This week’s post comes from an interview with Dr. David Stein. Dr. Stein is a pediatric psychologist who specializes in neurodevelopment; his background and experience give him a unique perspective on the COVID-19 pandemic and its effect on teenagers.

He’s not only a clinical expert in brain development, but he also has insight into the public and community health aspects of social distancing and “school at home.”

Dr. David Stein is the owner of New England NeuroDevelopment, which offers neuropsych testing and educational evaluations in Wellesley, MA. David was educated at Tufts University and William James College and trained at Harvard Medical School, Cambridge Hospital, and Boston Children’s Hospital. He was a fellow and then training director of the Leadership Education in Neurodevelopmental Disorders (LEND) program and has experience in clinical care, research, and advocacy and public health. Dr. Stein founded New England NeuroDevelopment in 2016.

So many parents wonder how this is affecting their kids. What do we know about how kids handle crisis?

The good news is that as long as kids have strong attachments and relationships, they are extraordinarily resilient. Attachment and relationships are the crux of life. There is significant research showing that when people have good relationships, they are happier and healthier, both physically and mentally. For kids who have those good relationships and healthy, supportive environments, the pandemic probably won’t have any long-term detrimental effects. What’s important right now is to preserve good familial relationships.

How do parents maintain those relationships during a global pandemic? Does that look any different?

First and foremost, all parents should be kind to themselves. This is a stressful, novel situation that none of us have been through before. There is definitely space for relaxing the rules a little under the present circumstances. If your teen doesn’t finish an assignment or wants 3 hours of screen time instead of 2, it’s okay to let it go.

On the other hand, having good attachment does not mean letting kids do whatever they want. In fact, rules and expectations actually help kids feel secure and keep anxiety at bay. Structure is what teens crave and need, even if they say differently or push back. So some level of structure is important.

Parents tend to lean one way or the other: stress either makes them double down on the rules or give up on them altogether. We all are working to find some balance, and that is really important.

What should parents prioritize when they are creating structure?

Bedtimes, wake times, meals, exercise, and some limits on screens will be useful for most families. For teenagers, it’s usually easier to set a wake time than a bedtime. If they need to be awake by a certain time, their bedtime will naturally recalibrate. Those limits and times may be different and more flexible than in the past, but don’t abandon them completely.

Being structured doesn’t mean you have to be rigid. In fact, being flexible and creative is a sign of good mental health in adults. If you start to feel inflexible as a parent, it probably means you aren’t handling your stress well. Go for a walk, take a little break, and reflect on why you’re responding in that way.

We’re hearing from families that teens are processing the COVID-19 pandemic very differently than their parents. Can you shed some light on these differences?

A sense of loss is prevalent for all of us right now. For adults, that loss is coupled with fear: about the health and safety of others, about the economy, and about what our world might look like. For teens, their loss is coupled with grief: they are grieving for all that they’ve lost by being socially and physically isolated. Teens I’ve spoken with don’t seem that anxious or worried about the world. Perhaps it’s too abstract for them to think about. But they do feel a deep sense of sadness.

To be fair, teens have lost a lot. The developmental “job” of adolescence is building your identity. Teenagers do that by spending time with their friends and away from their parents. That separation allows kids to test out different ways of being in the world. Those ways may be different than how their parents are in the world (although parents are still vital as a secure base they can always come back to). Right now, teens have lost their ability to go out and build identity in the world, and this loss is profound. It’s more than missing out on prom, sports, or the spring musical; it’s temporarily missing out on some key developmental needs. With that perspective, parents may be able to find more empathy for their teens.

Trying to talk with your teen is really important. Parents should try to do this without being annoying or pushy. Teens should feel like they have the opportunity to open up and communicate without feeling pressured to do so. You can talk about whatever makes sense in your family: school, the world, funny internet memes, etc. Remember that your kid may not be processing COVID-19 the same way as you. Their world is smaller, so be open to meeting them in conversation where they are.

What recommendations do you have for continuing academic skills now and through the summer?

Every student loses some skills when they don't use them consistently. With the quality of online instruction so varied, we expect there to be a “coronavirus slide” similar to the classic summer slide. The goal is to minimize the effects of the slide so that students aren’t behind next school year. Many key foundational skills (such as reading) are set by high school, so teens can focus on those skills related to executive functions. Organization, planning, and time management aren’t related to particular subjects and don’t have to pause during COVID-19.

