How will the pandemic affect children's mental health in the long term? We ask UAE parents and experts

Wilbur Langtry White, 9, who lives in Dubai, has attention deficit hyperactivity disorder. Until recently, his parents, Lala and Rupert, were able to manage his symptoms with regular exercise and frequent movement breaks. But since schools have closed and strict physical distancing rules have been put in place to help curb the spread of Covid-19 , Wilbur has struggled to regulate his emotions and mood fluctuations. So the family have decided to do something they never wanted to do: put him on medication. “We quite quickly, about a week into this current homeschooling situation, decided together with Wilbur that we would investigate medication,” explains mum-of-four Lala. “He’s struggled with emotional outbursts, he goes from nought to 60 with no in-between, and we’ve been enormously conscious of it.” Before the pandemic, Wilbur had the support of a clinical psychologist, who prescribed play and art therapy, but the family felt this did not translate well over a screen, especially as too much screen time is one of his triggers. “We were between a rock and a hard place, so we went to see a psychiatrist and discussed it with [Wilbur]; as he’s 9 he’s able to partake in the decision-making process.” Thankfully, the Langtry Whites soon realised this was the right decision. “Apart from noticeable side effects – such as a loss of appetite and he’s finding it harder to sleep – this has been beneficial for him in terms of concentration and emotional regulation.” Wilbur is now able to enjoy homeschooling and feel more motivated. “Would we have made that same decision out of lockdown? I’m not sure. But talking to him, he feels much happier.” This is just one small example of how young people’s mental health is being affected by staying at home. But what will be the potential long-term psychological impact of the current crisis on children? It's a question that weighs heavy on the minds of parents. Dolly Lalvani, a mother of two in Dubai, worries for her daughter Arya, 17, who was due to start applying for colleges this year. “She’s very much a people person and she misses being with her friends,” says Dolly, who is the chief operations officer at GFX – Group Fitness Experience, which has had to close its Business Bay gym to customers for the time being. "This was supposed to be one of her years, but she's missing out... This was her year to prove herself. She's been asking: what do I mention on my CV now?" At first, Arya, who attends Dubai International Academy, where she’s doing her International Baccalaureate Diploma Programme, was positive about the homeschooling situation. Now she’s finding it more of a struggle. "It's not been the best," she tells The National . "At first I was super motivated, getting all my assignments done before they were due. Recently, my motivation is decreasing. I've been finding it harder to get in touch with friends; everyone is tired. It's hard keeping up with the workload." Arya is worried about going back to school in September. “I think it’s going to be really hard to cope,” she adds. “I think it’ll be a big struggle to adapt back to the system and keep up with the deadlines.” At the same time, Arya’s brother, Tanishq, 23, recently graduated from university with a degree in business management and communications, and has been looking for a job in Dubai, which is an uphill battle at the moment. He will be missing his graduation ceremony, for which they’d already bought his hat and gown, and Dolly is becoming increasingly concerned that the economic situation will affect his chances of being employed in the near future. Fiona Falconer, another Dubai resident, has been having similar issues. Her son Max, 15, was supposed to be sitting his GCSE exams next month, but those have been cancelled . She says there have been a few ups and downs in their household. “[The students have] prepped for two, three, four years for these exams. It’s what they’ve been working towards and suddenly it’s been whipped away from them.” While Max was OK at first, and he’s found solace in being able to chat online with his friends throughout the day, he has his moments, Fiona adds. “The other day he had a bit of a meltdown, he was really upset. He says he can’t do anything about the results now, but he’s still studying, and he doesn’t see the point. He feels out of control a bit, and helpless as to what he can do to make anything better, but he’s still being told to do this homework and that. “I get it. I would have been the same.” Fiona’s other son, Charlie, 13, is dyslexic, so home learning has been tough for him. “The school [Dubai British School] has been really good though, giving him loads of support.” The teachers have done this by having Charlie focus more on practical subjects he likes, such as photography and anime cartoon drawing. “He’s been OK. I think he’s just a bit bored, really. My husband and I are both working full time, so we can’t really sit with them and watch a movie and bake and draw, and all that stuff. "We just haven’t got the time. In fact, we’ve probably got less time than usual, as hours seem to be longer.” Age is an important consideration, says Dr Catherine Frogley, a clinical psychologist at UAE mental health facility The Lighthouse Arabia “Depending on the development stage, children and adolescents will experience the coronavirus crisis in different ways,” she explains. “For children under 3, their developmental stage means they are developing a growing awareness of outcome, but have a limited understanding of cause and effect. "They may struggle to understand things they cannot see or touch, and they are focused on the present moment. They will also pick up on the emotions of adults, but lack understanding of this. Thus, they will need routine, structure and more affection to reassure them.” For children aged 3 to 7, she explains, they are more focused on their immediate environment and struggle to