Welcome to the second free issue this week addressing family mental health. In this issue I ran some questions from readers about their kids’ anxiety, isolation and uncertainty by three experts:
Carlin Barnes, MD is a double Board certified and licensed child, adolescent and adult psychiatrist in Houston (and mom of one) whose 20-year career is spurred by a passion for delivering care to special populations.
Marketa Wills, MD, the CMO of Johns Hopkins Healthcare, is a board-certified psychiatrist in Florida who serves as a physician leader in a provider-led managed care organization. She and Barnes are the co-founders of Healthy Mind MDs, LLC, a wellness enterprise whose mission is to improve the emotional and mental well-being of all Americans.
Emily W. King, PhD, PLLC is a licensed psychologist and health services provider in private practice in Raleigh, North Carolina. A mom of two boys, she has nearly 20 years of experience working with children and adolescents with anxiety, depression, ADHD, and autism spectrum disorders.
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"How can I recognize when kids of all ages are struggling? Most five-year-olds are not going to say, ‘My anxiety levels are high right now.’ Also, how should parents, other caregivers, and educators prepare for the amount of trauma our kids will re-enter the world with?
Drs. Barnes and Wills (B&W:) Youth (both kids and teens) who are experiencing emotional difficulties are likely to show problems in the following areas:
Changes in their routines or habits (e.g. sleeping too much or too little, eating too much or too little).
Regression of milestone developments (e.g. return of "baby talk in younger kids, separation anxiety, or bed-wetting).
School difficulties including school refusal, behavior problems at school, or decline in grades.
Social isolation or social withdrawal from family and friends.
Irritability and/or increased aggression.
Kids experiencing clinical anxiety or a clinical mood disorder may display excessive worrying, poor sleep patterns, persistently sad mood, elevated or low mood, problems with concentration, increased impulsivity, and/or increased irritability.
There are both short and long term negative mental health consequences of traumatic experiences such as pandemics. In our book, "Understanding Mental Illness: A Comprehensive Guide to Mental Health Disorders for Family and Friends", we discuss the negative effect of traumatic experiences on the developing brain. Given this information, it is imperative that parents, caregivers, and educators are able to provide early identification and intervention for youth who experience pandemic-related emotional difficulties.
Emily King (E.K.) We need to increase communication between our homes and wherever our kids are going, whether it’s daycare or back to school. Every child is experiencing something a little different: logistically, teachers who have an incoming class of kids want to know your home life and family and what you're into. Explain your child's sensitivities to teachers, maybe something comforting that you have figured out that works for them. Everything that used to go through our minds, when our kids started school for the first time ever—we need to get back to baseline with that.
A silver lining is that some older kids who are shy to speak up in class or have anxious social anxiety have been rocking it with sending emails to their teachers. We need to be more open about the good, bad and ugly and what we expect coming through. I hope globally we can recognize this is a year that everyone's just doing their best. They're a whole year older, there's so much development that’s happened that we can’t expect teachers to even know our kids like they did when they left. They’re going to have to get to know everyone again and the kids will have to get to know their schools again.
“I’m worried about how the pandemic is making existing disparities worse. We’re already dealing with a lot of intergenerational hardship and I’m really concerned about widening achievement gaps in addition to general wellness.”
B&W: The COVID-19 pandemic has shone a light on complex health and racial disparities. To move the needle towards solutions, we need to address issues such as social determinants of health, inequities in educational systems, lack of uniform access to affordable, quality, culturally-affirming healthcare, and systemic poverty. [Ed: note: see Tuesday’s issue on using activism as a way to any counteract post-inaugural depression and ennui.]
“Where is the line between ‘normal’ separation anxiety and anxiety that I'm supposed to do something about? Is that line different in a pandemic? And if we are over that line, what is the ‘do something’? Do I go to therapy or does my 4 year old?”
