Daily Life and Coping with Coronavirus

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Life has drastically changed for all of us as a result of the outbreak of coronavirus disease 2019 (COVID-19). At times, all of these changes can result in overwhelming feelings of fear, anxiety, sadness, and also grief. Many of us have experienced many losses over these past four weeks – from the loss of our ability to see our loved ones whenever we wish and the loss of seeing our co-workers in person, to the loss of jobs and the loss of loved ones. Some of us are struggling with the fear of having to go to work at grocery stores, pharmacies, gas stations, hospitals, banks, post offices, etc etc. Those of us who are not essential workers might be struggling with feelings of guilt – of feeling like we’re not doing enough. For parents working from home, it can also be very difficult having to balance your own work responsibilities with your child’s/children’s teaching responsibilities. IT’S A LOT. We, at the ADHD, Mood, & Behavior Center, would like to provide our patients, and anyone else looking for some guidance at this difficult time, with some tips on how to cope with these feelings and how to differentiate between a normal stress response and a response that may require professional help. We are currently offering video appointments with our psychiatrists and therapists for our current patients, as well as anyone else who is looking to initiate care at this time. Please do not hesitate to reach out for help if you need it.

Ways for adults to cope:
• Make sure to take breaks from COVID-19 related news stories or social media stories.
• Try to maintain a daily schedule if your day is now significantly less structured. Have a consistent bedtime and waking time. Have well-balanced and regularly scheduled meals. Exercise regularly.
• Make time to relax and engage in activities you enjoy. Try to get some fresh air when you can, while maintaining social distancing practices.
• Try to maintain social connections using video chats and phone calls. There are many apps now that allow you to have group video chats with friends and family.
• Take space when you feel you need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take breaks and get space when we need it.
• Avoid unhelpful coping strategies, like substance use and high-risk behaviors.
• Seek out help from a professional if you are struggling.

Ways for parents to help their children cope:
• Limit the amount of television or news children watch as the news can be frightening and disturbing to them. Instead, find accurate and age-appropriate information and have an honest discussion with them using language they can understand. Answer any of their questions honestly.
• Try to maintain a regular routine, as children feel more secure when there is structure to their day.
• Help facilitate video chats and/or phone calls with their friends and family.
• Make sure children get some fresh air whenever they can, while maintaining social distancing practices. Try to implement some sort of daily physical activity.
• It can be very difficult for children to be stuck inside, especially when the weather is beginning to get nicer. Try to come up with fun activities for the family to engage in. Have game nights. Have children help in meal preparation or menu planning. Encourage them to learn a new skill. There are many free online classes available now.
• Give children choices when possible, as this will give them a sense of control during a time when there is little they can control.
• Give them space when they need it. Sheltering in place could sometimes result in some of us feeling overstimulated by always having to be around those in our household. It’s important that we all take a break and get space when we need it.

Common stress responses in adults:
• Changes in sleep or eating patterns
• Difficulty concentrating
• Changes in energy levels
• Avoidance of activities previously enjoyed

Common stress responses in children and teens:
• Excessive crying, irritability, or acting out
• Regressive behaviors or returning to behaviors they have outgrown such as bedwetting
• Changes in sleep or eating habits
• Poor school performance or avoidance of school related tasks
• Difficulty concentrating
• Avoidance of activities previously enjoyed

When to seek out help:
• If any of these responses persist for longer than 1-2 weeks and/or start to get in the way of an individual’s function, it is likely time to seek out professional help from a psychiatrist or therapist.
• If you or your child becomes preoccupied with or has intrusive thoughts or worries surrounding COVID-19 or death.

How to Talk to Your Child About Disasters & When to Seek Help

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Recent disasters, such as the wildfires in California, the Thousand Oaks shooting, and the shooting at a Pittsburgh Synagogue, can be very frightening for children.  Since children often see or hear about these events either through the different news outlets that are accessible to them or through their interactions outside the home, it can be helpful to talk about the event with them in language they can understand.

The following guidelines can be useful when having these conversations:

  • Try to set aside adequate time and a quiet space.
  • Use a tone that’s calm and language that’s not overwhelming.
  • Ask the child what he/she already knows and what questions he/she has.
  • Be honest as children are very aware of their parents’ concerns and know more than we think.
  • Talk about your worries as well as your abilities to keep your child safe.

In addition to having these conversations, it is also important to look for signs that your child might be struggling after a disaster.  There are different factors that can affect a child’s response to a disaster that can include:

  • The way they experience their parents’ response.
  • How close they are to the disaster/whether there was direct involvement
  • Whether they know anyone that was directly affected.
  • The child’s age.

Behavioral changes that might indicate your child is struggling and may benefit from being evaluated by a mental health professional include:

  • Acting out or misbehaving in school or at home that is atypical for the child.
  • Refusing to go to school or other places the child typically attended without a parent.
  • Fears that persist long after the disaster, jumpiness, nervousness, and a much heightened sensitivity or alertness to danger.
  • Avoidance of people, places, and things that remind the child of the incident.
  • Sleep disturbances or changes that were not occurring prior to the disaster, such as nightmares or bed-wetting.
  • Depressive symptoms that can include low or irritable mood, appetite changes, fatigue, withdrawal from friends and family, decreased interest in activities, feelings of hopelessness, and in some cases suicidal thoughts.
  • Physical symptoms in the absence of a physical injury or illness, such as headaches and stomachaches.

What to Do if Your Child is Being Bullied

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It can be very difficult as a parent to watch your child come home from school in tears, withdrawn, or moody only to find out that they are being teased or bullied at school.  Here are some key tips to support your child and help resolve the situation as effectively as possible.

