Preschool and elementary teachers on the Big Island have reported alarming behavioral changes in young keiki following the pandemic.
“When COVID first happened, we shut down our preschool for two and a half months,” said YWCA’s Preschool Director Michelle Flemming. “When we reopened, we noticed a lot of changes in regards to not only social-emotional skills but cognitive skills.”
This included difficulties holding a marker or crayon, increases in the number of nonverbal students, more instances of acting out, and overall social anxiety.
“We’ve had to make our curriculum a little less intensive for our students,” she said. “We’re not starting where we usually would. A lot of it is focusing on their social-emotional skills.”
A 2020 study of 5,823 participants throughout five countries found those aged 1 to 6 had the largest increase in oppositional-defiant behaviors, while adolescents reported the largest increase in emotional problems.
“First-grade teachers (are) actually getting kindergartners” in terms of development, said Erin Henderson Lacerdo, who serves as executive director for the Association for Infant Mental Health in Hawaii. “All of the symptoms are essentially trauma symptoms, the withdrawing behavior. Children are more timid and shy because they feel uncomfortable. Those are things you would see in children who have experienced other types of trauma.”
AIMH HI deals directly with keiki trauma and provides support to parents and children in early childhood development.
“The pandemic didn’t stop other traumas from happening, either, whether that be neglect, substance abuse or just harsh parenting,” she said. “Adults were also experiencing the same trauma, so you’re talking about all the preschool teachers, all the (K-12)teachers, your pediatricians and nurses, everybody was experiencing the pandemic at the same time, and I think that’s what makes this a little more unique.”
The U.S. Centers for Disease Control and Prevention estimated that as of July 2022 more than 200,000 children in the U.S. have lost a parent or primary caregiver to COVID-19. A recent survey from the Hawaii Department of Health also revealed adults with a child under 18 were more likely to experience mental health issues over the last six month than those who did not live with a minor.
“The child’s mental health is pretty much dependent on the adult mental health at this zero-to-5 age range,” Lacerdo said. “I do think we’ll see anxiety increases in children if we do not address this, as well as some depression.”
The recent Access to Care survey of over 3,000 Hawaii residents and more than 300 local health care providers found over 50% of the public had to cut back on food during the pandemic, with 66% stating their mental health had deteriorated as a result.
The switch to online-only education during the pandemic also impacted local keiki.
“The American Academy of Pediatrics still recommends kids not receive much more than an hour a day of screen time, which obviously was not the case during the pandemic,” said Charmaine Higa-McMillan, director of the master’s in mental health counseling program at the University of Hawaii at Hilo. “The more screen time children get, including adolescents, the more behavioral and attention problems.”
Kathleen McGilvray, YWCA’s Hawaii Island CEO, addressed the impact of virtual learning on students as well.
“We brought them back by video first, and they were craving interaction,” she said. “Focus was really challenging. We needed to teach in a different way for the first few months as we brought them back in the classroom to try and catch them up.”
A cohort of both Hawaii government and community-based groups have proposed the Infant and Early Childhood Behavioral Health Plan, a comprehensive goal list and timeline to address early childhood mental health. An updated version from July focuses on the pandemic and pushes for additional policy, communication, services and workforce development.
“We really understand there’s a workforce shortage of folks who know how to work with our youngest keiki,” said Justina Acevedo-Cross of Hawaii Community Foundation’s health and wellness sector. “In order to expand services, we need more people in our workforce with early childhood mental health expertise.”
The Promising Minds Fellowship is a Hawaii-based cohort designed to increase the workforce by offering additional support and resources for parents. Of its 49 new members, seven are based on Hawaii Island.
“Early experiences compound, they build off of each other, so our early experiences actually shape how the brain gets built,” said Acevedo-Cross, who heads the cohort. “What’s great about working with the birth-to-5 range is you can help buffer and make some adjustments, where your brain architecture sets differently, and you’re set on a good life course.”
UH-Hilo is trying to help meet the demand for more behavioral health professionals.
“We definitely saw our enrollments, or at least our applications, nearly triple during the pandemic,” said Higa-McMillan of UH-Hilo’s master’s in counseling psychology program, which includes a hybrid option that allows students to enroll across all islands. “We see a lot of teachers who want to transition and see the need for behavioral and mental health.”
Federal support could help as well, with the Biden administration announcing this month $500 million to expand mental health services for schools to cope with pandemic-era needs. The news came after the U.S. surgeon general in July called the situation “a mental health pandemic for youth.”
“The starting pay is not great, and it could be better,” said Higa-McMillan, who supported a state bill this year designed to provide provisional licenses for recent graduates working as mental health counselors. The bill failed to gain support, but she’s hopeful it will be introduced again during next year’s session. “That would definitely help both new graduates work in a group or private practice and get paid for it, and provide those needed services.”
The Kids Count Data Book from the Annie E. Casey Foundation reported anxiety and depression among those 3-17 years old in Hawaii jumped from 5.9% in 2020 up to 22.9% in 2022.
“There’s a lot of anxiety tied to all of this,” said Lacerdo. “There’s anxiety about do we wear masks or not, is it okay, how do we interact with others? The kids are also a little worried that they’re going to get put back into a shutdown. They’re worried that they’re not going to see their friends anymore.”
Advice for concerned parents ranges from communicating with behavioral counselors to creating stable routines through preschool programs and other after-school activities.
“My overall advice is safety, consistency and being able to support the child,” said McGilvray of YWCA. “One of the important things we learned was consistent attendance in a program that focuses on child development.”
Identifying “positive stressors,” or moments of development, can also help overcome setbacks.
“Find ways to have a bite-size moment of positive stress, like being in a larger group, or having a playdate, or going to the grocery store,” said Acevedo-Cross. “Talk to your kids about possible fears and the risks and benefits of getting together. And for young kids like a baby or toddler, it might just be some talking with a hug and assurance.”
A variety of local resources for parents are available at helpyourkeiki.com, aimhhi.org, pacthawaii.org, familysupporthawaii.org.
“This pandemic has highlighted the pukas we have, and I’m grateful people are tending to it,” Higa-McMillan said. “I’m hoping that means we’re going to get more support.”
Email Grant Phillips at gphillips@hawaiitribune-herald.com.