It’s common, albeit sorrowful, knowledge that the COVID-19 pandemic has created a mental health crisis among young people the likes of which we haven’t seen in our lifetimes. Voices for Virginia’s Children, an analysis and advocacy group for the health and well-being of Virginia’s children and families, found that during the pandemic, more than 25 percent of the nation’s high school students reported worsened emotional and cognitive health, and more than 20 percent of parents with children ages 5 to 12 reported their children experienced worsened mental or emotional health. Reports of increased isolation, loneliness, and anxiety were related to growing mental health concerns.
Toward the end of 2021, the U.S. Surgeon General, the Children’s Hospital Association, and the Academy of Child and Adolescent Psychiatry declared a state of emergency in children’s mental health. In early 2021, emergency department visits for suspected suicide attempts soared by nearly 51 percent among girls ages 12 to 17, and increased by nearly 4 percent among adolescent boys, compared to the same time period in early 2019.
In our area, another factor has exacerbated the adolescent mental health crisis: Many kids find themselves in an academic, extracurricular, and athletic pressure cooker. That stress to succeed didn’t subside during the pandemic. Some of the best college prep schools and some of the top public schools in the country are in Northern Virginia, and all of them demand a certain attention to schoolwork, many with the goal of starting a pathway to an Ivy League university or other top higher education institution.
Stressed Out at School
“In this area, there is a lot of pressure on students,” says Dr. Bassam Atiyeh, a pediatrician with Northern Virginia Pediatric Associates. “Everybody wants to go and take the four Advanced Placement courses and honor courses. And everybody wants to play sports and play musical instruments. Everybody wants to go to the University of Virginia and all those prestigious schools. I always tell my kids that AP courses are for college. They do not need to be taken during high school. If you want to take them and you’re doing well, that’s fine. But there is absolutely no reason for kids at age 15 or 16 to be taking those college courses.”
Dr. David O. Clayton, a Fairfax-based adult, child, and adolescent psychiatrist, says that virtual classes were particularly challenging for students during the height of the pandemic. “I think online school was very hard. Now, the kids have a little bit more flexibility,” he says.
Many schools in the area have also reduced the students workload, and now have a more reasonable expectation about what it should be. “It’’s like, ‘Hey, if you can get this work done during school, then you don’t have to have homework,'” Clayton says. “So kids can be a little bit more balanced than they [were] prior to the pandemic. But it’s still affecting their social lives.”
The pressure to achieve starts as early as elementary school in areas like Northern Virginia, says Dr. Adelaide Robb, a Fairfax-based psychopharmacologist who researches depression, mood disorders, anxiety, and attention deficit disorder. “It’s like, ‘I have to be a starter on the soccer team, and I need to be the student council president, and I need a 4.4 GPA if I want to go to Harvard, and I can’t do that,’ and ‘I want to go to Stanford,’ and all the rest of it,” says Robb, who is also the chief of the Division of Psychiatry and Behavioral Sciences for Children’s National, a pediatric health system in Washington, DC. “I think there are some schools, even some of the public schools like Thomas Jefferson [High School], that are so incredibly competitive, it’s unpleasant for some of the kids. They go because they think they’re supposed to and it’s important, and then they’re very stressed out and unhappy. I think one of the bigger complaints I hear from the high schoolers isn’t that, ‘I’m sad and anxious.’ It’s that they are stressed out. They’re so busy trying to get all the work done. And all the after-school activities and all the extracurriculars make them feel like they’re in a pressure cooker.”
Lasting Effects of Isolation
The lockdowns and alternate attendance days that many area schools employed during the pandemic came at an especially critical time in the lives of adolescents, when friendship and peer support are so important for mental wellness, according to Robb. “The adolescent students felt very strongly the lack of peers,” she says. “And when kids were feeling depressed or anxious and alone, they couldn’t hang out with their friends at lunchtime or chat before class started. And many teens felt the isolation,” she says. “The other thing that happened is when teens feel out of control, a lot of times they want to control something. So many of them turn to eating issues. … We’re still seeing eating disorders, but it’s not as high as it was during the pandemic. And we’re certainly still seeing depression and anxiety. But things with the normalization of life and the return to school … have started to move back toward what it used to be.”