understand concepts such as the future and death. But they are more conscious of other people’s distress, and have a growing awareness of illness and health-promoting behaviours. “They will also need routine and structure, opportunities for play, concrete and simple answers and reassurance.” For those aged between 7 and 12, their understanding of illness, medicine and death will be greater, and they will be more aware of change in relation to the world. Yet they may still struggle with voicing their concerns, and parents need to carefully monitor any changes in behaviour. “Young people aged 12 years and above can think hypothetically and abstractly, which means they can imagine alternatives, can generalise to other situations and can think about the future,” Dr Frogley adds. “They are more likely to ‘put on a brave face’ and ask fewer questions. As parents, while we need to respect their privacy and need for autonomy, it is also important that we don’t assume they can cope on their own, and that we provide support and affection. “They are also going to be missing friends more. Therefore, discussions around friendship and dealing with isolation are crucial for this demographic.” Teenagers are the most “endangered species” in this situation, says Masa Karleusa Valkanou, a psychologist and psychotherapist at Thrive Wellbeing Centre by Dr Sarah Rasmi. “Psychological development dictates that a teenager is separating self from family and attaching more to a peer group,” she explains. “In the situation of isolation, they lose the comfort of their peer group.” Online chat cannot be a proper substitute, she adds. “Teenagers need love and support and someone to calm their anxiety and fears, but they can’t turn to parents, and can’t get it from friends, either. They can face serious feelings of loneliness and psychological isolation.” We also have to pay close attention to children with physical and intellectual differences, says Dr Frogley, adding that they may need consistent routine and structure. “Having said that, parents will also need to remain flexible in this structure – to take a break if and when the child becomes frustrated or loses concentration with learning, or to adjust parenting priorities to what the child needs.” This demographic may also find it harder to process and express their concerns, and these feelings might show up in their behaviour instead. When this happens, Dr Frogley advises giving the child increased connection, support and love. “Of course, you cannot give what you don’t have and therefore, as parents, you will need to give yourself compassion and care first and foremost.” Much of the advice for parents at this time centres around modelling good behaviour and staying in a positive mindset. Valkanou says: “Follow the airplane instruction ‘always put your own oxygen mask on first and then assist your children’. "I can’t stress enough the importance of that statement. If you keep your anxiety and emotions under control, your child will not feel the threat … If you, as a parent, feel overwhelmed, do not hesitate to ask for help. High anxiety is expected in this situation and therapy does work wonders if you commit to it.” But this is one of the biggest challenges of the current situation, says mum Langtry White. “It’s keeping that enthusiasm level up morning, noon and night – there’s no respite from it. For children, enthusiasm is infectious, so you have to have the get-up-and-go for them to follow suit. “As adults, we all have days that are flatter than others. I’m normally a glass half-full person, but there are days where we feel less like a ray of sunshine and that can be infectious through the house.” Her husband describes it like this: “It’s as though there’s a hole in the side of sinking ship that you’re trying to fill, but the water is constantly coming in, and you don’t know how far away land is.” With little clarity on when and how this situation is going to change, parents are also becoming increasingly concerned about spending the entire summer with children indoors, as it becomes too hot to play on balconies and in gardens, if they have them. Laetitia Tregoning, mum of Charlie, 7, and Eddie, 2, is finding it hard to answer her sons' questions about how long this is all going to last. “Daily I remind myself that this is trying and confusing for both of them, and this is manifest in their behaviour,” she says. “Eddie is frustrated for sure, but being so young he can’t articulate this, so it comes out in tears and tantrums. Charlie’s attention span is poor and he seemed to turn his attention to irritating his brother for a while.” Charlie, she says, misses his friends and the freedom to move around, and has been concerned about family members getting sick. “Naturally he looks ahead, to summer holidays with grandparents, plans to travel, and it is difficult telling him to suspend all expectation. Until when? How long? We can’t answer these questions.” Valkanou says having a clear line of communication with our children is important. “Talk to them to make sure they don’t have any unrealistic fears,” she says. According to an earlier study by the British Psychological Society, younger children could be at risk of blaming themselves or believing this illness is a punishment for their own bad behaviours. Signs and symptoms that your child is struggling include reassurance-seeking, fear of separation from parents, headaches or stomachaches, irritability, trouble sleeping and meltdowns or tantrums, says Dr Daniela Salazar, another clinical psychologist at The Lighthouse Arabia. “Children may not have the emotional language to express how they feel,” she adds. “For younger children, it might be useful to have a feeling chart, so they can say how much anxiety they might be experiencing at a given moment, rather than naming the feeling itself.” For older children, she suggests direct questioning. For example, ask: “Did anxiety get in the way of your day today?” or “Were you feeling scared this morning while