The Covid-19 pandemic and the subsequent lockdowns across the world are something which was never experienced before. Living in fear and anxiety is the new normal. The pandemic has psychosocial and mental health implications, both short and long terms, and worryingly, on children and adolescents.
The effects on children or adolescents in focus depend on factors such as age, educational status, presence of pre-existing mental health condition and being economically underprivileged.
The pandemic has brought about a complex collection of issues ranging from uncertainty to social isolation, and parental angst that have had an impact on the mental health of children and adolescents. Children usually thrive under predictable conditions, but the disruption of the same has certainly taken its toll. The pandemic has changed the way children typically grow, learn, play, behave, interact, and manage emotions.
Children have a lot going around in their head, and perhaps the biggest worries for them would be whether they will see their friends and relatives, go to school or get sick. As of April 8, 2020, schools had been suspended nationwide in 188 countries, according to Unesco. Over 91 per cent of enrolled learners (1·5 billion young people) worldwide were out of education during the peak of lockdowns.
There are 2.2 billion children (in the age bracket of 0-14) making up around 28 per cent of the world's population; and then we have those aged between 15 to 19 years making up 10 per cent. So that is 38 per cent of the world population.
For children and adolescents with mental health needs, school closures mean a lack of access to the resources they usually have. Regular school routines act as coping mechanisms for children with mental health issues. Hence, in the absence of it, the mental wellbeing of children may see deterioration.
Parents a concerned lot
This is a new and tricky situation for parents across the globe as they need to do their best to calm their children's anxieties and at the same time, deal with their own uncertainties.
New Delhi-based Preeti Sharma is worried about her son. She said, "My son had weak eyesight. Now there are these (online) classes. After the class, they use mobile phones. You can't really stop them from using the screens."
Anuja Pundhir, another parent from UP's Greater Noida, complained: "Three to four hours of online classes are taking a toll on children's health. They keep staring at the screen of a mobile or laptop after the class. They often rub their eyes and some have redness in the eyes."
Delhi's senior eye surgeon Dr AK Jain said online classes put too much strain on the eyes. "In the medical term, this condition is called Computer Vision Syndrome. Due to sitting in one posture for long hours, the blood circulation becomes stagnant in the brain and oxygen supply reduces, which leads to pain and burning sensation in the eyes and sometimes watery eyes. I would like to request parents and teachers to give a break to students after each 15-20 minutes during online classes."
"During breaks, the students should walk around and exercise their necks. They should also rub their palms and keep them on their eyes for a while. This will increase the blood circulation in their eyes," he added.
Scientific explanation for depression, emotional stress in kids during pandemic
The hypothalamic-pituitary-adrenal axis (HPA axis) is the central response system that controls reactions to stress and regulates various body processes such as digestion, the immune system, mood and sexuality, and energy usage. Under a lot of stress, the HPA axis may undergo dysfunction.
When we are under stress, our hypothalamus perceives this and releases corticotropin-releasing factor (CRF) which tells your pituitary gland to release another substance called adrenocorticotropic hormone (ACTH), which then goes on to stimulate cortisol release from the adrenal glands.
The production of cortisol leads to an increase in heart rate, blood pressure and blood sugar so that your body is well-equipped to survive the stress. This is helpful if we are under short-term stress.
But what happens if the incident is not momentary?
Factors such as work pressure, sleep deprivation, processed food, sugar and toxins can all stimulate the HPA axis.
Our human body is an intelligent system but it isn't built to deal with continuous stress, which is why symptoms such as fatigue, brain fog, muscle and joint pain, insomnia and mood imbalances are all so common in today's society.
The continuous output of cortisol, which is stimulated by stress, can eventually have a negative impact on the HPA axis, meaning that the body becomes less resilient to stress.
During the early stages of life, where a child or an adolescent is subjected to situations of long-lasting stress, this axis can have its activity dysregulated by molecules that can interfere with different physiological mechanisms.
Moreover, the homeostasis disruption caused by a dysregulation of the HPA axis in response to stress induces neuro immunoendocrine changes, which, if persistent, can induce poor health.
Impact on newborns and kids under the age of 5
Emotional stress and anxiety start showing their adverse effect on a child even before he or she is born. During times of stress, parents - particularly pregnant mothers - are in a psychologically vulnerable state to experience anxiety and depression, which is biologically linked to the wellbeing of the foetus. Pregnant mothers have a lot of stress concerning hospital visits in terms of encountering Covid-19 infected people. They also carry a lot of anxiety with respect to the actual childbirth.
Interestingly, there have been a few cases of babies being born with Covid-19 antibodies. However, the World Health Organisation said it is not yet known whether a pregnant woman with Covid-19 can pass the virus to her foetus or baby during pregnancy or delivery.
