‘KIDS ARE LOSING THEIR RESILIENCY’
As pandemic subsides, children are struggling with anxiety and depression
More than a year into the COVID-19 pandemic, child mental health services in Connecticut are severely overburdened as rates of anxiety, depression and other serious behavioral health issues surge among adolescents.
Dr. Lucia Benzoni, a Hartford HealthCare pediatrician in Litchfield, said the rates of anxiety and depression she’s seeing in her patient population are higher than ever before.
“There’s afternoons in my schedule that used to be physicals, sinus infections, ear infections and rashes,” she said. “Now I’m just filled up with anxiety and depression or med checks.”
She added that the therapists her patients tend to work with are “definitely more booked up than they have been, with longer wait times,” including just for initial intake assessments.
Nationally, the trends among children are concerning. The Centers for Disease Control and Prevention has reported that between April and October 2020 the proportion of pediatric emergency department visits that were related to mental health rose by 24% for children aged 5 to 11 and 31% for those aged 12 to 17, when compared to the same period in 2019.
Dr. Laura Saunders, a child psychologist
at Hartford HealthCare’s Institute of Living, said that the data presented by the CDC “absolutely” tracks with what she’s seen in her own work.
“I get referrals every day for outpatient therapy,” she said. “I’m reaching out to my friends, asking who has openings, and none of my colleagues in private practice and very few people doing outpatient work have openings. A lot of clinics have waitlists.”
Within the psychiatric system in Connecticut, Dr. Ruby Lekwauwa, a child adolescent psychiatrist at the Yale New Haven Psychiatric Hospital, has seen “a lot more strain on resources.”
“I’ve had a lot of pediatricians, friends of friends, calling to say, ‘Hey are you taking anyone new?’ ” she said. “And I’m just full.”
The Branford intensive outpatient program, where Lekwauwa is the medical director of the adolescent program, was “just slammed” with demand for care, particularly from January to March, she said.
It may have been that as the winter let up and COVID-19 metrics started to improve in Connecticut, more families began to seek care for adolescents in distress. Even now, Lekwauwa is seeing “a lot more acuity” — patients with more severe needs — than she otherwise would at this time of year.
“I’m seeing kids in my private practice who are otherwise stable, who have been stable for years, who are just decompensating,” Lekwauwa said, using a clinical term that describes a declining state of mental health. “The normal things we’d be telling them to do — get out of your house, meet up with friends — aren’t as easy to do right now.”
Adolescent mental health providers stress that children have endured a period of profound crisis — remote learning, diminished social contact, a deadly pandemic — with fewer cognitive resources than adults.
“Children don’t have the luxury of perspective, so changes in the life of a child are monumental,” Saunders said.
‘I’m not built to handle that’
The mental health and behavioral distress that many children are now experiencing has impacted both those with preexisting issues that have been exacerbated by the pandemic, as well as those for whom conditions such as depression and anxiety are new.
“A lot of what I’ve been seeing that’s different from before the pandemic is hearing kids who have always done well academically all of a sudden failing,” Lekwauwa said. “Talking with them, they’re like, ‘I don’t have my teacher. Usually my teacher notices when I’m not paying attention. I don’t have that anymore, so I have to work twice as hard to focus on a screen.’ ”
Data from Connecticut Children’s Medical Center indicates that risk of suicide has also significantly increased for kids in Connecticut. All children aged 10 and older who visit the hospital’s emergency department for any reason undergo a suicide risk screening. Typically, about 16% of children show signs of increased risk of suicide.
Last October, that proportion rose to 19%, then to 22% by January and to 25% in March — a steadily climbing six-month trend.
“I think kids are just now showing some delayed symptoms from the initial fear of the pandemic and all the stress involved with that,” said Dr. Steven Rogers, an emergency room physician at Children’s. “It’s basically like post-traumatic stress disorder. Kids are losing their resiliency.”
Many children have struggled with the transition to remote learning — and the turbulence of schools opening, closing and reopening due to COVID-19 outbreaks — as well as with the other disruptions to structure and routine that the pandemic generated.
Kids have had to contend with increased isolation and the loss of regular social interaction. Many have also been affected by the financial and emotional strain placed on their families. Some have lost friends or relatives to COVID-19, so fear of the virus persists.
“Everybody can hold a different amount of weight, or has a different trigger point. What the pandemic did is it asked everybody to carry so much more,” said Dr. Robert Keder, a developmental and behavioral pediatrician at Children’s.
“Some kids might be able to carry the extra 20 pounds totally fine, but many kids may be like, ‘I’m not built to handle that.’ ”
While some might buckle under that extra weight, others are able to withstand it. The difference, Keder said, often comes down to the presence of stable, nurturing and supportive adult relationships in a child’s life.
If parents or caregivers notice sudden behavioral changes in children — they’re sleeping all day or not at all, showing little engagement with school or other activities, asking repeated questions about death or they seem significantly more irritable — opening up lines of communication is critical.
“Any changes in terms of how kids are normally acting at home should make parents think, ‘My kid’s not being bad; they’re experiencing a lot of distress,’ ” Lekwauwa said.
Challenges expected for fall
The summer may offer children some respite, with COVID-19 metrics in Connecticut expected to continue to decrease and vaccination rates projected to rise. But, providers warn, many children may struggle to reintegrate into society. And the fall, when many kids will likely return to full-time in-person school, may bring considerable new challenges.
Lekwauwa said some children who have already partially returned to school, including those who transitioned from fully remote learning to a hybrid mode, exhibit intense anxiety and distress.
“Especially for kids who have anxiety, their preferred methods of coping is avoidance,” she said. “They’ve had six, seven, eight months of not having to deal with their peers, not having to deal with their teachers, and the idea of having to go back to school is a huge, huge obstacle and a source of a lot of stress for them.”
Children are also contending with continued uncertainty about the future. When they return to school, will it be permanently in person, or will it get switched to virtual learning again? What will the school day look like? Will they be able to see their friends? Will it be safe?
“What we’ve been seeing in child mental health the last couple months are the aftereffects of almost a year in quarantine,” Lekwauwa said. “And I think we’ll continue to see it with school refusal, school avoidance, that kids will be anxious on the return.”
For parents, teachers and school administrators, clearly laying out expectations about the coming year will be critical in helping students feel comfortable and in control as they make the transition, providers say. Directly addressing issues of safety and risk is also important. When working with children who are nervous to resume social interactions, Benzoni, the pediatrician, said that she tries to “talk facts” to them.
“I tell them, ‘Germs have been around forever; our body is made to fight germs, that humans have developed over time a very good immune system,” she said. “I’ll tell them that we have a vaccination against this, especially if they’re over 12.”
But the psychological impacts of COVID-19 may last for years to come. Many children, for instance, have deeply internalized the safety warnings surrounding COVID-19 that have kept them safe over the past year.
“The long-term repercussions are that this is the way they see the world: that closeness equals danger, that people are filled with germs [and] anyone outside your family is off limits,” Saunders, the child psychologist, said. “If you think about the unconscious and conscious messages that children have gotten, it’s going to be hard to undo that. You can’t just switch it on and off.”
If you are in Connecticut and experiencing thoughts of suicide, call 211 or text “CT” or “HELLO” to 741741. The National Suicide Prevention Lifeline is available at 1-800-2738255 (TALK). Connecticut’s domestic violence hotline is 888-774-2900. Residents looking for more information on youth suicide prevention and mental health can read the CDC’s COVID-19 Parental Resources Kit, and visit www. preventsuicidect.org or gizmo4mentalhealth.org.