At the beginning of the pandemic, most of the patients child psychologist Corinn Elmore saw at Walter Reed National Medical Center had mild symptoms, such as mild anxiety. “There was kind of an air of hopefulness about this being a temporary situation,” among military families, she said.

But she saw a pattern. As the pandemic continued, especially in the winter when children couldn’t go outside as much, and there was less daylight, she’s gotten more referrals for depression, lack of motivation, general irritability, and a lot of sleep disruption, especially with the increased screen time and different schedule changes, she said, during a panel discussion March 31 on military children’s mental health.

There has also been an increase in parents concerned that their child may have attention-deficit/hyperactivity disorder, because of their difficulty in concentration during all the virtual learning, she said, during the panel discussing some of the results of the Blue Star Families annual Military Family Lifestyles Survey.

The massive shift in children’s education brought major disruption to many households, and experts have expressed concerns about the long-term effects of the pandemic on the nation’s children.

The survey report’s researchers recommend that Congress commission a deep look at the long-term effects of the pandemic on the educational outcomes of military children, compared to their civilian peers. The study should also include the effects on military spouse employment, compared to their civilian peers, the researchers stated.

Dr. Terry Adirim, who is acting assistant secretary of defense for health affairs, said the issue of children’s mental health has been a concern for her and her pediatric colleagues during the pandemic.

Adirim, a pediatrician specializing in pediatric emergency medicine, said she’s very familiar with the stresses on military families, including the frequent moves that happen often in the middle of a school year. “Constant changing of friends and uncertainty. We know that with the pandemic, there’s a lot more unpredictability and lack of feeling of stability among our families and our children that’s been exacerbated by the pandemic.”

She noted that the Military Health System expanded behavioral telehealth options in the military treatment facilities as well as through Tricare civilian options. About 92 percent of military children receive their mental health care through Tricare in the civilian sector, she said, but noted that there are significant challenges with access to child mental health services in the civilian sector, and defense health officials “are constantly pushing our Tricare program to do what we can to increase that access.”

In addition to the help for children offered through the Military Health System, including through Tricare in the civilian community, Adirim noted another option for military families whose children have milder symptoms such as “a little bit of anxiety, a little bit of sadness, not serious mental health problems.” MilitaryOnesource.mil offers nonmedical counseling, and is available 24/7.

“One of the most striking characteristics of the pandemic was the unknown factor. We didn’t know how long it was going to last, how it would spread, what this would look like,” Elmore said. “At first we thought it was temporary. Anxiety in itself is a fear of the unknown.”

Elmore said the abrupt shift to virtual schooling has caused frustration for many children. The amount of virtual education in the military community has more than tripled during the pandemic, according to the results of the Blue Star Families survey. More than half —51 percent — of active-duty military family respondents to the online survey with at least one school-aged child said their child was doing virtual learning, compared to 15 percent the previous year. That said, more than half of the survey participants reported that their oldest child is thriving in school.

The survey was fielded online in September and October, 2020. About 10,926 people chose to participate in the online survey, and 6,767 people completed it. Of those, 45 percent of participants, or more than 3,000 people, were spouses or domestic partners of active-duty members, 17 percent were active-duty members (including Guard and Reserve); 20 percent were veterans/retirees; and 10 percent were spouses of veterans.

Parents have had trouble coping with all these large changes at once, Elmore said, such as working at home while trying to help children of various ages with their schooling. Children lost their friends, they lost their in-person learning, individual instruction, play time. They’ve had to develop new skills, navigating the schools’ portals, figuring out what assignments were due.

Parents found that strategies they may have used in the past no longer work. “So parents have gotten burned out and what I’ve heard from a lot of families is that they just take everything day by day, and there’s no real routine or schedule.”

The most important thing parents can do for their children is to develop a routine, Elmore said. Lack of a routine “is the biggest disruption that I see in the pandemic,” she said. “Having a consistent routine is most important for all ages….

“When everything in the world is unknown, having a routine that is predictable and consistent can be a real safe space for kids. So I help parents develop a routine… Have breakfast. Have time for school. Have a recreation time. That allows parents to kind of plan their work day around some of this, too.”

It’s also been difficult for military families who have made permanent change of station moves during the pandemic in a variety of ways. Children who aren’t attending the new school in person don’t know anyone on the Zoom call. They don’t have the opportunity to meet new people as they normally would, she said.

Another big issue with mental health and virtual learning is that a number of those with learning differences or ADHD have had difficulty without the specialized attention they receive in person at school, Elmore said. “For them to stay focused and pay attention to stay on a computer screen and stare at a teacher for six hours, is impossible to get work done, to get motivated, to find out what work you have to do. To even log in to the school can be hard,” Elmore said.

Elmore has seen some mental health effects even in infants born during the time of the pandemic, because some aren’t getting as much interaction with other kids, parents are busy, and the baby hasn’t been able to go to day care.

While there are stressors, Elmore said, she does see protective factors in military families. “One thing is that military families are often better equipped to deal with transition and change,” she said, because they’re moving so often, and having to start over. “A lot of kids have experienced several moves and have experienced not knowing the lay of the land before they started. Parents are also used to being flexible and adapting to things as they happen.

And that’s another piece of advice for parents: Be flexible and accepting. “This is a pandemic. We’re all stressed, we don’t know what’s going on. Families need to be okay with things not going perfectly. We have to let go of the old ideas of what success looked like before the pandemic, and be okay with what’s happening.”

Karen has covered military families, quality of life and consumer issues for Military Times for more than 30 years, and is co-author of a chapter on media coverage of military families in the book "A Battle Plan for Supporting Military Families." She previously worked for newspapers in Guam, Norfolk, Jacksonville, Fla., and Athens, Ga.

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