Stress, Anxiety & Building Resilience, Q&A with Dr. Ebele Okpokwasili-Johnson MD, MPH

BISB Parent, Dr. Ebele Okpokwasili-Johnson, is a Child, Adolescent & Adult Psychiatrist, lecturer at Harvard Medical School, and Medical Director of the Massachusetts General Hospital’s Behavioral Health Department at New Health Charlestown Health Center.  She is the 2016 recipient of Freedom House’s Next Generation Award which celebrated her dedication to improving the emotional health and well being for children throughout the community.  She also currently has a private practice located in Brookline, MA. 

For Children:

How can we develop resilience (the ability to cope and adapt in adversity) and support coping skills in our children?

This is an excellent question and one that is a journey along children’s developmental spectrum. Parental guidance and support are important factors that can increase resilience in youth. When children feel cared for, listened to and supported even in the event of adverse events, this fosters resilience. The seven C’s of resilience is a nice tool to remember some factors that can increase resiliency (confidence, competence, coping, control, character, contribution and connection: please see resource below for definitions (Portland Pediatrics).

How can we prepare our children to be better equipped to deal with changing circumstances?

Teaching children that changes occur naturally and giving them examples of past experiences and with stories, for example “remember that time we wanted to visit grandma and we had to reschedule due to the snow storm?” Reminding them that they have gone through changes in the past and giving them developmentally appropriate and truthful information about what changes are transpiring and what to expect will make them feel prepared. Practicing changes that will occur in class, “mask wearing” , distancing and role playing at home can help children feel prepared in action, not only in theory.

How can we help ‘back to school anxiety’?

Each child and family may have concerns or worries about going back to school. This is common each year and now we have children returning to school, whether in person, online or in hybrid form and this may present its own new set of questions. In addition some children are concerned about parents who are in the medical field or friends that they miss. It will be important to ask children if they have any concerns and listen to their responses. Some children may be less anxious than in prior years if they feel more parental support at home whereas others who have been ready to return to school happily in the past may bring up new matters. Once these concerns are addressed, assuring that children are equipped with factual information that can give them a sense of control, “washing hands and using hand sanitizer” will be helpful. In addition, avoiding news that is overtly negative or that can increase a sense of fear will be very important to foster children’s sense of safety. Having children draw, journal, play outdoors and engage in activities that enliven and give them joy and encouraging them to seek caring adults to speak to about emerging concerns can help alleviate some of this anxiety.

How do we talk to our kids about practicing social distancing and to abide by all the rules?

It is important for children to understand that this is also a learning process and that practicing some of this new social distancing ‘skill set’ will help keep them, their friends, their teachers, and their families well and healthy. In the same ways that we teach the ABC’s, have our children practice algebraic equations, it will be helpful for them to practice what that “mask wearing” and social distancing looks like in real time with family, neighbors or with friends on socially distanced play dates. Also, for a fun reminder, many of the children have worn masks for Halloween in some way shape or form, so this too is not new for many. Yet, for example, if they reach out their arm and can almost touch the person near them, they are likely too close in terms of distancing; in this vein they can make a creative 6 feet ruler out of cardboard at home so they get a sense in real time (for those that are old enough) to get a practical concrete sense of what distancing will look like when school starts. 

How can we encourage children to be open about concerns?

Some age groups and some temperaments lend themselves to sharing more about their present concerns. It is important to know that all children are having feelings and thoughts about the current situation. Some children may be more likely to talk about it, whereas others want to draw or write a letter. Normalizing that it is “OK” to be concerned, “OK” to ask any and all questions that come to mind and “OK” to feel joy amongst the changes, will foster openness. Still, some may open up at seemingly random times, for example, in the middle of a parent or teacher reading a book. The most important thing to remember is to be ready to embrace the question or concern when it arises and to gently inquire once in a while. Children are naturally incredibly resilient and flexible. Given a supportive environment and tools to thrive even in this new environment, you may see some children adapting very well especially if they have the love, support, encouragement and patience from their loving parents, guardians and teachers.

