Coronavirus lockdown: Despondency in adults can quickly spread to their children in times like these, warns child psychiatrist
The mix of information and misinformation, and exaggerated fears of the situation, result in symptoms of anxiety of various kinds depending on the age of the child, warns child and adolescent psychiatrist Dr Amit Sen.
As the fear of COVID-19 and the lockdown that began on 25 March gripped the nation, the children found themselves on the sidelines of the narrative of the pandemic that focussed on the virus, the infection and mortality rates worldwide, the challenges to the medical infrastructure, and more. However, the fear of the pandemic and the lockdown have overpowered the young minds, as they are also more emotionally vulnerable, leading to high anxiety, aggression, mood swings, depression, and even Post Traumatic Stress Disorder.
According to the UNICEF, 99 percent of children, adolescents and young people under 18 worldwide have been suffering due to partial or full lockdown. Apart from the actual threat of the virus and the necessary difficulties imposed by the lockdown, millions of families across the country are dealing with the disturbed mental health of their children, all due to the pandemic.
This underscores the urgency of proper care of children in India. In an exclusive interview with Firstpost, child and adolescent psychiatrist and co-founder and director of Children First — a multi-disciplinary centre for mental healthcare solutions for young people — Dr Amit Sen discusses the symptoms of the impact of the pandemic on the mental health of children and measures to deal with the situation. Edited
What is the impact of COVID-19 on the mental health of children and adolescents? What are the symptoms parents should be on the lookout for?
There are different kinds of impacts, which can broadly be categorised into two. One is the immediate impact of the physical threat of the virus itself and the other is the impact of the breakdown of infrastructure.
Because of the immediate threat of the virus, children are confronted with questions about life and death, what is this virus all about, who will get affected, etc. There is genuine fear in the community, and children being more vulnerable, feel it more. It is especially true if the channels of communication are not filtered because children have access to a lot of social and digital media. The mix of information and misinformation, and exaggerated fears of the situation, result in symptoms of anxiety of various kinds depending on the age of the child.
This anxiety appears in the way children react/ respond to any kind of stress, or even simple things like keeping to a routine, keeping up with the academics, cleaning their room, or maintaining daily hygiene. These things tend to get affected as anxiety becomes severe, leading to symptoms such as reactive behaviour, mood swings, becoming rude and defiant, refusing to do what is expected of them, and so on.
The other impact is due to the breakdown of infrastructure. We had so far taken simple things for granted, such as — our daily routine, waking up in the morning with a certain purpose, going to school, recreation, family time, etc. These things give a sense of structure and contribute hugely to a deeper sense of security. But now, these structures, of predictability in life, have gone out of the window.
In the beginning of the lockdown, many kids were happy that schools had closed and there was no classwork or homework. But within a week or two, they started missing school, complained about not having anything to do or not getting homework, and got bored and restless. In older children, the absence of these day-to-day things has led to a sense of hopelessness and helplessness.
The other thing that gives children a sense of loss is that they can’t anymore do things that give them pleasure — like ordering food, going out to eat/ to cinema/ parks, hanging out with friends, etc. This loss of freedom to choose is more marked in children who are impatient and impulsive.
Besides anxiety, some children might even be getting into depression or beginning to show the effects of trauma. Many children nowadays complain about not just nightmares but having vivid dreams, which they can’t fathom. That happens usually in a trauma, a situation when an event has disrupted their lives in profound ways, when nothing seems familiar, or in control.
When trauma happens, there is acute anxiety, anticipatory anxiety of something may happen, constant scanning of the environment for something going wrong. Children usually become too vigilant in such times. Repeated watching of what’s happening can come back as flashbacks.
I would like to highlight that children often respond to a situation the way adults respond to a crisis. If adults begin to lose hope, children will absorb it like a sponge. It’s important for parents and adults to choose their reactions carefully.
What should they do to combat any negative impact?
It would be best for children to talk about their anxieties. Those who are able to do so are more fortunate because there is perhaps an atmosphere conducive to such conversation in the family and they have access to spaces that are supportive, allowing them to talk about their fears, anxieties, feelings, thoughts about COVID-19, etc. Such children are also in a better position to deal with the situation. Otherwise, it would show up not just in moods and behaviours but would also affect their sleep and eating patterns. They will go to sleep at 4-5 am and wake up at noon, and either they stop eating due to anxiety or start eating excessively for comfort.
In younger children, it could manifest in other behaviour such as crying very easily, having tantrums, and in more extreme cases, even bed-wetting.
Who are more vulnerable -- children, adolescents or young adults (YA)?
It depends on different age groups, as they have different challenges. Many YAs are stuck outside in colleges, universities or for work and couldn’t get back home due to lockdown. They are isolated and completely on their own. Some can’t even cook.
Adolescents, on the other hand, are now at home and have access to information better than younger children. Adolescence, anyway, is a stage of internal turmoil, relationship issues, mood swings, self-doubt, etc. Outwardly, adolescents appear stoic but carry a lot of vulnerability inside. Infrastructure such as family, institutions, recreation centres, etc. help adolescents go through this phase of turmoil but all that is gone now. As a result, inner turmoil has got aggravated.
