Children Struggling with Mental Health as Pandemic Drags On
By Methmalie Dissanayake
“Due to the smaller number of infections and lower rates of physical complications, children and adolescents have perhaps received less attention globally during the pandemic.
However, the psycho-social effects of the pandemic on children and adolescents have been so staggering that it has been labelled a ‘parallel pandemic.’” This remark is made by Consultant Child and Adolescent Psychiatrist at Colombo South Teaching Hospital, Dr. Yashodha Rohanachandra, in one of her papers.
During the past few weeks, several incidents were reported where children were addicted to mobile phones and online gaming with many parents complaining that their children have become aggressive, impatient and stubborn. Parents, specially mothers are having a hard time balancing their professional lives and spending time with children who have become isolated at homes for more than one and a half years due to the closure of schools.
Addressing psycho-social impact
In her article ‘Addressing the psychosocial impact of COVID-19 on children and adolescents: The need for collaboration,’ published in Sri Lanka Journal of Child Health in 2021, Dr. Rohanachandra shed a light on many important aspects when it comes to the mental health of children during the pandemic. “Children and adolescents are more likely to develop negative psychological consequences due to the pandemic than adults.
As coping with stress is a developmentally acquired skill, children and adolescents are more likely to lack appropriate skills to cope with the lifestyle changes imposed to control the spread of the pandemic,” the article noted.
Accordingly, school closure is one factor that has contributed substantially to development of psychological problems in children. When the pandemic hit Sri Lanka, the schools islandwide was closed down considering the safely of children. However, even after one and a half years, the school closure is still in effect.
Although, the Ministry of Education says that they are planning to re-open schools gradually, they have failed to provide an exact date to re-open the schools. Dr. Rohanachandra, in her paper pointed out that schools not only deliver education but also serve to provide routine and structure, social interactions and peer relationships, all of which are critical in developing socio-emotional skills in children and adolescents. With school closure, children have lost their daily routine and structure. They have had to adapt to virtual education, with no prior warning or preparation. Extracurricular activities have ceased and they have lost contact with their peers and teachers.
Furthermore, children and adolescents in dysfunctional families were confined to their maladaptive home environments. Moreover, with school closure, children have lost the psychological support they receive through school counsellors. All these factors when combined are likely to place children and adolescents at a high risk potential for developing mental health problems, she said. Dr. Rohanachandra also said that lack of extra-curricular activities, lack of access to outdoor areas and limitation of social events have led to an alarming rise in screen time in children and adolescents globally.
Parents engaged in routine employment during lockdown, having no rules related to screen time and inconsistent parenting practices were associated with a higher risk of excessive use of screens. Increased screen time and problematic internet use were shown to be associated with increased psycho-social problems like depression, anxiety, suicidal ideation and Attention Deficit Hyperactivity Disorder (ADHD) as well as physical comorbidities like weight gain, nutritional deficiencies, musculoskeletal problems and chronic pain syndromes, she stated.
During the pandemic time, children engaging in physical activities became drastically decreased, especially among high school students. It may predispose children to develop physical complications such as obesity and metabolic syndrome and negative mental health consequences, she added.
Furthermore, she said that difficulties with sleeping, including delay in bedtime, increased sleep latency, increased sleep duration, poor sleep quality and delayed waking time, have been described in children since the onset of the pandemic as well.
“An increase in emotional and behavioural problems in children and adolescents has been reported globally. In addition, fatigue, loneliness, negative thoughts, lack of enjoyment of activities, boredom and fidgety behaviour have also been reported.” Another important fact that Dr. Rohanachandra highlighted is the risk of adverse psycho-social outcomes is estimated to be especially higher in children with neurodevelopmental disorders, special educational needs, chronic diseases and pre-existing mental health problems.
She said that children with Autism Spectrum Disorder (ASD) had more intense and frequent disruptive behaviour and worsening of mental health difficulties during the lockdown, which resulted in depression and anxiety in their parents. Not only that, there is evidence from several countries that suggested violence against women and children have increased. In Sri Lanka, a total of 121 complaints related to child cruelty was reported to the National Child Protection Authority (NCPA) from 16 March to 7 April 2020.
The UNICEF and the NCPA expressed grave concerns about the dramatic rise in this number since imposing the lockdown. “Financial difficulties, parenting stress and job loss contribute to this higher risk of child maltreatment. In addition, with school closure and social restrictions, children and adolescents have less contact with other supportive adults such as teachers and extended family.
Furthermore, there has been widespread disruption in child protective and community services supporting child welfare. These factors combined, make children and adolescents especially vulnerable to abuse in the face of the current pandemic. Moreover, increased use of the internet has put children and adolescents at risk of sexual exploitation and exposure to abusive and inappropriate material on-line,” she pointed out.
What can parents do?
Occupational Therapist at Leadership, Personal Growth, and Social Responsibility (LEAPS) project initiated by the Medical Faculty of Ragama said that in the first place, the parents need to manage their stress. “It is well known that adults are also stressed during the pandemic situation. Therefore, to help the children who are stressed, the parents need to manage their own stress in the first place. If the child ask you something when you are upset and stressed, you have to control your emotions before responding the child.
