Original article written by Judith Warner for the Washington Post Magazine.
Those with the loudest voices and the biggest platforms all appear to agree: The children’s mental health crisis is a consequence of covid-era political decisions — the child-sacrificing outcome of too-rigid social distancing, too-lengthy school closures and too much mask-wearing. “The pandemic’s disruptions have led to lost learning, social isolation and widespread mental-health problems for children,” the New York Times’ David Leonhardt summed up back in January in a much-quoted newsletter. “Many American children are in crisis — as a result of pandemic restrictions rather than the virus itself.
That’s an explanation that feels right, particularly if you’re one of the millions of parents trying to balance back-to-normal work expectations with the continued chaos of your school-age children’s lives. It feels especially right if you’re someone whose child, pre-pandemic, seemed basically fine (or fine enough) and then just … wasn’t.
The front-line providers who work with children have a different explanation: The pandemic hasn’t created a children’s mental health crisis out of nowhere; rather, it’s shone a spotlight on a catastrophe that has been hiding in plain sight for a very long time. “This is not a new problem,” Sandy Chung, a pediatrician in Fairfax, Va., and president-elect of the American Academy of Pediatrics, explained to me recently. “Over the last several decades, we’ve been seeing an increase in mental health conditions in children and adolescents.”
M any of the doctors spoken to for this article were haunted by stories of mental health disasters — or near-misses — that long predated the pandemic. That is why so much of the current talk about the children’s mental health crisis makes people who have long been working in the field kind of, well, crazy. “We’re suffering from a crisis that until recently people didn’t dare to speak aloud,” Mitch Prinstein, the chief science officer for the American Psychological Association (APA), told me in a recent phone interview. “We have essentially turned a blind eye to our own children for decades. And because we’ve spent decades not doing anything for children, we’ve seen this escalation.”
By escalating a situation that’s been decades in the making, the pandemic has the potential to finally spark real change in how we think about and deal with children’s mental health. But for that to happen, we need to take a hard look at what we’re really talking about when we tell stories of kids “in crisis.” To start, we must tease apart what’s truly been new in the covid era from the bigger and deeper problems that have been present all along.
A November 2020 finding from the Centers for Disease Control and Prevention showed that between April and October of that year, the proportion of mental-health-related emergency room visits for children ages 5 to 11 had increased by 24 percent over the same period in 2019, while visits by 12- to 17-year-olds rose 31 percent. That finding has ricocheted through news reports and commentary ever since.
It’s always tricky to make arguments about changes in the prevalence of mental health disorders, particularly when it comes to kids; so much depends on who is surveyed and how, what questions are asked, and what use is made of the answers. That said, there is a huge body of research that consistently and unambiguously shows that children’s mental health in the United States was already really bad before the pandemic. Epidemiological studies throughout the 2010s indicated that depression in particular was hitting kids more frequently and at younger ages. By 2019, a year before the pandemic, 1 in 3 high school students, and about half of all high school girls, reported “persistent feelings of sadness or hopelessness.”
However ambiguous the research on children’s mental health during covid may be, the data on adults is crystal-clear: We have been having a very, very tough time. In October 2020, a study in the journal Pediatrics revealed that 27 percent of parents said their mental health had worsened in the early months of the pandemic — a proportion that was, interestingly, much higher than the 14 percent who said their children’s behavioral health had gotten worse. In written testimony to a Senate Health, Education, Labor and Pensions Committee hearing in early February, the APA’s Prinstein cited studies showing adult emergency room visits for mental health crises surged during this time, along with eating disorders, sleep disruptions, problem drinking and illegal substance use. Parents’ tolerance of stress — including their own children’s — is lower when they themselves are anxious. “Perception is different and behavior is different,” said Alan E. Kazdin, the longtime director of the Yale Parenting Center.
It’s hard to apply the words “silver lining” to anything having to do with a disease outbreak that has claimed nearly 1 million American lives and brought a secondary epidemic of loss, grief and fear to even more survivors. But it’s nonetheless true that, when it comes to children’s mental health, the past two years of collective trauma have had some unexpectedly positive side effects: The subject has come out of the shadows to be part of the conversational mainstream. It has bridged what was once a seemingly impassible gulf between parents of children with and without emotional, behavioral or learning issues. By creating an unprecedented amount of shared pain, it could inspire a very real demand for change that’s based on compassion and clear-mindedness, not on fearmongering and division.
That’s why it’s dangerous to allow the children’s mental health conversation to get stuck in the toxic loop of pandemic politics. The acute traumas of the covid era will end, and with them some of American families’ situational distress. But the children’s mental health crisis won’t. If we don’t open our minds to its totality, then all the new and ramped-up attention from the past two painful years will end up little more than “mealy mouthed statements … like the ‘thoughts and prayers’ after a school shooting,” as Peter Jensen put it. That is to say: just talk.
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