Add Kids’ Pandemic Anxiety to List of Back-to-School Concerns, Experts Say

As students return to school, it’s critical to know how to spot children who may be suffering from pandemic-related anxiety, experts advised.

At a webinar Tuesday hosted by The REACH Institute, a New York-based non-profit that promotes evidence-based mental health care for children, panelists also spoke about the importance of modeling self-care and teaching resilience.

REACH trainer Wendy Silverman, PhD, director of the Yale Child Study Center Program for Anxiety Disorders at the Yale School of Medicine in New Haven, Connecticut, discussed the use of an anxiety assessment tool she calls “FISH,” which stands for frequency of a child’s anxious behaviors, intensity, severity, and how long the behavior has been occurring.

The more frequent a behavior, “the more likely it’s leading to impairment,” she said, and that can affect family life, school life, and interactions with friends. In essence, it means children aren’t moving forward developmentally, and “that’s not a good thing.” And the longer the duration of a behavior, the more likely it is to become a significant problem, she noted.

Silverman also highlighted the multiple “A’s of anxiety,” including attitudes and avoidance. She advised that the following tendencies among kids should send up red flags:

• Overestimating a threat: “I’m going to get COVID. I’m going to die.”
• Difficulty tolerating uncertainty: “I don’t know what’s going to happen if I go to school. What’s going to be there? I don’t know that I can handle it.”
• Underestimating the ability to control a situation: “I’m going to go nuts. I’m going to get sick. I’m going to die.”
• Feeling an increased sense of responsibility: “If I do get sick and I get my parents sick, it’s my fault. I’ll never be forgiven.”

As for avoidance, kids with anxiety disorders may “stay away from social interactions,” said Silverman. “They stay away from germs and contamination. If they have obsessive-compulsive [disorder], that’s another keystone behavior of an anxiety disorder.”

Silverman was asked about assessing anxiety in preschool-age children, and she recommended the free, reliable, and valid Spence Preschool Anxiety Scale, as well as the Anxiety Disorders Interview Schedule that she and a colleague developed. She pointed out that the developmental trajectory in younger children typically involves a specific phobia, a selective mutism, or a separation anxiety.

“And as you get more into childhood, you start then seeing social anxiety, generalized anxiety, and panic disorder,” Silverman said, noting that Yale’s SPACE program helps to teach children “non-avoidance” and competency.

Promoting resilience is also important, both at home and in the classroom, panelists stressed.

Children need to try to return to “normal routine activities,” Silverman said, although she cautioned that everyone will have to figure out what a “new normal” looks like.

Ramona Outlaw, an affiliate leader for Windy City CARES, part of the National CARES Mentoring Movement, said school staff may need support as well. When “the adults are well, they’re much better in the delivery of services to children,” she explained.

Emily Bader, LMSW, high school advisor for the JED Foundation, a nonprofit focused on suicide prevention among young people, emphasized that parents should model good self-care for their children, such as journaling for 5 minutes each day, keeping a gratitude list, meditating, cooking a meal together, or going for a walk as a family.

She pointed out that having children see adults caring for themselves “is so valuable….It doesn’t have to be anything that’s too out of the ordinary, but just something that helps you kind of keep yourself together during this time.”

Other “protective factors of resilience” are being proactive and leveraging community, connections, and attachments, said Mary Alvord, PhD, psychologist and founder of Resilience Across Borders.

Many people have felt very isolated over the last 18 months, “and those attachments to family, as well as friends, coworkers, and other people” matter. “We are social creatures,” noted Alvord, who is a co-founder of Alvord, Baker & Associates, a Maryland-based psychotherapy practice.

She recommended that adults and children problem-solve together, while Silverman noted that children learn better through “coping models” rather than “mastery models,” referring to the social learning theory proposed by Albert Bandura, PhD.

Parents shouldn’t be thinking, “‘Oh I gotta be like … macho man and I gotta do this’… It’s about showing the child [that] it’s challenging,” Silverman said. “‘It’s difficult, but look, watch mommy or daddy handle it and cope.'”