Parents know that social distancing has had a big mental health impact on teens and tweens. We asked local pediatric experts for some advice on how to talk to teens about how they are feeling and when to seek professional help. 

A survey conducted by Common Sense Media confirmed some things we already knew: Teens are worried about COVID-19’s impact on their  families, and being isolated from peers has made them more lonely. So what can parents do to help their tweens and teens weather the mental health impacts of COVID-19? We reached out to three local pediatric mental health experts for advice. Here we mention some of the results of the Common Sense Media survey as well as some preliminary research published in medical journals, and our experts offer up actions parents can take.

According to an April Common Sense Media survey of teens, 61 percent worried that someone in their family will be exposed to COVID-19. How can parents talk to their teens about this to ease their worries? 

“Honesty is the best policy when it comes to talking with teens about serious issues like coronavirus. Most of our kids, and especially our teens, are technologically savvy and connected. What we don’t tell them, they will often find out from other often not-so-reliable sources. As a preparatory step, parents should first inform themselves of the facts and latest developments by using a reliable resource. They should then set aside time to sit down and have a frank and open discussion with their teenager. While honesty is important, it is also important to consider how much information your individual teenager can process and emotionally manage, and to adjust your approach accordingly. We all feel more empowered and hopeful if we focus efforts on what we have control over versus getting caught up in all that we’ve lost. While covering concerns about risk of infection should be one part of this discussion, it is important to then take it to the next level by talking to teens about how best to protect themselves and those with whom they come into contact. If everyone plays their part in prevention efforts, the rate of exposure will drop and we will all be at lower risk.” — Jane Uchison, Psy.D., behavioral health program director and pediatric psychologist at Metropolitan Pediatrics


In that same survey, 63 percent worried about the effect COVID-19 may have on their family’s ability to make a living or earn money. How can parents talk to their teens about this to ease their worries?

“This is a very understandable worry! I think one approach to talk to a youth about this is actually not to talk at all, but to give opportunity for the youth to voice their concerns and listen with empathy. Worries can carry less weight when they are in the open, and can be shared with someone who validates those emotions and understands. Before addressing this concern with the youth in the family, I do think it is important for us as caregivers to check in on our own thoughts and worries: How we are actively working to mitigate them and cope with difficult emotions, and what our own action plans are. While a lecture will not be welcomed by most teens and tweens, having an honest and matter-of-fact conversation around the unique situation your family is in financially and what the adults are doing to ensure safety for the family can be reassuring. If appropriate, inviting the youth in your family to offer their thoughts and advice and play a role in contributing to supporting the family can mobilize that worry into positive action. Some examples of what this could look like a teen taking over a chore around the house to contribute to the family while the parents work from home or having a family discussion over how to be more judicious in spending.” — Jacquelyn Collura, M.D., a pediatrician board certified in child and adolescent  psychiatry at Kaiser Permanente’s Sunnyside Medical Center

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And 42 percent of teens surveyed feel more lonely than usual. What are some things parents can do to help their teens feel less lonely and still keep physically distant from others outside their household?  

“This is a question that has come up a lot with our families in the past several months. In some ways, social media is playing an important role in helping some kids to stay connected and feel less lonely. In other ways, it has been a curse to those parents who are desperately trying to enforce responsible social distancing as their teen sees posts with a large group of their closest friends spending time at the lake together. Balancing screen time, and specifically social media engagement, with other types of activities is key. With careful planning and a little creativity, parents can help facilitate some limited in-person interaction with their teenager’s friends. One teen I know arranged a socially distanced Starbucks date with several friends by setting up appropriately distanced lawn chairs in an empty parking lot nearby. Another family hosted a backyard graduation party to celebrate their high schooler’s recent graduation, but required all guests to wear masks, and staggered attendance over the course of the day to allow people to maintain a safe distance from one another. I know that some of the local athletic organizations are being very creative with their practices by doing things like having kids complete ‘drills’ from chalked-in squares that are spaced at least 6 feet apart. Parents, schools and communities will continue to need to think outside the box to find safe ways to keep our kids both physically active and social.” — Jane Uchison, Psy.D.


According to a research letter in JAMA Pediatrics, Chinese scientists found that 22.6 percent of students under shelter-in-place orders reported having depressive symptoms, which is higher than other investigations in Chinese primary schools (17.2 percent). What are depressive symptoms that parents should look for? What should they do if they see them?  

