Questions to ask parents about their primary school-aged child’s mental health during COVID-19

Who is this resource for?
This resource is for all practitioners who work with parents. It has a particular focus on supporting parents to consider the mental health of their primary school-aged children.

The coronavirus (COVID-19) pandemic, on the back of the Black Summer bushfires has had a significant impact on the mental health of many Australian children. The pandemic has seen major disruptions to elements that are crucial to children’s social and emotional wellbeing, including interruptions to education and routines, forced distancing from family members and support networks, fear of the future, and increased social isolation.

As the year has progressed data has increasingly pointed to the negative mental health toll that these disruptions and uncertainties are taking. A recent Monash University study found that depression diagnoses in children and young people under 19 had doubled compared to the same period in 2019 (Monash University, 2020) and anxiety and depression are becoming increasing issues for primary school-aged children. More children are exhibiting signs of mental health difficulties, yet less than half of those who need support are accessing specific mental health services (Oberklaid, 2020).

The events of 2020 have seen a significant increase in children contacting Kids Helpline for mental health support. From March 1 to September 30, 285,636 children reached out for services – an increase of 22% from the same period in 2019 (yourtown and Australian Human Rights Commission, 2020b). Of the children who accessed counselling services, 18% were 5–12 years old, an increase of 3% from the previous reporting period. About three quarters of these contacts were related directly to mental health, emotional wellbeing and family relationship issues (yourtown and the Australian Human Rights Commission, 2020a).

As children’s needs for mental health support increase, parents continue to report a lack of confidence in identifying and responding to concerns. The Royal Children’s Hospital Melbourne’s National Child Health Poll shows only 35% of parents believe they could recognise mental health symptoms in their children, while only 44% reported being confident of knowing where to go for help if their children were experiencing social, behavioural and emotional problems (The Royal Children’s Hospital Melbourne, 2019). Many parents describe long waiting lists for specialist child mental health services.

So, if the current reality is increasing mental health difficulties in primary school-aged children, a lack of confidence from parents that they can support their children, and lengthy waits for specialist services, what role can practitioners outside of the mental health sector play? How can a general practitioner, social worker or allied health professional have conversations with a parent who is concerned about their child’s social and emotional wellbeing, in ways that support preventative or early intervention strategies?

Between January and March 2020, the most prominent COVID-19 related concerns expressed by young children (aged 5–10 years) who contacted Kids Helpline were:

• mental health concerns resulting from the pandemic
• impacts on family life
• impacts on education
• social isolation; and
• fear of someone contracting COVID-19 (yourtown and the Australian Human Rights Commission, 2020b).

These concerns all relate to specific domains of a child’s life. Practitioners can support parents to consider each of these domains by conducting respectful, curious, child-centred conversations. This has the effect of considering the ‘whole child’ and can help parents to demystify the mental health needs of their children.

On the following pages, you’ll find some example questions relating to five important domains in a child’s life: Parent-child relationship, Emotions and behaviours, Routines, Communication and meaning making, and Support networks (for the child). These questions can help you to start these conversations with parents and provide guidance around these specific domains.

The parent-child relationship is a crucial consideration for all parents who are concerned about their children’s social and emotional wellbeing, particularly during these challenging times. It may be that a parent’s own experience of adversity is causing them more financial or social stress or exacerbating their own mental health concerns.

Practitioners can help parents to consider strategies to support their relationship with their child, in non-blaming or stigmatising ways.

• ‘What’s it like being a parent to (child’s name)?’
• ‘How would you describe your relationship with your child?’
• ‘Have you noticed any differences in the way your child responds to/approaches/interacts with you during tough times?’
• ‘What aspects of (the adversity) impact on your relationship with your child the most? What do you think your child is noticing about this?’
• ‘When there is stress or conflict with your child, what do you do? What does your child do?’

Children’s emotions and behaviours might be harder for parents to interpret during these challenging times. For example, a child who is concerned that their parents might contract COVID-19 if they go to work, might throw tantrums or cry uncontrollably.

Practitioners can help parents to have conversations which identify their concern, and allow for calm, honest and open conversations about COVID-19 and what can be done to minimise the risk of contraction.

