Michigan Association of Health Plans

There’s a Childhood Mental Health Crisis — Parents and Guardians Can Help

This story appeared in Hour Detroit Magazine. Read more here

Mental health professionals who work with children and teens have a disturbing message for society at large: Our kids are not alright. Last October, the Association of American Pediatrics, the American Academy of Child and Adolescent Psychiatry, and the Children’s Hospital Association took the extraordinary step of jointly declaring a national emergency in children’s mental health. In making the declaration, the organizations cited the ongoing impacts of the COVID-19 pandemic — physical and social isolation, uncertainty, fear, loss, grief.

Indeed, Centers for Disease Control and Prevention statistics offer a grim paint-by-numbers picture of the pandemic’s toll: Between April and October of 2020, emergency department visits for mental health emergencies rose by 24 percent among children ages 5 to 11 and 31 percent for children ages 12 to 17. Emergency department visits for suspected suicide attempts, meanwhile, spiked by nearly 51 percent among girls ages 12 to 17 in early 2021 compared with the same period in 2019.

Yet to be fully measured is the psychological impact on children who have lost caregivers to COVID. At the time of the physicians’ emergency declaration, available data showed that more than 140,000 U.S. children had lost a primary or secondary caregiver, with children of color affected disproportionately. Those numbers continue to climb.

“We are caring for young people with soaring rates of depression, anxiety, trauma, loneliness, and suicidality that will have lasting impacts on them, their families, their communities, and all of our futures,” then AACAP President Gabrielle A. Carlson said in a statement announcing the declaration.

But while the pandemic may have ignited an acute mental health crisis, many underlying causes of this epidemic of childhood stress, anxiety, and suicidality are chronic. They predate COVID-19 and will persist after we return to something resembling pre-pandemic normalcy. The pandemic merely poured gasoline on a fire that had been worrying pediatric and adolescent mental health professionals for at least a decade before the arrival of COVID-19.

Here again, the numbers are dire. From 2007 to 2017, the share of kids ages 12 to 17 who had experienced a major depressive episode in the previous year jumped from 8 to 13 percent, according to a 2019 Pew Research Center study. That means the number of severely depressed teens in the U.S. rose from 2 million to 3.2 million over a single decade.

Even more worrisome: Suicides among 10-to-24-year-olds rose by 56 percent over that same period, according to a 2019 CDC analysis. For the first time, suicide overtook homicide as the second leading cause of death for that age group, behind accidents.

“And the scary part,” says child and adolescent psychologist Kelly Melistas, program coordinator of the Pediatric Behavioral Health Integrated Care Program of Henry Ford Health System, “is we were seeing [anxiety] affect kids younger and younger. It wasn’t just the middle school kids and high school kids that were coming in. We were seeing 5- and 6-year-olds with fears and anxieties and worries.”

Left unaddressed, those worries can lead to severe depression and suicidality, she says. In fact, a 2019 study published in the journal JAMA Pediatrics found that emergency room visits for suicide attempts and suicidal ideation in kids ages 5 to 11 rose from 580,000 in 2007 to 1.1 million in 2015.

Understanding both the scope and the causes of this mental health crisis is essential to finding solutions, but explanations remain largely speculative. They range from the increasing use of digital media and exposure to cyberbullying to relentless pressure to excel to generalized worries about — among other things — deadly school violence, the toxic state of the country’s politics, racial divisions, and environmental disasters.

Educators and mental health professionals consulted for this article concur that while these systemic causes will be challenging to resolve, there’s a lot parents can do to ease the impact on their own children. The first step is taking a hard look at some of the most likely culprits.

It’s tempting to blame the alarming rise in childhood mental health struggles on the evils of social media, especially since it coincided with increased use of digital devices by kids. But damning social media with too broad a brush misses important nuances about how an increasingly virtual life — not just social media, but virtual classrooms and online gaming as well — is affecting kids.

According to Melistas, kids are having to navigate this complex and confusing digital space long before their brains are equipped to handle its challenges. The frontal cortex — home to executive functioning skills such as planning, judgment, and emotional regulation — doesn’t fully develop until the mid-20s. Kids are being flooded not just with potentially toxic online feedback but also with frightening news and information that’s well beyond their brains’ processing capacity, leaving some of them confused and anxious.

“They are so much more inundated with that information, be it from their phones, their peers, their peers’ access to technology — because your kid might not have access to a phone at 8, like mine, but they have peers who have it, and then the peers talk. It’s just this inundation with media in general,” Melistas says.