“Signs of depression are sleeping more than usual, disengaging from activities and social interactions, feeling and looking sad. Most teens will share their feelings if asked in a nonthreatening way: ‘I’m worried about you. You seem sad and disinterested. How can I help? How are you feeling?’ Also you should ask if your teen has any thoughts of self-harm or of suicide. If you feel your teen is experiencing depression that is persistent, or any self-harm thoughts, you should seek the help of your pediatrician or a therapist. If your teen is suicidal, call a crisis line or bring them to the ER.” — Lisa Reynolds, M.D., a pediatrician in Portland and the mother of 19- and 21-year-old sons

“It is important to normalize feelings of sadness during what has been an unbelievably difficult time. It is OK for kids to grieve the loss of what life was like pre-coronavirus, and to take some time to think and talk about their sadness. At the same time, it is important for them to learn now to manage their negative emotions. One way of doing this includes setting aside designated time (no more than 15 to 20 minutes) each day to be sad, angry, or worried about the ramifications of coronavirus. A watch or timer should be used to keep track of the time. When the 15 to 20 minutes expires, the time devoted to those concerns ends until the following day. If additional concerns or negative emotions about this topic cross their mind later that day, they should practice ‘postponing’ these concerns until the next designated time.” — Jane Uchison, Psy.D.


A reflection in The Lancet cited a British survey of youth up to 25 years old with a history of mental illness in which 83 percent of respondents said the pandemic had made their conditions worse; 26 percent said they were unable to access mental health support. What should parents of tweens and teens who have already been diagnosed with mental health issues especially be aware of?

“This question brings up two important points — the limited access to mental health support, as well as the increased risk of recurrence after initial diagnosis with a mental health condition. I do think realistically, many individuals are experiencing feelings of being overwhelmed and hopeless with this combination. In this setting, it is helpful again to go back to the basics that we know from research as well as clinical experience that can make a big difference in one’s mood and ability to tolerate stress. For teens and tweens more concretely this means aiming for nine hours of sleep a night, having three meals a day with a good variety of fruits, veggies and protein and limited sugar intake. Most of us work best following a regular schedule, which has become more challenging with less external structures such as school and in-office jobs. While a regimented structure may not be necessary, having clear expectations of when to awaken, when meals are and when to wind down for sleep at the end of the day can be helpful and reassuring. Regular exercise, getting outside in a safe way following social distancing precautions, and social interaction are all important for us to maintain a healthy mind. Similarly, there is good evidence behind meditation and mindfulness-based practices to help with depression and anxiety. If you know someone who has been diagnosed with a mental health condition previously and have concerns they are likely to experience distress again, checking in around these areas and taking a ‘preventative’ approach can be very helpful. If you are concerned that you are observing mood or anxiety symptoms or other changes or have any concerns for your child’s safety, calling your child’s primary care provider and/or mental health provider if they are already in care to re-establish a connection as soon as possible will be important.”  — Jacquelyn Collura, M.D.

Apps such as Insight Timer, Breathe, Calm, and myStrength (some of which may be available through your health care provider) can offer support around developing/maintaining healthy routines, mindfulness activities and some basic health coaching. — Jacquelyn Collura, M.D.  

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Resources for teens and parents

YouthLine offers phone call, text and online chat-based support for youth and young adults ages 11 to 21. 877-968-8491, oregonyouthline.org.

The Trevor Project is a national organization offering support to LGBTQ youth. 24/7 crisis and support: 1-866-488-7386, thetrevorproject.org.

County Crisis Lines can help with in-the-moment crisis support, as well as helping teens and parents assess service needs and access appropriate care:

Washington County: 503-291-9111

Clackamas County: 888-414-1553

Multnomah County: 503-988-4888

As a last, but sometimes necessary resort, if a parent does not feel that they can keep their teenager safe due to self-harming behaviors or suicidal thoughts or plans, they should call 911 or transport their teen to the nearest emergency room for a safety assessment. If possible, it can be helpful to first contact the county crisis line for guidance, as they may be able to provide other options for immediate assessment and/or help coordinate assessment at the appropriate hospital emergency room. — Jane Uchison, Psy.D.

Sources:

» surveymonkey.com/curiosity/common-sense-media-coronavirus/ 

» jamanetwork.com/journals/jamapediatrics/fullarticle/2765196

» thelancet.com/journals/lanchi/article/PIIS2352-4642(20)30109-7/fulltext

Denise Castañon
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