Children of Quarantine

Starting on April 6, a bearded and earnest neuroscientist at the University of Oregon named Philip Fisher began to send a digital questionnaire — at first weekly, and then, beginning in August, biweekly — to a representative group of a thousand American families with young children. He’s curious about how they and their kids are doing. They aren’t doing so well.

At first, writing into blank spaces on the questionnaire as if they were diaries, parents conveyed a fresh sense of surprise at their new reality. They observed their kids’ sudden regressions and general nervousness as novelties. Toilet-trained children were wetting their beds, and kids who once went to sleep easily became hard to soothe, waking at night or crawling in with their parents. “My son is suddenly scared of everything,” one Ohio parent wrote in the first week of June. An Arizona parent corroborated: “Our 2-year-old has had a very sudden increase in separation anxiety. She doesn’t like it when we leave the room, and at night she takes a long time to fall asleep because she doesn’t want us to go.”

By summer, the cabin fever and separation from friends, as well as the disruption of routine, were taking a toll. At week 12, 79 percent of parents of kids under 5 said their children were more fussy and defiant than before, and 41 percent of their children were more fearful or anxious. Harried parents reported frequent tantrums and incessant, escalating sibling fights. One young boy in New York mourned the loss of his day care, shuttered for more than two months, and chanted the name of each child in his class every night in an incantation of grief. Just after the Fourth of July, a mother in Missouri noted that her daughter had gotten more demanding, wanting extra attention especially when she was on video calls. That same week, a young mother in Pennsylvania worried that four months of isolation had been “devastating” to her daughter’s mental health. “She really needs to get back in counseling, but we’re concerned about exposure.”

The trend lines showed an interesting pattern. Until the first week of August, fear and anxiety toggled up and down but always hovered around 40 percent of responses, like a fever that’s stable but just won’t break. But by late summer, that line became jagged, spiking up to about 53 percent in the third week of August, then sinking to 36 percent in early October, only to rise again to 50 percent the following week. Meanwhile, the number of kids who were fussy or defiant never fell below 70  percent. “Our 6-month-old cries the entire day. The entire day,” wrote one late-30s mother in Ohio in the middle of August. “Every moment she’s awake, she scream-cries. She cries so much her voice is hoarse. She gave herself a bloody nose yesterday. So our 4.5-year-old is reasonably distressed and just hangs out in the basement or hides in our home ‘office’ with his earphones on.” As school started, the bed-wetting continued. Children who had mature vocabularies regressed to baby talk. And then fall came with its catastrophes. “Now the fires are going, and we really can’t go out,” wrote one mother in California. “I wonder how this affects my baby’s development.”

In mid-November, New York City schools closed down again, after two months of ill-attended in-person instruction. Across California, where San Francisco and Los Angeles hadn’t even tried to open their schools, a new wave of shelter-in-place guidelines were announced. New records were set, nationally, for coronavirus cases and hospitalizations, and across the country, parents who had let themselves breathe a little bit during the summer and early fall found themselves staring down a grim, bunkered winter — this global experiment in child psychology lasting perhaps another six months. The returns so far are distressing. A recent study in JAMA Pediatrics found that in Hubei province, where COVID-19 raged during the winter months of 2020, school-age children who quarantined for just 30 days reported measurably more depression and anxiety than similar pre-pandemic cohorts. A small Harvard study on the effects of the pandemic has found that caregiver-reported depression, anxiety, and misbehavior among American kids in the general population to have reached levels typically seen only in those previously diagnosed with a form of mental disorder. According to a literature review out of the University of Bath, persistent loneliness and isolation among children of the kind that has become quite widespread during the pandemic can lead to suicidal ideation and self-harm and to significant depression. “The kids will carry these experiences through life,” Fisher told me. “And it’s not going to be good.”

Throughout the pandemic, parents have often expressed their concern for their kids in terms of external forces: the closures of schools, the absence of friends, the replacement of every human interaction with screens. They wonder what future neuroses will grow from mask-wearing and handwashing and being shut in, what ruination of outlook will result from breathing the air of political and racist animosity, climate-change paralysis, constant fear of contagion, and the prospect of death. But psychology researchers regard calamities differently. They look at the environments in which kids live. In particular, they look at the parents: How well are they able to protect their children from the storms outside? And what kind of supports do they have to help them?

Fisher describes the parent-child dynamic in terms of “serve and return.” He isn’t talking about tennis; serve and return is psychologyspeak for the essential signals that travel continuously between young kids and their parents or the people who care for them. A baby fusses or wails or droolingly smiles; the caregiver notices and responds with a diaper change, a warmed bottle, a sloppy raspberry kiss. This constant exchange and recognition is the bedrock of the evolutionary business we now call “parenting.” Fisher focuses his research on kids 5 and under, and though serve and return refers to that cohort, parental balance and reassurance are protective at every age.

