For over a year, we have psychologically balanced the impact of inconvenience and discomfort with the hope of “returning to normal.” Casual reference to “returning to normal” is stated as a motivator to continue enduring the social sacrifices we anticipated would end soon after vaccines were available and distributed. With emerging research out of Columbia University’s Irving Medical Center predicting current vaccines to be less effective in neutralizing the U.K. and South African variants of the SARS‐CoV‐2 virus, mitigation efforts like mask wearing and physical distancing will need to continue while we wait for faster vaccine roll outs that can stop the virus from spreading. As we are also learning, it is becoming more difficult to hold on to the notion that we will be able to travel freely, socialize with our friends and family without worry, and return to the predictable structure of school and employment any time soon.
This reality suggests that we may need to shift our language and perspectives to establish a healthier, more accurate framework that allows adults and children alike to continue progressing and moving through days without feeling as though circumstances in our world must change entirely to achieve a sense of productivity and satisfaction with daily life. It is still much too early to ascertain when precautions will no longer be necessary. But what is growing evident as time passes is that there is no guarantee that the “normal” we once knew may ever completely return. If this is in fact the case, how helpful is it to be urging kids to cling to the notion that their lives will return to a past concept of “normal” that may not be attainable for years, if ever?
Admittedly, this is a thought‐provoking topic that requires further consideration. However, it is not premature to begin contemplating strategies for how to prepare youth for ongoing uncertainty and adaptions to a new sense of “normal.” Consider the following tips for supporting youth as an evolving “normal” continues to establish itself.
Tips you can use
- Remain informed and up to date on information pertaining to the virus and the recommended guidelines, both nationally and locally. Presenting youth with accurate information can reduce false hope or misunderstanding. Society is at a point where some have grown weary in their vigilance and are exhibiting inconsistent adherence to masking, physical distancing, and limiting attendance for social gatherings. Explaining current regulations when kids ask to participate in social activities that may not follow guidelines can help them understand why some plans are not yet prudent for the safety of our communities and reduce the assumption that a parent or grown up is simply dismissing or prohibiting requests to socialize. When children inquire about the timeframe of regulations, it is important to be honest and transparent about the likelihood that masks and physical distancing could be a part of socializing, in at least some capacity, for years to come, depending on virus variants, time of year, size of gatherings, and the health of self and others with whom we are interacting. Help them understand that, despite our desperate wishes for the pandemic to end and become a distant memory, it is more realistic that the impact of the pandemic will slowly fade over time.
- Use age‐appropriate language when discussing the pandemic. Younger children benefit from concise explanations and reassurance whereas adolescents tend to pursue deeper understanding on issues directly affecting their daily life and experiences. Amazon offers a relatively impressive selection of children’s books about COVID‐19 that use pictures to help younger children process current events in a developmentally appropriate style. Avoiding frequent discussions related to the pandemic will likely contribute to stress and anxiety in children, of any age, in the longer‐term.
- Validate emotions often and genuinely. Although circumstances around the pandemic have been difficult for most adults to conceive, the adjustments required of children will likely change the youth of Gen Z and younger forever, as vital stages of development have been interrupted and paused for months, with the possibility of this extending to years. It is important for youth to know that parents, teachers, doctors, and grown‐up support people understand these changes have been intolerable at times, without overreacting to the words or behaviors selected during emotionally charged moments. Validate their distress and support them in identifying thoughts and emotions. Oftentimes we feel more supported when others can create a space for validation without immediately kicking into problem‐solving mode. When executed successfully, it can be easier to engage a child in cooperatively identifying better strategies for coping with big emotions.
- Encourage functioning and stepping out of comfort zones. Stay at home orders and recommendations to discontinue non‐essential travel and socializing has naturally contributed to decreased physical and social functioning. It has become acceptable to find entertainment at home without relying on leaving the house. Consequently, many are experiencing a sort of social atrophy. For children who were socially anxious before the pandemic, returning to school and socializing, after several months of having a reason to avoid anxiety provoking situations, will likely increase anxiety. Children who were seemingly socially well‐adjusted prior to the pandemic are not excluded from the probability of feeling apprehensive and less self‐assured in social situations. Adults should support youth in labeling their worries and fears then assist them in setting small, attainable goals upon which they can progressively build momentum to overcome the social, or even general, anxiety that has developed. Sound familiar? This approach is known as exposure and response prevention, a scientifically supported intervention for treating anxiety disorders across the lifespan. Encouraging a child or adolescent to work through anticipatory anxiety and tolerate distress instead of avoiding non‐threatening, anxiety provoking situations can lead to lower levels of anxiety over time. Thus, quality of life and distress tolerance improves.