Whereas, younger children, including infants, pick up everything from parents — their body language and feelings, conflicts, underlying tensions, heaviness in a family atmosphere, etc. — almost as if absorbing it from the air. If parents are able to contain their own anxieties, then children are better off.
What are the best practices that should be adopted at home for children during this lockdown?
As I have said earlier, children are facing a challenge because of the breakdown of infrastructure and lack of activities that gave them joy. The only two things at our disposal are our homes and digital media, so we have to be creative in using these.
Most important is to have something called a “Worry Break”, to combat the immediate threat of the virus. The worry about COVID-19 is genuine but if it is lurking around all the time, it will not allow us to relax and will intrude in our consciousness, preventing us from doing anything else. So, we have to become aware of it, identify it and compartmentalise it.
In a worry break, we keep some time of the day to take stock of the situation. We slot over an hour/ half-hour period twice or thrice a day when the family comes together to discuss the pandemic. But you have to close the discussion at the end of the hour. If a thought or a message comes in between, you will not look at it but tell yourself that it will be addressed at the next time slot. Older children can do it themselves.
The in-between period has to be engaged in doing other things.
Second thing is to structure the rest of the day. The family can sit together and discuss all the things that give it pleasure, were done in the past or before the lockdown, but are missing from life now. Then, think about things that can be done individually, and together as a family. Like, reading books to your children, or the movies you watched together, or the holidays you have been to, playing board games, looking at photos… there are many things that you can begin. Children can be engaged in cooking one day of the week, where they cook and serve like in a restaurant, as this generation is big on food.
By doing so, the pleasure element is created, giving a wonderful family time. This will give a sense of connectedness in times when we all are feeling uprooted. When we look at things from the past, they begin to root us, showing that our life is not just now but a longitude. The story of our lives often recharges us.
Third is about supporting the family by helping in household chores. Children need to participate in some way or the other and there has to be ownership.
If the children are not engaged thoughtfully through the day, they are likely to be hit by severe anxiety even by just being an observer of things around them. This has long-lasting effects. For instance, after 9/11 in the US, those constantly watching scenes of the attack also suffered Post Traumatic Stress Disorder (PTSD).
Is there a higher risk for children already dealing with pre-existing psychological conditions?
Yes, definitely. Those who were already in depression are now stuck. There are children who face abuse at home. They could avoid home by going out but now being completely at home, have become very vulnerable. Another ailment, Obsessive-Compulsive Disorder (OCD), is scaring them. Due to the present situation, there is a fear of contradiction. Unlike in the past, one is now asked to wash hands several times a day. It has a paradoxical effect. If one is symptomatic, now the condition will return with vengeance, which will lead to anxiety.
Could the pandemic have lasting effects on children’s mental health even after it’s over?
If the experience is very traumatic, the impact will be for a much longer period -- months or even years.
How can one help their child cope with isolation?
As a parent, I would add a caveat — you have to be constantly mindful about how you are feeling and keep yourself free from worries and anxieties. As discussed, you need to engage your child in a fun, productive and creative way, either in the kitchen or in the living room, recall happy memories, have a sense of togetherness, be realistic, firm, protected and assured that things will improve. This is the time we need to question things we take for granted, what do material things and success mean, we need to redefine those.
This pandemic has turned out to be a great leveller, affecting people across the class divide; it is not associated with poverty and deprivation, unlike TB. The class divide is very telling of our lives, and we need to have this conversation with our children, to help them see the world with different lenses as they grow. They have to learn to question the established values such as what it means to go to the best college, to succeed with a certain number of marks, to have a white-collared job, a posh car, etc. This small virus has challenged all the values that had been created over these years.
Due to the pandemic and subsequent lockdown, some parts of board examinations for Class 10 and 12 have got suspended, which has caused serious anxiety among students. How one can deal with it?
Not being able to write board examinations due to the lockdown causes anxiety. Some have got admissions in colleges but don’t know if they would be able to go. Even those transitioning from middle school to senior school or from Class 10 to 11 are facing anxiety. All kids need a certain direction, certain goal and meaning to their life. Now as there is no certainty, it gives rise to another kind of anxiety altogether. They should keep an eye on longer goals and not lose hope.
The children with special education needs, such as those with Autism Spectrum Disorder (ASD), Attention Deficit Hyperactivity Disorder (ADHD), etc., are also at risk. What is your advice for their care?
Children with specific needs like ASD or ADHD thrive on structured routine. Once they get into a routine, it’s hard to change those. They have to be prepared in a systematic manner, at home and outside through schools, therapies and special educators they go to. Those become part of a daily ritual and they do well. The therapies we give to these children are very hands-on, you have to interact with the child, there’s a lot of physical contact — gym, music, moving around with the therapist.