  1. Listen to your child without judgement. Allow your child to tell you the full story in their own words without interruptions and minimal reactions.  It is already difficult for a child to recount what has happened so they may minimize what happened if they feel you are getting upset.  Use open ended questions and phrases such as:  tell more about that, how so?
  2. Find out the facts. When appropriate make sure you get the  who, what, when, and where of what occurred so that you can record it and let your child’s teacher know. Keep a record of an future incidents.
  3. Problem solve. Engage in problem solving with your child so that they know how to self-advocate if the situation occurs again.  Come up with several strategies (including finding a safe teacher or administrator that your child can go to) with whom your child feels comfortable.  Practice using the strategies with role play.
  4. Reach out. Talk to your child’s teacher as soon as possible.  Keep in mind that teachers don’t always and can’t always know when bullying occurs.  Kids are smart and know when to tease/make cruel remarks when the teacher is occupied or out of earshot.
  5. Ask for a copy of your school district’s bullying policy. This will send the message that you know how to advocate for your child. Also, every school should make this available to parents upon request by law.
  6. Take your concerns up the chain of command. If the problem persists, meet with your child’s school principal and ask for documentation of how the problem will be resolved.  Familiarize yourself with the state law and pursue that the school do a full investigation and document a case of HIB (Harrassment, Intimidation, or Bullying) if you feel like you are not getting results.

Find out more here:

http://www.nj.gov/education/students/safety/behavior/hib/ParentGuide.pdf

 

http://www.stompoutbullying.org/information-and-resources/parents-page/what-do-if-your-child-being-bullied-and-resources/

 

  1. Watch for signs of serious stress, anxiety or depression.  Having your child talk to a professional can be particularly helpful especially if you see emotional or behavioral signs of stress such as social withdrawal, sleep issues, changes in appetite, or mood swings.

How to Talk to Your Child About School Shootings

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Sadly school shootings have become normative in our culture and parents are faced with the question of how and when to talk to their kids about being safe in school. Here are a few tips and resources to help parents navigate these discussions:
1. Keep discussions age appropriate. Younger children need more reassurance and less specific information. They may have questions about active shooter drills or why there was a school walkout. Keep information short and age appropriate and reassure your child that adults are always taking measures to keep students safe. Older kids and teenagers will want to talk more and may want to get more involved in advocacy efforts. Make sure to make time to talk and practice reflective listening. Echo back their concerns and ideas.
2. Limit exposure to the news. News tends to refresh and replay the same upsetting images and soundbytes. Exposure to these stories via television or on the radio can be upsetting and confusing for children. Also, keep an eye out for newsfeeds that come up as ads or pop-ups on social media. Your child may be watching news footage unbeknownst to you.
3. Pay attention. Know the signs of stress or anxiety in your child. Pay attention to changes in behavior such as excessive worry, nightmares or sleep disruptions. Consider reaching out to a qualified child mental health professional if you see any of these symptoms for an extended period.
4. Stay on top of what is happening locally. Follow and attend school board meetings, talk to your child’s school principal or administrator. In the wake of the latest shooting at Parkland, many school districts have made changes to their safety policy. Share this information with your child as well as with other caregivers so that they can be prepared for changes in school visitation or pickup policies.
5. Stay connected. Encouraging regular communication with your child is the best way to know what’s going on in your child’s school . Consider scheduling a regular time to meet with your child to discuss any concerns they may have. Creating an environment of open communication will beget open communication.

Resources for parents:

Check out this recent piece which was featured in Time magazine by Dr. Ross Greene:
https://www.livesinthebalance.org/Nineteen-years-tragedy

The Anxious Child

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All children experience anxiety. Anxiety in children is expected and normal at specific times in development. For example, from approximately age 8 months through the preschool years, healthy youngsters may show intense distress (anxiety) at times of separation from their parents or other persons with whom they are close. Young children may have short-lived fears, (such as fear of the dark, storms, animals, or strangers). Anxious children are often overly tense or uptight. Some may seek a lot of reassurance, and their worries may interfere with activities. Parents should not discount a child’s fears. Because anxious children may also be quiet, compliant and eager to please, their difficulties may be missed. Parents should be alert to the signs of severe anxiety so they can intervene early to prevent complications. There are different types of anxiety in children.

Symptoms of separation anxiety include:

  • constant thoughts and intense fears about the safety of parents and caretakers
  • refusing to go to school
  • frequent stomachaches and other physical complaints
  • extreme worries about sleeping away from home
  • being overly clingy
  • panic or tantrums at times of separation from parents
  • trouble sleeping or nightmares

Symptoms of phobia include:

  • extreme fear about a specific thing or situation (ex. dogs, insects, or needles)
  • the fears cause significant distress and interfere with usual activities

Symptoms of social anxiety include:

  • fears of meeting or talking to people
  • avoidance of social situations
  • few friends outside the family

Other symptoms of anxious children include:

  • many worries about things before they happen
  • constant worries or concerns about family, school, friends, or activities
  • repetitive, unwanted thoughts (obsessions) or actions (compulsions)
  • fears of embarrassment or making mistakes
  • low self esteem and lack of self-confidence

Severe anxiety problems in children can be treated. Early treatment can prevent future difficulties, such as loss of friendships, failure to reach social and academic potential, and feelings of low self-esteem. Treatments may include a combination of the following: individual psychotherapy, family therapy, medications, behavioral treatments, and consultation to the school.

If anxieties become severe and begin to interfere with the child’s usual activities, (for example separating from parents, attending school and making friends) parents should consider seeking an evaluation from a qualified mental health professional or a child and adolescent psychiatrist.

Re-printed with Permission from American Academy of Child & Adolesccent Psychiatry