The pandemic stresses still go deep, according to Dr. Jennifer Park, a board-certified adult psychiatrist who received a Bachelor of Science in Biology and Brain and Cognitive Science from Massachusetts Institute of Technology and practices in McLean. “The students trying to get back into school have lost the opportunity to make friends for years,” Park says. “They sort of feel left out in some way, especially kids who missed their freshman year of college, who were trying to find their place in a new school and figure out how to meet people.”
Park says the students she sees today are beginning to advocate for themselves by talking to their professors or asking people at school for help. “I think that had been an issue because people are so used to being able to just text someone,” she says. “Young people got out of the habit of being able to physically go talk to someone [or] call them up and talk to them to ask for help. And I think that’s gotten worse.”
She says that she and her young patients are doing role-playing to try to help those students recognize how to talk to someone. “How do you go and ask for help? I’m finding that that’s really hard for teens. It’s not something that they were prepared for.”
“Here in Northern Virginia, we’re pretty lucky that we do have quite a few mental health resources,” Clayton says. “But even then, people are having the hardest time finding good help for their kids or themselves. We get like 10 phone calls a day.”
Clayton says that his practice can get people in for simple medication evaluations, but some patients might not need that. “They just need somebody to talk to and somebody to kind of help them through some of these difficult times,” he says. “And finding a good therapy person can be really hard to do these days, especially if you want somebody on your insurance plan. That can make it even harder.”
There is a sense that the worst of the pandemic is behind us, but going back to the “same old, same old” can be difficult for adolescents, explains Dr. Catherine McCarthy, who is certified in child, adolescent, and adult psychiatry, and is based in McLean. “There is still lots of healing to do,” she says. “It feels harder than before, but it also feels like it never happened. But for kids to just suddenly leapfrog back in, when their brains haven’t had the gradual changes required to get there, is impossible.”
“I really talk to a lot of parents about trying to help their kids be more independent,” Park says. “Of course, there are situations where students may just be having so much trouble, they need their parents to step in. But really, it’s kind of helping them to practice these skills themselves. And I think even before the pandemic, we were thinking the kids were not getting enough of those skills to be able to do that themselves. So you do need to be kind of a squeaky wheel to get help sometimes.”
Mental Health Warning Signs
As a parent or guardian, there are certain warning signs you can look for to determine whether a child or adolescent is having mental health issues.
“Avoidance is the enemy,” McCarthy says. “The more we avoid, the bigger these things get. The avoidance can show up as procrastination or lack of motivation. There are basically three things to look for: intensity, duration, and recovery. We don’t treat intensity because it’s more of a quality. But we look at how much they bounce back.”
That avoidance can also turn into isolation. “They’re isolating more when they used to be more active with family,” she continues. “And maybe they are not engaging as much with friends. Maybe they’re staying up a lot later at night, on video games or on the internet.”
Atiyeh says that when an adolescent starts spending most of their time in their bedroom with the door locked, isolating, that is when they start losing interest in activities. “Many kids play sports and lose interest in things that they normally do,” he says. “They may start having sleeping issues; they may start becoming more irritable. These are all signs that maybe we need to keep a closer eye on this individual and maybe do a bit of investigation.”
Clayton agrees that it’s important to observe mood issues, such as sadness and irritability, to figure out if there is a serious problem. “We think of irritability as ‘maybe’ a depressive equivalent for kids and teenagers,” he says. “Changes in their interests and worry that’s causing problems — like being worried that they are actually not going to be able to function during a test. It’s a worry that they can’t let go of, or a worry that’s causing them too much stress.”
Bottom line: You as a parent or guardian should trust yourself to make the call on whether changes in your child’s mood are concerning because you know your child almost better than anyone else, Robb says. “As a parent, you know when something is profoundly different,” she says. “I think it’s changes in behavior. So if your child used to be a very chatty, talkative person, and now they’re sort of quiet and sitting in the room and withdrawn, that’s worrying.”