This disruption has raised the levels of tantrums. It’s very worrying that some of them have shown regression of symptoms, been set back developmentally and experienced outbursts. As open spaces are not available due to the lockdown, we have to innovate quickly to help such children. We have tried our best to do things online but it’s very difficult for a child, particularly younger ones, to deal with the screen. We have made programmes, where we work in a group comprising child and a parent. Some broad principles that we have talked earlier about the structure, fun time, family time, bonding, apply here too and will help. Parents have to see the special area of interest of the child, which can help the child through the day.
For instance, a child with ASD may be fascinated with birds or dinosaurs, so you can make those stories with dinosaurs and make them part of your daily life.
According to the National Commission for Women, there is an increase in domestic violence during this lockdown period. What will be its impact on children?
No doubt the incidents of domestic violence lead to a traumatic experience for most of the children, who witness this. And children who have lived through domestic violence many times have huge psychological issues. Now when fathers can’t go out to work or the mothers can’t go out, they find that domestic violence behind closed doors has clearly gone up. This will lead to clinical depression and PTSD, especially when there are hopelessness and helplessness when the pleasures have gone away, and the connections we take for granted have gone away.
Can this isolation followed by anxiety and stress lead to clinical depression?
Of course, this sense of hopelessness and helplessness can lead to clinical depression.
Some cases of suicide by youngsters have been reported during this period, apparently over trivial issues. Is this an impact of the pandemic or is it a growing concern which has been around since pre-coronavirus times?
COVID-19 will, of course, exacerbate some of the already prevalent phenomena such as anxiety and depression, and when that happens, particularly with depression and PTSD, suicidal ideas, etc., become common. When the atmosphere is more conducive, it is easier to deal with the crisis. But when there are hardly any resources in the family and the family itself is under so much stress, it becomes so much harder.
Suicide rates in our country are one of the highest in the world. It’s the number one cause of death for the 15-30 age-group. There are several reasons like pressure to prove oneself, perform better, high expectations, etc., but one of the biggest reasons is that we hardly pay any heed to emotional health in our country. We don’t even pay much attention when children sometimes talk about killing themselves. We label it as attention-seeking behaviour, we completely rubbish it, we don’t ask our children what is making them talk about taking their life. In fact, parents require more counselling than children.
World Health Organisation, which has in the past warned against ‘Gaming Disorder’ due to video or digital gaming, as it leads to change in the behaviour pattern of an individual, is now actively encouraging people to play video games during this lockdown. Your take?
— Tedros Adhanom Ghebreyesus (@DrTedros) March 28, 2020
At present we have to choose between depression and Gaming Disorder, and I think the latter is better, having much less risk. Once the coronavirus threat is over, we will deal with it, as it’s a lesser evil. It may be worthwhile to have those conversations even when you allow children to do more gaming. Tell them, you also know it is not the right thing, but these are unusual times, then we prepare the child for future when the lockdown is over.
A lot of fake news or texts, photos and videos related to Coronavirus are being circulated on WhatsApp/ Facebook/Instagram and other social media platforms, creating panic among children who are now on mobile phones almost throughout the day...
Instagram, Facebook, WhatsApp, etc., are making children extremely panicky. That’s why worry breaks are important. Instead of telling children, ‘how can you even think or say such a thing,’--let them open up. Often parents react sharply and call it trash, when they see children watching something on FB or WhatsApp. As a result, children clam up. Instead, parents should say, “Oh let us see what they are saying. Let us see what the scientists say on this issue. Do you actually want to know or just want some fun?” Next time when children visit any of these social media platforms, they will actually research on the veracity of the post and its source. So, we have to open up to these conversations, otherwise, children will remain isolated and we won’t have an inkling of what they are doing or seeing.
At what point should a parent or guardian seek psychiatric help?
When events go completely out-of-hand; when none of the generic measures are helping; a child is showing these signs of severe anxiety, trauma, depression, panic attacks, massive mood swings, feelings like “I’ve had enough,” “I don’t want this life,” things going completely out of hand, or their sleep, appetite or hygiene is going down, making attempts to harm themselves, isolating themselves completely, shutting the room all the time, etc. -- all of these should prompt parents to reach out for help.
Finally, five key takeaways from you on dealing with the current situation.
First, be careful about the ‘worry virus’ because like real coronavirus, the worry virus too can create havoc if not stemmed.
Second, be aware of the time being spent on worrying and discussing the coronavirus. It has to be limited.
Third, as parents, we’ve to ensure that our family remains stable and together.
Fourth, children and adolescents will go through emotional turmoil and there may be bad behaviour, which is a reflection of times we’re going through. We don’t have to punish children as this will have an adverse impact.
And, fifth, it’s an opportunity to revisit our core issues like our values, aspirations, how we want to live after COVID pandemic gets over, etc in a positive manner. After lockdown we’ve known what kind of damage we’ve done to our environment. Pollution has plummeted to an all-time low. We need to rethink our priorities about materialism and ensure not to cause damage to the environment for our needs.
Change is good but constant change takes a toll on mental health and not all of us can cope with it
In January, Japan logged a whopping 10,124 COVID-19 deaths, the highest ever in the country since the beginning of the pandemic. Experts state that the growing number of elderly people, who have lower immunity, is driving the fatality count up