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Kids’ Anxiety and Mental Health During the Pandemic

The signs of anxiety in children may be different than you would expect. Here's what parents can do to help.

When you think of the perfect student, you might think of a quiet child who doesn’t cut up in class, talk out of turn, act out or mess around. They might read at lunch while others get a bit boisterous. At home, they might keep their nose in a book or play video games. They’re out of your hair as you get dinner started or wrap up some work tasks. You could be describing the perfect student, or you could be describing a kid with crippling anxiety.

“They could be sitting out at recess under a tree reading, and we go, ‘Oh, they just enjoy being by themselves,’” says Jay Campbell, principal at Great Lakes Academy in Plano, a school that specializes in helping kids with learning differences, including anxiety. “No, they’re wrapped in seven different layers of anxiety. They’re over there, tormented, and nobody knows because no one has a relationship with them.”

Medical professionals just issued a warning about a mental health crisis in students as the pandemic stretches into a third year. “The pandemic era’s unfathomable number of deaths, pervasive sense of fear, economic instability, and forced physical distancing from loved ones, friends, and communities have exacerbated the unprecedented stresses young people already faced,” warned U.S. Surgeon General Vivek H. Murthy in a 2021 report.

The disruptions to routine and uncertainty, combined with the bombardment of distressing media reports have created an extended state of emergency that kids just aren’t equipped to cope with or even articulate. And the adults, says Campbell, aren’t listening.“A lot of educators don’t identify anxiety as being a real obstacle. They see it as being an excuse or a way around doing your work because kids tend to not be great communicators … Imagine that.”

What Avoidance Looks Like

Most parents are familiar with signs of anxiety in toddlers. It usually comes out as a tantrum when mom or dad tries to leave them somewhere: school, church, with a babysitter. No one ever names it for us, and we fully expect them to grow out of it. That behavior is a response to anxiety called avoidance. When a child has anxiety about a situation, like being without their parents, they want to avoid it. That’s why they fight to stay with you.

As kids get older, avoidance is still a go-to strategy; it just looks different. It’s hard for parents to identify avoidance in older children, though, because it can be seen as growing up and wanting alone time, being difficult, or disobedience: not doing homework, missing class, skipping practice, hanging out in their room all the time.

The child may insist they are sick, hurt, that they don’t want to do an activity they used to love, or don’t enjoy kids they used to be close to. It’s easy to focus on the symptom rather than the cause, because the solution looks easy: Just do what you’re supposed to do! But what parents don’t see what’s between the child and the goal: the giant brick wall that is anxiety.

“Simple things get her into a state of being frozen, and it goes from being frozen to outbursts.”

What’s different about this moment is that we are all in a situation no one can avoid—the COVID-19 pandemic. Whatever your thoughts are about the pandemic, the response, vaccinations or herd immunity, there’s no denying that right now is a stressful time, and a recent report by Children’s Health in Dallas bears that out. The annual report, Beyond ABC: Assessing the Well-Being of Children in North Texas, is startling in terms of the measurable impact of the pandemic on students.

Emergency rooms saw a 24% increase in mental health-related visits for children ages 5–11 and a 31% increase for older children. Food insecurity has tripled. Texas students ages 11–21 were more than twice as likely to think about or attempt suicide in the early days of the pandemic than one year earlier. More than 38% of Texas high school students felt hopeless or sad every day for two or more weeks at a time.

RELATED: What to Know About Anxiety and Your Child’s Behavioral Issues

It can be a snowball effect: A child zones out in class because they are stressed and don’t know how to handle it, then they don’t understand the assignment, so they avoid starting the homework, and all of a sudden they are failing a subject or grade. Then they avoid their parents because of their grades. The original stress is still there, but now it’s compounded with missing assignments, failing grades and beating themselves up over letting it get this way.

Recognizing the Signs

Schools are seeing evidence of this. Campbell has been an educator for 22 years. Since his school specializes in students with ADHD, autism spectrum disorder and anxiety, he’s uniquely equipped to note the difference the pandemic has made in the way students move through the world and learn in it.

