As the COVID-19 pandemic continues to affect lives around the globe, children are struggling with overwhelming stress and uncertainty during these challenging times. At Atrium Health, our psychiatric emergency department adolescent admissions increased by 28% from April 2020 to July 2020. Clearly, many children are struggling with the uncertainty of the pandemic, social isolation, virtual learning challenges, concerns about school safety, racial injustice, a distressing news cycle, and more.
If you or your child is struggling, call Atrium Health’s Behavioral Health Help Line at 704-444-2400 for 24/7 mental health crisis assistance. We can help. You are not alone.
Atrium Health Experts Weigh In
With no clear sign of when the pandemic will end and when social distancing might ease up, children are going to continue to face significant mental health challenges. Atrium Health Behavioral Health Services and Atrium Health Levine Children’s experts weigh in with some tips and advice on how parents and caregivers can help children and teenagers who may be dealing with mental health issues.
Question 1: What are kids and teens struggling with right now? What specific stressors are young people experiencing?
Answer 1 | Ryan Livingston, MD, Medical Director of Psychiatric Emergency Department with Atrium Health Behavioral Health Services: This has been an unprecedented year for all of us. A lot of kids have had difficulties, both from a mental health and physical health standpoint. Of course, many kids are going to school virtually or a combination of in person and virtually, and that’s different for them. Some kids are used to being high performers in school but might have a difficult time with virtual learning. Kids are used to seeing their friends and social peer groups, so there’s been an increase in social isolation. Some kids are worried about their safety. For all those reasons, we've seen an increase in kids coming to our psychiatric emergency department.
Q2: What kind of symptoms are these children exhibiting? What makes parents bring their children in to the psychiatric emergency department?
A2 | Dr. Livingston: We see kids come in for symptoms of depression, anxiety, and suicidal thoughts. Most of the time, when they come in, parents have noticed some change in their child, whether it's isolating more than normal or losing enthusiasm about a particular activity. Children might also experience things like a change in their sleeping habits, their appetite, or their ability to concentrate. Usually parents bring their children in when it's gotten to a point where safety becomes a concern.
Q3: What are some warning signs that a child might be struggling mentally?
A3 | Gillian G. Regan, PhD, Pediatric Psychologist at Atrium Health Levine Children’s: Parents know their kids very well, so anything that seems like a really major change in kids’ behavior is concerning. For younger kids, that may look like they're having trouble managing their behavior or managing big emotions, when the response that they have is quite different than the triggering event. For older kids, that may look like depression or increased isolation – for example, wanting to be in their rooms a lot by themselves. Of course, that's further complicated by COVID and all the isolation kids are experiencing because they aren't able to utilize coping skills like going to see friends.
Some other warning signs could be a lack of interest in things that used to make them happy and lacking motivation to do daily activities like school, talking to friends, chores around the home. Any noticeable changes in grades or behavior would be cause for concern, If there’s a stressor that the whole family is dealing with, that could be a signal to parents just to check in on their child's behavior and mood and to see how they're doing with anxiety and nervousness.
Q4: What are some mindfulness exercises and tips to help your anxious child or teen?
A4 | Dr. Regan: There are techniques kids can use like trying to increase awareness of some of their sensations. For example, they can try the “5-4-3-2-1” mindfulness exercise: name four things you can feel or touch, three things you can hear, two things you can smell, and one thing you can taste. If you have a pet, kids can pet the animal while noticing what that feels like, grounding themselves in that moment. Take a nature walk and observe what you can see or hear. Deep breathing is a great exercise as well.
Q5: When should you seek professional or medical help for your child or teen?
A5 | Rabiya Hasan, MD, Child/Adolescent Psychiatrist with Atrium Health Behavioral Health Services: Depression in children and teenagers doesn't have to look the same as it does in an adult, but it can still have a significant impact on overall functioning. The symptoms can be more subtle. If a normally outgoing child isn’t reaching out to friends like they did before, or a normally happy child is suddenly more irritable or frustrated, that can be a sign that help is needed. In younger children, they might make negative statements about themselves, or seem hopeless. Teens might have a loss of interest in activities or changes in sleep or appetite. If they seem hopeless or if they make any statements about wanting to hurt themselves, or just not wanting to be alive, these would all be really concerning symptoms that mean you should seek help.
