While the COVID-19 pandemic is rightly blamed for harming the mental health of children (and adults), the mental health crisis started a decade earlier, according to Sarah Jerstad, PhD, LP,  the clinical director of psychological services at Children’s Minnesota and guest speaker for UMRA’s April 16, 2024, Living Well Workshop. 

From 2010 on, surveys show a steady increase in the number of teens reporting persistent feelings of sadness and hopelessness. The incidence was higher in females. Also in 2010, Jerstad noted, the iPad made its debut, followed in 2011 by the social media messaging app Snapchat.

Then COVID hit. Among U.S. high school students, 29 percent had a parent or caregiver who lost a job, 55 percent experienced emotional abuse, and 11 percent were physically abused. Without school, many lost access to counseling, academic support, and meals. And social skills decreased—something Jerstad observed herself in counseling sessions—due to decreased access to peers and adults. 

What is causing the children’s mental health crisis? For healthy child development, Jerstad said it is essential to establish normal behavior first. She played a video demonstrating the importance of reciprocal dialogue, or responsive caregiving, between babies and adults. In the video, a baby and mother exchange faces, sounds, and hand motions. Then the mother turns away, and turns back with an impassive expression. The baby tries all of her tricks to get a response, and eventually, when there is no response, she cries out in frustration. All is well when mother smiles and reacts again. 

‘Hot and cold cognition’

Preschoolers need to play and begin finding their independence (“me do it.”) Grade school age children want structure and interaction with peers to develop their sense of self. Tweens and teens seek autonomy and more time with peers, and demonstrate “hot and cold cognition”—they can seem like little adults when calm and exercising complex cognition, but, when emotions run high, they sometimes can’t control themselves.

Back to explaining “why” the increase in children’s mental health diagnoses, Jerstad offered several reasons. 

• There is a decrease in stigma for admitting mental health concerns, and an increase in societal stressors. 
• The age of puberty is dropping, especially for females, which does not match their cognitive development. 
• Parents are more anxious and protective, allowing less opportunity for kids to face their fears in a natural setting. 
• The ubiquitous nature of digital access and social media. 

The average amount of time children and teens spend in front of screens, over and above any time spent on schoolwork, is beyond and sometimes twice what pediatricians recommend. It is the opposite of the preferred reciprocal dialogue model. Studies show a high correlation between more screen time and lower psychological well-being.

What is a parent or other caring adult to do? Create a culture of conversation in which adults and children share information. Direct questions often don’t get much of a response from kids, so engaging in dialogue can draw out more information. Demonstrate how people handle challenges by including examples of your own. Play a video game with the child or watch a show together and talk about it. Parents need to understand and acknowledge the importance of screen time for kids, Jerstad said, but they also need to set boundaries (e.g., phones get charged in the kitchen at night). In short, the role of a parent is to help kids be well-rounded.

And as for those “terrible twos” toddler tantrums? Well, they’re probably inevitable, but if they happen more than a few times a week and for more than a few minutes, the family might want to consult a professional. 

—Julie Sweitzer, UMRA president-elect and Program Committee chair