By Dr. Ashley Miller (biography and disclosures) and Dr. Linda Uyeda (biography and disclosures). (Members of the Child and Youth Mental Health and Substance Use Community of Practice and the Working Group on Adverse Childhood Experiences)
Ashley Miller: Disclosures: Dr. Miller is the co-author of What to Say to Kids When Nothing Seems to Work: A Practical Guide for Parents and Caregivers. Mitigating Potential Bias: Recommendations are consistent with attachment literature and do not relate specifically to the contents of the book.
Linda Uyeda: Disclosures: Engaged in public speaking and has received honoraria. Mitigating potential bias: The information provided about attachment theory and the recommendations outlined are referenced clearly to show where the evidence was obtained.
(Please stay tuned for Article #3: The Importance of Attachment Theory in Healthcare)
What I did before
When the pandemic first hit, I think most parents were in shock. How could we manage to work from home, do our regular daytime tasks and take care of our children full time, without the help of our usual supports? Families of youth with mental health issues (1,2) and neurodevelopmental differences (3,4,5) were hit especially hard, as well as those already living with financial insecurity and other psychosocial adversity (6). I struggled to get my kids off their devices, let alone getting them outside to exercise, and while I saw the impact restrictions were having, I felt powerless to do much about it. Many of the parents I worked with were facing much worse circumstances, and they felt exhausted, irritable and worried about how to make life manageable for their children and for themselves.
What changed my practice
As I started to understand that this pandemic would wear on, I had to figure out how to help my patients’ families and my own family navigate our way through this totally new reality. I drew on the science of attachment, resilience and healthy relationships to make a plan. I found several new resources developed during the pandemic and turned to others that had been particularly helpful in the past, most notably Circle of Security Parenting (7,8). The program is based on fifty years of research in attachment science, and was developed by Glen Cooper, Kent Hoffman and Burt Powell.
Although the pandemic was a totally new experience, the parenting dilemmas were essentially the same: 1) how to protect our kids from harm and provide comfort while supporting their essential needs to grow, learn, and explore, and 2) how to prevent completely burning out in the process.
What I do now
Provide a secure base
- Just be present when possible. As we described in our previous article, “showing up” is half the battle in parenting (9). With many activities shut down, it became easier for many parents and caregivers to spend more time at home with their kids. But being there and being present can be two different things. Parents will naturally have times when they are preoccupied with work, tasks, and other stress. There are days when I’m distracted on my phone or lost in thought about a patient or a crisis. Fortunately, the evidence tells us that parents don’t need to be perfectly attentive to their kids; just being emotionally present, enough of the time, is the key (10). We don’t need to solve their problems or have all the answers; we can just listen with an open heart. I recognize the pandemic as a time they need me more, and so I’m doing my best to be available to them as much as I can.
- Stick to routine. During times of anxiety and global unpredictability, having daily and weekly family routines helps give kids a sense of stability and safety. Making too many decisions (Do I need to sanitize my hands? Should I walk around this person?) actually weakens our executive functioning and can cause “decision fatigue.” (11) Having things planned out takes away some of the mental strain. Routines can also increase connection and joy. My family established Friday Games Night and Saturday Movie Night and we haven’t veered from them all these months. Even regular family meals can have a huge benefit (12).
- Take care of the basics. As soon as school shut down, sleep schedules went out the window and screen time went through the roof. There is no shame in this; it happened to everyone, but we can help kids get back on track each time they slide out of healthy habits. Parents and caregivers can set expectations for regular sleep and wake times and enforce limits on screen use, especially at night. Everyone can benefit from spending time outside and exercising whenever possible.
- Remember to play. We all thrive with fun and play (13). At the beginning of the pandemic, and then again with the vaccine rollout, I found myself scouring journals and media looking for information that would keep my patients and family safe, sometimes taking hours away from fun, normal activities. I had to make a conscious effort to rein this in and turn toward my family. Sometimes it takes real effort to find fun during these dark days, but just setting an intention to do something purpose-less with kids, for at least 10 minutes a day, can improve family connection and child mood (14). We don’t always have to have the same interests as our children but taking time to show enthusiasm for what our children enjoy, can be validating and improve their sense of self-worth.
Help kids face this new world
- Give information and listen to concerns. Everything keeps changing during the pandemic, and kids can sense the uncertainty even before they’re old enough to sense the cause. We can continue to give them age-appropriate information, reassurance, and practical guidance for each new stage. A lot happens at daycare and school every day and it’s helpful to check in with our kids. For kids who don’t like direct questions, doing an activity (e.g. a walk, a drive, playing cards, or doing artwork) can create space for them to bring up the “worries of the day.”