Q6: What therapies and medications are available, and when are they necessary?
A6 | Dr. Hasan: For milder symptoms, talk therapy – whether one-on-one or in a group – can be very helpful. If therapy alone is not effective after about four to six weeks, then you may want to consider medications. Starting medications earlier can help alleviate some of the symptoms of depression and anxiety and allow the therapy to be more effective. Medications that we typically recommend would be antidepressant medications, and there are some that have been well studied in children. Overall, these medications are safe and well tolerated. Some may have minor side effects that usually improve within the first week or two. More concerning side effects can include an increase in thoughts of self-harm. This is rare, but it's important that you talk with your healthcare provider to know what to expect and so that you and your child are aware of what symptoms to monitor.
Another question I get asked a lot by parents is: if we start this medication, how long does the child have to stay on it? It’s not a lifelong commitment. If the child feels better, we recommend treatment for about 9 to12 months after, and then the child can come off the medication gradually, with the help of their healthcare provider.
Therapy and medication can help retrain our brains, and they can help them change negative patterns. The overall goal of treatment is to get children back to a place where they're able to enjoy their lives.
Q7: How do you talk to kids about what's happening around them, like the pandemic, racial injustice, or the political environment?
A7 | Daniel Huang, MPA-LPA, Child/Adolescent Psychotherapist with Atrium Health Behavioral Health Services: It’s important to establish communication and express to your children that it’s okay to talk about these things. Check in with them on a regular basis. You can designate a time that that you can talk to them, whether it's dinnertime or sometime after school.
Instead of being direct, and saying “This is what you need to try to think” or “You shouldn't worry about this,” try to ask your children, “How have these things affected you?” Let them put their main concerns first; then, if they ask questions, that’s when you can be more direct.
If the child approaches you, you can try to talk about things in a balanced way. You don’t need to get too caught up in details, but you can try to give a straightforward answer and come back to how your child feels about it.
Q8: How do you balance kids’ screen time and socializing during the pandemic?
A8 | Huang: In a way, screen time has become socializing, since we now spend so much time on screens. Make sure there is adequate socialization outside of solitary screen time. Whether it’s playing a video game or getting on the tablet or being on your phone, there is solitary screen time vs. social screen time. Emphasize the screen time that has more social interaction and be able to fold in those moments where you're actually having interactions with your friends, but make sure that it's done safely.
Q9: What are the signs and symptoms that your child or teen might be struggling with suicidal ideation?
A9 | Kate Penny, LCMHC, Zero Suicide Program Coordinator with Atrium Health Behavioral Health Services: Suicidal ideation is having thoughts of suicide or self-harm, including thoughts of wanting to die or wanting to kill oneself. A big sign is a drastic change in mood and loss of interests. Reckless behavior is another one. That might include engaging in experimentation with alcohol or drugs, or if you have a teen who is driving, driving more recklessly not wearing a seatbelt. Sexual promiscuity can be another one.
Another sign to watch out for is if your child seems to be preoccupied with death, dying, or talking about death. If it's a younger child, this might come out in their drawings or writings. When other suicides happen, children can become focused on that.
Watch for anything where it's a really big change in their personality, where you say to yourself, “Hey, that’s not my kid. Something is different here.”
Q10: How do you ask your child or your teenager if they're contemplating suicide? Do you just come out and ask that question? What's age appropriate?
A10 | Penny: It's a very difficult topic to address with anyone, particularly children and adolescents. The key is to make sure that you're regularly having open conversations with your children, telling them, “We're here for you. We want to know what's going on in your life.” When you have that built-in trust, it's easier to have those intense conversations.
It is important to come out and ask your child, “Have you had thoughts about suicide? Is this something you've ever thought about?” Make sure that they don't feel judged. You asking that question is not going to put that thought in their head. That’s a myth. It’ll actually open up the conversation and allow them to share with you if they are having those thoughts. And it's very important that they do feel comfortable reaching out to you so that they can get the help that they need. If it's a younger child, you can ask, “Have you thought about going to sleep and not waking up? Have you had thoughts that you wish you were dead?”
