The chair of the Morgan Stanley Alliance for Children’s Mental Health talks with the head of the Child Mind Institute about how to support kids during the COVID-19 outbreak. Here are highlights.
At the beginning of this year, we launched the Morgan Stanley Alliance for Children’s Mental Health (Alliance), tapping the resources of Morgan Stanley and the Morgan Stanley Foundation and the knowledge and experience of our key nonprofit partner organizations in this space to address the challenges of stress, anxiety and depression in children, particularly those in vulnerable communities. At the time, we knew this work was critical: In the U.S., one in five children—more than 17 million—have a diagnosable mental health disorder by age 18, and the rates are worsening1. Adolescent depression has increased 41% between 2006 and 2014 in the U.S. alone2. And roughly two-thirds of youth living with mental illness do not receive help3.
Now children are facing new stressors amid the COVID-19 pandemic, an unprecedented global public health crisis that has also brought about a sudden and sharp economic downturn. How can we help them navigate this new landscape? Last month, Joan Steinberg our Global Head of Philanthropy, President of the Morgan Stanley Foundation and Chair of the Morgan Stanley Alliance for Children's Mental Health sat down for a Q&A with fellow Alliance board member, Dr. Harold Koplewicz., the founding President and Medical Director of the Child Mind Institute, an independent, national nonprofit dedicated to transforming the lives of children and families struggling with mental illness and learning disorders. Here are highlights from their conversation.
Joan Steinberg: Hello and welcome Dr. Koplewicz. It’s a pleasure to be speaking with you today about keeping our children mentally healthy during the coronavirus outbreak. The pandemic, of course, is a global health crisis, but as far as how it is affecting our children, most of whom who are lucky enough not to be dealing with the disease themselves, it’s a huge disruption to their day-to-day lives. What’s the best way to get kids adjusted to that disruption?
Dr. Harold Koplewicz: So there is a new normal. The new normal is that school is out. We're stuck in the house. We still have to work. It seems almost like there isn't a difference between a weekend and a weekday. Days start early. They end late. And because of that, it becomes essential that we structure our time and our kids' time. So we still wake up in the morning and we make our beds and brush our teeth and have meals at a regular time. And we plan what the kids will do during the day. If we don't do that, it can become a very lazy Sunday every single day. And that lack of structure is particularly bad for children who are inattentive, anxious or moody. And it's actually bad for all us if it goes on for too many days. There's nothing wrong with taking a day off and doing nothing. But your essential focus should be to create as much structure for yourself and your family every day as you can.
Steinberg: What about unscheduled time? How should kids be spending that?
Koplewicz: First of all, for younger kids, arrange regular FaceTime playdates. Don’t just plunk them down in front of the screen—organize an activity the kids can do together. Have them play checkers or chess. Something you can do on two screens. Try to keep it to one or two friends. When you have large groups of kids on a Google Hangout, for instance, it's hard for them to really engage. It should be one or two kids playing a game or, if it's grandma or grandpa reading a book, they read one page, and your child reads another page.
The other aspect is spending time together as a family. How do we have fun differently? Let's do an art project. Let's bake together. Showing your kids flexibility, showing your kids resilience, showing your kids perseverance is really a good model that they can use later on.
Finally, I would say, practice mindfulness together. Mindfulness is being in the moment. So, when you take a nature walk together, you're not thinking about the e-mail that you've got to send, the phone call you haven't made, what's happened to your 401(k). You are listening to the birds. You are smelling the flowers. And you can talk to your kids but you're talking to your kids about the trees, the breeze, the warmth of the sun.
Steinberg: You mentioned FaceTime. Do you have advice regarding screen time in general?
Koplewicz: At this point, I think you need to think about screen time differently. The social connection that screen time offers has gone from a mixed blessing, at best, to a necessity. The way to think about it is as three buckets. There are educational screens; there are entertainment screens, and there social connection screens. Most likely, your children will be using the first for most of the day. But there should be time for the others. I think it may be better to work on a guidelines that are based on behavioral patterns rather than strict rules. Are your kids able to moderate their usage? Are they showing problematic usage patterns? If so, you need to limit their screen time. I think a general rule of thumb should be about an hour, and maybe in two, 30-minute segments. If you have a teenager, you might let them have two hours, because they're going to be FaceTiming, texting with friends and trying to stay connected even more than younger kids will. If you have a middle school student who might want to play video games, again, maybe limit that to 60 minutes or 45 minutes a day.
Steinberg: How can you reassure kids about what’s going on if you are feeling anxious yourself?
