Did it cause mental illness in children or did it make it worse? :: WRAL.com
CNN – There is a crisis in adolescent mental health, suggesting a marked increase in mental illness, sadness and hopelessness among adolescents, according to the United States Centers for Disease Control and Prevention. These findings leave many experts wondering whether the pandemic has led to an increase in diagnosable mental health conditions among adolescents or whether the impact of Covid-19 has exacerbated the symptoms of already emotionally challenged adolescents.
As a psychologist with experience treating preteens and teens, I’ve seen more children in my office report that their anxiety, depression, and attention problems are getting significantly worse. I wondered if my experience was typical, so I turned to Dr. John Walkup, chief of child and adolescent psychiatry at Northwestern University Feinberg School of Medicine and chief of the Pritzker Department of Psychiatry and Behavioral Health at the ‘Ann & Robert H. Lurie Children’s Hospital of Chicago.
Walkup said he believed the pandemic had not led to an increase in the incidence of mental illness among adolescents, but had “unmasked symptoms” that could have been managed otherwise.
I spoke with Walkup to discuss their research findings and what parents and caregivers can do to help their children at this time.
CNN: You’re saying we haven’t seen a lot of new mental illnesses in children over the past two years? What we are seeing are difficulties that have been exacerbated by the pandemic, are we not?
Dr. John Walkup: Yes. You know, 20% of kids have a mental health issue before they graduate from high school on average in the United States. Only half of these children receive some sort of assessment or treatment, and of this population, only about 40% achieve clinically meaningful benefits. About 15% of children with a mental health problem receive help. Then take away school, family, peer support, and sports, and you force them to stay home. You know these kids won’t do well over time.
There’s probably a small group of kids who get long Covid where you could say there’s a direct impact of the Covid virus on the brain, but that’s a pretty small group of kids. But overall, when you think about what Covid has done, it’s really destroyed the infrastructure for kids with mental health issues. If you really think about it in a little deeper way, we’ve been advocating for children’s mental health for a long time. Families and schools are more aware of mental health issues, so now you have this kind of perfect storm of increased awareness and increased advocacy, resulting in an increased need for care. And the structure of that care has collapsed over the past two years.
CNN: Given these numbers, do you think the pandemic will shine a light on children’s mental health needs that we wouldn’t have seen without this crisis?
Walkup: I think we would have seen increased revival anyway because the advocacy efforts are there. We now have effective treatments for all major psychiatric disorders in children, and the treatments are good. Once you have treatments, you can advocate effectively, right? So before the pandemic more and more children came for care, good care. But then when you take away all the supporting infrastructure (school, activities, etc.), those kids are going to become symptomatic much faster. Without this infrastructure, we have seen a dramatic and unexpected increase in pathology.
CNN: You highlighted a distinction between mental illness and distress. What is the difference?
Walkup: Anxiety and sadness are normal human emotions. Anxiety helps us prepare for difficult outcomes, and sadness helps us connect with people. What we are working on in terms of mental illness are pathological forms of anxiety or sadness. It’s clinical depression and anxiety disorders, and those things are qualitatively different from normal human sadness or normal proportional predictable anxiety.
During Covid-19, when children did not know what to expect, they would have increased normal levels of anxiety and distress because they are not with their friends and not at school . They wonder about their future. But it is not pathological. It’s predictable, proportionate and understandable, and it will go away when things normalize.
CNN: You also suggest that the pandemic has had a greater impact on girls and the LGBT community. Any idea why this might be?
Walkup: When the pandemic hit, more untreated or poorly treated children started coming forward for care. The prevalence of anxiety and depression in young women is higher than in men, which may explain disproportionate treatment seeking. More girls needed help that hasn’t been there in the past two years.
In the LGBT community, these young people are struggling. It’s hard to be different when you’re young. This group also experiences higher rates of bullying. Many feel that they don’t necessarily fit in, even within their own families. So you would expect these kids to really struggle during that time, and they did.
CNN: What risk factors should parents and caregivers look for now?
Walkup: This is really important. Parents should look at their family history. If there’s a psychiatric disorder somewhere in that family history, know that those things are genetic. They pass from one generation to another. It is also important for parents to understand that these psychiatric disorders occur at very predictable times in development. Children with ADHD present between 4 and 7 years of age. Children with anxiety disorders present between the ages of 6 and 12, and children first present with depressive disorders in mid-adolescence.
So, if you have a family history of ADHD, you should look for ADHD symptoms in your 3, 4, and 5 year olds. If you have an anxiety disorder in your family history, you should research anxiety between the ages of 6 and 12 and similarly depression. Share this information with your pediatrician. Your pediatrician knows what these symptom presentations look like so you can deal with them early.
CNN: You’re saying don’t wait for a pattern of symptoms to show up in your child? Be proactive.
Walk: Alright. If you have a family history of ADHD and have a 2 or 3 year old child, get really good as a parent because these kids are hard to raise. If you have a family history of an anxiety disorder, mom and dad should make sure they are both in good emotional shape. You will have to become fearless because we know that treating anxiety takes care of those things that are scary or difficult. We also know that for families where there is a strong history of depression, being physically active and engaging in the world is the best behavioral treatment.
If you know your family history, you know the age of risk of onset, you know what you can do to mitigate that risk once the disease strikes. Your child will be much healthier and easier to treat if all of this work has been done before the symptoms actually show up.
CNN: What can parents or guardians do to help their children ease the emotional difficulties resulting from the Covid-19 pandemic?
Walkup: Take a deep dive into your family history and don’t just attribute all symptoms to Covid. If you have a strong family history and you see symptoms in your child, don’t ignore them. Take this seriously. Learn, read, and talk to your pediatrician, because they know these conditions. They will begin to lay the groundwork for an intervention. If you don’t need intervention now, laying the groundwork and being prepared is much better than being surprised by a condition later.
Families often hire a financial or legal advisor. Why not get a mental health counselor if you have a family history of psychiatric disorders? Ask this mental health counselor to work with you early on around prevention and early intervention. If you start taking care of these conditions early, you can minimize the impact. If you don’t, you risk the maximum impact on long-term results.
CNN: Do you have hope for the mental and emotional well-being of our children?
Walkup: I think we have great treatments, and if we can get the kids into treatment, we’ll be fine. We have a lot of “anti-treatment” sentiment in this country and a lot of pandemic mental health reduction. We don’t take it seriously enough, so my feelings are mixed. If we welcome children, we manage very well with them. They are responding well and improving. On the other hand, there are so many hurdles families have to jump through to get care these days. This can make it difficult for children to get the care they need.
Overall, we will see a huge decrease in the burden of children’s mental health simply because parents and guardians figure out how to anticipate emotional difficulties. This parental leadership within a family can ease a lot of grief.
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