A year and a half of lockdowns, school closures and social distancing caught adolescents at a vulnerable time in their emotional development, says Dr. Shelly Ben Harush Negari, a physician specializing in adolescent medicine.

Many kids have forgotten, or haven’t had a chance to learn, how to conduct themselves outside the home. Others are suffering serious consequences of lost class time and socialization.

“Normally, adolescents start shifting their focus from parents to friends. The social aspect is very important for their development and creating their own point of view. But the pandemic is disconnecting them from friends,” says Negari, director of the Center for Adolescent Medicine at Shaare Zedek Medical Center in Jerusalem and of an adolescent medicine clinic at an HMO in Jerusalem.

How have the past 18+ months impacted adolescents? How can adults help them move forward as we learn to live with Covid-19 and other future pandemics?

In addition to Negari, ISRAEL21c interviewed clinical psychologist Batya Ludman, a member of United Hatzalah’s Psychotrauma and Crisis Response Unit and advisory board member of Get Help Israel; clinical psychologist Stuart Chesner, director of the Israel Academy for Social and Emotional Learning (a teacher and parent training center); and clinical social worker Adimika (Mika) Smith of Positive Health Counseling.

They identified plenty of problems that need addressing, but emphasized that not every teenager suffers negative impacts of the pandemic. Some, in fact, have benefited from the extra time with their parents.

Chesner says it’s a case of “The rich get richer and the poor get poorer.”

In other words, kids with a stable family, positive role models, and ability to learn remotely and independently generally do fine “stuck” at home. Kids in the opposite situation are more at risk than ever before.

Still, pandemic-related issues can affect any adolescent. Here are some of our experts’ areas of concern and practical tips for parents.

BODY IMAGE AND EATING DISORDERS

Dr. Shelly Ben Harush Negari, director of the Center for Adolescent Medicine at Shaare Zedek Medical Center in Jerusalem. Photo courtesy of Dr. Negari

“Zoom created a situation where adolescents always look at themselves [on screen] rather than their teacher and classmates,” points out Negari.

“Suddenly I received messages from kids saying they need to look better because others are looking at them, and they want to look perfect when they go back to school.”

Heightened obsession with body image can sometimes trigger eating disorders.

“I get daily phone calls from teachers, parents and doctors concerning cases of bulimia and anorexia, and treatment programs are flooded,” says Negari. “We see it at an earlier age, and more requests for treatment, perhaps because parents are home more and see what their kids are eating.”

Other pandemic-related factors that can lead to eating disorders include being home all day with constant access to food, and irregular sleep cycles that skew the sensations of hunger and satiation.

TIP: “Family meals are very important. Even if the kids are living without their usual structures, eating together as a family is useful in preventing eating disorders,” advises Negari.

ABNORMAL SLEEP HABITS

“Usually you have daytime and nighttime and now it’s a mishmash — they sleep all day and watch Netflix and text with friends all night,” says Negari.

“The delayed sleep cycle has a strong influence on mood and hormones.”

TIP: If school is closed, find daytime activities to interest and stimulate your child. “They can find a buddy and go get groceries for someone who is shut in. They can try new recipes. They could create videos. Ask them what they think they can do rather than be in a lull,” suggests Ludman.

DECREASED MOTIVATION

Dr. Batya Ludman, clinical psychologist based in Ra’anana. Photo courtesy of Get Help Israel

“Some kids, especially those with ADD, have a hard time maintaining interest amid the uncertainty and lack of routine and structure at home and school,” says Ludman.

“One child I was video chatting with during the day was under her covers in her pajamas. I could see that her room was a mess. I said, ‘Hey, your desk looks cool. Give me a tour of your room.’ She quickly cleaned up and then I got her engaged.”

TIP: “We need to make sure our kids are thinking about the future and not getting from us the message that everything is lost and broken,” says Negari. “Adolescents’ brains are developing, and there is so much they can do. Encourage them to volunteer. They want to feel they are part of something and doing something.”

INCREASED ANXIETY

Negari notes that quarantines and lockdowns are “like heaven” for adolescents with social anxiety.

However, staying in their comfort zones gives them no opportunity to practice social skills, adding to their existing anxiety when they are in social situations.

