Is your child showing signs of anxiety?

The COVID-19 pandemic has worsened an already disturbing decline in children’s mental health, medical experts and school counselors say.

Students show more signs of anxiety and depression than before the pandemic, and many youngsters are frozen socially and emotionally at the age they were when the pandemic started in early 2020, according to more than 350 licensed school counselors surveyed by The New York Times in April.

The decline led the United States Preventive Task Force, an independent panel of disease prevention professionals, to recommend in April that all children ages 8 to 18 be screened for anxiety. The panel reported that a 2018–2019 National Survey of Children’s Health found that 7.8 percent of children ages 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression, according to the taskforce.

The issues with children’s mental health is no surprise to pediatricians on the Cape.

“We were already seeing it, for sure, but the pandemic has definitely made it worse, especially at the beginning — the first year – when everybody was in isolation at home and trying to do school through Zoom,” Kenneth Colmer, MD, of Bass River Pediatrics, said. “Especially for young people, a big part of their development is socializing and making friends and all that. It’s so hard to be isolated. You can’t grow up that way.”

Dr. Colmer also blames the emphasis on social media for young people’s mental health struggles. “Some of the stuff that’s out there in social media, it can definitely make matters worse, for sure,” he said.

Healthy kids are engaged with friends, family and school, said Bart L. Main, MD, a psychiatrist with Cape Cod Human Services, Inc. who specializes in children and adolescents.

“Normal, healthy kids should be enthusiastically engaged with their friends,” he said. “They should not be devoted to electronics. They should be spontaneously responsible at home – by that, I mean they should see what needs to be done and do it. They should be actively engaged in their school environment, both academically and in extracurricular activities.”

Signs to Watch For

Dr. Main estimates he’s treated over 18,000 children in his career. “I do believe that the level of anxiety in the culture is significantly higher than it was 20 years ago,” he said. “The optimism that I experienced when I was an adolescent is not present in the adolescent now.”

Dr. Colmer’s practice sees more mental health issues among teenagers but does see problems among children as young as 9, Dr. Colmer said.

His practice already screens patients for mental health issues at their annual physical, using the Pediatric Symptom Checklist (PSC), a simple tool available for parents and kids. The form, one of several available to pediatricians, helps to identify changes in emotional and behavioral health by listing symptoms and rating questions of “Never,” “Sometimes” or “Often.”

These symptoms and behaviors include:

• Have trouble concentrating.
• Down on yourself.
• Do not understand other people’s feelings.
• Blame others for your troubles.
• Have trouble sleeping.
• Act as if driven by a motor.

“It’s sometimes hard to see, to pick it out at home,” Dr. Colmer said. “A lot of times the parent, or even the child, wouldn’t bring it up, but when they fill out that form, you can pretty much pick out whether they’re having a lot of sadness or are worried a lot or don’t have a lot of friends.”

If a pediatrician uncovers an issue, the traditional standard would be referral to a therapist and/or medication that can be prescribed by a pediatrician. Children with continuing issues, or who don’t respond to therapy, would then be referred to a psychiatrist. But the biggest issue for Cape and Islands children right now is finding therapists, Dr. Colmer and Dr. Main said.

The maze of therapy services is confusing, and practices are often overwhelmed or don’t take health insurance, both doctors said. Parents often turn to Falmouth Hospital or Cape Cod Hospital emergency departments during a crisis. In that case, there are sometimes things patient advocates can do to help find reimbursable treatment, said Sarah Simonelli, lead behavioral health case manager with Helping Hands, part of Cape Cod Healthcare’s Accountable Care Organization (ACO). Helping Hands coordinates care between insurance organizations, including MassHealth, and some local doctors and health centers.

What Parents Can Do

In the meantime, parents need to be on the lookout for signs such as withdrawal, changes in hygiene, rage or hopelessness, poor sleep habits, and changes in appetite, Dr. Colmer said. If a child seems to be suffering, here are some steps to take, according to doctors and other experts:

• Do all that you can to encourage a healthy lifestyle, including outdoor exercise, social connection, and creative activities. Encourage breaks from screen time and social media;
• Consult your pediatrician;
• Talk to your child’s school psychologist;
• Ask your insurance provider for a list of therapists;
• Consult online sources such as Talkspace and the Psychology Today directory, which allows search criteria such as geographic location and insurance. Keep in mind that the site is self-reporting and may not always be up to date.
• If your child is in crisis, go to the emergency department or call Cape Cod Human Services, Inc.'s 24-hour hotline: 800-513-4728. You can also call The Samaritans, a local suicide-prevention hotline at 800-893-9900 or the National Suicide Prevention Hotline at 800-273-8255, or connect by calling 988.