto it. But he cried easily and was quick to anger. During fits, he’d swing his head back so violently that Camille considered buying him a helmet.

His mother didn’t understand his emotional outbursts, so when Camille heard about a research study on stress and its biological and social roots in kids Gabriel’s age, she enrolled him. For the past 12 or so years, Gabriel, now 15, has visited the University of Washington for a battery of biological and psychological tests. Just before the pandemic, researchers scanned his brain using a magnetic resonance imaging machine. (The Seattle Times is using only Camille and Gabriel’s first names to protect their privacy.)

The researchers studying Gabriel and hundreds of other Puget Sound-area families knew that early-life stress can have long-term consequences for mental health, which in turn can have profound effects on a child’s ability to learn in school. But what, exactly, happens to kids’ brains?

Answering that question became even more urgent when the pandemic hit, and the daily lives of so many children and teens were suddenly plagued by stress. Adolescents are generally more prone to anxiety and depression, but an unusually high number — more than half — were reporting these symptoms around six months into the pandemic, the researchers found. Their latest findings on depression and anxiety, published this month, are a dire signal that the pandemic’s toll is steep, and they hold lessons for parents and teachers navigating an unpredictable path back to in-person learning.

Among the timely solutions the researchers have identified: having a structured daily routine and limiting passive screen time during the pandemic protects kids against depression and anxiety. Research is clear on the link between mental health and academics. Kids struggling with fears or having trouble regulating their emotions are more likely to experience challenges in school. The researchers’ work may prove invaluable to families — but also to teachers, who are rushing to understand how the pandemic might affect children’s learning and academic success.

At the start of the pandemic, the news was all bad, all the time. George Floyd was murdered by police, and social uprisings ensued. Schools were closed, and friends and teachers — typical buffers against the consequences of stress — all but disappeared. Liliana Lengua, UW’s Maritz Family Foundation Professor of Psychology, focuses on trauma / stress and its impacts on youth brain development and social / emotional /mental health outcomes.

This is the therapy I wish I knew about when I had cancer

This is the therapy I wish I knew about when I had cancer

I laughed as I told a friend about my cancer diagnosis, “No worries, I am not freaking out.” I naively tried to deny any stress at the time. It was 2002 and I was desperately trying not to overreact to the “big C” that had cut my mother and grandmother’s lives short. They died long before anyone knew about the BRCA gene. Now I knew that I carried this gene that makes breast cancer up to 70 percent more likely and increases vulnerability to recurrence and other types of cancer.

Mika on managing stress, practicing mindfulness

April 30, 201902:01

Nonetheless, I decided that worry wasn’t going to rule me. On some level, I assumed that if I let myself acknowledge any anxiety or fear, I’d be overwhelmed like a terrified, depressed patient I treated as she coped with cancer.

As a psychoanalyst for over 30 years, I wanted to prove to myself and everyone else that I could handle what was happening. I did not want to face being thrown off balance, gripped by the strong emotions that left so many of my patients feeling out of control.

While I initially tried to deny how I felt, there was no avoiding my anxious middle-of-the-night worries about the future. Could I continue to work? Would I be weak and needy? Or see my children grow to adulthood? My guilt seemed unescapable. As a parent my job was to keep my children safe. It was hard to shake the feelings of sadness and responsibility that I may have passed the BRCA gene to them. I was unsure of myself.

My professional competence working with children and their families felt beside the point as I faced talking to my own children about chemotherapy, a lumpectomy, a 12-hour bilateral mastectomy and oophorectomy (removal of ovaries). How could I keep their trust and be honest about my long-term risks and their potential vulnerability? My normal self-assurance was nowhere to be found. Was I doing this right?

At the time I didn’t know constructive ways to deal with the stresses of cancer. I wish I had!

I’ve now spent the last 20 years expanding my views and writing a book about how to effectively cope with the social and emotional sides of the disease, called “Coping with Cancer – DBT Skills to Manage Your Emotions and Balance Uncertainty with Hope.” Breast cancer survivor Elizabeth Cohn Stuntz applies the tactics of dialectical behavior therapy (DBT), developed by Dr. Marsha Linehan, to the unique challenges of cancer for the first time.The Guilford Press My co-author, Zen master Dr. Marsha Linehan, developed Dialectical Behavior Therapy (DBT) in […]

Five ways you can help ease kids’ stress from the last year

Five ways you can help ease kids’ stress from the last year

Parents, especially moms, have been stressed during the past year and that stress can trickle down to children , impacting behavior and health . And while policies and programs that lessen stressors can help, some child development experts say there are also simple things caregivers can do to mitigate some of pandemic’s impact on children, especially when it comes to isolation or trauma. Most kids will be fine even after facing stress, said Stephanie Jones, a professor of education at the Harvard Graduate School of Education and faculty co-director of the school’s Saul Zaentz Early Education Initiative. But, “there are very subtle things that can maintain equilibrium that keeps children going.”

Here are some of those main suggestions from experts:

  1. Be responsive: When a baby cries or babbles or a toddler says a few words and the caregiver responds back in a “loving, supportive” way, “the baby’s brain is literally being strengthened,” said Rahil Briggs, national director of HealthySteps, a pediatric care program. That includes things like paying attention to what the child is focused on, acknowledging what a child is doing and giving children opportunities to respond. The ability to do this “serve and return” type of interaction is especially important during the first three years during the peak of brain development; but it can be harder for caregivers dealing with their own stress, depression or trauma, which is why supporting caregivers is so important, Briggs added. While there’s no magic number of minutes caregivers should aim for when interacting with their children in this purposeful way, Briggs said caregivers should look for simple ways to add in “language-rich” moments, like narrating their daily activities, reading books and singing songs. Caregivers can start with just five minutes each day and work up to longer time periods.
  1. Share information: Being transparent with kids, at an appropriate level for their age, can lessen anxiety kids may feel — especially as restrictions lift and schools reopen. “What children do in absence of information is they fill in the gaps with their imagination,” said Shalyn Bravens, who directs several early childhood and family programs for United Way for Greater Austin. “They fill it in with the worst-case scenario.” Bravens said it’s normal to see some regression, especially in kids from birth to age five, when there are transitions approaching. But talking through these changes can help. “Explain what’s going on,” Bravens said. “What’s really stressful for kids is not knowing what’s going on.” Parent-coaching programs like Bright by Text and home-visiting can be especially helpful for parents to get support with this, she added. Keeping solid routines can also be critical, said Jones of Harvard, so children know what to expect in the face of changes and stress.
  2. Help children share their feelings: Children tend to express their emotions through actions and behavior, which may not always be safe or constructive, said Donna Housman, founder and CEO of the Housman Institute, which focuses on emotional intelligence. “What we want to do is re-channel that into words,” she said. Helping children name their emotions, including anger, sadness or fear, and giving them language to express their feelings can help children process and regulate those emotions. “There will be a time when the adult or parent isn’t present and we want our children to have these skills so that they can do this on their own and feel strong and secure.” This could be especially important as children go back to group care and feel separation anxiety, said Linda Smith, director of the Bipartisan Policy Center’s early childhood initiative.