E.K. My threshold about therapy for a child is how much functioning is impaired. That’s relevant to all of us: as an adult, you ask, am I in bed all day, am I having trouble getting to work, am I spacing out during the day, am I not showing up in the spaces in my life I usually do, am I not caring about things I used to care about? It’s tricky because we’ve got to redefine what we’ve been caring about. If we have access to being grateful and seeing a silver lining, that means we’re adapting.
If a parent feels they have their own stuff that’s getting in the way of staying regulated and calm to help their child, then you’d need therapy for yourself to work through your own stuff. If you're realizing your kid is triggering you in a way that's not their fault, that may be something for you to work on so you may have more emotional stamina in those moments.
At the preschool age, a child may be super duper clingy, more so than usual—but do the parents still get them to separate and play with friends or be with a family member? Or does it affect play, sleep, food and toileting? Those are our kids’ jobs. If this anxiety impacts their social physical emotional development, that would be when to seek out help.
A play therapist can work with a four year old and help them connect to their feelings. In neurotypical kids, that is the earliest we’d start therapy, although I work I work a lot with children on the autism spectrum, and with them I start even young on engagement and play skills. With school age kids, what's going on with them socially or academically? If their emotions or anxiety is derailing them to develop or connect, then it’s time to seek help.
However, moodiness can ebb and flow and be so appropriate for a child’s age. If there’s a health need (again, toileting, food, sleep, that kind of stuff) going on for several weeks or a month, we’d think about seeking help. With emotional stuff sometimes it’s a season. Sometimes it’s a growth spurt and it’ll even out. If they’re not functionally impaired, they’re still playing/sleeping but they’re moody or seem emotional, wait several months.
“How can a parent encountering what they perceive to be an anxiety attack in their child for the first time identify it and how can they help their child?”
E.K.: Anxiety attacks typically have physical symptoms, characteristics like temperature changes, the child feeling hot, any type of shaking or hands trembling, or a fast heartbeat. Some older kids can look like they’re fine but be feeling these physical symptoms so it’ll be important to check in on how their body is feeling if they appear to have an attack. If that's happening, drastically reduce or take out any pressure that is happening in that moment because usually when we are in a panic attack it’s the same as a fight or flight or freeze response. No learning can happen, not much talking can happen. Just remind your child that they’re safe and you will sit with them until they feel better. If they’re little, say, “I'll sit with you until your feelings are smaller and we can talk about it.” Some kids like to be touched or snuggled and hugged and some do not.
“How can I help my adolescent kids stay socially connected while physically isolated—and manage them when they chafe at the boundaries of social distancing?”
B&W: Keeping your adolescent socially connected while implementing physical distancing measures is very important. Here are some ways that parents can help to ensure that your teen stays socially engaged during the pandemic.
Encourage your teen to use video platforms to virtually visit with friends and family.
Schedule quality family time activities (e.g. family walks or bike rides, game nights, movie nights).
Consider a safe "social bubble" to include a few friends who are practicing safety measures.
Help your teen to plan or participate in socially distanced drive-by events.
Suggest participation in virtual concerts, comedy shows, movie nights that will also be attended by their friends.
Support, encourage, and allow your teen time to connect with others.
Developmentally, it is typical for adolescents to have a "nothing bad will happen to me" mindset. If your teen is testing the boundaries regarding social distancing, discuss your concerns in a non-judgmental manner. Encourage your teen to visit sites like the CDC to learn information about safety measures for teens and young adults. In some cases, your teen's resistance regarding compliance with social distancing could be a sign of more serious pandemic-related issues such as anxiety, loneliness, or extreme social isolation. We suggest seeking help from a qualified mental health provider in such cases.
E.K.: I’ve seen this pendulum swing during the pandemic; we used to think of screen time as good or bad, but now screens are everywhere. We have all jumped in the deep end, because there’s no choice: school is on a screen, social is on a screen. We have to figure out teaching our kids all the different ways we interact on screen and all the boundaries of how that make us feel.
