What Therapists See in the Children they Treat during the COVID-19 Pandemic

What therapists see in the children they treat during this no-good horrible pandemic is likely a subject of interest to many parents right now. Children may be showing an increase in negative behaviors. Parents, meanwhile, may be wondering whether their children’s behavior is normal or if they might need therapy. Ask a therapist, and they will tell you that therapy never hurts, and may just help children and their families get through the endless nightmare of COVID-19. But just in case you want to check the mental health pulse of your child and that of your family, read on to see what child therapists are seeing in the clinic while the coronavirus marches on:

Most Common Pandemic Behaviors

Dr. Carole Lieberman has long experience in treating children who have experienced trauma—and the pandemic qualifies as exactly that—a source of trauma exceptional in its ability to keep us in its grip. Lieberman, a media psychiatrist and the bestselling author of Lions and Tigers and Terrorists, Oh My! How to Protect Your Child in a Time of Terror, is seeing an increase in both negative behaviors and depression in the children she treats. But this Beverly Hills psychiatrist is also seeing one brand new mental health issue: “COVID Paranoia.” Lieberman offers a list of the most common COVID-related child behavioral issues she sees in her clinic:

• Depression – Children are feeling depressed for several reasons, mostly because of not being able to see their friends at school or to play sports. They’re also depressed because they’re bored or because they’ve been bullied on social media by kids who are also unhappy and take it out on other kids.
• Anxiety – Children are feeling anxiety about a lot of things, many of which they don’t understand—from COVID-19 to politics to violence in the streets. They spend too much time watching TV and seeing scary things—from people dying to people looting.
• Frustration and anger – What is really getting to kids—and making them act out in uncharacteristic ways—is that there is no end in sight for the things that have turned their world upside down. For example, there are no plans for most schools to reopen; more people are getting sick with COVID-19 despite masks; many malls aren’t reopening; and many parents aren’t letting their children have play dates.
• ‘COVID Paranoia’ – This is a new phenomenon. Some kids have developed paranoid fears and obsessions about catching COVID-19. They’re afraid to go outside of their homes because they don’t want to get too close to people who may be COVID positive. They don’t want their parents to go to work or even to go to the grocery store. Even kids whose parents couldn’t get them to clean up their rooms, have now become compulsive about cleaning the whole house to get rid of germs.

Breaking it Down By Age

Do these negative behaviors therapists see in the children they treat during COVID-19, vary according to age? Dr John Mayer, a leading expert on children and families, shared his own list of the pandemic-related behaviors he is seeing in his clinic. Mayer breaks it down by age:

Ages 6-7 and under:

• Tantrums, and needy, clinging behavior as children sense the tension and anxiety in their homes and in the world. They typically don’t understand what’s going on.
• Difficulties stemming from the lack of socialization.
• Children don’t understand why they can’t see grandma and grandpa and their other relatives.
• Anxious behaviors as they model the same behaviors they see in their parents.

Ages 8 and older:

• Anxiety expressed through fears along with increasing temper tantrums.
• Socialization issues—missing friends, an inability to occupy their time or play on their own.
• School performance issues—unable to learn via eLearning
• Hyperactive behaviors that are not clinical hyperactivity, but rather a response to too much pent-up energy.
• Unable to respect boundaries at home; consequently, they disturb parents and engage in negative behaviors to get their parents’ attention.
• Modeling parents’ anxious behaviors.
• Poor parenting—children are home more with their parents, who may not be at their parenting best, due to the stress and anxiety of the pandemic.

Mayer mentions hyperactive behaviors that are the result of pent-up energy. Maybe so, but psychologist Avital K. Cohen says she’s seeing an increase in referrals for ADHD testing and evaluation for children who attend school remotely. “Sometimes these kids are just having a natural reaction to being in front of a screen for extended periods of time. But there are also kids who had mild challenges they could cope with and compensate for in the typical classroom, before the pandemic. These children are now struggling with being in the home setting, which means a decrease in structure and an increase in distractions.

