The 2019-20 academic year ended in the most unexpected of ways as schools made a fast shift to remote learning and proms, graduations and other significant events were put on hold. And the 2020-21 school year came with many more unknowns. Amidst these uncertain times, many young people faced a great deal of stress and uncertainty. And, along with that, reports of rates of pediatric depression and anxiety began to surface.

A program evaluation done by the Blue Cross and Blue Shield of Minnesota case management team showed depression and anxiety trends showed this trend held true among our membership. There was a 37 percent increase in the number of claims for treatment related to depression and anxiety in members under the age of 18 in 2020.

Helping children through mental health challenges is important for parents and caregivers. It can also be overwhelming, leaving parents and caregivers at a loss.

To offer resources and help make a plan, we sat down with Dr. Russ Morfitt, co-founder and chief clinical officer at Learn to Live, to discuss what parents need to know. The following are his top tips and resources.

Understanding children’s changing behavior

First of all, it is important for parents to take note of their children’s behavior. If there’s a noticeable change from their regular behaviors, that could be cause for concern.

Behavior changes to watch for in children and teens include:

• sleeping and eating too much or too little,
• isolating more than usual,
• decreased interest in things that your child once loved and
• physical markers, like rapid weight loss or gain or GI problems

Dr. Russ also notes that younger children are more apt to vocalize their worries and show anxiety about leaving their parents.

“These are all difficult things to measure,” Dr. Russ says. “So, it’s important for parents to be able to recognize these changes and take steps to try to prevent them from worsening.”

Talking with children about stress and worries

Talking about anxiety and depression can be difficult to discuss with children, especially given that young children sometimes do not have the vocabulary to discuss their feelings. Dr. Russ recommends having healthy and calm discussions with your children.

“The conversations that work best involve the parent noticing their behaviors and asking them if they are feeling mad or sad and the parents putting words to it,” Dr. Russ says. “Sometimes our parental impulses can misguide us a bit. Too much reassurance sometimes isn’t helpful, coaxing isn’t too helpful, telling your child to stop worrying isn’t helpful.”

Dr. Russ emphasizes the importance of discussing mental health in an optimal setting. He says the best way to do this is by adopting a nonjudgmental tone, deliberately taking time out of your day to have these important discussions, avoiding a reactive situation and asking the child for clarification where it’s needed.

Dr. Russ also recommends that parents model healthy behaviors for their children. Behavior modeling shows children that adults have struggles too and that it’s alright to express these emotions.

“It’s important, whether the conversation is with a child or teen, that the parents themselves have emotions and are modeling that it’s okay to disclose them,” Dr. Russ says. “Anxiety and depression are multigenerational. Yes, genes are part of it, but part of it is the messages that we pass along.”

Finally, for parents whose children are less likely to have open discussion with them, Dr. Russ suggests talking to other parents to gauge your child’s behavior.

“This can be a benchmark of whether your child’s reaction is similar to peers or if it is time to have a serious conversation about professional support to treat anxiety or depression,” he explains. “Sometimes talking to another parent can do a world of good to benchmark parents’ concerns.”

Navigating the line of activities and rest

Many parents tend to place a great deal of importance on extracurriculars and school. Dr. Russ says it’s important to help your children navigate the appropriate balance between structured activities— like sports, school and working— and unstructured activities, such as hanging out with friends.

“Parents have plenty of latitude to be able to let their children know that ‘I love that you have so many interests and that you’re good at so many things, but we can only pick a few extra things for you to do,’” he notes. “Children need time to sleep and play. While we want them to be learning, they need to have plenty of time to rest, too.”

Having an adequate amount of sleep is extremely important for children. “It’s important to recognize that children need much more sleep than adults,” Dr. Russ says.

To ensure this, he emphasizes having an appropriate amount of time set aside for sleeping and to set a healthy bedtime routine.

“Don’t become a sleep sergeant. While you want to allow the opportunity to sleep, do not force it,” Dr. Russ says. “Instead, set a healthy evening routine that will prepare your child to wind down for rest.”

Incorporating CBT techniques into daily life

For families managing any level of anxiety, depression— even mild stress or worry— there are many cognitive behavioral therapy (CBT) techniques that can help. Dr. Russ offers three popular and effective techniques.

Technique 1: Behavioral activism

This means working to intentionally become more active and trying to find specific activities to accomplish when depression tries to make you inactive—when just lying on the couch sounds like the best idea. Sometimes this looks like helping other people or doing things that used to be fun, like going for a nice long walk or doing a favorite activity with a friend.

Technique 2: Mindfulness

Mindfulness, which Learn to Live calls present awareness, means allowing anxious or depressive thoughts and feelings to simply come and go, rather than be complicit with them.

Technique 3: Managing Worry

There are many ways to manage the worry-filled thoughts that take over when anxiety or depression hit.  Worry time is an effective technique to idle worrying thoughts. This means setting aside time during the day to express some worries can confine them rather than let them consume you all day. When you are tempted to worry, you remind yourself that you can worry about it at the time you intentionally set aside for that day.

When to get outside help

If a child’s anxiety or depression reaches a level that is directly affecting their daily life, it might be time to discuss professional care, such as talk therapy.

“If children are starting to miss school, consistently withdraw from social gatherings or showing significant anxiety or putting an undue level of pressure on themselves, or showing any of the physical markers I’ve noted, it may be time to talk to your child’s doctor or a trusted therapist for help,” Dr. Russ says.

While this can be difficult, Dr. Russ offers the reminder that, “There is no shame in asking for help. If someone gets to that point, seeing a therapist can be a very positive and helpful step.”

Find more mental health resources from Blue Cross MN

Blue Cross MN has many mental health resources for our members. Available resources do vary by plan, so it is best for members to call the number on the back of their member ID card to learn more about coverage specific to their plan. Learn more about mental health coverage on our website.

About Learn to Live

Get more information  about Learn to Live and take their online assessment at learntolive.com. Blue Cross MN members can learn more about the program on bluecrossmn.com. To find out if it is covered under your Blue Cross MN health plan, call the number on the back of your member ID card or visit bluecrossmnonline.com to review your offerings. 

Editor’s note:

Dr. Russ suggests the following books for parents and caregivers seeking to support their children’s mental health:

• The Grit Workbook for Kids: CBT Skills to Help Kids Cultivate a Growth Mindset and Build Resilience by Elisa Nebolsine
• What to Do When You Worry Too Much: A Kid's Guide to Overcoming Anxiety (What-to-Do Guides for Kids) by Dawn Huebner
• Overcoming Depression One Step at a Time: The New Behavioral Activation Approach to Getting Your Life Back by Michael Addis

The Worry Cure: Seven Steps to Stop Worry from