September used to signal back-to-school shopping, high school football, track meets, student government elections, band, orchestra, choir, drama, debate club, homecoming, and now, with Halloween creeping up on us, haunted houses … #normallifewemissyou.
But teens are actually missing a lot more. They’re missing opportunities to work on the critical tasks that help them mature emotionally:
Acceptance of one’s body image (height, weight, and sexual development); they can’t master this task if they have more free time to become obsessed with their bodies and convinced that there’s a problem.
Achieving independence from their parents; they can’t master this task if they’re quarantined together.
Growing through peer interactions; they can’t master this task if they’re not socializing in groups.
Establishing their identities, including sexual identities; they can’t master this task six feet apart.
What happens when they don’t master these tasks? Many problems. A few examples:
At 3 p.m., a 17-year-old boy was lying on the examination table in my office, wanting to go home to go to sleep. During the pandemic, he was sleeping all day and awake all night. A recent editorial in the Association for Child and Adolescent Mental Health pointed out the high likelihood of sleep problems during the pandemic, especially in people who have preexisting anxiety, depression, attention deficit hyperactivity disorder, or autism spectrum disorder.
A 15-year-old girl believed that she was “fatter” than her friends; during the quarantine, she started restricting calories and exercising for 90 minutes a day. Three months later, and 20 pounds lighter, she stopped having monthly menstrual periods. A survey in the International Journal of Eating Disorders in July found that nearly two-thirds of people with anorexia and nearly a third with binge-eating disorder reported a worsening of symptoms during the pandemic.
A 16-year-old patient’s eating became “out of control.” After skipping breakfast, she would binge eat, consuming more than 2,000 calories in a frenzy. Then, she purged. A survey focused on people with bulimia nervosa found that almost two-thirds of previously hospitalized teens with bulimia nervosa worsened during the pandemic.
An 18-year-old girl who used marijuana daily was admitted to the inpatient pediatric unit due to uncontrollable vomiting. Diagnosis: cannabinoid hyperemesis syndrome. A study published in the Journal of Adolescent Health found that alcohol and cannabis use increased among Canadian teenagers during the quarantine.
All of the cases I have described are my own patients. In the near future, I expect I will also be seeing patients with post-traumatic stress disorder (PTSD), a diagnosis we usually associate with soldiers who have been in combat. Symptoms of PTSD include stress, anxiety, depression, intrusive thoughts or memories of the event, nightmares, or flashbacks. In a recent study by the Centers for Disease Control and Prevention (CDC), PTSD was found to be four times higher in children and teens who had been quarantined compared with those who were not. PTSD can happen in the first few weeks after an event or even years after the trauma.
Look under the masks: Speak with children and teens about how they’re feeling during the pandemic. Encourage teens to stay connected to friends and family through social media.
Avoid weight comments: Many of us have gained weight during the pandemic. Telling your child to lose weight may spark an eating disorder. Encourage intuitive eating: eating when hungry and stopping when full.
If you or someone you know is thinking of suicide, call the 24/7 National Suicide Prevention Lifeline at 1-800-273-8255, or text TALK to the Crisis Text Line at 741-741.
Rima Himelstein is a pediatrician and adolescent medicine specialist at Nemours/Alfred I. duPont Hospital for Children.