You want to allow them to express themselves to you, so that you know where they are and what a good next step might be at that point. Again, there is no evidence that shows that asking a child or adolescent about having suicidal thoughts will put that thought in their head. Instead, it actually does the opposite, and can help that person feel comfortable opening up. These conversations are difficult but could save a child's life.
Q11: What tips are there for parents about how to regulate their child’s use of social media, and how much is too much?
A11 | Dr. Regan: Try to have an idea of what they are consuming with regard to social media, knowing what apps they're looking at. Parents should try to find a balance between giving their kids some autonomy, but also ensuring that they're safe.
One of the conversations I've been having recently with some of my patients and their families is about how to actively consume social media as opposed to passively consuming it. A lot of us passively consume it and aren't really putting thought into what we're doing, or how it makes us feel after we've consumed it. Have conversations with kids about how they feel when they’re scrolling through posts. Does their mood change or anxiety increase? If so, then perhaps there should be more limitations on consuming social media.
Put time limits on it, particularly before bedtime. There's a recommendation to avoid screens at least 30 to 60 minutes prior to bedtime. Kids need to let their minds and their bodies relax before going to bed because sleep is so important.
Dr. Hasan: We all have to take social media with a grain of salt because it is shiny and glossy. Just because other people may not look like they're having struggles, based on what they're posting on social media, doesn't mean that they aren’t struggling. So look at social media like you would a TV show. There's only a small dose of reality there, and I think that's helpful for teenagers to remember right now.
Q12: Mental health issues are common, yet people don't always talk about them. How can we reduce the stigma and normalize talking about mental health?
A12 | Dr. Livingston: It used to be that people who struggled with mental health didn't talk about it. Now, it's become more normalized. There are celebrities who have come out and talked about their struggles with mental illness, which can be very impactful. More TV shows and movies are addressing about it than ever before. There are more news reports on mental health, and reporters have done a fantastic job with that. I think more people realize that this is something that affects everybody.
We still have a long way to go It still is something that people are always a little bit apprehensive to talk about. But if you do it the right way, in the right setting, you can show people that it's okay to talk about it. I think we owe it to society to be the leaders in trying to get people to recognize the severity of some of these things that we're seeing and give people a chance to open up and talk about them.
Q13: What would you say to parents who are apprehensive about taking their child to a doctor for help with mental health issues?
A13 | Dr. Livingston: It can be challenging for parents to navigate the mental health system if they’ve never experienced it before. The important thing is to take that initial step to get help, whether it’s seeing an outpatient provider or coming into the emergency department. I try to normalize it. I compare it to a medical illness, which is very accepted in society. No one wants to feed bad physically or mentally, but they can’t help it. It's just like going to a medical professional for something non-behavioral health related. We have treatments now that can help with whatever they're going through.
Q14: What can parents do today to open the lines of communication at home to help create a mentally healthy family?
A14 | Dr. Regan: Let kids and teenagers know that it's important and it's okay to talk about feelings. Parents model behavior for their kids. Share with them if you’re feeling worried or down or irritable on a certain day. Parents taking care of their own mental health can be so impactful for kids as well– they need to see that a parent is doing something that helps them cope on a day that they're feeling more anxious or they're having a really hard time. That will show kids that there are things they can do to help themselves feel better, too.
Q15: 2020 has been tough for us all. What can parents do if they might need some mental health services themselves because they're struggling?
A 15 | Dr. Hasan: Parents are trying to work, balance their child’s school schedule, and so much more right now. Sometimes I will meet the parents separately after the child’s appointment is done, just to check in with them and ask them if they need any resources. We have providers in our clinic who will work with adults. Also, I like to let parents know that helping themselves is also helping their child. Parents should feel free to ask questions and reach out.
- If you or your child or teen is struggling right now, call Atrium Health’s Behavioral Health Help Line at 704-444-2400 for 24/7 crisis assistance.
- Read more about our child/adolescent behavioral health care offerings here.
- Atrium Health offers a free Mental Health First Aid (MHFA) course. MHFA is a skills-based training course that teaches participants about mental health and substance use issues.