“The rapid willingness of children to detach from their support networks and retreat to social media and online gaming is a sign that children are having a difficult time managing anxiety and depression. The balance between physical friendships, sports, clubs, afterschool activities, and online gaming [and] social media, is broken. The pandemic broke it, and the anxiety mitigation and ‘self-medication,’ so to speak—kids using social media and gaming to respond to their needs—they just couldn’t put it down when they had too much.”

Campbell also points to what kids aren’t saying. “Another sign of distress we have seen is a general lack of communication with parents and friends about meaningful things and a reluctance to really speak about substantive things with their counselors. It translates into a disconnected student in a classroom who may not see the purpose of the content, the connections between peers and with the teacher, and with all of the academic and social-emotional skills we are trying to give them.”

Eleven-year-old Isabella Salas, who lives in Wylie with her family, has struggled with anxiety since she was 2. The pandemic has been especially hard on children like her. “Before the pandemic, she did taekwondo to help with performance anxiety, social skills and to give her experience with losing in a supported environment,” says Isabella’s mother, Karin Leiva.

“She was in chess, Fortnite, and Pokémon Go clubs at school, and those were helpful for her because they were small groups where the kids had this one thing in common. Those all went away when everything went online, and we lost all the progress we had made.” Leiva says she realizes that there wasn’t necessarily a better way to handle any of this—but for kids like Isabella, big transitions are traumatic.

“At first, I thought being online would help us avoid certain triggers, but the transition back seemed to reset everything,” Leiva shares. “She’s a great student; I don’t have a worry for her when it comes to academics, but she just stopped working. There was nothing. She just froze.” This response may sound familiar to many parents. Kids who were once straight-A students are now drowning under piles of missing assignments. It can feel like kids are taking advantage of being online and having a reduced sense of accountability, when really it could be this avoidance-freeze response to the anxiety of not knowing if you’ll have school next week or not, or if your parents, siblings or grandparents will get sick.

The life changes over the past two years have no doubt taken a toll. “When you’re at a point where you should be hitting developmental milestones, and some of those may have been skipped, that creates a level of anxiety,” explains Gregory Southworth, clinical director for Communities in Schools, a dropout prevention program that works to create a connection with schools and families throughout Dallas-Fort Worth. “Suddenly you’re having to go back and catch up on those social milestones very quickly, and catch up on your schoolwork, too. That’s really hard.”

Part of the concern for this generation of students is that the pandemic has led to an increase in what’s known as adverse childhood experiences (ACEs)—potentially traumatic events that occur in childhood. This could be exposure to a harmful environment, experiencing or witnessing violence and abuse, the death of or separation from a parent or other close family member. According to the Centers for Disease Control, ACEs are known to have long-term negative impacts on physical health, mental health, substance use, education, job opportunities and even earning potential.

“If a child’s environment is impacted in this way as a result of the pandemic, they could be at risk for an ACE,” says Roshini Kumar, a licensed professional counselor and outpatient psychology clinical manager at Children’s Health in Dallas. What this means is that we don’t know right now, and may not know until this generation becomes adults, how this stress has impacted health and well-being across an entire generation.

RELATED: How to Help Kids Manage Their Anxiety

Creating Connection

“Isabella would get stressed over the cafeteria menu, everything. Simple things get her into a state of being frozen, and it goes from being frozen to outbursts,” says Leiva, recalling the struggles her daughter has gone through as she transitioned back to in-person learning. “I am immunosuppressed, so she’s worried about my health, too.”

“[Kids] are afraid that if they tell us they’re OK, we’ll move on to something else and they’ll be left to deal with the world by themselves.”

When a child or student regresses in this way, it can feel fake. But that’s not the case, says Campbell. “What a kid is doing at that moment is [communicating that] they want us to be there for them and be a net underneath them. They are afraid that if they tell us they’re OK, we’ll move on to something else and they’ll be left to deal with the world by themselves. So what I tell parents when that starts to happen, let your child know, no matter what happens, ‘I’m here. I’m your net. I’m never leaving. I’ve always got you. I’m never going to let you fall.’”