What Therapists See: Brain Fog

What has yet to be mentioned are the children who have been ill with COVID-19. In addition to increased behavioral issues, Dr. Roseann Capanna-Hodge, a psychologist and pediatric mental health expert, is seeing issues specific to children dealing with the after effects of the virus. “The most common mental health issues that I am treating in children and teens due to the pandemic quarantine are anxiety, depression, obsessive-compulsive disorder, attention and learning problems, and family discord. I am also seeing cases of post-COVID infection brain fog that I am treating with better nutrition, neurofeedback, and brain-based exercises.

The learning problems, says Capanna-Hodge, mostly have to do with the changes in learning structure since the pandemic struck. “Parents and teachers weren’t trained to teach kids virtually and this has had an impact on kids’ learning. From difficulties with learning due to limited instruction, too much digital instruction, lack of structure, routine, and movement, and not enough social interaction,” says Capanna-Hodge, “kids are having a hard time. Parents are overwhelmed and unsure of how to help their children get focused and absorb information.”

Like Dr. Cohen, Capanna-Hodge says the lack of structure is another pandemic-related issue that is causing issues in the children and adults she treats. “Families are spending a lot of unstructured time together at a time of global stress, and family communication is breaking down, so I am seeing more families struggling with mismatched expectations, high frustration levels, and increased discord.”

What Therapists See: Small Children Fare Best

In her Ridgefield, CT center, Capanna-Hodge says the effects of the pandemic seem to affect all her patients, irrespective of age, having an impact on children, teens, and their families in many ways. She sees behavioral, cognitive, and emotional effects, all related to living under the cloud of COVID-19. “Younger children seem to fair best of all, because they rely on their parents’ response to the pandemic in how they self-regulate their own behavior. If a parent is managing well or maybe even thriving during this pandemic quarantine, then their kids are going to do well both mentally and behaviorally.”

In school-aged children, teens, and college students, on the other hand, Dr. Capanna-Hodge is seeing more than ever, kids who are struggling with attention and learning. “This is due to the need for remote learning,” she says. “Between ill-prepared teachers and haphazardly prepared curricula, parents are struggling to support their children’s learning at home. Some children may have had preexisting attentional or learning challenges. For others these are new issues related to distance learning.

“With teens and college-aged children, I have seen a marked increase in depression due to long-term isolation. Teens are social beings and are just finding their independence. This quarantine has really taken a toll on them. The teens and young adults I treat may not have found healthy ways to cope with stress and isolation and as a result, they struggle. For those teens that have a small pandemic pod and/or are attending school in-person, they seem to be okay emotionally, because they have that all important connection with peers.”

A Silver Lining

But Capanna-Hodge sees a silver lining to the pandemic: parents are now addressing issues they either never got around to taking care of before, or didn’t really know were significant until they spent so much time with their children. “They are taking the time and doing the therapy for both themselves and their children using a variety of proven therapies such as neurofeedback, biofeedback, meditation, and psychotherapy to really resolve those core issues.”

Now that you know what therapists see in the children they treat during COVID-19, you may have a better handle on your own child’s situation. If your child is showing some of the behaviors these experts see in the clinic, you can work to eliminate the factors that cause them. You might think about how to give your child more structure and lessen distractions during the time your child is learning remotely. When your child seems cranky and out of sorts, you might want to consider whether your child is modeling your own grumpy behavior that is a reaction to the pandemic situation. If so, work on doing a better job of self-regulating your own behavior, in order to model a better example for your child.

Living through a pandemic is awful, no matter one’s age. As adults, however, it is our job to steer our children through this difficult time so they come out safe on the other side. It may be that part of that journey involves some therapy for you, your child, or your family as a whole. No parent can fix everything and no parent is perfect: we can only do our best. So, if you begin to see what child therapists see during this pandemic, it may be time to make some changes, or to seek out the right therapist for your child.

Here’s to better times, and many healthy, happy, thriving families!