- Find creative ways to stay connected. Daily overuse of technology for entertainment and coping was a pre‐existing pandemic of its own long before COVID‐19 arrived and has only worsened since. The well‐documented consequences of excessive screen time across all domains of childhood development are too vast to cover in this brief article but have been reviewed in previous CABL pieces and are excellent references. With that said, technology has undeniably played an essential role in remaining connected to family, friends, and co‐workers when in‐person interactions are not safely possible. Imagine how people endured the influenza pandemic 100 years ago without technology! While a useful luxury for certain, setting limits on screen time is important — for all of us. Be prepared to hear frequent complaints of boredom AND be encouraged that boredom can sparks curiosity and creativity! Think innovatively about activities that safely connect youth with their friends and peers in person, now, without waiting for life to “return to normal.” Participate in activities with your kids, students, and patients that emphasize problem solving, physical activity, critical thinking, skill building, social skills, exploring new hobbies or interests, etc. Remember to encourage stepping out of comfort zones while validating distress as kids develop and navigate a plan of attack. Expect a level of push back and commit to enforcing compassionately firm limits when there is relentless begging for more “tech time.” They will survive. In fact, the belief is that they will ultimately thrive.
- Prioritize structure and consistency. Rarely will youth independently request structure. However, most would agree that children respond well to structure and consistency. Create visual schedules and establish set timeframes for meals, schoolwork, tech time, free time, family time and, perhaps most importantly, nighttime routines/bedtime. Real or perceived loss of control is at the core of anxiety and stress. Structure and consistency can offset the negative effects of stress, especially when there is much uncertainty surrounding us at present.
- Model healthy coping. Children and, yes, even teens, look to adults for valuable information on how they should think or feel in various situations, ranging from trivial to more serious ones. It is essential to practice self‐care. Acknowledge the stress and challenges encountered in daily life and talk about how you can/will cope with them. This normalizes distress and highlights the importance of healthy coping. Allow kids to hear and participate in discussions that intentionally identify “silver linings” to this pandemic — like getting to spend more time together or appreciating how less traveling has contributed to amazing improvements to our environment. Research has shown that gratitude makes a significant positive contribution to mood and physical and emotional health.
- Recognize mental health concerns. Mental health issues in youth have been on a steady rise in recent years, with alarming rates of increased suicidality and psychiatric hospitalizations observed nationally. At one point during this pandemic, the number of children who have CAMBPED — a term that refers to patients admitted to medical beds at Hasbro Children’s Hospital while they wait for an open spot at one of the local psychiatric units to become available — was up 50% compared to the same time period last year. Dr. Margaret Paccione, psychologist at Bradley Hospital, comprehensively outlines and addresses mental health patterns and trends within the Lifespan system in interviews with Rhode Island Monthly (April 2020) and Providence Journal (February 2021). She recommends watching for the following signs that may indicate it is time for you to reach out for additional support:
- expressing excessive anger, anxiety, worry or sadness
- significant changes in eating or sleeping patterns
- hypervigilance to one’s health or body
- feeling helpless
- difficulty concentrating or attending
- talking about or hurting self or others
- asking for help.
For additional resources, you can speak to a trained counselor at SAMHSA Disaster Distress Helpline on 1‐800‐985‐5990 or by texting TalkWithUS 66746.
You can also contact your physician or your insurance company if they have a consultation line to ask health‐related questions or to seek mental health support.
Heather Pelletier, Ph.D., is a pediatric psychologist at Hasbro Children’s Hospital and clinical assistant professor in the departments of Psychiatry and Human Behavior and Pediatrics at the Warren Alpert Medical School at Brown University. Dr. Pelletier provides integrated clinical services to medical specialty clinics including pediatric rehabilitation and gastroenterology. Her primary areas of clinical and research interest are in pediatric pain and rehabilitative restoration.