Dr Pradipta Majumder, Child Psychiatrist, Site Medical Director, WellSpan- Philhaven- Meadowlands York, Pennsylvania, US, focusses on the evaluation and treatment of childhood behavioural disorders such as ADHD, oppositional defiant disorder, anxiety, depression, bipolar disorder, PTSD, psychosis, and Autism spectrum disorder.
The COVID-19 pandemic has proved, in a short period, that the virus is not only affecting the human body but also playing tricks on the human mind directly or indirectly. However, the research on this topic is still developing. While the immediate effect is visible, the longer-term consequences are yet to unfold. Nevertheless, this virus has changed the world that we knew.
The ongoing lockdown is a big transition for everyone, necessitating each of us to make a variable degree of adjustments in our lives. This ‘adjustment’, by definition, is stress. Billions of children are out of school or childcare, and many without any access to age-appropriate activities that can keep them busy. Keeping children active at home can be challenging, especially for families with limited support. Most of the schools are closed and have changed to online classes. The kids cannot go outside, cannot meet their friends, and they are utterly bored and isolated at home. Whereas, the parents are under tremendous stress that impacts their capacity to parent the children effectively. Some have lost jobs; others are worried about losing one. Some are getting infected, others are worrying about it, and some are experiencing losses of a near and dear one. There is also significant financial stress associated with the recession. Those who are fortunate to be able to work from home are not living a comfortable life either. Many are working from home while taking care of the kids who cannot go to the daycare or school or cannot be left with anyone else. There is no doubt that the increasing parenting stress is making them vulnerable to display anger and frustration on children or even towards their spouses. Research has shown that the risk of child abuse and domestic violence increases during such health-related emergencies. Greater difficulty in obtaining mental health and other medical services are also making the situation worse.
How are kids responding to the change?
For many children, the lockdown started as an early summer vacation, but soon they realised that this staycation is not even close to the summer break. Many children have nothing to do at home and are indulging in playing video games or spending too much time on their phones. The social isolation related to COVID-19 pandemic is a significant risk factor for depression, suicidal thoughts, alcohol, and drug use. An increasing number of children without any history of behavioral disorders are showing signs of irritability, boredom, anxiety, depression, stress, fear, worry, and various other negative feelings. During the previous SARS pandemic, there was an increase in suicide and anxiety in certain age groups. Many children with pre-existing emotional and behavioural health issues are experiencing an upsurge in their behavioural symptoms. Kids who are more prone to the effect of this transition are children with autism spectrum disorder, anxiety, depression, and a variety of other behavioral conditions. Children with anxiety and depression are getting more anxious, worrying about what if they or their loved and dear ones get affected by this deadly virus. Children with attention deficit hyperactivity disorder (ADHD) are also showing uncontrolled behaviour. There is an increase in hyperactivity, acting out behaviour, and tantrum outbursts making it challenging for parents to address.
Recommended coping strategies
First of all, the following are simple guidelines. Every family is unique, and each family has its own way of dealing with stress. Mental health professionals can recommend various strategies for families to follow.
- We cannot treat a child without paying due attention to the adults in the house. Strategies such as mindfulness, meditation can be helpful for the parents as well. Treatment should help parents to be mindful of their own emotions.
- Recommend to maintain normalcy as much as possible while following social distancing. One of the ways to maintain normalcy is to help families maintain a routine, such as getting up at their usual time, exercise, getting dressed before starting office work/ school work.
- Recommend and encourage parents to attend to their children’s questions, answering them in a developmentally appropriate language. It is not recommended that children be overwhelmed with the flow of information coming from every direction such as television, newspaper but, at the same time, parents also should not lie to their children by merely saying that everything is alright. One of the essential strategies is to provide the information that they can process.
- Professionals should assist the families in embracing the change. Change is life, and if we resist, the challenge persists. Radical acceptance of the changed situation and working on their problem- solving skills could be one of the good ways to cope with the stress.
- Recommend that the family members use this time to strengthen family bonding. It is quite apparent that the lockdown has brought families together. Professionals can encourage families to spend time together and get involved in various activities. Such activities can be as simple as playing board games such as UNO, chess, monopoly etc. Other ideas could be that parents learn newer games from their children. Recommending family movie nights, watching movies with inspiring stories, reading inspiring story books, or biographies and sharing with the whole family can also be other good ideas to strengthen the bonding. Watching movies on Zombie apocalypse or on conspiracy theories or other sad or scary stories are possibly not a good idea at this time.
- Mental health professionals should recommend that the families maintain ties with the outside world through various means such as Facetime/ video chatting with friends, and extended families. Arranging virtual playdates for children with their friends can be a good idea that can help children coping with boredom.
- Recommend to practice relaxations, meditation, progressive muscle relaxation can be crucial to manage anxiety and stress. Other coping skills can be other simple things such as singing, dancing, listening to music, praying to God depending upon the faith.
- We should also help families not to panic. One of the elements of preventing mass- hysteria is to limit social media, not to keep news channels on 24X7. One of the very important messages that we can give to the families we are working with is not to spread unverified and sensational information.
- Mental health professionals can engage in various problem-solving activities with their patients and families. One of the common concerns that we hear is parental stress related to children being at home 24X7. We can recommend that if parents feel overwhelmed, they should take turns and share the responsibility with their spouses.
- Mental health professionals should also spend time educating the families regarding medication compliance or compliance to various psychotherapy during the time of quarantine.
COVID-19 is not the first or the last pandemic that the human race is going to face. We do have experience in managing pandemic situations, and history can show us the path. The pandemic may feel like growing up in war-time. Fortunately, children are resilient; the human race is extremely adaptable and has survived so many natural disasters. This phase will pass, too if we continue doing the right things at the right moments.