What Fisher worries about now is how many young children — what portion of America’s 20 million kids under 5 — are serving into a void. He starts with the premise that parents love their kids and want to care for them, that even overwhelmed humans know in their cells how to nurture. But after 37 weeks of pandemic, too many American parents are too tapped out. Decades of research has definitively shown that the presence of a responsive caregiver, especially during early childhood, when the brain is extremely plastic, is the crucial ingredient in healthy development. This stable adult attention is exponentially more meaningful when children are growing up in persistent adversity: environments of neglect, abuse, deprivation, or poverty that medical and psychological professionals call “toxic stress.”

But when kids ask and they receive no answer, or when the answer they do receive is inconsistent, unpredictable, or cruel, the long-term consequences on development are dire. They include cognitive delays; learning problems; impulsivity or aggression on the one hand and numbness or lack of affect on the other; addiction and alcohol abuse; and social difficulties, including with romantic partners and authority figures. Children who grow up in environments of toxic stress, without the buffering presence of a responsive adult, struggle as they get older — not just with more psychiatric disorders but with higher rates of asthma, diabetes, teen pregnancy, and lower educational outcomes. Toxic stress was already endemic before this pandemic. Too many families were struggling to keep it together. And now there are too many more.

The 250,000 dead — that’s just the beginning, with each one of these deaths afflicting children and grandchildren in varying degrees, always with grief, perhaps also with the loss of an indispensable caregiver or a beloved friend. More than 18,000 people between the ages of 25 and 54 have died of the virus, many of them parents with children at home. But the suffering isn’t limited to the dying or those who mourn them. The experience of those who’ve stayed healthy, inhabiting the same crowded spaces as their kids, has been grueling. Burnout is rampant everywhere, even among the well-to-do. Parents are keeping it together while children dangle off their laps on Zoom, juggling meetings to help with science assignments while everyone squabbles over unending household chores. These are the lucky ones. Eleven million people are unemployed, city eviction moratoriums are coming to an end, and federal aid is petering out with no infusion of money in sight. In July, a Brookings Institution analysis showed that 16 percent of American families were experiencing child food insecurity (up from 3 percent two years ago), which means that 14 million kids sometimes don’t have enough to eat.

“There are huge inequalities in parents’ ability to create a predictable environment, and those disparities are widening,” said Katie McLaughlin, a psychologist at Harvard who is studying the effects of the pandemic on teens. “That doesn’t take away from the fact that we are all experiencing this. We no longer have the ability to predict what the next month is going to look like. How are we going to organize our lives? It’s a risk factor that really cuts across the board.”

It’s all too much. “The extent to which parents are not saying ‘I’m okay; I can still do this even though it’s hard’ is deafening,” Fisher told me, a notion echoed in responses on his questionnaire. “I’m exhausted,” an Arizona parent wrote back in July. “It’s hard to get out of bed every day and go to work. I want to yell at my son all the time and it’s not his fault.”

The kids who are suffering most in this pandemic are the kids who were already suffering most. Kids with intellectual or physical disabilities, for example, whose lives depend on reliable schedules or in-person care, are disconnected from their lifelines. In Fisher’s data, their emotional difficulties are at a peak. And there have always been children growing up in a desert of adult attention or for whom that attention was a threat. For these children, home may never have been a refuge, and they are not helped by Zoom.

“I’m concerned most about children who don’t have an adult who’s thinking about them and doing what needs to be done,” said Ann Masten, a psychologist at the University of Minnesota who studies resilience in kids. “I worry about kids who are isolated. Or children who are now at home in a dangerous situation. They’re hidden. The kids we used to monitor — we don’t see them anymore. Or they’re homeless, moving around. We don’t encounter them, and they’re suffering in quiet silence. Isolation is a necessity right now, but some children are much more isolated than others. That really worries me.” In October, an article from the Chicago Tribunecirculated on an email chain among the highest ranks of the American Psychological Association. It described a 7-year-old girl who was sexually assaulted during online school. The teacher told the other children to log off. She called the police, and the assailant was arrested, but for this child, the loss of in-person school and the eyes-on attention of teachers is more than an inconvenience or a blip; it’s dangerous.

Charles Zeanah, a psychiatrist who works in New Orleans with vulnerable kids, told me that in the first months of the pandemic, he was delighted with all the therapeutic work he found he could achieve on Zoom, but more recently, he’s been stuck thinking about the fact that he never knows who is lurking just outside the frame. “When people are all huddled in their homes, it’s very hard to know what’s happening,” he said. “We’re all acutely aware and concerned about it, and have an increased level of vigilance, but if the sources of information aren’t there, they aren’t there.” New data from the Centers for Disease Control and Prevention shows a 24 percent spike over last year in emergency visits for mental-health issues among 5-to-11-year-olds and a 31 percent rise among 12-to-17-year-olds. Researchers speculate that this rise is, at least in part, due to a lack of access to mental-health care that would have been otherwise available at school; it also comes at a time when Americans have been reluctant to visit the hospital for any reason. Or to even, for stretches of the spring and summer, go outside. One Montana mother wrote in Fisher’s questionnaire that she was keeping her kids indoors indefinitely because her neighbors, also cooped up, had set free their dogs, which were now roaming wild.