In one of the preliminary studies tracking the pandemic, it was found that children (aged 3-6 years) were more likely to develop symptoms of clinginess and the fear of family members being infected. Reports also suggest that children of this age group often experience disturbed sleep, nightmares, poor appetite, inattention and separation-related anxieties ever since countries started enforcing lockdowns.
Effects of Covid on schoolgoing children and adolescents
Pre- lockdown, the learning of children and adolescents predominantly involved one-on-one interaction with their mentors and peer groups. Regrettably, the nationwide closures have damagingly impacted over 91 per cent of the world's student population.
The confinement of children and adolescents to their homes has resulted in a lot of uncertainty and anxiety, leading to considerable disruption to their education, physical activities and socialisation. The absence of a structured form of learning in schools is increasingly leading up to a disruption in routine, increase in boredom and lack of opportunities to engage in academic and extracurricular activities.
Such an environment may be leading children and adolescents towards an emotional breakdown and the same may lead to these children resisting to return to school post-lockdown. This is primarily owing to losing their pre-lockdown routines and the loss of touch with their peers and mentors. In addition to this, the lockdown-related constraints can have a long-term negative effect on their overall psychological wellbeing.
The prolonged confinement of children and adolescents at home has in turn seen a huge increase in the use of the internet and social media. Children may access objectionable content and may also be subjected to cyberbullying or abuse.
Perhaps, the worst side-effect of all can be the matter of children being subjected to exploitation, violence and abuse. Children are rarely able to report violence and abuse at home, especially when they are not going to school. Regular school visits may enable children to express their concerns to peers or teachers.
Effects of Covid on children, adolescents with special needs
In the USA, there are about 1 in every 6 children within the age group of 2-8 years who experience neurodevelopmental, behavioural or emotional difficulty. The global ratio may be quite similar to this figure.
Children with special needs (autism, attention deficit hyperactivity disorder, cerebral palsy, learning disability, developmental delays and other behavioural and emotional difficulties) have been encountering a lot of challenges during the pandemic. They are unable to handle uncertainty and have an intolerance for the same. Lockdowns and enforced restrictions aggravate their symptoms as their regular routines are hampered.
Children with special needs may find it difficult to understand the very concept of "new normal". In addition to this, the closure of special schools and daycare centers for these children has resulted in a lack of access to resource materials, peer group interactions and opportunities for learning and developing important social and behavioural skills during this pandemic. These could lead to an outburst of temper tantrums, and conflict between parents and the children.
Children with autism also find it very difficult to adapt to changing environments. They often exhibit agitation and exasperation when things change too fast too much around them. Such children may also resort to self-harm during times of intense stress. Lockdowns may have also resulted in the suspension of speech and occupational therapy sessions and it takes times for them to get adjusted to online sessions or classes.
Children with Attention Deficit Hyperactivity Disorder (ADHD) struggle to make meaning of what is going around them from the cues they get from their caregivers. It is difficult for them to remain confined to a place and not to touch things, which might infect them. Confinement in one place increases the hyperactivity of the children along with heightened impulses and this will make parenting and caregiving very challenging.
Children with obsessive-compulsive disorder (OCD) are suspected to be one of the most affected ones by this pandemic. Due to obsessions and compulsions related to contamination, hoarding, and somatic preoccupation, they are expected to experience heightened distress.
Effects of Covid on underprivileged children
Social disparity has often been associated with the risk of developing mental health challenges. The pandemic and the resulting lockdowns have seen the world move towards an economic downturn which has directly worsened the pre-existing social disparity and inequality.
In developing countries, the underprivileged children face acute deprivation of nutrition and overall protection, owing to nationwide shutdowns. The prolonged period of stress and anxiety could have a long-term negative impact on their overall mental and physical development.
In India, which has the largest child population in the world with 472 million children, the lockdown has significantly impacted 40 million children from poor families. This number includes children working in farms across rural areas, migrants and street children. Given the effects of complete lockdowns, it is safe to assume that an increasing number of poor and street children now have no source of income or food, making them a high-risk population to face abuse and mental health issues with greater susceptibility and exposure to hostile economic, social and environmental conditions.
Those underprivileged kids having a home may fare no better. Restriction of movement due to lockdowns may see these children being exploited and subjected to violence and abuse at home.
This is no longer an assumption but a fact of the matter as the deputy director of 'CHILDLINE 1098' announced that India saw a 50 per cent increase in the calls received on helpline for children since the lockdown began. This increase in rate is alarming and has made an increasing number of children, victims in their own homes.
