By Carly Menker
Max*, a young man with congenital immunodeficiency, felt extremely anxious this summer and wanted to avoid going back to school in-person.
He decided on a strategy of ensuring he would catch the Delta variant of the COVID-19 virus so he wouldn’t have to return to classes, something he confided during a conversation with Dr. Ellen Rome, Head of the Center for Adolescent Medicine at the Cleveland Clinic Children’s Hospital. He was willing to risk his life so he could avoid facing his anxiety focused on the classroom.
After over a year of the pandemic, not all youths have the same views as Max, but many are facing heightened rates of anxiety that manifest different symptoms and behavior for each adolescent as the return to in-person schooling is being implemented.
“We have seen the whole spectrum. We have kids who are so excited to get back into school and think that COVID was a drastic inconvenience. And we also have kids who are terrified to set forth in the classroom, as well,” Rome said.
The changes resulting from the pandemic has impacted adolescents immensely. According to the 2020 American Psychological Association Stress in America Survey, 43% of teens 13-17 years old said the level of stress in their lives increased over the last year; 51% said the pandemic makes planning for their future feel impossible; and 81% said that they have been negatively impacted by school closures. More notably, 56% of young adults have reported anxiety and depression due to the pandemic compared to 41% of adults, according to a Kaiser Family Foundation report.
“Returning to school is important for the health and development and well-being of children,” Rome said. “Kids tend to learn best when they’re physically present in a classroom, and they’re also learning social and emotional skills while they’re getting healthy meals, getting regular exercise and theoretically getting the mental health support and other services that traditionally have not been so easily replicated online.”
Providing validation and support for youth is crucial during the back-to-school transition. To help cope, Rome suggested that adolescents use positive visualization techniques, confide in a parent or loving adult and utilize resources such as apps, including Calm or Headspace. She also offered advice to parents and caregivers.
“A parent, or loving, caring adult can say, ‘We’re going to keep you safe by making sure we protect you against illnesses with vaccinations as for all of your childhood diseases, and for the COVID vaccine when it’s available. We’re going to help you mask when that’s appropriate. We’ll get you awesome at hand washing, so that you and I can both stay as safe as possible and keep you growing and learning,’” Rome said. “‘Our job as caring, loving, parents and adults is to keep you safe and growing and thriving.’”
Dr. Avanti Bergquist, a psychiatrist at the Pathlight Mood & Anxiety Center in Bellevue, Washington, said the many pros and cons to going back to school result in both anxiety and excitement for kids.
“There is worry about getting sick or getting others sick on top of the typical worry that happens with starting school or anything new,” she said.
With each day, the partnerships between parents, teachers and students are crucial to create a safe and comfortable school environment regardless of what happens.
“Kids are resilient and have been doing a lot better during COVID than we predicted that they would,” Bergquist said. “However, they will still need a lot of support, and some kids will not do as well as others. It is important for schools and districts to have support in place to be prepared for this.”
Adolescents, though more mature than the younger kids, often have even deeper anxieties. They love routine, certainty and habits, something that has been sparse during the pandemic with the uncertainty of information and constant changes. It is hard to anticipate the unknown, and with the emergence of variants, there is much that experts cannot confirm, according to Bergquist.
General intolerance of uncertainty means uncertainty creates stress and anxiety, said clinical social worker Amanda Fialk, who is the Partner & Chief of Clinical Services at The Dorm. The facility is a young adult treatment community based in New York City, New York and Washington, D.C. that offers different therapies, as well as services that include skill-building, health and wellness and academic and vocational support.
“COVID has flooded teens with uncertainty and a lack of predictability. Guidance around safety is constantly changing, new variants are emerging, politicians and news media are sending inconsistent messages, schools open only to close again,” she said.
Adolescents who have been schooling with virtual learning may seem unsure of how best to jump back into in-person schooling despite their enthusiasm. This is something that looks different for everyone.
Their anxiety may manifest itself as changes in appetite, energy and interests, difficulty sleeping and concentrating, body and stomach aches, worsening physical ailments and/or increased substance use, Fialk said. Their stress and anxiety can also cause teens to feel angry, sad, worried, numb and frustrated.
Fialk and Rome both suggested that adolescents facing back-to-school anxiety should try to take care of their physical health, eat healthy, exercise, get plenty of sleep, meditate, make time for fun and take breaks from watching social media, including news on the pandemic. Youth should not be afraid to speak up and ask for help.
Some warning signs of anxiety signaling that adolescents may need professional help to guide them through their anxiety include skipping meals or overeating, chronic worrying, isolating from friends/family, signs of self-harm, lying to teachers/parents, substance abuse, sleep problems, withdrawing from friends and suicidal thoughts, according to Fialk.
Rome noted that there are many options for professional treatment, including but not limited to a variety of non-addictive prescription medications and various types of therapy, such as Cognitive Behavioral Therapy (CBT, or behavioral modification) and Dialectical Behavioral Therapy (DBT, or behavioral modification + insight).
Adolescents ages 12 and older can do their part by getting vaccinated and continuing to wear a mask, said Dr. Arthur Lavin, chair of the Committee on Psychosocial Aspects of Child & Family Health at the American Academy of Pediatrics. He emphasized the importance of vaccines to protect teens from getting sick and from the fear of getting sick.
With the Delta variant of COVID-19, infection cases in children and teens have risen exponentially, pediatric ICU rates are rising and the unvaccinated population is impacted most by the pandemic. Vaccine approval for children under age 12 is expected sometime this fall.
The emergence of COVID-19 vaccines aids greatly in fighting the pandemic; however, it can be a source of anxiety for parents and youth who know they are around people choosing not to get vaccinated even though it puts themselves and others at risk.
“Day in, day out you don’t know if your sports team is going to meet, you don’t know if your school is going to open, you don’t know if your school opens, whether it’s going to stay open, you don’t know if you could go on your college tour, you don’t know if you should get together with friends,” Lavin said. “And the message is that if you do, you might be okay to get COVID because you’re young. But you might infect a parent, or uncle or aunt or grandparent, and they might die. If that doesn’t induce anxiety, I’m not sure what would.”
The need for a universal sense of empathy is greater than ever. Lavin said that we are not at the end of the pandemic, rather we are in the middle of a historic time that is an anomaly and the need to stay vigilant in saving lives is more important than ever.
“We have to pay attention to what’s happening and respond to signals that things are going well, better than we thought, or signals the things going not as well as we thought and we have to be supple, quick on our feet, responsive, honest and learn together,” he said. “I think we need to shift our goal until the pandemic ends away from seeking routine and more towards joining together to be smart, responsive, thoughtful and we can engage kids in that project. There’s something very good about what we’re doing and they’re part of working hard with us to respond to the danger.”
*Name has been changed to preserve anonymity
Carly Menker is a health, environment and science reporter for the Medill News Service and a Comer Scholar at Medill. Follow her on Twitter @carlymenker.