New Data Confirms Emotional Toll of Virtual Learning

There has been much conversation over the past year about the impact that virtual learning has had on children and families. The ways that virtual learning has been used during the pandemic have varied -- sometimes abruptly -- as school systems and families have reacted to infection rates, clusters of outbreaks, and the availability of vaccinations for faculty and staff. But almost all students have faced reduced class time and many have dealt with the unavailability of effective online learning as well, when families lack computers or efficient high speed internet connections.

A new study released by the CDC has examined the impact of virtual learning on the mental health and well-being of children aged 5-12 by looking at almost 1300 families. Of those families, approximately 46% had children receiving only virtual instruction. Another 31% received in-person instruction and approximately 23% received hybrid instruction, both virtual and in-person.

The study looked at 17 indicators of child mental health and found that children who were getting virtual instruction scored worse on 11 of the 17 mental health indicators. In addition, children learning virtually full or part time spent less time outdoors, spent less time with friends (both in person and online), and reported decreased physical activity. And it wasn't only the children who were affected by virtual learning. The study noted,

"Parents of children receiving virtual instruction more frequently reported their own emotional distress, difficulty sleeping, loss of work, concern about job stability, child care challenges, and conflict between working and providing child care than did parents whose children were receiving in-person instruction."  

None of the statistical findings of the CDC study will come as a surprise. Hopefully, with increased vaccination of teachers and school staff and lower Covid rates as more of the general population gets vaccinated, in person instruction will increase and families and schools can turn to addressing the academic and emotional challenges that have affected children and families during the past year. Making up for the impact of the pandemic will not be easy.

 

ADHD Treatments for Young Children - A New Study

A new study just released by the Centers for Disease Control and Prevention (CDC) finds that while more than 75% of young children (ages 2-5) with attention-deficit/hyperactivity disorder (ADHD) are prescribed medication, only about half receive behavior therapy* to address their attention difficulties.

 

This preference for medicating young children runs counter to the clinical guidelines established by the American Academy of Pediatrics, which in 2011 recommended:

"For preschool-aged children (4–5 years of age), the primary care clinician should prescribe evidence-based … behavior therapy as the first line of treatment and may prescribe [medication] if the behavior interventions do not provide significant improvement and there is moderate-to-severe continuing disturbance in the child's function."

The AAP guidelines go on to caution that, “…in areas where evidence-based behavioral treatments are not available, the clinician needs to weigh the risks of starting medication at an early age against the harm of delaying diagnosis and treatment.” The AAP noted that even students whose attention difficulties do not rise to the diagnostic criteria of ADHD may benefit from a behavioral approach to their attention issues.

The CDC study observed that approximately 6.4 million U.S. children ages 4-17 years had a diagnosis of ADHD in 2011-12, which was an increase of 42% increase compared to 2003. The study used insurance claims for psychological services (which includes behavior therapy) and ADHD medication from both Medicaid and private insurance to determine the frequency with which each approach was utilized. 

The CDC reported that the strength of evidence for behavior therapy exceeds that for ADHD medications. It noted that behavior therapy might require more time to impact child behavior and might require more resources but that the impact lasts longer relative to ADHD medication and does not have the side effects associated with these medications. Most of these side effects are minor but they are experienced by approximately 30% of children aged 3–5 years who take ADHD medications and more than 10 % of the children in this group stopped medication treatment because of such side effects.

Here at The Yellin Center we always recommend behavioral strategies for school and home when dealing with attention issues. When appropriate, we can also provide consultation and ongoing prescription management for medications, but we strongly believe that medication should only be considered in the context of a student's overall educational plan, and never thought of as a "quick fix" for school difficulties.

*Behavior therapy in this context includes any psychological interventions that are designed to change problem behaviors, including ADHD symptoms, by modifying the physical or social contexts in which the behavior occurs and can be delivered to the child by a therapist, teacher, parent, or other provider.