Is My Child’s Distress Normal? Or Do We Need Help?
Pandemic distress may transform from worry and sadness into anxiety and depression when ADHD brains grow frustrated and hopeless over extended isolation and uncertainty. Here, learn how to recognize and respond to troubling signs of mood disorder in your child or teen.
As we continue to shelter in place, anxiety is growing in lockstep with discouragement. Activities that were once comforting and interesting are beginning to lose appeal, and motivation is bottoming out. Many adults and kids are struggling in new and different ways each week.
For young people with ADHD, who naturally struggle to manage strong feelings, coping with this extended confinement can be especially difficult. Their lives were upended quite suddenly and dramatically, and they’ve lost both excitement about and control over the immediate future. As we all work to wrap our brains around this unprecedented situation, children and teens with ADHD are left worried, sad, and frustrated — in part because they may not fully grasp the severity of what’s going on.
The stress of dealing with changes in routines, disconnection from peers, and ongoing disappointments from cancellations of important events can lead to an array of new behavioral challenges for kids with ADHD — and possibly more serious mental health conditions.
With their Now/Not Now brains, these kids sometimes struggle to stay optimistic about the future when the present reality — devoid of in-person contact with peers at school, sports, or other extracurricular activities — seems interminable. As time goes on, we’re seeing their sadness, worry, and frustration morph into distressing levels of anxiety, depression, and rage. Which begs the important question: When do predictable reactions to COVID-19 turn the corner into something concerning that needs professional attention?
We can expect that kids will experience a range of emotions each day. It’s common to feel a mix of loneliness, anger, and sorrow — as well as contentment, pleasure, and satisfaction. The emotional shifts from feeling good one moment to terrible the next are part of grappling with the strangeness of our current situation. But there’s a critical difference between thinking that you really dislike this isolation and staying stuck at home all day, and genuinely believing that life will never be okay again and there’s no point in doing anything. It’s one thing to feel scared that your grandparents could become sick, and another to think that germs are everywhere and nothing is safe. And though we expect kids to lose their tempers sometimes, it’s unacceptable for them to hurt other family members or display violence.
Children with ADHD often struggle with flexibility, impulse control, emotional regulation, and self-awareness. These executive functioning skills are critical for adapting to new situations and dealing with the uncomfortable feelings that accompany change. And there’s a lot of discomfort currently in our lives.
- When kids don’t feel the safety or security they need, and worry constantly about uncertainty, their heightened worries lead to anxiety.
- When they feel helpless, hopeless, and ashamed, they experience depression.
- When they wrestle with more disappointment than they can actually process, they become enraged.
- If they are living in households strained by poverty, domestic violence, sexual or physical abuse, or substance abuse, they often experience trauma as well.
- Because there are just so many things they cannot do, and so many activities and events that have been cancelled, their tolerance levels have dropped.
You may see your children biting their nails, pulling their hair, picking their skin, arguing, screaming, staying up all night, withdrawing to their rooms for hours at a time, hitting people, or breaking things. These behaviors are outward signs of their internal turmoil.
They are flooded by feelings they just can’t manage, but they can’t express these sentiments verbally or exert any control over them. In these times, children with ADHD may act out emotions that are overwhelming their coping mechanisms and regress into earlier, less functional ways of handling things. Some regression during this time is normal. But when transgressions come daily, you are right to be concerned.
Frequent panic attacks, widespread anxiety, specific phobias, withdrawal from family contact, repeated comments about worthlessness or inadequacy, or intense sleep disturbances (too much or too little) indicate that your son or daughter probably needs professional help. Kids who have previously received psychological treatment for co-existing conditions are more likely to show an increase in their symptoms, so stay in touch with their providers.
Let’s look at the warning signs that indicate that your child or teen is struggling beyond what we would expect in this unusual situation:
- Excessive worry, sadness, crying, irritation or withdrawal
- Inability to enjoy activities they previously liked
- Poor eating or sleeping habits
- Avoiding responsibilities they were previously able to meet
- Greater trouble with focus and concentration than you would expect
- Unexplained headaches or other physiological complaints
- Evidence of drug, alcohol or tobacco use
- Giving away belongings
If your son or daughter is demonstrating these behaviors for more than a week, contact their pediatrician or primary care physician immediately and set up a virtual appointment. Explore other possible medical causes and talk about your choices for interventions. Ask for referrals to psychotherapists who understand both ADHD and co-existing mental health issues. Many therapists are conducting virtual therapy right now and ensuring that parent or family sessions are part of the treatment.
You can also follow these suggestions to promote well-being in your family:
- Validate your child’s experiences: Instead of offering falsely positive reassurances or irritated dismissals about your son or daughter’s emotions and questions, acknowledge what you’re observing and hearing from them. Think about their behaviors as signals that something is amiss and put on your Sherlock Holmes hat. Ask open-ended questions that begin with “What…” or “How…” and reflect their answers back to them with “Did I get that right? Is there anything else?” You can’t make things better, but you’ll offer comfort to ease their pain and fear.
- Stick with the facts: Real information is key. Kids need clear guidelines about the purpose of the quarantine and what actions they can and can’t take. Limit your family’s exposure to the news and be aware of what you are saying on the phone or Zoom when your kids are around. They really hear more than you think they do.
- Remember that we are suffering apart and together: There’s a universal feeling of unease right now, which is combined with the loss of usual routines and decreased social, in-person contact. Staying connected to your social network is essential, so help your kids, especially younger ones, connect with friends and extended family. Social media and group Zoom chats help people check-in with each other and decrease loneliness.
- Avoid over-using substance or discussing how they can ease your pain: Relying on extra wine, beer, marijuana, or other substances right now to manage your stress sets a poor example for your children. What they learn is that coping with uncomfortable feelings or insecure situations means relying on drinking or smoking to get by. This isn’t the message we want to send to our kids. If you have a nightly glass of wine or a can of beer and that’s what your kids are accustomed to, then that’s fine. But increasing your usage now raises your risk for developing dependence and shows them that’s the best way to cope. Instead, go for a family walk after dinner, play a game, or watch a show together. Discuss your frustrations in appropriate ways rather than falling back on self-medication.
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Updated on May 21, 2020