- Encourage safe, social connection. Social isolation is proving to be one of the most important risk factors impacting youth mental health (2). Some children are seeing friends and peers regularly, but for those who aren’t, parents can support them to arrange virtual contact or safe outdoor activities. Even older teens with more social anxiety may benefit from a parent helping them brainstorm options to create greater connections (e.g. text a friend or send a meme).
- Support brave behaviour. Though we may want to protect kids from all possible harms, there can be downsides to avoiding activities too. Helping our kids through mild to moderate stressors, allows them to gain confidence so they can overcome obstacles in the future. Every family has their own challenges. Some children may struggle with school activities while others resist new experiences or engaging in physical activity so each pathway to healing will look different. We may not be able to encourage our kids to hug each other just yet, but we can bring them to the park to play in the mud. We can orchestrate a food fight at home. And we can keep in mind that one day this pandemic will end, and we’ll want them out in the world once more.
Provide comfort and support – Be kind to our kids and ourselves
- Physical touch can be soothing. Safe physical touch can calm the nervous system and help kids feel love and connection (15). Being sensitive to what they prefer, we can provide hugs, a touch on the shoulder, or a massage at bedtime. Some children may prefer plush toys, blankets or pets for physical touch if direct touch seems like it’s too much at first.
- Recognize the emotions and needs beneath the behaviors. Oppositional behavior can be an unconscious way of “reaching” a parent who they perceive is less available or it may be the only way a child who is struggling knows to communicate their needs (16). Two of the greatest gifts we can give our kids are opening the conversation about difficult feelings (e.g. anger, frustration, loneliness, fear, inadequacy) and acknowledging their experience without judgment.
- Connect with my own supports. We all lose our emotional balance as parents, and even more so when under stress (17). After an incident with my kids, I’ll make time to debrief with my husband or a friend. I’ve talked to my own mentor or therapist when I’ve needed to around particularly difficult times. The more embarrassed I am about my parenting behaviour or the more worried I am about my child, the more important I find it is to talk to someone about it, so I can settle myself.
- Practice mindfulness and take breaks when needed. When I feel like I’m starting to lose it, I often take a short pause to collect myself. I might take some deep breaths or practice a short meditation. I use Dr. Kristin Neff’s “self-compassion break”(18) to remind myself that all parents struggle sometimes. When my kids were younger, I would have to do this while in the room with them. As they got older, I could make sure they were safe and take a moment to myself under a blanket or even in the bathroom if I needed to! Circle of Security refers to this as “Time-Out for Parents.” It’s an essential recommendation for parents during this time of being largely stuck at home and an important way to prevent escalation to harmful behaviors.
- Remember: it’s not what you do, it’s what you do next. Many parents feel defeated after they have had a negative interaction with their child. We can always go back to kids and retry an interaction in a more calm or supportive way (19). In attachment terms, the process of “rupture and repair” is what strengthens relationships (20). Children learn that it’s normal to be imperfect. They will learn to repair with others when we do this with them. Nobody has to “get it right” all the time. Often, when they seem mad at us, it actually has less to do with us and more to do with whatever is going on for them.
We have all been stretched during this pandemic and this includes kids and youth. Although our stressors are daunting (bills, job security, putting food on the table), their stressors are just as important and being emotionally present with them during this challenging time can mean the world. When we give them a secure base, courage to face the new world with ample comfort and support, they, in turn, will give these gifts to the world.
Practical Supports for BC Families (finances, housing etc.)
