The coronavirus pandemic has been challenging for parents and children in ways both big and small, but for a smaller subset of children, it hasn’t just been hard; it has been traumatic.
There are not good estimates of how many children in the United States or abroad are grappling with traumatic stress and post-traumatic stress disorder (PTSD) as a result of the pandemic. But experts say there’s reason to believe both are on the rise as millions of families have lost loved ones, lost jobs and faced constant fear over the past year.
“The COVID-19 pandemic certainly is an unusual, unexpected event that is causing many to worry and even panic,” Adam D. Brown, clinical assistant professor in the Department of Child and Adolescent Psychiatry at NYU Langone, said in a recent story on that hospital’s website. And that worry and panic can lead to really debilitating psychological reactions.
With that in mind, here is what parents and caregivers should know about children and COVID-19 trauma, and what to look out for in their own families.
Fear, anxiety, trauma and PTSD are not all the same.
When trying to gauge how your child is coping emotionally, it’s helpful to keep in mind the often subtle differences in anxiety and depression versus trauma versus full-blown PTSD. Though the terms are sometimes used interchangeably, the experience of trauma, traumatic stress and PTSD are all related, but they’re not necessarily the same as anxiety and depression.
For example: When experts talk about “traumatic stress,” they’re generally referring to a stress response to a particular event (or events). But a person grappling with traumatic stress does not always develop PTSD. With PTSD, an adult or child will start to experience symptoms — like intrusive memories, avoidance, negative changes in their thinking and mood, or changes in their physical and emotional reactions — that last for at least a month.
And again, children might be experiencing fear and anxiety or depression during the pandemic that isn’t necessarily the same as traumatic stress.
“COVID in itself isn’t a trauma,” explained Melissa Brymer, of the UCLA-Duke University National Center for Child Traumatic Stress. “It’s causing a lot of stress and disappointment for many of us, but not all children are experiencing a trauma.”
Ultimately, it’s up to mental health professionals to make these important distinctions. The role of parents and caregivers is to be on the lookout for signs that children are having a hard time coping, so they can lend support and help connect them with outside resources as needed.
Parents should consider: What traumatic circumstances has my child faced?
One way mental health experts determine if a child is struggling with traumatic stress is to consider the specific events or stressors they’ve experienced. A child who has lost a loved one to COVID-19 — particularly if they were unable to grieve that loss through normal rituals, given the restrictions around social distance and gathering — may be more likely to be coping with traumatic stress, Brymer said.
Children whose families have experienced significant economic hardships as a result of the pandemic may be at greater risk for trauma, particularly if it has led to major changes in their environment or living conditions, she added.
Experts are also concerned about children who’ve encountered multiple stressors: Maybe they lost a loved one, their parent lost a job, they’re not going to school, and they live in a part of the country that has been affected by a recent disaster, like wildfires.
“Some kids have adjusted well ... but some have not. They’re feeling isolated, disconnected, withdrawn.”
“We know those experiences have caused additional trauma for kids,” Brymer said.
That’s not to say that only children who experienced one or more major traumas are having an especially difficult time coping right now, but those children are certainly at higher risk for serious mental health outcomes like PTSD.
Be on the lookout for unwanted thoughts, avoidance and physical changes.
The length of time a child’s symptoms last is an important barometer for mental health professionals, who generally won’t diagnose someone with PTSD unless those symptoms have lasted for a month or longer. (Sometimes, PTSD can take years to appear.)
As a parent, you want to be on the lookout for things like unwanted thoughts (which can sometimes surface as nightmares), avoidance of things or places associated with the trauma, or even just everyday tasks like schoolwork, changes in how quickly and easily they startle, and physical symptoms or changes in appetite. (The National Child Traumatic Stress Network has a helpful breakdown of children’s responses to traumatic events by age.)
In general, mental health experts say that anytime you’re noticing changes in your child’s behavior that are getting in the way of their ability to function, that’s a red flag, regardless of whether that flag signals they’re dealing with traumatic stress or something else.
“We want to monitor kids’ depressive levels and anxiety. Some kids have adjusted well ... but some have not,” Brymer said. “They’re feeling isolated, disconnected, withdrawn.”
Also, don’t forget how important it is to talk to your child, Brymer urged. Ask them what they think they know about the pandemic, and be honest with them about what you’re feeling so they know they are not alone. If you have any concerns, absolutely reach out to their pediatrician or school right away.