Koplewicz: Anxiety is particularly contagious. I don't think people realize that. So it really is important that not everything is done in front of the kids. There used to be a philosophy that we should hide everything from the children and do everything behind closed doors. Then there was a parenting philosophy that advocated you should let it all hang out. The best approach is somewhere in the middle. There are certain things that you can share with your kids and certain things you can't. I think it's OK at certain moments to tell your children, "I'm just spent right now. I need a nap," or "I need some alone time," or "I’m just overwhelmed with how much I have to do." Or, when your child tells you how scary it is for them, it's all right to validate their feelings and say, "I'm scared, too". But don’t present it to them in a way that will make them stressful. In other words, your kid is going to look to you for strength, for your reassurance that this will turn out OK, so it's important to tell your kids how you are coping. Don’t vent. And if you want to fight with your spouse, wait until the kids are asleep and fight quietly.
Steinberg: How can you tell if your child is struggling? Are signs different in older kids?
Koplewicz: There are four things you need to watch for as red flags in children and adolescents when it comes to depression: loss of interest in things that normally give them pleasure, loss of concentration, change in appetite and change in sleep habits. If any of those changes are lasting more than a week or two, then you should be concerned. If it's a just a few days, well, this a new normal and it takes a while to adjust.
For teenagers, it’s a little different. When teenagers get depressed, they are irritable. Considering that a lot of teenagers are irritable to begin with, it becomes intense irritability.
Steinberg: You mention the importance of having conversations with your kids right now. Sometimes kids don’t want to talk. How can you engage them?
Koplewicz: The silver lining here is that we're going to have the opportunity more conversations with our children, particularly at meals, than we routinely do, because most of us are now home for lunch. If you want those conversations to be useful, you have to talk about topics that your kids are interested in talking about, so that you don't get back answers of "yes" and "no" or "I don't know." If you are a businessperson, think of your child as the client right now. The way you engage a client is how you should try to engage your child. Listen to their opinions. Pay attention to what's important in their lives. And that may require you to do some background as you would with someone that you want to make a sale to. You might have to go online and read a lot about a certain TV program that your kid has been following or a certain video game they like to play. That’s the best way to engage your kids.
Steinberg: What about older kids who are grappling with things like their senior prom being canceled?
Koplewicz: High school graduation, senior prom—those are milestones that kids really look forward to, and I think that it's really essential to validate how disappointing it is not to be able to experience them. If you minimize it, if you say, “Oh it's no big deal. You're so lucky. So many people are struggling. They're losing their job,.” that doesn't mean anything to your teen in the moment. They may be glad that mom and dad have a job and that you have your home, but that doesn’t minimize the disappointment they are feeling right now. It's OK for our kids to feel sad and demoralized when bad things have happened. We have to acknowledge these lost events in their lives, even if they may seem relatively unimportant and even though right now we're just trying to keep our heads above water.
Steinberg: How do you help a child cope if someone he or she knows is sick with Covid-19? Or even dies?
Koplewicz: If someone you know has gotten sick, it's worthwhile talking to your child about how concerned you are for them. But also talk about how the majority of people who get sick will get well. And they're getting the best care possible. If someone you know dies, first, talk about how sad you are, how concerned you are about the other person's family. And then, you have to ask your kids what they're worried about. I don't think there's anything new about talking about death to children, in that it's a hard concept for young children or even teenagers to accept. What makes it much more difficult right now is the fear. And you have to remember how egocentric, how self-absorbed normal kids are. They need to be reassured that A, you're not going to die, and B, that they're not going to die.
If it is someone close to the family who dies, of course, you have the added burden of not being able to grieve together. These rituals, whether it's a wake or a shiva or however your culture mourns, are really powerful psychologically because of how they were structured: You are surrounded by your community. People will cook for you. They will visit with you. They will commiserate with you. And then, you go back out into the world and you start life again. But we don’t have that now. We can’t even hug some one who is grieving. So it’s important to support your children through that as best you can.
Steinberg: What’s the most important thing to be telling our kids right now?
Koplewicz: That we will get through this. That message has to come through loud and clear to your children, that we will find solutions. We are in the forest right now, a forest that seems scary, but there is a path, and we as your parents are going going to find our way along it. That message, either directly or indirectly, has to be sent to your kids on a daily basis.
To listen to the full interview, click on the player below.
For more information and resources about helping children get through this time of crisis—including a schedule of Facebook Live events—visit the Child Mind Institute website: https:/childmind.org/coronavirus.
1Kimball, H. and Miller, C. (2015). Children’s Mental Health Report. New York: Child Mind Institute.
2Mojtabai, R., et al. "Olfson N., and Han, B. National Trends in the Prevalence and Treatment of Depression in Adolescents and Young Adults." Pediatrics, vol. 2016 Dec; 138 (6) e20161878. https://doi.org/10.1542/peds.2016-1878
3Merikangas, K.R., et al. Service Utilization for Lifetime Mental Disorders in U.S. Adolescents: Results of the National Comorbidity Survey Adolescent Supplement (NCS-A). Journal of the American Academy of Child and Adolescent Psychiatry, 2011 Jan; 50(1): 32-45. https://doi.org/10.1016/j.jaac.2010.10.006