you were doing your e-learning?” She also stresses the importance of finding positives in any situation, as well as the need to be truthful and avoid giving too much reassurance. “It is important to share with them information about what is happening in the world at the right level depending on the age of the child,” says Dr Salazar. “This will help the child feel more in control and they will then be able to put things into perspective in a healthy manner. “For all children, avoid getting into a cycle of reassurance,” she adds. “It is easy for them to rely solely on parents reminding them they are OK and when we aren’t able to give them this reassurance, their anxiety worsens. In this case, I would recommend reminding your child of all the things that you’re doing as a family to take care yourselves – washing hands, staying indoors – and encourage focusing on the things we can be doing in the moment.” Tregoning, who manages her own public relations company from home, has found it helpful to focus on what they “can do”, as opposed to what they “can’t do”. “Charlie is working on a YouTube video for kids’ fitness, which is a project in itself. He’s doing lots of painting, table tennis, games, puzzles. “We’re always at the ready with a solution before the words ‘I am bored’ come out!” Langtry White, who works as a doula and has three other children – a daughter, Loveday, 7, and twin boys, Digby and Arto, 4 – has, in some ways, found having a bigger family to be an advantage in this situation, particularly with the twins, as they have a “ready made school mate” of the same age to play with. But it’s still taxing, she adds – and it’s difficult to get them to do any physical exercise, even though they’re all usually very active children and really enjoyed online workouts at first. “Now, if anyone hears the name Joe Wicks there’s an audible groan,” she says with a laugh. “No one has any interest in doing another online exercise class at all. We get the slippy slide out in our tiny garden from time to time, and 'the floor is lava' is a popular one, but that’s about it. They also like wrestling, but that inevitably ends in tears.” It’s “all hands on deck” throughout the day, she adds. “Homeschooling requires a lot of support. The children need us beside them. Then I do my own classes and support in the afternoon, I cook dinner. No one’s going to bed early.” Elsewhere, the Lalvanis have been trying to maintain a routine of family dinners every evening. They play Monopoly together on the weekends and have Zoom chats with their extended family members regularly. Arya has also picked up a few new hobbies in her bid to stay upbeat. “I’ve started baking, a hobby I dropped in Year 6. I love arts, so I’ve started painting a lot … I’m also spending a lot more time on social media,” she adds. “If this continues to go on throughout the summer, I just want my motivation back.” "The coronavirus crisis is likely to be a once-in-a-lifetime event and it will effect every family in its own unique way," says Dr Frogley. But that doesn't mean the pandemic needs to be dangerous to the mental health of our children, she adds. "In fact, if we navigate this in the right way, we can use it as a valuable opportunity to teach children resilience, anxiety management tools, frustration tolerance, empathy, gratitude and the importance of coming together to support the global community." Valkanou agrees. "Every crisis is an opportunity. Some children might experience extreme anxiety, which can be a seed of worry for their later life, but some will grow from this experience, learning gratitude, new creative skills, remembering beautiful family time and having their parents present, as they always longed for." It is how parents react at this time that will really make all the difference, Dr Frogley continues. "How children are supported – or not – during this time and how we help them to make sense of what is happening, will inform their core beliefs; their views of the world, what they can expect from others in their life and how they view themselves." The UN Secretary-General’s Envoy on Youth has organised a series of webinars on how young people can cope with the crisis, alongside Unicef and the WHO. These sessions invite viewers to send messages throughout, with many reporting increased anxiety that has been amplified due to feeling overwhelmed by the news, as well as a proliferation of misinformation. Adolescents around the world said they are also experiencing a lack of productivity during lockdown, disagreements with loved ones and family members, plus worries about the future and missing a lack of face-to-face connection with others. Other young people are concerned about marginalised communities, a lack of safe spaces for anyone suffering abuse and about spending too much time on social media. Not much is known about the long-term mental health effects of large-scale disease outbreaks, and the consequent change of life, on children and adolescents. There is an important gap in the research, a recent article in the medical journal The Lancet stated. What is known, however, is that the situation is going to affect children differently depending on their socio-economic background and family dynamic. Reports have shown social isolation has exacerbated situations in abusive homes. For example, Jinai County in Hubei province, China, saw more than a tripling in reported domestic violence cases during the lockdown in February. Also, any child who already suffers from mental health difficulties may struggle more than others. A survey from charity YoungMinds, which included more than 2,000 participants up to the age of 25 with a mental illness history in the UK, found 83 per cent said the pandemic had made their conditions worse.

How will the pandemic affect children's mental health in the long term? We ask UAE parents and experts

'If we navigate this in the right way, we can use it as a valuable opportunity to teach children resilience,' says one Dubai psychologist