Joe Amabile, a 20-year veteran Michigan high school math teacher who now coaches fellow teachers in Oakland County, has paid close attention to alarming changes he’s observed in students’ mental health over the past decade or so. He worries that the time kids spend online has altered how they form their sense of self, replacing traditional real-world sources of feedback — family, teachers, schoolmates — with an amorphous, anonymous, and often unkind virtual-world feedback loop. We wonder how a kid could threaten a school on social media, Amabile says. But if an isolated kid finds that making such threats elicits a lot of social media attention, it’s easy to see how it might become more tempting.

Even before the pandemic forced kids into physical isolation, children were experiencing troubling rates of social isolation, says Paul Liabenow, executive director of the Michigan Elementary and Middle School Principals Association. Liabenow has been working with the University of Michigan and other organizations to develop educational approaches and school-based programs aimed at curbing childhood depression and suicide by building social-emotional skills and fostering resilience.

“There are many theories about what’s going on, but I personally believe it was about isolation and it continues to be about isolation,” Liabenow says. “The access that kids do have to others is via the internet, the web — everything from TikTok to Instagram. And a lot of the communication is … well, it is not always positive, let’s say. It’s easier to bully someone when they’re 100 miles away — even your peers, when you may or may not see them for two or three months at a time.”

Liabenow cites a promising pilot program he helped develop in Niles, Michigan, that’s demonstrating the efficacy of connecting meaningfully with isolated kids. It’s called Class Catalyst. Through it, middle school students spend about 90 seconds each morning checking in virtually with their classroom teacher to report on their readiness to learn. It’s a chance for them to tell their teacher privately if they’ve had a bad experience at home or are struggling in some other way, positioning teachers to get kids help before they slide into depression or self-harm.

“So those kids in the back of the room, with their hoodies over their heads, are now engaging with the classroom teacher because they’ve found that they can share privately and they’ve found an adult who is trustworthy,” Liabenow says. “It’s been remarkably successful.”

There’s a cute, if slyly biting, scene in the 2020 documentary Chasing Childhood that may hit uncomfortably close to home for many of today’s parents. In it, writer and free-range childhood advocate Lenore Skenazy, who caused a stir in 2008 with a New York Sun column explaining why she’d allowed her 9-year-old boy to ride the subway alone, sits at a table of middle school kids and poses a simple question: “How many of you come home from school, eat a snack, and run outside and play?”

From the incredulous looks on their faces, you might think she’d asked, “How many of you have ever walked on the moon?”

The kids take turns explaining that they don’t have time to play because they’re far too busy with after-school activities — hip-hop dance class, filmmaking, acting, STEM design, stop-motion animation. Upon further consideration, one girl admits, “On Monday I do nothing because my brother has piano, and so I get like an hour by myself.” That prompts an envious classmate to tease, “Lucky!”

The scene captures with humor the very serious message of the film: Childhood has changed — and not for the better. Modern American childhood bears little resemblance to the childhoods most of today’s parents enjoyed themselves. It’s a lovingly constructed childhood in which unstructured, unsupervised, and possibly even — heaven forbid — mildly dangerous play has been replaced with safe, scheduled, supervised activities arranged for the child’s enrichment, in many cases with an eye toward the ultimate goal of admission to a “good school.”

The result, the film argues, is that over-parented, over-protected, over-scheduled, and highly monitored kids feel tremendous pressure to meet expectations, often at the expense of their mental and emotional well-being.

That analysis rings true for Amabile.

“I would say most of the mental stress is from perfectionism,” he says of kids he’s taught. “Holy cow — the number of kids in a high-level math class that I’m teaching where their parents are pushing them, pushing them, pushing them to be these perfect, perfect kids. That’s a huge stress.”

And all that pressure to keep up and measure up — compounded by the everyday pressures of hectic family lives and, more recently, pandemic-related trauma — is just too much for some kids to handle.

“A lot of what we see with kids is this anxiety, this worry about ‘Am I good enough? What if I don’t do this?’ That sort of perfectionistic kind of needing to be the best,” Melistas says. “And that stems from a number of places. It stems from their peers. And it stems from us as parents, to some extent, and what our expectations are.”

That extent may be greater than many parents would like to admit. Julie Lythcott-Haims, former dean of freshmen at Stanford University and author of How to Raise an Adult, puts it plainly in Chasing Childhood: “I think, in some ways, we’ve mortgaged our kids’ childhood in exchange for the chance that they will have the grand future we have in mind for them. But when you mortgage your kid’s childhood, it’s a debt that can never be repaid.”

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