How can we promote empathy and collaboration?

I have seen when school and work environments speak out loud about kindness, empathy and give real time models and missions of empathy and collaboration among staff and students, this fosters and engenders an environment of empathy and collaboration. Children are ready learners and they see, feel, sense and teach this when it  surrounds them. I think storytelling, sharing books that give examples of perspective taking, collaboration and empathy can give children a sense of what it is on a concrete level in addition to role playing in school and at home.

What signs should we look for in kids (does it vary by age/stage?) that they are feeling stressed/anxious/fearful         

This is an excellent question and yes, fear,and anxiety certainly can look different from age to age and from person to person. What is true, is that there are very common age-related fears, such as fear of the dark for preschool age children and fear of getting ill during the elementary age. Thus some of these fears are normal and transient. One of the hallmark signs to be aware of is a change in functioning for the child, especially in terms of sleep, appetite, interest in usually fun activities for that child, new stomach discomfort, or headaches. It is true that increased screen time during the remote learning of the pandemic had increased some somatic symptoms such as headache and eye strain. Yet, keying in on additional symptoms and consulting your child’s pediatrician or a child and adolescent psychiatrist if there is mounting concern, is always a prudent step, especially if these symptoms persist for more than 1-2 weeks.

For Parents:

Recommendations for helping busy parents juggle everything.

Yes, this is a time where parents are doing Herculean tasks from working to teaching their children and maintaining a secure and healthy home base. I think starting with the basics of self care such as sleep, exercise, nutrition will always give parents a head start. In addition, if there is any room to shift what ‘needs’ to be done versus what ‘should’ be done, this is an important time to re-calibrate what that is and focus on the former. Delegate chores across the household and include children (they love to help and be industrious where they can) Where there is room, take time to deliberately experience joy, and start each day with acknowledging what you appreciate(including yourself).

How can we avoid parent burnout? What are the signs?

Asking oneself,  “when was I last feeling positive, healthy” and recounting what the activities and circumstances were at the time. If at that time, one was resting more, reading more or taking walks outside-it would be important to reincorporate those elements in ones life. In addition, this time of Covid-19 pandemic is simply an unprecedented time and radical acceptance of what one can control and what is within one’s control can also be a relief and an important model of ‘doing what one can’ in challenging times. The signs of burn out is different for each individual, but can include difficulty sleeping, restlessness, a change in weight, mood shifts and irritability.  Parents are resilient too yet having a support network such as fellow parents, friends and confiding in caring adults is very important now.

What tools can we employ as parents to take time for mindfulness?

Many parents have mentioned that this time has had surprising silver linings-the time where we all had to stay home during the surge in Covid-19 cases in the spring, found some painting more, baking more, gardening or simply observing the blossoming flowers over a long period. Mindfulness is just that, at times closing ones eyes and centering on the scents of the coming spring, feeling the breeze on a cool day, breathing deeply, or touching the silky texture of a new rose. Taking a meaningful pause and being present to the world around us, even for a deliberate 60 seconds, can decrease stress hormones and increase a sense of well being.

How can we role model best behavior for children regarding empathy, collaboration, sharing etc?

As parents, firstly reminding youngsters that the practice of empathy is a lifelong one and there may be bumps along the way, yet centering on this being a process of mastery and growth, and teaching it through, books, history, lived experience and what we wish for in terms of  fostering humanity and good citizenry, is key. Giving concrete examples as to how we treat friends, how we wish to be treated and what to do when we hurt others are discussions that can be had directly and through play, books, and stories.  It feels heartening to children to understand that in life everyone can get hurt, but we each have the power to learn from a mistake, repair  and work to do better next time.

Resources:

http://www.portlandpediatric.com/console//page-images/files/building-resilience/All%20Ages/Seven%20Cs.pdf

https://www.aacap.org/App_Themes/AACAP/Docs/latest_news/2020/Coronavirus_COVID19__Children.pdf

https://www.aacap.org/AACAP/Press/Press_Releases/2020/Needs_Students_During_COVID-19_Era.aspx