Dr. Shah

It’s safe to say it’s been a difficult year for many children. They have been socially isolated, have new school routines, have limited outings, and some kids may have experienced serious illness in their homes.

It may be too soon to know how the pandemic is affecting children mentally. But Santa Rosa psychiatrist Anish Shah, who worked with children who lost their homes in the 2017 and 2019 North Bay wildfires, says that kids living through COVID-19 may have similar mental health symptoms to wildfire victims.

Shah, founder of the Siyan Clinical Corporation, a private psychiatric practice in Santa Rosa, specializes in mood disorders such as depression, ADHD, PTSD, substance abuse and schizophrenia.

He spoke with Bay Area Parent about how catastrophic events may affect kids and how parents can help.

Have you seen an increase recently in children who are suffering from stress, anxiety or depression?

Yes, I have seen quite an increase in anxiety and depression in our children. Children go through extreme stress and anxiety after experiencing emergencies such as wildfire or the COVID-19 pandemic. They do not have a well-developed coping mechanism to extreme stress and may demonstrate, typically younger children, some emotional aspects such as outbursts and depression. They are prone to nightmares; they may not perform well in school due to distractions caused by trauma. This is an extremely distressing predisposition for children.

Do you know if there is any data available showing how the pandemic is affecting children?

I’m not aware of any formal clinical trial or survey for the pandemic and its impact on children. At Siyan, I’m doing a study right now surveying about 500 patients who have been affected by the pandemic. Our study includes adolescents and adults.

What symptoms are you seeing?

For an emergency or catastrophic disasters, such as wildfire or the pandemic, I’ve seen children suffering from serious stress or behavior that involves irritability, emotional outbursts, some may experience nightmares, they may easily get distracted, they may have mood swings, they may feel lonely or withdrawn. Also, some experience irritability while dealing with their parents or other adults and friends.

Can symptoms vary depending on the age of child?

Younger children, less than age 10, may have additional symptoms like bedwetting. Very young children, less than 5 may want to go back to bottle feeding. The older children may not want to stay alone in the house. Children younger than 8 may blame themselves for the event. Older children might be more irritable and angry, which can be displayed more outwardly in their expressions.

Can social isolation, such being away from friends and school, cause mental health issues in children?

Yes. Children need the comfort of social connections. The way children cope is by being with their peers in play settings, having structure in their schedules that schools provide to them. Unfortunately with the pandemic, children are more isolated and there is more depression.

Do you have an example from your own experience with helping children during the wildfires?

I can tell you a story of child who was 11 and happened to come to our clinic. The family lost their home in a wildfire. The family was displaced. They were living about 40 miles from their original home and school. When I saw this child with the family, he was having extreme difficulty with sleep. He had excessive guilt about causing the fire. He thought he was responsible for the fire. Those are the kinds of irrational thoughts he was struggling with. He had trouble with focus. He was withdrawn. He had issues with eating and proper nutrition. He had some mood swings. What we did was to explore his feelings in our sessions. We looked at what was occurring in his life. We looked at his belief systems. We tried to bring a rational perspective to his beliefs. We had to start medication to improve his sleep and mood. Ultimately after 16 weeks of treatment, he was very positive and happy. He returned to school and started seeing a private therapist. He was able to get off the medications and developed good coping skills.

How can parents help if they think their kids are having mental health issues?

  • Give enough time and attention to children and let them know that you are there for them. This is especially important during the first few weeks or months of a catastrophic event. Some children may regress into earlier behaviors such as bed wetting or wanting a bottle. If children are feeling guilty, try to explore and ask them questions. Listen to their feelings about what they are feeling and try to reassure them if they have guilt that is irrational.
  • Allow younger children to express their feelings through nonverbal activities such as drawing or painting. There are excellent ways to relieve stress and engage in social activities with other children and adults.
  • Encourage older children to express their feelings and thoughts with their peers, as well as with parents and caregivers. As children express their feelings and thoughts about their experiences in the wildfires or pandemic, it helps reduce their anxiety levels and the confusion that they may be experiencing in the middle of the tragedy. Adults interacting with children should engage with them using appropriate language while addressing their concerns and questions. Parents should assure children that they are available at all times to manage their emotional problems.
  • Helping children manage their regular schedules for meals, bedtime and play is helpful. It’s also helpful to schedule Zoom dates or Zoom play groups or other audio visual social gatherings..
  • Try to reduce or encourage children to reduce social media browsing and news viewing. This information affects children. It makes them more traumatized and more vulnerable to psychotic issues. My suggestion is to minimize this to no more than two or three hours (per day).
  • When school activities start again, I would encourage parents to put children back to their regular school schedules because that is the most healing for children after a disaster. When parents have been displaced by wildfire in the past, I’ve always encouraged them to get children back to their regular school schedule.
  • Some children may have difficulty falling asleep and it may help to provide them with a stuffed animal, soft blanket or flashlight to take to bed. Telling them a positive story can be helpful.
  • Also, encouraging them to be involved with philanthropic activities can be very healing, such as writing letters to first responders.

When should parents consider counseling or therapy for their child?

If children are having depression symptoms or anxiety for more than a few weeks and parents notice it getting worse, I think they should get help. If they see the children struggling emotionally and at the same time their school performance is going downhill, then that’s a time to consider therapy. If children have problems of depression with extreme social isolation where they don’t want to get engaged with anyone and you see this more than two to three weeks on a consistent basis. If children have suicidal thoughts, they should be taken very seriously. In all situations where children have suicidal thoughts, a therapist or mental health professional must be consulted. If children have trouble sleeping for more than two weeks, not sleeping even six hours a night, I think you should consult your pediatrician or mental health professional. Extreme behavioral problems in which outbursts lead to throwing furniture, making holes in the wall, running away from home, those are situations when you should see a mental health professional.

Teresa Mills-Faraudo is an associate editor at Bay Area Parent.