Connection with teachers can work much the same way to reduce anxiety. The classes where Isabella excels are also the classes where she has the most trust with the teacher. “Her math teacher has really fostered a relationship with her so that she doesn’t feel embarrassed to reach out. She feels safe in those environments,” says Leiva. They’ve reluctantly agreed to reduce expectations in classes where the trust with the teacher isn’t there, which has been a revelation for a family with high-achieving parents who have the same expectations for their children. “We focus on certain subjects and not others,” Leiva shrugs with a bit of sadness. “It’s a hard thing for me to say.”

What Parents Can Do

Parents and teachers can help kids cope right now by creating as much certainty as possible. Consistent bedtimes, wake times and mealtimes help. So does posting schedules for after-school activities and giving as much notice as possible about changes in routine. Create as little uncertainty as possible, because the world is dishing it out as fast as we are adjusting.

Keep in mind that students who are doing well on paper can be fighting anxiety, too. Kids can be high-functioning or low-functioning in this area, says Southworth. “What schools often have to do is deal with the students who are [visibly] struggling the most in the moment. There may be a lot of students who are suffering out there, but suffering in silence.”

Communicate with your student about how they are feeling daily, using descriptive words, emojis or a “feeling thermometer,” suggests Kumar. Children often lack the vocabulary or a safe setting to share their feelings. Parents can teach a ‘feelings vocabulary’ by posting emoji feeling faces paired with feeling words on the refrigerator, and create a time to review these feelings, such as around the table at dinner, reviewing a high of the day and low of the day.” A similar idea is the check-in exercise “Roses and Thorns.”

Go around and ask each person to share:
A rose—the best or most special part of their day
A thorn—the most difficult part of their day

You can also add:
A bud—something they are looking forward to or are excited about
A leaf—something they did that day (that wasn’t a rose or thorn)

Ways Parents Can Help:

  • Establish and reinforce trust. Eat dinner together, chat before bed or talk one-on-one in the car.
  • Have a schedule and stick to it as much as possible. Have regular bedtimes, mealtimes and wakeup times. Post schedules where kids can see them. Use clear communication to eliminate unknowns when possible.
  • Help children and teens describe their moods with precise words. Are they anxious, excited, stressed, nervous or scared? Have your child draw a “feeling thermometer” and identify how their body responds as their tension increases. “It provides insight into the mood-body connection and a guide on when to implement a cool-down coping strategy,” explains Roshini Kumar of Children’s Health. “Identify three coping strategies to practice when experiencing a climb on the feeling thermometer.”
  • Teach your child coping strategies. This could be box breathing (four counts breathing in, four counts holding breath, four counts exhaling, four counts holding breath), body awareness, journaling, drawing, meditation or yoga.
  • Find a counselor for your child. “We may think that we know our kids best and can solve all problems, but we are not all counselors,” says Plano educator Jay Campbell. “And even if we are, most counselors do not counsel their own kids for a reason.”
  • Communicate with schools, counselors and therapists. Keep everyone working with your child looped in when working through a specific situation.
  • Find community and support by finding in-person meetups or online groups for parents of children with anxiety.

Talking about feelings and naming them is helpful for students of all ages, as is talking about signs we are experiencing stress and how to mitigate it. Leiva and Isabella work on this together constantly. “When Isabella’s anxiety is ramping up, going quiet and shallow breathing are our cues that she needs to pause, let herself experience the feeling, and then we talk about how we are going to get through it. Slowly, that’s translating to positive self-talk that she uses on her own.”

In some places, life does seem to go on as if there is no longer a pandemic. But it’s important to remember that for students, life is not normal. Every day, they go to school and try to catch up on all the subjects, social skills and milestones they have missed over the past two years. They wonder if school will be canceled again; if sports and clubs and their favorite activities will continue. They wonder if their friends and family will be OK. They feel pressure that they will miss out if they aren’t on social media or online games, and yet those things can make them feel as left behind and alone as ever.

The good news is that parents, teachers and mentors have powerful tools to support students: time, connection and trust. These tools work if we use them. Talk to the kids in your life. Even if they don’t answer, ask them daily how they are doing and how you can help. Trust is built slowly, but you can build it, one question at a time.

Illustration: iStock