RISK AND RESILIENCE: EXAMPLES

EXAMPLE #1: Alex, four years old

Alex is a four year old boy who is living with his mom and his grandmother who is 71 years old, during the COVID-19 pandemic. He has been home from daycare for four weeks since his state enforced a shelter-in-place order. Alex's mother is an essential healthcare worker and has been worried about risks related to her job and the health of her family. While his mother is at work, Alex is at home with his grandmother, who spends most of the day watching the news. For the last three weeks, Alex has been wetting the bed regularly and clinging to his mother before she leaves for work. He sometimes refuses to eat until she comes home.

Symptoms: At Alex's age, the behaviors he is exhibiting (bedwetting, clinging to his parent, and refusing to eat) may be an indication that he is experiencing distress.

Risk: As per our ecological model, certain risk factors in Alex's environment may make his mental health more vulnerable to the effects of the crisis.

More Details:

Without the structure of daycare, Alex is spending most of his time watching TV. Research shows that disruption to a child's routine is related to the impact that potentially traumatic events have on their mental health.
Even though Alex is not old enough to understand what is going on, he notices that his grandmother seems very worried while watching the news. He also notices that his grandmother and mother both seem anxious when she leaves for work in the morning. Alex has never seen them look so worried before and he may be feeling confused or scared that something is wrong. Studies have found that when a child's caregivers are experiencing high levels of stress, it can be more challenging for kids to cope following potentially traumatic events.
At 71 years old, Alex's grandmother is in an age group that is at risk for complications due to COVID-19. This may be an additional factor contributing to higher stress levels in the home.

Recommendations:

Alex's caregivers can consider implementing a daily routine for him to create structure and help him feel less removed from what life was like before shelter-in-place.
Alex's grandmother can reduce the time she spends watching the news every day to help reduce her stress levels, as well as Alex's. Instead, she and Alex could engage in play or other activities that he enjoys.
Building a sense of safety, connectedness, and hope in the home may help Alex feel safer and calmer.
If Alex's symptoms don't start to improve after taking these steps, contacting his doctor may help to get more information on how to help him.
Finally, it is important to make sure that Alex's mother and grandmother are getting support for themselves during this time. If family members are experiencing high levels of stress, children at this age may feel scared or confused.

EXAMPLE #2: Serge, nine years old

Serge is nine years old and is living with his mother and father during the COVID-19 pandemic. He is in the fourth grade and has been home from school since the shelter-in-place order went into effect. For most of the day, both of Serge's parents are working from home in different parts of their home. Serge's mother frequently works late into the night after he has gone to sleep. The family currently has only two computers in the home, which his parents are using for work. Since Serge's school transitioned to remote learning four weeks ago, he has been using his mother's iPhone to attend his online classes. Serge rarely concentrates during class and frequently uses the phone to play games. He often wanders over to his mother's study and clings to her while she is working.

Symptoms: At Serge's age, the symptoms he is exhibiting (poor concentration, school avoidance, and clinginess) may indicate that he is experiencing distress.

Risk: As per our ecological model, certain risk factors in Serge's environment may make his mental health more vulnerable to the effects of the crisis.

More Details:

As Serge is no longer going to school and both of his parents are working from home, he is now spending most of the day unsupervised by an adult. The lack of structure and social support may be making it more challenging for Serge to cope with the changes that have occurred since the shelter-in-place order.
It may be harder for Serge to pay attention to his online classes and feel motivated to complete his schoolwork because he is using a small iPhone screen and cannot access a computer during the day.
Serge's mother works long hours and may be experiencing higher levels of work-related stress or fatigue.

Recommendations:

Serge's parents can consider implementing a daily routine for him to create structure in his day and help him feel less removed from what life was like before shelter-in-place.
They can also try to help him build motivation to engage in his schoolwork by asking him about what he is learning and checking in on his progress when possible throughout the day.
If Serge's symptoms don't start to improve after taking these steps, his parents may want to consider contacting his doctor to get more information on how to help him. In addition, they may be able to get support from a professional at his school.
Finally, it is important to make sure that Serge's parents are getting support for themselves during this time. If family members are experiencing high levels of stress, children at this age may feel worried or scared.

EXAMPLE #3: Aanika, thirteen years old

Aanika is thirteen years old and lives with her mother, father, and eleven year-old brother in a state that is experiencing a major COVID-19 outbreak. Her father lost his job two weeks ago and her parents have been arguing frequently about how to manage their finances. Aanika is in the eighth grade and loved going to school before her state enforced a shelter-in-place order. She has been attending remote learning classes for the last three weeks but keeps her video off and usually doesn't pay attention. Aanika is having trouble falling asleep at night and often stays awake scrolling through social media and watching shows on Netflix. She has been starting fights with her brother and has not done her homework since her classes went online.

Symptoms: At Aanika's age, the behaviors she is exhibiting (loss of interest in school and disengagement with schoolwork, disrupted sleep schedule, increased aggressiveness) may indicate that she is experiencing distress.

Risk: As per our ecological model, certain risk factors in Aanika's environment may make her mental health more vulnerable to the effects of the crisis.

More Details:

Since Aanika's father lost his job, he and her mother are experiencing higher levels of stress due to the increased financial strain on their family. Aanika understands that her parents are worried about money and she may be feeling scared or helpless.
Aanika's parents have also been arguing a lot recently. Research suggests that conflict between family members can make it harder for adolescents to cope after a potentially traumatic event.
Since the shelter-in-place order went into effect, Aanika has not been able to go to school and has not been engaged in her schoolwork. Research shows that disruption to a child's routine is related to the impact that potentially traumatic events have on their mental health.
Aanika's sleep schedule has also been dysregulated and she has not been getting much sleep for a few weeks. Consistent sleep is important for adolescents' ability to cope with stressful events.

Recommendations:

Working with Aanika to implement a daily routine during shelter-in-place may create structure in her day and help her feel more motivated to engage in her schoolwork. Building in some time for exercise and setting a family bedtime may help regulate her sleep schedule.
Aanika's parents can implement a family media plan or set some ground rules about her screen time. Research has found that using screens before bed can make it harder to fall asleep. A consistent sleep schedule can help adolescents cope during the COVID-19 pandemic.
If Aanika's symptoms don't start to improve after taking these steps, her parents may want to contact her doctor to get more information on how to help her. In addition, they may be able to get support from a professional at her school.
It is very important for Aanika's parents to get support for themselves during this time. If family members are also experiencing high levels of stress or conflict, adolescents may have a harder time coping with the effects of a potentially traumatic event.