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COVID's Effects on Children Coming into Focus

August 12, 2020
Ron Manderscheid
By Ron Manderscheid, President and CEO, NACBHDD and NARMH
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The opinions expressed by Psychiatry & Behavioral Health Learning Network bloggers and those providing comments are theirs alone and are not meant to reflect the opinions of the publication.

Slowly, anecdotal examples of the COVID-19 pandemic’s effects on children—and the ways in which behavioral healthcare can address some of these issues—are beginning to emerge to illuminate these topics.

Most of our children spent the period between March 15 and June 1 attending school online. At the same time, they were sequestered at home with their adult family members who either were working virtually from home or were laid off. Stay-at-home rules were in place to avoid the COVID-19 contagion. Very young children could not participate in play groups, and older children could not spend time with friends and peers.

Now that school is “out” for the summer, the situation has not changed appreciably. Many summer camps and family vacations have been cancelled, and the vast majority of teens do not have summer jobs. Many stay-at-home orders remain in place, and social distancing rules are nearly universal.

Within just a few days, we will reach the five-month point for this very surrealistic situation. Among adults, the near-universal effects are fear, stress and anxiety. For some, even more serious effects occur, such as depression, drug use and self-medication. What are the effects on our children?

Perhaps one way to look at these effects is to describe several of the situations in which children spend most of their time.

Interaction with parents and family adults. Clearly, children are spending many more hours with their parents each day than in the past. This time is very likely to be much more intense than earlier, as parents try to work from home and parent at the same time. Such situations can and do engender conflicts and even hostility. Further, children have much less private time away from parents because of stay-at-home requirements.

If parents have problems with alcohol, drugs or violence, these are likely to become manifest, and potentially can lead to child abuse.

In such situations, children can develop stress reactions, anxiety or even depression. As we know well, these adverse childhood experiences can take a major toll on children as they become adults.

Attending school virtually. Online school attendance can require long periods of attention to a computer screen. This can range from 5-6 hours per day for older children to 2-3 hours each day for younger children.

Many issues already are being noted with online-only education. Very small children simply do not have the attention span to spend 2-3 hours on a virtual system without major breaks, interpersonal play groups, and strong emotional support from teachers. Older children respond to the virtual classroom in a manner similar to their response in a physical classroom. Some play “hooky,” some text with friends, and some act out in the virtual classroom. Field reports suggest that as many as 30% of children did not participate at all in virtual education during the spring.

Virtual education also exerts far less interpersonal control and support from the teacher, compared with interpersonal training in the classroom. (Imagine a Zoom meeting in which the teacher is expected to pay close attention to 40 students who are 13 years old.)

Behavioral healthcare will need to transition from more traditional work in a physical classroom to work in a virtual one. We must begin to think how we can give clinicians direct time to work with the students each day in a virtual classroom. This might be training on mindfulness, socio-emotional support or other topics. Similarly, there is no reason that a virtual classroom could not be used to share brief videos every day on key behavioral health topics.

Interaction with peers and friends. Prior to COVID-19, children interacted with peers and friends both interpersonally and virtually. In that context, virtual communication supported interpersonal interaction. Now, most communication with peers and friends is virtual.

Video interaction among friends can approximate the intensity and content of interpersonal communication. However, it does not teach some of the emotional skills required for direct interaction. That is why it is much easier for most people to interact virtually than to interact interpersonally.

A colleague recently described the situation like “being an extrovert trapped in introvert heaven.”

Thus, we must ask how this era of virtual interaction is affecting our children. What will be the longer term effects of less time spent in play groups, friendship groups, organized groups and just “hanging out”?

Should we take counter measures? If so, what steps?

I would like to hear from you if you have done work in any of the areas discussed here. We need to accumulate much more suggestive evidence that will help to point our work with children in the right direction.

There is no more important topic than the future of our children. Our own future will depend upon it.

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