• ‘What happens for your child when they are upset? How do they show you that they are stressed or upset?’
• ‘What do you do to manage any worries that your child might have about (the adversity)? How do you talk to your child about their worries?’
• ‘How do you think your child feels about what is happening? Do you think their understanding of what is happening is having an impact on how they feel?’
• ‘When you are experiencing extra stress, what do you think your child might notice or worry about?’
• ‘Have you noticed anything specific about your child’s behaviour and emotions? (E.g. difficulty concentrating; acting withdrawn, shy, or fearful; bullying others; acting defiant; refusing to go to school; complaining of physical symptoms; spending time on their own; or withdrawing from spending time with others)’

Interruptions to education, sport and social activities have been a leading cause of distress for primary school-aged children during the COVID-19 restrictions.

Practitioners can help parents to identify how these changes in routine might have affected their children. They can also help parents identify strategies to safely reintroduce routines that have been disrupted during COVID-19, or find alternatives which help support their child’s social and emotional needs.

• ‘Have there been any changes in routine recently?’ OR ‘Have there been any changes recently that have impacted on your household/family routines?’
• ‘What does your regular weekly routine look like? What are your busy/quiet times?’
• ‘Do you share any activities or hobbies with your child? What do you do that you both enjoy? Are you able to find time to read or play games with your child?’
• ‘What happens for your child when you are not with them? Do other people know about their daily routines?’

Children make sense of the events around them in complex ways. They may feel a sense of anxiety, foreboding and hopelessness about external issues such as the pandemic, bushfires and climate change. Primary school-aged children regularly hear theories about world events from peers at school and unless they can discuss these topics and concerns with their parents and family members, they may continue to feel anxious.

Practitioners can help parents to work through any hesitation or discomfort they may have around talking with their child about adversity or ‘tough times’, and to prepare for conversations that are age-appropriate and help the child to better understand the situation.

• ‘What opportunities do you get to spend time talking with your child?’
• ‘How do you think your child might be making sense of the current COVID-19 restrictions? What messages do you think they need from you at this time?’
• ‘Does your child communicate to you about their worries through their words or behaviour?’
• ‘What are the best times for you and your child to talk about things? Are there particular activities that help you to talk?’
• ‘How have you helped your child make sense of tough times in the past? Do you think this helped them worry less about what was happening for you?’

As shown by Kids Helpline data, social isolation is a leading cause of mental health issues in Australian children. Social isolation has been exacerbated for many Australian families during the pandemic and this can mean that children lose connection to grandparents, supportive relatives and peers.

Practitioners can talk to parents about practical strategies that help children maintain important support networks, even when face-to-face contact is not possible.

• ‘Who does your child enjoy spending time with?’ (Prompt – ‘Do they have a close relationship with another adult?’)
• ‘Does your child see their grandparents or aunties and uncles much?’
• ‘What does your child enjoy the most/least about school? How is your child progressing with schoolwork? How confident is your child in their learning?’
• ‘What connections do you think your child is missing most at this difficult time? Are there ways that this connection can be supported while you wait for things to return to normal?’
• ‘How do you support your child to stay connected to activities at home when you are going through tough times?’

While it should be noted that children with acute or chronic experiences of anxiety or depression should absolutely be referred to a mental health professional, practitioners across the board play a role in helping parents to feel more confident in asking their children about their mental health and the important domains in their lives.

This paper has provided a brief overview of some questions practitioners can ask parents about the domains of a child’s life, but, as always, Emerging Minds looks forward to continuing this conversation with practitioners who are working with parents to support the mental health of their children, particularly throughout this challenging time. In post-pandemic Australia, it will be even more important for all practitioners to contribute to the prevention and early intervention of mental health issues of children who are showing early symptoms of depression or anxiety.

References

Monash University. (2020). Children of the Pandemic – less likely to be infected but more likely to suffer mental health issues, report of 1000 GP practices warns. Available here.

Oberklaid, F. (2020). Virtual Roundtable: Children and Young People’s Mental Health During Covid-19. ARACY.

The Royal Children’s Hospital Melbourne. (2017). Child mental health problems: Can parents spot the signs? RCH National Child Poll, Poll 8, October 2017. Available here.

yourtown and Australian Human Rights Commission. (2020a). Impacts of COVID-19 on children and young people who contact Kids Helpline. Available here.

yourtown and Australian Human Rights Commission. (2020b). Kids Helpline 2020 Data Report Special Covid-19 Edition: National.