If your kid is struggling with a specific subject, they should put more effort into those areas with support, such as a parent or tutor. Certain students will benefit significantly from individualized instruction right now, so they don’t lose the hard-earned progress they’ve already made.

Are there additional considerations for teens with learning issues?

If your student has a learning disability or disorder, we can think of it as having less “cognitive reserve” in that particular area. Cognitive reserve acts like a buffer against losing skills. For a student with a learning issue, a disruption to their learning has more impact than for someone who doesn’t have a learning issue. For example, if you have ADHD, the loss of structure (school schedule, teacher instruction, etc.) hits you a lot harder than someone who does not have ADHD.

What concerns do you have about the impact of the COVID-19 pandemic on education?

I agree with other experts that there may be a wave of problems with mental health and education related to COVID-19. When some semblance of “normal” school returns and students are being assigned real grades, the kids with vulnerabilities might suddenly be way behind.

Academics will likely be more challenging; it takes effort to reacquire the skills and information lost during a slide. The loss of conceptual abilities and new ways of thinking is part of that slide; if that kind of mental flexibility doesn’t come to a student easily, it will take work to get it back.

We also know that kids with learning challenges are at far higher risk for emotional problems like anxiety, depression, and substance abuse. It’s a cascade. So if academic problems worsen, emotional problems will likely worsen as well. This is why support in all forms is so important right now.

The other concern I have is around identifying learning challenges and disabilities. Teachers are often the first to identify a student’s learning challenges. They set a chain of events in motion that leads them to a practice like mine, for neuropsych testing, and eventually to getting the support and/or treatment they need. Teachers don’t have that level of oversight right now. When we return to our “new normal,” it may be hard to differentiate between COVID-19 slide, emotional problems, learning disabilities, or all of the above.

What can parents do to minimize the risks to their students?

Stay attentive to any changes in your teen’s behavior. Examples include avoidant behaviors (sleeping too much; playing video games all day; putting off assignments) and resistant behaviors (fighting back about homework, chores, etc.). If you sense they’re struggling with a lack of motivation or an inability to get things done, definitely reach out for support. Your student may have a relationship with a tutor, coach, or therapist; that’s a good place to start.

If you haven’t seen an issue like this before or don’t know where to begin, that’s when neuropsych testing can be really useful. It gives families concrete information about what their student is struggling with and allows them to identify the best type of support. Without an understanding of the deeper issues at play, families can spend significant time, effort, and money trying out different kinds of support that may not be necessary or effective.

What kind of challenges can neuropsych testing help identify?

We complement neuropsych testing with emotional, social, and behavioral assessments. There’s a long list of conditions we can identify, including ADHD and other attention disorders; autism spectrum disorder; dyslexia, dysgraphia, and dyscalculia; anxiety, depression, bipolar disorder, and adjustment disorder; and trauma.

Most kids and learning issues are complicated; they’re layered and they overlap. For example, there is a high likelihood of anxiety and depression concurrent with a learning disorder and/or ADHD. Testing allows us to see the whole picture. From there, we make the appropriate referrals and connect families to the right resources. It’s really rewarding to see this information, and the resulting support, change a student’s entire trajectory.

Your practice is innovating new methods for testing that respect social distancing. Can you share more about what you’re doing?

We’ve developed a protocol for completely contactless testing in our office. We have a dedicated patient room that is used by one family per day. Windows on either side of the room allow our team to interact directly with families without coming into direct contact with them.

We can administer all of our assessments this way, so we are never in the same room with our clients. And of course, we’re taking the usual precautions that have become more standard: sterilizing rooms and equipment while wearing masks, etc.

What’s great about this is that the physical separation reduced our need to wear masks once we are in our respective rooms. Although we’re interacting with families with a sheet of glass between us, that sheet of glass allows us to smile at one another. It makes the entire assessment process more comfortable and personal. It’s an interesting way to think about the “new normal.”

For more information on Dr. Stein’s practice or neuropsych assessments, contact david.stein@neneurodevelopment.com or visit neneurodevelopment.com.