School closure coupled with economic adversity may force children and adolescents with rural and underprivileged backgrounds into child labour. Likewise, children without parents or guardians are more prone to exploitation.
Research and findings
The pandemic has forced parents and/or caregivers to also work from home. Many families have also lost their financial independence due to job losses. These circumstances are installing fears in children as they are not only worried about them getting infected but also seeing their parents facing uncertainties. Many underprivileged families are struggling to feed their children as they were dependent on school programmes for meals.
An online questionnaire survey was administered to 359 children and 3,254 adolescents aged 7 to 18 years during the spread of Covid-19 in China. The questionnaire included a depression scale, an anxiety scale, and a coping style scale. It showed 22.3 per cent of youth had scores indicative of clinical depressive symptoms, which is higher than the 13.2 per cent estimated prevalence of youth depression in China. Anxiety symptom levels were also higher post-Covid. A problem-focused coping style was associated with lower levels of clinical depressive symptoms, whereas an emotion-focused coping style was associated with higher levels of clinical depressive symptoms.
In another online survey, 8,079 junior and senior high school students in China completed assessments about depressive and anxiety symptoms during the pandemic. The prevalence of depressive symptoms was 43.7 per cent, anxiety symptoms 37.4 per cent, and both depressive and anxiety 31.3 per cent. Depressive and anxiety symptoms were higher in females, and with increasing grade level from junior to senior high. Students without depressive and anxiety symptoms had more knowledge about preventive and control measures, as compared to those students with depressive and anxiety symptoms.
Mental health of children was assessed during the lockdown in Bangladesh via an online survey of 384 parents with children aged 5 to 15 years. Children's depression, anxiety, and sleep disorder scores were grouped into severity categories. Severity and percentages of mental health problems in the children were as follows: subthreshold (43 per cent), mild (30.5 per cent), moderate (19.3 per cent), and severe (7.2 per cent).
Italy & Spain:
The emotional impact of the Covid-19 quarantine was assessed for children and adolescents from Italy and Spain. Participants included 1,143 parents of children aged 3 to 18 years who completed a survey about the effects of the quarantine on their children. The study found 85.7 per cent of parents reported changes in their children's emotions and behaviours during the quarantine. The most frequently observed changes were difficulty concentrating (76.6 per cent), boredom (52 per cent), irritability (39 per cent), restlessness (38.8 per cent), nervousness (38 per cent), loneliness (31.3 per cent), uneasiness (30.4 per cent), and worries (30.1 per cent).
About 75 per cent of parents reported feeling stressed about the quarantine situation. Parental stress was associated with increased reports of emotional and behavioural symptoms in their children.
Recommendations and advisories by international agencies
International organisations and advisory bodies have issued various guidelines considering the mental health needs of children and adolescents during the pandemic. They have suggested parents interact constructively with the children by communicating to them about the current situation according to their maturity level and their ability to comprehend the crisis.
Parents should plan their children's tasks one at a time, involve them in various home activities, educate them about following hygiene habits and social distancing, engage in indoor play and creative activities. In addition to these activities, adolescents are advised to be involved in household chores and understand their social responsibilities.
Interventions supervised by adults can help them in understanding their concerns. Children should also be encouraged to socialise with their friends and classmates through digital forums under adult supervision.
Handling young children:
Younger children seek more attention. Hence, they crave their parents' physical presence. Parents should devote more time to provide the child with undivided, positive attention and reassurance.
Efforts should be made so that a consistent routine is followed by the child, with enough opportunities to play, read, rest and engage in physical activity. Family sessions with board games and indoor sports activities may help keep the kids away from the long exposure to mobile phones and video games.
Despite all this, it is quite possible to see small changes in the behaviour of children.
This is the optimum time for parents to model the most important life skills with their children. These may range from stress management, coping with emotions, problem-solving mechanisms, etc. Frequent cancellation or postponement of exams may also put these adolescents under a lot of uncertainty. To avoid falling prey to this, students can divert their attention and efforts to learning new skills like cooking, managing money, learning first aid, organising their rooms, contributing to managing chores like laundry, cleaning and cooking, etc.
Excessive internet surfing related to Covid-19 should be avoided as it results in a lot of anxiety and stress. Similarly, excessive use of social media or internet gaming should be avoided. Parents should encourage adolescents who are introverts to keep in touch with their peers regularly.
It is critical that parents, guardians, educational institutions, governments and health authorities protect and safeguard the mental health of children and adolescents consistently through open communication and facilitate professional counseling to address their stress and anxiety.
(The writer is a Singapore-based Open-Source Intelligence analyst)
(With inputs from Abhishek Anand)