Seven-year-old ML was always shy, but never sad or morose. The class II student, who lives in Gurugram, Haryana, and is part of a big joint family, was attentive in class, polite with acquaintances, and happy in the company of friends and family. It all changed this summer, when the second, devastating wave of covid-19 engulfed the country.
His paternal uncle—a regular playmate of his—had to be hospitalised in May-end. He recovered but in the weeks following the diagnosis, ML withdrew into a shell. He would be distracted in class and extremely quiet at home. The spells of quietude were interspersed with irritability on being asked to finish homework or a task. His mother, a teacher, would find him awake at night, unable to sleep. In July, he began asking for the lights to be switched on at night. “I still remember the first night when he mentioned he was feeling scared in the dark. That’s when I decided to see a counsellor,” she says.
In the counselling sessions, he was asked to draw whatever he felt. The drawings were filled with greys, blacks and browns, with just the lone figure of a child in an empty home. “That’s when we realised how badly the uncertainty of the situation was affecting him,” says his mother.
ML is not alone. According to an article published by the Centre for Infectious Disease Research and Policy, University of Minnesota, US, on 9 August, anxiety rates in children around the world may have shot up sharply since the start of the pandemic. “(This is) according to the results of a meta-literature review published in JAMA Pediatrics. The researchers looked at 29 general-population studies, one of which was not peer reviewed, and found pooled depression and anxiety rates at 25.2% and 20.5%, respectively.” The researchers write that the sharp rise was associated with the pandemic’s later stages. Till the pandemic, anxiety rates were estimated to be 11.6%.
If the study is to be believed, one in five children is reporting anxiety. The reasons are several: social isolation, loss, financial stressors, disruptions, and, most importantly, a drastic change in routine.
Usually, childhood is a period of exciting new experiences that help tiny tots inch towards independence in thought and action. This happens through big and small incidents, such as going to school on a bus, making friends, working in a team. The pandemic has disrupted all this, leading to increased dependency on parents.
The reassurance of a regular schedule has vanished. Not all homes are comforting spaces, with children being subjected to abuse, or being witness to acrimony between family members. More screen time, often unsupervised, is also making children vulnerable to online offenders.
“I would change the word to emotional difficulties. For small kids, we don’t have usual tests but projective techniques through which you can figure out if a child is going through some emotional issue. I wouldn’t want to pinpoint and label it just as depression but I can call it emotional difficulty,” says Khushnaaz Noras, a Mumbai-based consulting psychologist.
In young children, until the age of seven-eight, parents need to watch out for symptoms like decreased food intake, low self-esteem and withdrawal from activities they might have loved doing otherwise. Watch out if any of the troublesome or peculiar behaviours is magnified. In an already timid child, the timidity might be amplified by pandemic-related fears. “I also see many kids becoming very distracted. Sometimes parents feel it’s normal, especially during these unprecedented times. However , it could be a marker of emotional difficulties,” she says.
Ruchita Dar Shah, founder of the global community for mothers, First Moms Club, has seen posts, often anonymous, from parents about changes in their children’s behaviour during the pandemic. There are concerns about moodiness, or children snapping when they are asked a question. Some are refusing to go out and play, even when offered a safe environment to do so. “This is being reported across age groups, not just in teens but in younger kids as well,” she says.
For children with pre-existing health conditions, the pandemic has brought new challenges. “One is seeing a relapse or worsening of those problems due to stress caused by the pandemic,” says K. John Vijay Sagar, professor and head of department of child and adolescent psychiatry, National Institute of Mental Health and Neurosciences (Nimhans), Bengaluru.
According to the study How Is COVID-19 Pandemic Impacting Mental Health Of Children And Adolescents?, published in September 2020 in the PubMed Central repository of the US National Institutes of Health’s National Library of Medicine, children with neurodevelopmental conditions, including Attention Deficit Hyperactivity Disorder (ADHD) and Autism Spectrum Condition (ASC), might struggle with the lack of structure and routine during the pandemic. This may, in turn, impact mental health. “In fact, one original study measured children’s ADHD behaviors during the covid-19 outbreak and found them worse compared with their normal state, showing increased irritability and more challenging behaviors,” states the study.
Radhika Nair, a Mumbai-based clinical psychologist, says anxiety or emotional difficulty doesn’t reflect just as sadness. In very young children, regardless of whether they have a neurodevelopmental condition or not, it also manifests as anger. “There is this emotional discomfort and children don’t have the words to articulate it. If your child’s behaviour has changed—eat very little, or a lot, isolate themselves, cry over something that may seem trivial to adults, and sleep a lot—you need to take note. This is happening because they are too choked up and overwhelmed by emotions,” she explains. Changes in sleep rhythm can be another indicator of stress.
Nair recounts instances involving a friend’s eight-year-old son. Having absorbed the panic around covid-19, he would refuse to go out in the apartment complex, and started having nightmares. His mother tried talking to him but he couldn’t articulate his feelings. Nair asked him to draw whatever he felt. The child drew elaborate visuals about schools being shut and changes to his routine. These helped his mother understand his fears. “He wasn’t depressed but had a lot of fear and anxiety. Using play and drawing is therapeutic and helpful in a situation where kids don’t have words to express what they feel,” says Nair.
Updates on the number of covid-related deaths have been a major trigger. Children now feel stressed about anything they consume through newspapers and TV channels. “Do you think the Taliban will come to India?” I was asked by a nine-year-old girl—a friend of my daughter’s. “Isn’t covid-19 enough of a problem in the world? Why are people fighting?”
Dr Vijay Sagar says children in the seven-nine age group may have a lot of questions and if these are not answered properly, may become fearful and withdrawn. “Very young children, up till the age of six, may start clinging to parents. When the fear or anxiety becomes severe, one will notice a persistent sadness around some kids. Even preschoolers get stressed out. Sometimes you will find older kids expressing death wishes,” he explains.
Since children have been cooped up at home, “they are not even getting a chance to think for themselves. In school, on occasions such as Independence Day, children get to perform or recite something. If they forget something, the teacher gives them ample time to recall. But now, with online classes, they just look at the parent for reminders,” says Noras. This is leading to lowered self-worth. They are constantly wondering: Am I capable of doing this, or am I doing well only because my mom and dad are present?
Noras is currently working with a five-year-old who has had learning difficulties. “Earlier, he would say ‘my teacher did this, my friend did that’. But now that he is at home, there is no one to blame for the difficulties. So he has turned the emotions inwards and feels that the learning difficulty is his fault,” she says. He has started daydreaming, to the extent that he doesn’t respond even when his parents call him. “He has gone into his own shell. This can be considered depression that is veiled,” says Noras. “Regarding emotional difficulties, parents should be a little watchful about what is happening in the house,” she advises. Most of the issues are due to environmental factors in the house, and fights between people. “If you see persistent changes in behaviour lasting beyond a few weeks, do seek professional help.”