It is very important because the positive environment in a home entirely depends on the mood of parents. Since this is a very challenging period, the environment in a home should be positive, so, the children can be happy and calm,” he said. Gunarathne also advised to take back the digital screens from the children at least an hour before their sleeping time. It is important to prepare a time table for the children regarding activities such as eating, sleeping, playing, etc.
“Since, the children are engaged in online education these days, parents should be mindful regarding the time children spend online and materials they come across with. There are many online materials regarding COVID-19 which could be a very disturbance to the children’s minds. It is easy for the children to become victims of fake news, adult materials, etc., when they spend time on internet.
Parents should be very careful about this,” he said. Not only the internet, sometimes, news and other programmes related to the pandemic which broadcast on television and radio, too can disturb the children mentally. So, the parents should always try to educate children with correct information such as how to protect themselves from the virus, how to maintain personal hygiene and so on according to their ages and spend time with children as much as possible.
Also, parents should not direct children to study and engage in education related stuff all the day. It is better if they can direct the children to begin study in the morning until 1 – 2 p.m. in the afternoon, because this is the time which schools were functioned before the pandemic, he noted. “Parents can also direct children to find new hobbies and engage in music, dancing and aesthetic activities,” Gunarathne said.
He recommended the book titled ‘My Hero is You’ developed by the Inter-Agency Standing Committee Reference Group on Mental Health and Psychosocial Support in Emergency Settings (IASC MHPSS RG), to assess children’s mental health and psychosocial needs during the COVID-19 outbreak.
This book could be read to the children by a parent or a teacher. “Finally, the parents should take care of their mental health too. If parents are happy and mentally stable, the children will feel the positive vibes inside the homes. Therefore, parents maintaining a good mental health is equally important during this pandemic,” he pointed out.
UNICEF urges to re-open schools as soon as possible
UNICEF on Thursday (16) closed its social media channels for 18 hours to send a message to the world to re-open schools for in-person learning as soon as possible. The UN Educational, Scientific and Cultural Organisation (UNESCO) joined with UNICEF, together with the World Bank, the European External Action Service (EEAS), the European Commission Humanitarian Aid Operation, the LEGO Foundation and the WEF Global Shapers community of world youth in this regard.
The right to go to school is central to every child’s development, safety and well-being. Yet in too many countries, classrooms remain closed while social gatherings continue to take place in restaurants, salons and gyms, the UNCEF said. The UN agency said that it believes “this generation of children and youth, cannot afford any more disruptions to their education.” According to the new numbers from UNESCO, released on Thursday (16), show that schools are now fully open in 117 countries, with 539 million students back in class, ranging from pre-primary to secondary levels.
This represents 35 per cent of the total student population across the world, compared to 16 per cent who returned to school in September 2020, when schools were only open, or partially-open, in 94 countries. Around 117 million students, representing 7.5 per cent of the total, are still affected by complete school closures in 18 countries. The number of countries with partly open schools, has declined from 52 to 41 over the same period.
In all countries that had prolonged full school closures, education was provided through a combination of online classes, printed modules, as well as tuition through TV and radio networks. UNESCO and its Global Education Coalition partners have been advocating for the safe re-opening of schools, urging full closures to be used as a measure of last resort.
Since the onset of the pandemic, schools were completely closed for an average of 18 weeks (4.5 months) worldwide. If partial closures are accounted for, the average duration of closures represents 34 weeks (8.5 months) worldwide, or nearly a full academic year. For UNESCO, the past two academic years have resulted in learning losses and increased dropout rates, impacting the most vulnerable students disproportionately.
Vaccination is the key
Rising vaccination rates among both general population and teaching staff, has also been a key factor in re-opening schools. The vaccination of teachers has been prioritised in around 80 countries, allowing for the inoculation of some 42 million teachers. In a handful of countries, the vaccination of students aged 12 and over, is an important factor in determining the full re-opening of schools. Action to accelerate the recovery of learning losses remains an essential component of national COVID-19 education responses. For that, UNESCO said teachers and educators need adequate support and preparation.
Role of the governments
Speaking on the matter, Dr. Yashodha Rohanachandra noted that COVID-19 pandemic may go on for a few more years, with possible exacerbations and further lockdowns in the future. “Therefore, Governments need to learn from past experience and be prepared to address the psycho-social needs of children and adolescents in case of further lockdowns.
The Government and private sectors should work together to provide flexible working hours for parents, so that they can support children with their distance learning endeavours.” In addition, as there is a wide variation of distance education provided by different schools, the Government should aim to standardise distance learning by formulating guidelines for online education.
Teacher training in online mediums of instruction is another important measure to ensure that all education professionals have the same competency in conducting distance learning. Parents should also be empowered by providing guidelines and recommendations on supporting their children with their distance learning. As the social distancing measures may limit the access to support services, continuation of these services via tele-health facilities need to be considered and the Government should provide the necessary infrastructure to make this possible.
Several reports suggest that separation from infected parents may be more harmful to the children than contracting COVID-19 themselves. Hence, recommendations for care arrangements for children who are separated from their parents due to COVID-19 need to be formulated. Finally, data on the psycho-social impact on children in Sri Lanka are quite limited. Therefore, Government funding, supporting research in this area, is also needed. That would be a long-term investment on the future welfare of children who would grow up to be the next generation of Sri Lankan adults, Dr. Rohanachandra pointed out.