I’m in my 40s; the biggest thing is that we didn’t grow up with screens and we’re teaching them how to use them. We Instagram-scroll before we realize “I’m tired.” We’ll need to have kids realize, “How do you feel after you've been talking to your friend for 30 minute vs. mindlessly scrolling Youtube or Instagram for an hour? Does that make you feel better? Does that make you feel disconnected?” When we can get back in person it’s going to feel better and we’ve got to figure out how we feel in real life vs. how we feel online. We've forgotten how good it feels to be with friends in person and laugh with friends in person.
Some parents have set rules for their teens that fall in place if the more general rules are not followed. A lot of families are challenged to work on their honesty and trust with their teens. They're not necessarily being difficult; they're just trying to socialize. They're being teens. It doesn't surprise me that right now kids think “I can see my friends at the park and nothing will happen if I don’t tell my mom.” Some parents have figured out that if there's a significant other or a best friend, it’s worth it to get in each other's bubbles as long as the families talk about openly about following the same rules the same way.
“What are parents of 2E children and/or children with ADHD telling you about what their kids are struggling with during the pandemic and how do they cope?”
E.K.: The main thing with kids with ADHD or sometimes autism or 2E (when they’re really gifted but they have a learning disability) is that regarding any differences in executive function, organization, attention, regulation while they’re learning—it’s really hard to do on a screen. Kids with ADHD are impulsive and the computer is so distracting for them. I'd remind these kids who are feeling like they were doing OK in person and that this is not the way they learn best is to validate them: “This is COVID school. This is not regular school. This will not be forever.” I want kids and parents and teachers to talk about what is working and what is not working so that when we go back they can discuss where they need more support. I know a child who used to have a strategy down for remembering to turn in his work. It was a physical piece of paper, and he had a system. None of that is physical or tangible this year so we've had multiple students saying “I don't remember if I clicked ‘submit.’ I don’t know where that goes,” because they can’t feel it or see it. Other kids I work with benefit from that physical check in, a teacher noticing that they’re off task in class and losing focus and offering support. Teachers are struggling to notice if a kid is off track now. They can’t see them, and they're at a disadvantage. I want kids to remember that this is temporary.
"So many of my kids’ sad outbursts comes from them saying things like, ‘I just want this to be OVER,’ and, ‘When this is OVER,’ etc. How do I manage their expectations about when that will be or what it will look like?”
B&W: It is important for parents to validate these feelings of frustration and sadness. Allowing your kids the space to express their negative feelings about this public health crisis will help them cope and manage their emotions and expectations. There are many uncertainties regarding the novel coronavirus pandemic. Be honest with your kids when you do not have the answers for important questions. The American Academy of Child & Adolescent Psychiatry is an excellent resource for helping parents talk to kids about the pandemic.
E.K.: Talk to kids about the baby steps we’re seeing: the vaccine being approved, the vaccines getting into arms, the inauguration, just 2021 beginning. No, nothing magically changed, but time is moving, and we are getting closer to this being over. But time is so different for them. I challenge parents to think about how time felt to us as kids: summer used to feel like forever.
Kids are used to us knowing the answers. If they break a bone, they know we can’t fix their arm but we know where to take them. They’re looking to us for answers, but we don’t know either! To help them, we need them to trust that we’ll keep them safe. This is why parent mental health is so important. We’re all having to maintain our sanity to be good models for kids. This is the ultimate challenge.
End credits
I’m sending all of you and your kiddos big virtual hugs.
Thank you for reading Evil Witches, a newsletter for people who happen to be mothers. If you have any questions, ideas, suggested topics or questions about submissions, you can reply right to this email. You can follow Evil Witches via Instagram or Twitter. Some future upcoming (lighter) topics include how to pull off an actually fun Zoom party/shower and tips from a thrifty, clever friend of mine who can put any random outlier pantry/freezer ingredient to good use. Got something in your kitchen that you can’t figure out what to do with but don’t want to throw away? Email me and I’ll try to stump her.
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