Building Resilience in Our Children for the Aftereffects of COVID-19

It has been over a year since the World Health Organization confirmed that we were all living through a global pandemic. Since then, many of us have experienced tragedy, loss, and sustained threat and continue to do so. At times, we are navigating these stressors with uncertainty, limited guidance, and national divisions. Measures necessary to maintain our physical safety have caused isolation. Although technology has helped us maintain a sense of connectedness, its limitations prevent it from sparing us from the full impact of aloneness on our emotional life. Compounding the effects of the isolation that the pandemic has inflicted are additional ravages to our mental and physical well-being in the form of unemployment, academic interruption, and the loss of loved ones.

If ever there was a time to prioritize the building blocks of resilience, it is now. Our profession strives to provide resources to strengthen support systems, alleviate burdens, and help those most vulnerable. We have guided our patients in building new coping mechanisms, utilizing technology to engage in therapy, and identifying resources as we were developing these skills for ourselves. We aim to build resilience as individuals face what was once an acute stressor that has become chronic.

In truth, we know very little about what constitutes resilience. However, an accurate and humbling acceptance of our developing understanding of resilience can inform our aspirations and target our approach. Resilience is a physics term; it literally means that the spring bounces back to its original form. In our clinical circles, we use the term to refer to the return to prior function and, in a very narrow fashion, to describe the absence of symptomatology or dysfunction.

This clinical definition is limited because it does not reflect the possibility of biological and psychological factors that may be bringing the individual closer to a threshold of symptom expression and altered function. In other words, it is below this threshold where the truly resilient live, but also those whose allostatic loads (the cumulative burden of chronic stress and life events) have increased in a clinically unnoticeable manner. Identifying the factors associated with resilience will allow us to better assess the impact of stressors on an individual.

Some of the variables that play a role in resilience center on the individual and others in the individual’s environment. The presence of a robust support system, a dependable relationship, perseverance, optimism, and a sense of humor all come into play. It is essential to assess these as we evaluate how our patients will bounce back. The possibility for adaptation, bouncing back to an even better stance, should also be a goal.

Contrary to popular belief, children and adolescents are not resilient simply by virtue of being young. The opposite is true. They are, in fact, more vulnerable. This is why we take care of them. Developmental dynamics during a period of active neuronal and physiological development may place youth at higher risk. Children and adolescents do have the capacity to become resilient and adaptive when we give them the opportunities and resources to do so. But it is of concern that half to two-thirds of those needing mental health services may not have access to them.

Resources for building resilience are crucial because the pandemic has had a significant impact on our youth. According to a report by the Alliance for Excellent Education, more than 8 million children had limited or no internet access, impeding their ability to participate in academic courses during the pandemic. Students have also lost teachers who left the education workforce because of pandemic stressors or death from COVID-19. And according to the Centers for Disease Control and Prevention, between April and October 2020, the proportion of emergency visits related to mental health increased by approximately 24% for children aged 5 to 11 years and 31% for children aged 12 to 17 years.

The adverse effects of adult unemployment also touch kids’ lives in very direct ways. For every 1% increase in unemployment, there is a 20% increase in child neglect and a 10% increase in abuse of any type, according to a paper published March 19, 2020, by the Social Science Research Network (SSRN).

Children from diverse families are particularly affected by the pandemic. According to a report by the United Hospital Fund, Black and Hispanic children in New York experienced the death of a parent or caregiver at twice the rate of Asian and White children. Asian families have faced additional stressors. Although hate crimes overall decreased last year, a report this year by the Center for the Study of Hate and Extremism showed that anti-Asian hate crimes in 16 major U.S. cities had an overall increase of 149%.

The mental health challenges of COVID-19 will continue to manifest long after the pandemic is over. The time to develop innovative interventions that build resilience and disseminate treatment delivery and preventive interventions is now. Recognizing functional change is just part of the work. Maximizing resilience and adaptation opportunities that take into account the burden of the pandemic and its associated stressors is essential. Children need advocates who can initiate and lead collaborations with leaders in communities, school districts, technology, among others, to build effective programs and interventions. We need to disseminate these within the systems where our kids socialize, study, and play. Policy work that helps to sustain these resilience-building projects is critical as it recognizes that “resilient” does not mean symptom-free. ■