Supporting youth with anxiety disorders during the COVID-19 pandemic

By Dr. Nicola Keyhan, Child and Adolescent Psychiatrist, Hospital for Sick Children

The COVID-19 pandemic has created anxiety in many people. Some anxiety is helpful. It motivates us to prepare and protect ourselves—such as by handwashing, physical distancing, and following other advice from health experts.

But for people with anxiety disorders, anxiety can become dysfunctional, meaning it is not helpful. It can come at times when there is no actual threat, or be out of proportion to the threat.  A person with this type of anxiety may have fears that aren’t grounded in reality. They may also:

  • have strong negative feelings like fear or sadness,
  • feel physical discomfort, like stomach aches or difficulty breathing, and
  • try to cope using behaviours that aren’t helpful, like avoidance or compulsions (repetitive behaviour like excessive cleaning).

People with anxiety disorders usually overestimate the risks of a threat and underestimate their own ability to manage a situation. They are more likely to focus on worst-case scenarios.  They also have a strong need for control and can struggle in situations that are not routine or predictable.

Living during the COVID-19 pandemic, we are having to cope with change almost daily. Routines like school, work, extracurricular activities, and socializing with friends have all been disrupted. People with anxiety disorders may find it especially challenging to adjust.

Because the pandemic involves the threat of a virus, children who have Illness-related fears and/or obsessive-compulsive tendencies may find it even more difficult. Without support, they may become even more afraid of contamination, which in turn may lead to (or make worse) behaviours such as excessive handwashing.

How to help children and youth with anxiety disorders

Children or teens with anxiety disorders tend to worry excessively, and they will have different kinds of worries.

Minimize your child’s exposure to things they already worry about a lot. So, for example, if your child tends to wash their hands compulsively, be honest, but don’t focus too much on handwashing for a certain length of time. That may cause them to worry even more.

Here are some suggestions for talking to anxious children and teens about the pandemic:

  • Ask them what they know and what questions they have.
  • Correct misinformation and address their questions in a thoughtful, honest, age-appropriate, and reassuring way.
  • Avoid too much detail, which can create more worries.
  • Explore and validate their thoughts and feelings about the situation.
  • Ask whether they have any physical discomfort, which may suggest anxiety.
  • Limit their exposure to media that focus on negative outcomes, particularly things that your child already worries about. Seeing too much media can make existing fears even worse.

Specific ways to help your child’s dysfunctional thinking patterns associated with COVID-19

For children who are about 8 years old (developmentally) or older, you can:

  • identify and challenge anxious thoughts,
  • help them recognize how some thoughts can lead them to overestimate the chances that their fears will come true, and
  • guide them towards more realistic thoughts, which may make them less anxious.

Some tips include:

  • Ask your child/teen to write down their worried thoughts (for example, “I’m going to get sick”).
  • Help them think through the evidence that supports the worry (“Other people are getting sick”) and the evidence that goes against the worry (“Nobody I know is sick yet,” or “Most kids do not get sick from this illness”). This will help them develop a more realistic sense about whether the fear will come true.
  • Think about other ways to look at the situation that are more balanced and optimistic (“This is hard, but it’s temporary. Life will go back to normal”).
  • Remind them that they (and much of the world) are already doing a lot to protect themselves by social distancing and handwashing. These actions will make it less likely that their fears will come true.
  • Reassure them that even if they (or someone they love) do get sick, there are supports and resources that will help them get through it.

By keeping routines normal, and reassuring children and youth that they are able to cope with this situation, you’ll make it easier for them to manage during this challenging time, and to get back to normal when the time comes:

  • If your child or teen is involved in therapy for anxiety management, consider keeping it going (many professionals are offering virtual sessions), or make sure they continue to practice the skills they have learned.
  • If your child or teen is on medication, do not stop it without consulting a health professional.
  • Keep your own anxiety in check, because your child or teen will pick up on it. Model positive coping skills.
  • Make the best of the situation and focus on the positives, like increased family time and more opportunities for activities that foster closeness and bonding.
  • Keep in regular contact with loved ones, teachers, and friends through video chats or phone calls.
  • Keep routines (bedtimes, time for school work) consistent.
  • Make lifestyle choices that foster physical and emotional well-being:  healthy eating, physical activity, healthy sleep routines, limiting screen time.
  • Make time for activities that provide joy, are calming, and/or are healthy distractions.
  • Use coping tools that can reduce anxiety, like deep breathing, muscle relaxation, imagery, mindfulness.
  • If you are struggling, reach out for support.

When life goes back to normal (it will!)

At some point, this will end, and life will return to normal. While for many, this will be a huge relief, anxious children and teens may have challenges during this process as well. If they have illness-related fears, they may continue to worry about being exposed to the virus. This can cause distress and lead them to avoid certain situations.

Spending so much time at home with their parents may create (or worsen) separation anxiety in some children, making it difficult to go back to school or work.

Children or teens who are socially anxious and who feel more comfortable at home may not want to go back to the social pressures of school and extracurricular activities.

  • Talk about these transitions before they occur.
  • Use some of the tips above to get ready to face these challenges.
  • Expect that there may be some setbacks. Have a plan to work through them.

Keeping in contact with important people like teachers and friends during the pandemic should make the transition easier.

This is a difficult time for everyone. If you feel like you or your child needs extra support, don’t hesitate to reach out to your doctor or a mental health professional. You and your family can get the help that you need to feel safe and supported.