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The pandemic caused the shut down of schools and resulted in virtual learning for most of the world's children and adolescents. How did they fare?
Virtual schooling during the pandemic presented challenges that might have long-term effects on children and adolescents, according to Karen Dineen Wagner, MD, PhD. Wagner discussed findings from numerous studies looking at the well-being of youth and their parents as a result of virtual instruction at the 2021 Annual Psychiatric TimesTM World CME Conference.
Wagner, who is professor and chair in the Department of Psychiatry and Behavioral Sciences at University of Texas Medical Branch, reported there have been increases in anxiety, obsessive compulsive disorder, conduct problems, pro-social behavioral problems, sleep issues, and worsening of preexisting mental health disorders. This, in turn, resulted in increased mental health related visits to the emergency department. Children at highest risk for increased psychiatric and behavioral problems included youth who were disadvantaged or refugees as well as those who had a chronic disorder, adverse childhood experiences, a preexisting mental health disorder, added Wagner, who also immediate past president of the American Academy of Child and Adolescent Psychiatry and member of Psychiatric TimesTM editorial board.
The impact of virtual schooling went beyond the computer as a classroom and affected other areas of well-being, Wagner said. In a nationwide survey of parents (N = 1290) of children aged 5 to 12, for instance, children who attended virtual school were more likely to have decreased physical activity as compared with those students attending school in-person and combined in-person and virtual school (62.9%, 30.3%, and 52.1%, respectively.1 Virtual students also reported less time spent outdoors, less time spent with friends virtually, and less time spent with friends in person. Similarly, 24.9% of students attending virtual school reported worsened depression and anxiety compared with 24.7% of those in combined schooling and 15.9% of those attending in-person.
The impact was also felt by the parents. In comparison to parents whose children attended in-person or combined schooling, parents whose children attended virtual school were also more likely to report loss of work, child care challenges, conflict between working and providing child care, emotional distress, and difficulty sleeping.1
Negative impact on youth was not seen only in the United States, but also in countries around the world. For instance, Wagner discussed the results of a cross-sectional survey of 367 students in Saudi Arabia.2 The investigators found 55% of respondents had moderate stress while 30.2% had high stress levels.
Youth with attention-deficit/hyperactivity disorder (ADHD) and their parents especially struggled with the virtual schooling world, Wagner added. In one study of 239 adolescents, 118 of whom had ADHD, investigators found those with ADHD had fewer routines and more difficulties with remote learning.3 Parents of adolescents with ADHD reported more difficulty in supporting home learning and home school communication. Even parents whose children with ADHD had an individual education program reported remote learning was more challenging. To help support remote learning, 22% of families incurred financial costs.
As a result of the pandemic, Wagner noted the American Academy of Child & Adolescent Psychiatry and the American Psychiatric Association devised a list of recommendations for virtual schooling.4 The groups noted that education, including school attendance, is an essential component of health development. When classroom-based education is not possible, the groups said it is a priority to find methods that optimize social interaction. Importantly, they noted additional resources should be made available for children with special needs, and the mental health of students must be continually addressed. They also advocated for systems that effectively and efficiently identify issues early and have means for interventions.
Ultimately, there are certain things needed to better support a virtual schooling system. “There needs to be access to mental health services, as well as individual educational programs, there also needs to be resources for disadvantaged youth,” Wagner concluded. “Attention has to be directed toward the importance of physical activity. And also, participation in extracurricular activities, as well as other peer group activities.”
1. Verlenden JV, Pampati S, Rasberry CN, et al. Association of children's mode of school instruction with child and parent experiences and well-being during the COVID-19 pandemic - COVID Experiences Survey, United States, October 8-November 13, 2020. MMWR Morb Mortal Wkly Rep. 2021;70(11):369-376. Published 2021 Mar 19.
2. AlAteeq DA, Aljhani S, AlEesa D. Perceived stress among students in virtual classrooms during the COVID-19 outbreak in KSA. J Taibah Univ Med Sci. 2020;15(5):398-403.
3. Becker SP, Breaux R, Cusick CN, et al. Remote learning during COVID-19: examining school practices, service continuation, and difficulties for adolescents with and without attention-deficit/hyperactivity disorder. J Adolesc Health. 2020;67(6):769-777.
4. American Academy of Child & Adolescent Psychiatry and American Psychiatric Association. American Academy of Child and Adolescent Psychiatry (AACAP) and American Psychiatric Association (APA) Detail Steps Necessary for Safely Reopening Schools This Fall. Press release. July 2020. Accessed September 30, 2021. https://www.aacap.org/AACAP/Press/Press_Releases/2020/Needs_Students_During_COVID-19_Era.aspx.