We must watch for signs of childhood trauma, grief
No infectious disease since HIV/AIDS in the 1980s has captured the world’s attention in the way COVID-19 has. The HIV/AIDS pandemic is still with us nearly 40 years later. Effective treatment has made HIV/AIDS a manageable medical condition rather than the almost certain death sentence it was in the beginning, but a vaccine still eludes us. More than 32 million people have died of HIV/AIDS since the beginning of the pandemic, including about 700,000 Americans. Children were almost an afterthought in the early days of HIV/AIDS. Many children died, and even more suffered emotionally in response to the deaths of caregivers and relatives.
So far, it appears that children are being spared the brunt of the COVID-19 pandemic from a physical health perspective, but there is no doubt that there will be lifelong mental health consequences. Proactive measures implemented now, including raising awareness regarding children’s trauma and grief-related responses to the pandemic, can mitigate these potentially debilitating outcomes.
Research tells us that youth who have experienced prior traumas and losses — nearly half of U.S. children — are at significantly higher risk of developing mental health problems in the face of current adversity. As a recent Houston Chronicle article points out, this has important implications for Houston’s youth, many of whom have already been exposed to traumatic events such as Hurricane Harvey, school shootings or domestic violence prior to the pandemic. We know that many of society’s greatest problems are a result of unresolved childhood trauma or loss, speaking to the need for early identification and intervention.
Bereavement, or the death of a loved one, is the most common form of trauma worldwide. Within Texas alone, approximately 6 percent of children will experience the death of a parent or sibling before the age of 18, and unfortunately, this number is likely to grow as a result of COVID-19. Bereavement is also the most distressing form of trauma in the general population. Our recent research shows that bereavement is the strongest predictor of poor school outcomes among adolescents, above and beyond the effects of any other trauma including physical abuse, sexual abuse or witnessing domestic violence.
Youth in underserved communities, who are often faced with poverty, chronic traumas and losses, are at particularly high risk for both post-traumatic stress and debilitating grief reactions in the context of COVID-19.
Children who have been exposed to prior traumas are “wired” to quickly respond to danger and are more likely to develop symptoms of post-traumatic stress than are youth who do not have a trauma history. For example, a child who was terrified while being trapped at home during Hurricane Harvey may experience similar, or even stronger, physiological reactions (heart palpitations, trembling) while being confined to their home during the pandemic, particularly in the context of insufficient food or parents’ employment loss.
Similarly, children who have experienced prior losses, such as being separated from a caregiver or the death of a loved one, are likely to have more intense grief reactions in response to a current loss or even hearing about the growing number of COVID-19 deaths.
We have learned a great deal through the HIV/AIDS pandemic about losses that cannot be socially sanctioned or publicly mourned. These types of losses, often referred to as “disenfranchised
grief,” can lead to more complicated grief reactions and functional impairment in children. Given that both social support and the ability to “say goodbye” to dying loved ones are two of the most powerful protective factors, it is critical to recognize the ways in which necessary social distancing can potentially exacerbate children’s mental health problems.
While early and accurate identification of mental health problems is key to early intervention, identifying children with posttraumatic stress or maladaptive grief is challenging in that these symptoms can mimic other mental health issues. For example, hypervigilance (being “on edge” or “jumpy”), a primary symptom of post-traumatic stress, can closely resemble hyperactivity, one of the signature behaviors associated with ADHD. Similarly, both post-traumatic stress and grief in young children can manifest as aggressive or oppositional behavior, often resulting in these children being mislabeled as “behavior problems.”
What can we do as a community to buffer these potential mental health ramifications of the pandemic? As we enter into a “new normal,” it will be more important than ever for schools, hospitals and pediatric offices to become both “trauma-informed” and “grief-informed.”
Teachers will need to know what signs and symptoms to look for in their students and better understand the impact of trauma and loss on school behavior. Pediatricians will need to accurately identify physical symptoms of post-traumatic stress or grief and make mental health referrals when necessary.
We also need to recognize that children are like sponges, soaking in the stress, anxiety or grief that they observe and experience in their daily social environments.
Consequently, caregivers, teachers and health providers must ensure that they themselves are obtaining the support and self-care that they need to be fully present and effective in helping children.
Shedding light on these issues, through training and education, will enable the early identification of “at-risk” youth, prevent future mental health problems and ensure the health and wellbeing of Houston’s children long after the pandemic has passed.