Adolescents who thrive on peer companionship, on the other hand, have anxiety about not getting together with friends.

Another anxiety trigger is the pandemic itself.

“I was seeing kids afraid of going out, afraid of getting covid or bringing it to their family,” says Ludman. “Some have ill family members and that scares them. Some have medical conditions that make them feel very anxious about going to school and seeing their friends.”

She finds that kids are more likely to feel anxious about not being able to get vaccinated than about getting vaccinated. “Vaccination gives them more freedom to get out.”

Those in unsafe homes can become desperately anxious. “In a normal functioning home, it’s not terrible to be at home for two weeks. When the home is dangerous, two weeks is very stressful,” adds Negari. “We see a rise in anxiety, depression and even self-harm.”

TIP: Encourage kids to express their feelings by writing, painting or dancing, suggests Ludman. Many adolescents are open to learning how to do breathing and relaxation techniques to help them self-regulate.

VIRTUAL REALITY

Dr. Mika Smith of Positive Health Counseling. Photo courtesy of Dr. Smith

“Parents have to limit kids on social media and other forms of screen time,” says Smith.

“Research shows that when people are looking at a screen for more than eight hours it changes their brainwaves. They must do something physical outside to stimulate their brains and get off their screens.”

A study conducted by the Hebrew University of Jerusalem, University of Haifa and Reichman University (formerly the Interdisciplinary Center) in Herzliya found that 83 percent of children and teens became addicted to screens during the pandemic.

Negari adds that teens may endanger themselves by making connections to people in the virtual world, and parents should closely monitor this sort of activity.

TIP: Parents must be investigative about their children’s virtual encounters, says Smith. “Don’t be afraid to ask questions. They may get annoyed with you, but your questions show you love them and could even save your child’s life.”

QUESTIONABLE ROLE MODELS

Dr. Stuart Chesner, director of the Israel Academy for Social and Emotional Learning. Photo by Shaya Chesner

“The primary effect on emotional wellbeing is connected to isolation,” says Chesner, who specializes in teens at risk.

“Isolation can be harmful for anyone, but especially for teenagers who are struggling to consolidate their identity and really depend on role models to do that,” he explains.

“As a result of being so isolated, teens have been blocked from interacting with many significant role models such as counselors, teachers and even athletes,” Chesner says.

He notes that kids in lower socioeconomic circumstances tend to have fewer positive role models in their personal sphere.

“If real-life role models are unavailable, they withdraw more into their fantasy world, creating fantasy identifications – for example, with a gangster rapper — and internalizing values that are unproductive and disconnected from them and their world. That increases all risk factors for any kind of bad outcome.”

TIP: Find ways for positive role models to be present in the home virtually, says Chesner. “While we’re used to using digital technology to increase the efficiency of our interactions, we never thought of using it to enhance the intimacy of our interactions and now we need to figure that out. One idea is to schedule a Zoom meeting with a positive role model, perhaps a distant family member, where the meeting itself is the goal.”

MANAGING EXPECTATIONS

Whereas adults think more about the future, adolescents focus on the here and now, Negari explains. This fact should affect how parents communicate expectations during the pandemic.

“To say that going out with friends is dangerous because they could get infected — it’s too far away for them. Trying to scare them about the future doesn’t work. They need information of what is expected in the next two weeks.”

TIP: Tell adolescents exactly what you expect regarding facemasks, hygiene and distancing.“You can say, ‘I want you to be able to play basketball with your friends, and to do that you need to do 1, 2 and 3,’” suggests Negari. Ludman encourages parents to reward compliance and be consistent with consequences for breaking the rules.

COMMUNICATION GAP

Many adolescents tell Negari that they filter what they tell their parents so that their parents won’t worry.

“Parents can tell their kids, ‘I’m the adult and I’m responsible for you. Don’t worry about me; I’ll manage.’”

However, Ludman adds, “It’s okay to let them know if you are having a difficult time. And when parents get the help they need, it helps the kids.

“Even in these uncertain times, let’s communicate the message that we will get through this together, moving forward with positivity.”

TIP: Schedule weekly “dates” with each child individually. Let them choose where to go, even for just an hour, and sit and listen to what they have to say.