No in-person school. Isolation from friends. Lost rites of passage like graduation ceremonies. The COVID-19 pandemic upended the lives of many children in the United States.
“A lot of children’s joy comes from being with friends or from play, and from social interaction. When you ask kids, ‘What's making you happy?’ 90% of the time, it’s being around friends or doing things with friends,” says Elena Mikalsen, head of the Psychology Section at The Children's Hospital of San Antonio in Texas. “That was kind of taken away during the pandemic. … For the longest time, all kids had was the academics and no joy.”
A recent report finds that the uncertainty and disruption caused by COVID-19 has negatively affected the emotional and mental health of about one-third of America’s youth. So much so that the American Academy of Pediatrics (AAP), along with other children’s health organizations, has declared a national emergency in child and adolescent mental health.
“Elevated symptoms of anxiety, depression or stress,” says Nirmita Panchal, a senior policy analyst at the Kaiser Family Foundation (KFF), a nonprofit organization focusing on national health issues. “There's also been a number of changes in behavior that parents have reported with some children having a poor appetite and difficulty sleeping. For others, it may be fear or irritability and clinginess.”
Panchal co-authored the report which found that, prior to the pandemic, 8% of children between the ages of 3 and 17 had anxiety. That number rose to 13% among adolescents ages 12 to 17.
“During the pandemic, children, just like everybody else, have experienced a number of changes and disruptions,” Panchal says. “That includes school closures, possibly financial difficulties at home, isolation, perhaps the loss of loved ones and then difficulty accessing health care. So, all of these factors may be contributing to increased mental health issues among children.”
Rates of children’s mental health concerns and suicide steadily increased between 2010 and 2020, according to the AAP, which says the pandemic has made the crisis worse with “dramatic increases” in the number of young people visiting hospital emergency rooms for mental health-related concerns, including possible suicide attempts.
Maryland psychologist Mary Karapetian Alvord says uncertainty, as well as losing out on school activities, provoked varying levels of grief in young people.
“Particularly high school students, who really lost out on all of the fun activities, the fun clubs, and also graduations and homecoming, football games and all the social as well as the outlets that they have,” says Alvord, who is also an adjunct associate professor of psychiatry at The George Washington University School of Medicine. “So, those are themes that have dominated this pandemic, I think, grief, loss on all those different levels, and then just constant uncertainty. And we then get a rise in anxiety.”
Alvord says the young people being seen at her practice have a sense that they’re not moving forward, which has led to anger, frustration, sadness and anxiety.
“It runs the gamut, but kids have lost time,” she says. “They have a sense that they have lost time, and not in terms of only maybe some academic skills, which a lot of the schools are concerned about, but in terms of maturity. How do you mature as a kid? It's not by being home 24/7.”
And while children missed being in school with their friends, the idea of returning to in-person classes also triggered some anxiety.
“Some kids were scared to go back to school because they were afraid of contracting COVID. They were afraid of what school might look like and what that would entail, especially kids that already were more predispositioned to have anxiety or depression,” says psychologist Nekeshia Hammond, former president of the Florida Psychological Association. “It basically made that process a lot more stressful. And not just school but going back into social situations.”
The pandemic has shaken the sense of safety most children feel. More than 140,000 children in the United States lost a primary and/or secondary caregiver to COVID-19.
“The majority of kids just have this innocence, in a way, that the world is safe. ‘I'm going to be OK. People are here to protect me,’” Hammond says. “And that got stripped away for a lot of kids who don't feel the world is safe.”
Children of color have been disproportionately impacted by the losses caused by the pandemic. And not solely because they were more likely to lose a loved one to the virus.
Mikalsen, who works primarily with minority youth and inner-city youth in Texas, found that many of the children she spoke to were forced to use their smartphones for their schooling because they didn't have computers at home. Spotty internet connections made it difficult to stay in touch with their schoolwork and to get their assignments.
Some of Mikalsen's young patients were home alone all day because their parents are essential, front-line workers.
“A lot of the kids that I was talking to during the pandemic, they were completely alone at home, left to be there by themselves and, ‘Hey, if you can get connected to school, that'd be great, but if you don't, no big deal,’” Mikalsen says. “So many kids that I talked to, they just slept all day and had nobody to talk to. Things like that can really cause a lot of depression and anxiety.”
And then there was the societal upheaval caused by the police murder of George Floyd, a 46-year-old Black man in Minneapolis. Video of police officer Derek Chauvin pressing his knee into Floyd’s neck while Floyd struggled to breathe went viral, sparking nationwide protests against police brutality.
“All of that affects kids of color in a different way, on top of a global pandemic, on top of, ‘You can't go to school, and you lost a loved one.’ It was basically more compounded,” Hammond says. “There were so many different stressors all at one time, which made it extremely difficult as far as coping, and as far as mental health.”
The AAP is calling for more federal funding for mental health screenings and treatment for all children from infancy through adolescence, with an emphasis on making certain kids from less privileged homes get the services they need.
“We don't want to wait until it's unmanageable. We want to have scaffolding and services in place to catch kids when they're having that much trouble,” Alvord says. “We're all tied to one another, and if your family is doing better, then those kids get sent to school and they're doing better in school. Which helps the whole health of the classroom. Which helps the teachers do better to teach and do what they need to, instead of having to deal with the mental health crisis.”