Since March 2020, children in the United States have faced mandatory social isolation in response to the global COVID-19 pandemic. Experts aren’t yet certain if this imposed isolation from peers will have a long-term mental health impact on children. Increasingly, parents and clinicians are reporting signs of mental distress in children of all ages. This indicates immediate mental health impacts that must be addressed. And, to that end, we reviewed current research and spoke with practicing clinicians to identify the immediate impact of isolation on children and adolescents, with an eye toward interventions to minimize lasting concerns.
Historic Examples of Social Isolation
Since the social isolation response to COVID-19 is unprecedented, researchers have limited historical examples from which to draw evidentiary conclusions. Still, the authors of “The Impact of Social Isolation and Loneliness on the Mental Health of Children and Adolescents in the Context of COVID-19,”[i] reviewed 80 studies, examining the mental impact of loneliness and social isolation on previously healthy children and adolescents. Their findings were presented in a Rapid Systematic Review, in the Journal of the American Academy of Child & Adolescent Psychiatry. Just one was a retrospective investigation conducted after a pandemic, and nearly all included data were observational. As such, the authors acknowledge that these “studies had a high risk of bias.” This is to be expected, since reports of loneliness are highly subjective.
Nevertheless, we should take seriously the study conclusion that “[c]hildren and adolescents are probably more likely to experience high rates of depression and probably anxiety during and after enforced isolation ends. This may increase as enforced isolation continues. Clinical services should offer preventative support and early intervention where possible and be prepared for an increase in mental health problems.”
Current Evidence of Impact on Infant, Childhood, and Adolescent Mental Health
With widespread, enforced social isolation, it’s a fair assumption that COVID-19 shutdowns are having an immediate impact on the mental health of children of all ages. Yet, according to Candida Fink, MD, a New Rochelle, New York-based child and adolescent psychiatrist, not all of that impact will be negative.
She says, “For socially fearful kids, or kids who have been victims of bullying, their mental health has improved. They’ve felt better and relieved, and school function got better with distance learning. Some kids have even increased socialization, using virtual connections to create a bigger social group.”
She also notes that many former ‘helicopter’ parents no longer have the bandwidth to micromanage their children’s lives. She says, “Parents are backing off a bit, and for kids who need that, it’s been great.”
While children at this end of the spectrum have experienced mental health relief, others are not as lucky. “Super-extroverted, high-social-drive kids have been very affected [by social isolation] right from the beginning,” says Dr Fink. Already, her patients show signs of “loss, irritability and withdrawal.” Now, these negative symptoms are apparent in children of all ages.
But, says Dr Fink, social distancing is most challenging “for older kids, especially adolescents and teens. The social drive is so key to what they’re doing developmentally, because the need to connect is so powerful, and the impulse control isn’t there yet, so we’re seeing that teens are not making good choices. Adolescents are so socially driven that social isolation presents unique risks,” both to their mental health and, by extension, their physical well-being, says Dr Fink.
When it comes to infants and toddlers, so much is dependent on caregivers’ state of mind, says Rahil Briggs, PsyD, national director of the Healthy Steps program and a clinical professor of pediatrics, psychiatry, and behavioral sciences at Albert Einstein College of Medicine in Bronx, NY.
She explains that social isolation poses no real developmental threats to the mental health of infants and toddlers, so long as families and caregivers are doing well with the impact of social isolation. But, says Dr Briggs, “It’s that caveat ‘if’ that’s concerning. Studies in pediatrics already show a massive increase in parents reporting their own mental health concerns, and we know that there’s no such thing as child mental health without parent mental health.”
Concerns Over Long-Term Mental Health Impact
Because the COVID-19 pandemic presents so many uncertainties, clinicians can’t truly speak to the long-term impact of social isolation. They can, however, point to areas of concern where intervention is indicated.
Dr Fink says, “I think kids who are vulnerable to depression, either due to family history or previous diagnosis, will be at greater risk. Kids with anxiety disorders, who were school phobic, did great now, but we’ve lost a lot of ground [in terms of reintegration].” Basically, she says, we can expect to see a “worsening of pre-existing vulnerabilities, leading to serious psychiatric issues.” She also emphasizes that, “all of these are potentially things to worry about, as part of a trauma and loss story.” They are not, however, givens.
With infants and toddlers, the concerns again return to full-family wellness. If caregivers are able to preserve a language-rich, stimulating environment, there should be minimal, if any long-term mental health impacts on infants and toddlers. But if struggling parents are unable to create that environment, Dr Briggs says there may be multiple impacts, particularly “on language development. The most significant predictor of a toddler’s language abilities is the amount of language spoken to that child in the first years of life. A depressed caregiver won’t talk as much. Also, depression impacts secure attachment relationships, so we start to see more insecure relationships. This can even impact breastfeeding and infant weight gain.”
With extended parental depression, says Dr Briggs, “Even toddlers themselves can become depressed. They may show changes in eating, sleeping and engagement. One of the most wonderful toddler characteristics is their glee in everything we put in front of them. A sign of concern would be if their affect is blunting,” she explains.
Of course, these are simply areas of concern. The extended impact of COVID-19 isolation will depend on how long it lasts, and how families and clinicians respond to this period.
Says Dr Fink, “We need to shift our goal, it’s not binary; we’re not going back to the way things were. All of these are huge vulnerabilities that require a change in the grown-up world. We have to think differently and model new ways of interacting. We need to acknowledge the given that we’re home a lot more, and that our children are spending a lot less time with other kids, and determine how we do the best we can. Make more efforts at virtual connections, and look for new and creative solutions to help ourselves grow into this new story.”
The bottom line? Just like Dr Briggs, Dr Fink says much of the work here falls on parents. “As we do it, our kids will do it. We must acknowledge that it’s really hard. We’re sad and mad. But we can also figure out ways to do things differently. And that’s a good starting point.”
Loades ME, Chatburn E, Higson-Sweeney N, et al. The impact of social isolation and loneliness on the mental health of children and adolescents in the context of COVID-19 [published online May 28, 2020]. J Am Acad Child Adolesc Psychiatry. doi: 10.1016/ j.jaac.2020.05.009.