By the time children and teenagers in NSW start returning to school in late October, they will have been remote learning for almost five months. While the stay-at-home orders have been a necessary public health response, it's clear the lockdown has had an emotional impact across all age groups in society, including the young. The NSW Chief Psychiatrist Murray Wright recently cautioned, "Assume your kids are struggling," after reporting an increase in NSW emergency department visits due to self-harm and suicidal ideation in the 0-17 age group.
In addition to the challenges of remote learning, young people are missing out on many rites of passage and social experiences that help them develop social and emotional skills. Professor Valsamma Eapen, chair of Infant, Child and Adolescent Psychiatry at UNSW Sydney suggested the COVID-19 pandemic restrictions will have a cumulative effect post-lockdown on children and adolescents.
"People don't really take into account the kind of emergency room presentations we're now seeing. There has been a 25 to 48 percent increase in children coming to the hospital and the presentations are becoming more acute, more and more younger children are presenting, and the complexity of the presentations are increasing."
Prof. Eapen said the support children and adolescents would normally have access to isn't currently available to them due to the lockdown—which would typically include extended family or friends. The amount of time family and siblings are spending together with no reprieve—weeks and months on end—is also a potential stressor and the tipping point for some.
What are the signs of distress?
What should parents or carers look out for if they suspect their child is mentally struggling with lockdown? Prof. Eapen said there are generally two signs to look for: either 'withdrawal' and isolating oneself, or 'acting out' with anger, irritability, aggression etc.
"Not coming out of their room and not interacting with their friends could be a sign and similarly 'acting out' can also be an indicator. These are two ways young people usually respond to distress—they either internalize, don't talk to you and suppress everything or they act out and become very hostile and irritable. While you may think he or she is just frustrated, they may be showing signs of distress."
Prof. Eapen said depending on the child-parent relationship, in some cases it may be difficult to start interacting with the child in a way that you haven't done before when they are exhibiting these behaviors. However, she said, that shouldn't stop parents or carers from trying to figure out or understand what's going on.
"Sometimes parents find it difficult to get young people to open up to them and at other times parents find it difficult to acknowledge and validate the young person's experience which may make things worse.
"It may be worth asking the young person's consent to enlist someone else who could have a chat if the parent doesn't feel like they're going to get very far with them. Let the child know you're concerned for his or her mental wellbeing and perhaps they can suggest someone they're comfortable talking to. In these situations, it's important to see whether there is a friend, a relative, a teacher from school or a sports coach who could have a word with the child to see how they are going."
"There will be normal variations in behavior during lockdowns that's acceptable but displaying consistent signs of either withdrawal or acting out should be a cause for concern and if the behaviors persist, that will warrant further assessment. It's not a bad idea to seek help, at least to see what's going on and whether anything further needs to be or could be done."
Depending on the level of distress and the severity of the issue, there are a number of options available including parenting helplines or online parenting programs, mental wellbeing support services and resources available through Beyond Blue or Raising Children Network.
"A helpline or mental health support service may be able to assist with working out what might be going on and what might be needed or alternatively seek a consultation with your GP for further advice. They can provide you with resources that you can either engage with directly or may recommend further assessment and interventions."
Setting aside 'worry time' may be beneficial for children who tend to internalize their worries and find it hard to either talk about their fears or would be constantly expressing their fears and seeking reassurance. For example, if the child has a fear of catching the virus or fear of death and is constantly asking parents for reassurance repeatedly, implementing 'worry time' may be a better way of 'containing' the situation and managing the information exchange.
Prof. Eapen said a positive way to address the issue is by starting with something like, 'that's a good question, let's discuss that during our worry time today' and that worry time should be devoted to help manage the issue during the "allocated" time.
"If you're unable to contain that worry during 'worry time', you may need to seek help as that means it's spilling beyond what can be contained and managed by the family."
There is a silver lining
Prof. Eapen said there was a silver lining to all this, with a recent youth survey revealing the pandemic had made some family units more connected as they were spending more time together and having quality time which they have never had before.
"Some people have been able to use the pandemic in a more positive way. Families have had the opportunity to enjoy board games together, go for walks together if that was allowed, and enjoy cooking together. Some have taken up a new hobby or learnt to play an instrument, which could also be done online with friends."
Prof. Eapen suggested some children may find it helpful to retreat and have quiet time with a favorite toy, book or music while others may find releasing energy, useful. This could be achieved by using a punching bag or a 'DIY' bouncing castle with pillows.
"Activities will vary based on your child and each family's interests but see whether there is anything that you can put into a daily routine. This could include a daily routine of regular sleep and wake up time, finding time for exercise, and connecting with family and friends."
Provided by University of New South Wales