Parenting During the Pandemic
Anxiety Management Strategies for Kids
Supports for Parents of Children and Youth with Mental Health Challenges
- https://keltymentalhealth.ca/ (child, youth, family, educator and professional resources)
- https://foundrybc.ca/ (youth 12-24 and their caregivers)
- https://familysmart.ca/ (parent peer support and education)
- Courtney D, Watson P, Battaglia M, Mulsant BH, Szatmari P. COVID-19 impacts on child and youth anxiety and depression: Challenges and opportunities. Can J Psychiatry. 2020;65(10):688-691. DOI: 10.1177/0706743720935646. (View)
- Cost KT, Crosbie J, Anagnostou E, et al.Mostly worse, occasionally better: Impact of COVID-19 pandemic on the mental health of Canadian children and adolescents. Eur Child Adolesc Psychiatry. 2021. DOI: 10.1007/s00787-021-01744-3. (View)
- Colizzi M, Sironi E, Antonini F, Ciceri ML, Bovo C, Zoccante L.Psychosocial and behavioral impact of COVID-19 in autism spectrum disorder: An online parent survey. Brain Sci. 2020;10(6):341. DOI: 10.3390/brainsci10060341. (View)
- Ameis SH, Lai, MC, Mulsant BH, Szatmari P. Coping, fostering resilience, and driving care innovation for autistic people and their families during the COVID-19 pandemic and beyond. Mol Autism.2020;11:61. DOI: 10.1186/s13229-020-00365-y. (View)
- Ueda R, Okada T, Kita Y, et al.The quality of life of children with neurodevelopmental disorders and their parents during the Coronavirus disease 19 emergency in Japan. Sci Rep. 2021;11:3042. DOI: 10.1038/s41598-021-82743-x. (View)
- Saggioro de Figueiredo C, Sandre PC, Catarina L, et al. COVID-19 pandemic impact on children and adolescents’ mental health: Biological, environmental, and social factors, Prog Neuropsychopharmacol Biol Psychiatry. 2021;106. DOI: 10.1016/j.pnpbp.2020.110171. (View)
- Hoffman K, Cooper G, Powell B, Benton C. Raising a Secure Child: How Circle of Security Parenting Can Help You Nurture Your Child’s Attachment, Emotional Resilience, and Freedom to Explore. New York, NY: Guilford Publications; c2016. (View with UBC or request with CPSBC)
- Powell B, Cooper G, Hoffman K, Marvin B. The Circle of Security Intervention: Enhancing Attachment in Early Parent-Child Relationships. New York, NY: The Guilford Press; c2013. (Request with CPSBC)
- Siegel D, Bryson TP. The Power of Showing Up: How Parental Presence Shapes Who Our Kids Become and How Their Brains Get Wired. New York, NY: Random House Publishing Group; c2020. (Request with CPSBC)
- Woodhouse SS, Scott JR, Hepworth AD, Cassidy J. Secure base provision: A new approach to examining links between maternal caregiving and infant attachment child development. Child Dev. 2020;91(1):e249–e265. DOI: 10.1111/cdev.13224. (View with UBC or view with CPSBC)
- Danziger S, Levav J, Avnaim-Pessoa L. Extraneous factors in judicial decisions. Proc Natl Acad Sci U S A. 2011;108(17):6889–6892. DOI: 10.1073/pnas.1018033108. (View)
- Federation of American Societies for Experimental Biology (FASEB). Families that eat together may be the healthiest, new evidence confirms. ScienceDaily. April 23, 2012. https://www.sciencedaily.com/releases/2012/04/120423184157.htm. Published April 23, 2012. (View)
- Fearn M, Howard J. Play as a resource for children facing adversity: An exploration of indicative case studies. Child 2011:26(6):456-468. DOI: 10.1111/j.1099-0860.2011.00357.x. (View with UBC or request with CPSBC)
- Bratton SC, Landreth GL. (2012) Child Parent Relationship Therapy (CPRT) Treatment Manual: A 10-Session Filial Therapy Model for Training Parents. New York, NY: Routledge; c2020. DOI: 10.4324/9781315537948. (View with UBC or request with CPSBC)
- Murphy MLM, Janicki-Deverts D, Cohen S. Receiving a hug is associated with the attenuation of negative mood that occurs on days with interpersonal conflict. PLoS One. 2018;13(10): e0203522. DOI: 10.1371/journal.pone.0203522. (View)
- Segrin C, Flora, J. Fostering social and emotional intelligence: What are the best current strategies in parenting? Soc Personal Psychol Compass. 2019;13(3):13e12439. DOI: 10.1111/spc3.12439. (View with UBC or request with CPSBC)
- Furrow JL., Palmer G, Johnson SM. Emotionally Focused Family Therapy: Restoring Connection and Promoting Resilience. New York, NY: Routledge; c2020. DOI: 10.4324/9781315669649. (View with UBC or request with CPSBC)
- Neff K. Self-Compassion. Self-Compassion. selfcompassion.org. Updated 2021.
- Lafrance A, Henderson KA, Mayman S. Emotion-Focused Family Therapy : A Transdiagnostic Model for Caregiver-Focused Interventions. Washington, DC: American Psychological Association; c2019. (View with UBC or request with CPSBC)
- Tronick EZ. Emotions and Emotional Communication in Infants. Am Psychol. 1989:44(2):112-119. DOI: 10.1037/0003-066X.44.2.112. (View with UBC or view with CPSBC)