Coping With Back-to-School Uncertainty and Anxiety with Dr. Ethan Benore

Podcast Transcript

Deanna Pogorelc:  Welcome to the Health Essentials Podcast, brought to you by Cleveland Clinic. I'm your host Deanna Pogorelc. Now as summer winds down, and the coronavirus is still circulating in our communities, there's no doubt that this back to school season is going to look a lot different. Whether it's kids going back to school and wearing masks and social distancing in their classrooms, or doing schoolwork online from home. All of these changes can be really tough on kids, and on parents and caregivers too. Here to help us navigate these stressful and uncertain times, is Dr. Ethan Benore. Dr. Benore is a Psychologist and head of the Center for Pediatric Behavioral Health here at Cleveland Clinic. Welcome Dr. Benore. Thank you for being here.

Dr. Ethan Benore:  Thanks for having me.

Deanna Pogorelc:  To our listeners, please remember that this is for informational purposes only and is not intended to replace your own positions at bikes.

Dr. Benore can we start a little bit by talking about how the last full year ended with kids shifting to virtual learning because of the pandemic and what consequences have you seen or do you anticipate seeing as the result of more kids doing virtual learning?

Dr. Ethan Benore:  Sure. It's a great question. The end of the last school year clearly was not what we expected and to put it in perspective, I think it's important that people remember, this was an urgent response that the state and the school system had for our ability to try to mitigate or reduce the spread or surge of COVID-19. When we really didn't have as much time to prepare, when we also we're trying our best to protect our healthcare providers due to a shortage of supplies.

I give a lot of credit, both to our state and to our schools to do the best that they can in the short time that they had. That being said, it was a very uncertain time for individuals. The way that we taught children was not ideal, and now five months later, there's concern that there's going to be a lack of gain or even a regression of some skills in children. A lot of children either had to do a lot of work online or do a lot of worksheets. They had less time with teachers and their parents. They may have had less time with parents, as well as parents were trying to figure out what they were going to do for themselves and for their family during this time.

Deanna Pogorelc:  Does the lack of socialization with classmates and teachers and even the lack of structure, what kind of effects can those have on kids?

Dr. Ethan Benore:  It can have a very large effect on children. Children respond very well when things are ordered and predictable. While it may have seemed wonderful to have an extended spring break, that extended sense of, not knowing what was going to happen next or next week, can be very anxiety provoking for children. Also, children look to their parents and other adults for a sense of security. When the other adults don't seem to know what's going on, it's also anxiety provoking for children. I think that whole uncertainty was very tough. We were able to make it through the summer, but children, I think, have really suffered from lack of access to their playmates. I think about young kids who don't have as much ability to see some of their other friends. Social gatherings have been cut short and everything has been virtual, it feels like. For older kids, for teenagers, socialization and some of their sports teams are really a source of identity for them and so to not be able to be a part of a team or be a part of a group, is really impactful for their own identity and self-esteem.

Deanna Pogorelc:  Now, every school district in state is a little bit different in how they've made decisions about what's going to happen this coming year. I know some schools are leaving it up to parents to decide whether to send their children back for in-person classes or to keep them at home to avoid exposure to the virus. That seems like a really tough decision to make. If there are parents who are still kind of weighing the pros and cons of each, what are some of the things that they should consider?

Dr. Ethan Benore:  Sure. First off, my heart goes out to the parents. I'm a parent of school children as well. It is a tough decision again, because of the uncertainty. What psychologists often recommend for any type of anxiety, is to try to reduce uncertainty by providing information. The Centers for Disease Control and Prevention has wonderful information on their websites. I would strongly encourage parents to go to that website. There's a lot of information written just for you, so that you can understand what's happening with the virus and what's happening with school, so you can prepare best for schools. The American Academy of Pediatrics has put out similar information. There's also a website, healthychildren.org. It's managed by the American Academy of Pediatrics. Those are excellent resources for parents. Again, the more knowledge you have, the less uncertainty or anxiety you will feel and I think the better you'll be able to support your children.

The other thing that I would recommend about getting information is, I would go to Trusted Sites. I would not go just to what your neighbors are saying, or what's being posted on Twitter. Please go to Trusted Sites for information about what's happening. Your school systems have to follow these guidelines as well as state mandates and any questions that you have. Schools have been really good again, they've had time now to do a lot of research and a lot of preparation. They're able to answer most of the questions that you have. Please reach out to your school systems as well.

Deanna Pogorelc:  Yeah. The kids who have learning challenges or struggle with anxiety or ADHD, is there any other considerations for those parents as well, in terms of whether their children might do better at school or at home?

Dr. Ethan Benore:  Yeah. For children who have any kind of specialized needs, whether it's ADHD, whether it's a learning disability, whether it's autism, whether it's giftedness, in a typical school setting, we have modifications or accommodations that are provided for them. I would reach out to your school psychologist and identify what kind of accommodations can be provided for your child this year. We all are making accommodations and sacrifices to get through this year. One, to try to prevent continuing spread of COVID, but also to try to get back to as much normalcy as we can and to facilitate the academic growth of our kids. The other thing that I would recommend for parents though is, this is going to be a year for you guys to step up and assist with your child's education.

The school is going to do the best that they can, but anything that you can do to also facilitate your child's education is going to be important. Read to your child, read with your child, talk about historical events with your child, do math with your child, play board games with your child to increase some socialization as well as applying some of these skills. But really as best as you can, be active in your child's education this year. Again, if you have special needs for your child, talk with the school and figure out what the school is going to be doing, and then what you can do as parents so that they don't suffer any further or unnecessarily from accommodations or modifications that will be going on this year.

Deanna Pogorelc:  Yeah. On the other hand of having to make that decision, I know some states or districts have also decided either to proceed with in-person classes or distance learning or some combination of the two. I'm wondering, when parents aren't given a choice. That choice is made for them. Is that more stressful or less stressful? Are there ways that we deal with those decisions being made for us, that we might not necessarily agree with?

Dr. Ethan Benore:  Sure. Whether it's more or less stressful, I think depends on the person. It is very difficult making these decisions. Again, I feel for all of the administrators who have to make the decisions about what is best for preventing spread of COVID-19, as well as what is best for educating kids in this current climate that we're in. Some people may struggle from not having a sense of control and making the decision themselves and again, if that's the case, I would encourage, ask as much information so you have a good understanding for why the school's made the decision that they did.

Again, they did not make these decisions lightly, so ask. Second is, some people may have more anxiety or nervousness about making the decision. We were just on our school board meeting last night, there are several schools that are providing different options for people and sometimes making this decision is difficult. Again, seek as much information as you can, go to reputable sources, contact the school, ask the questions so that you feel comfortable making the best decision that you can with the information that we currently have available. Knowing that this situation is evolving, you have to give yourself some level of forgiveness and compassion, that we're doing our best in the current situation.

Deanna Pogorelc:  How do we go about explaining some of these nuances to kids? That maybe their friends in a different district might not be going back to school or might be doing something different and their cousins. How do we explain this to them in a way that makes sense and it's not overwhelming?

Dr. Ethan Benore:  Sure. No, that's a great question. One way that I think is important is to create a narrative or a story. Just a plausible story that a child can easily understand. Oftentimes less words is better than more, so if you need to practice before speaking with your child, I think that that's very helpful. One of the things that's important is to try to explain to your child what will be the same and then add what will be different. You will be returning in this example, you will be returning to the same school. You will be riding the same bus. Jasmine will get on the bus with you just like before, and you'll go to the same school. What would be different? You will be wearing a mask. You will be using hand sanitizer. You will be asked to wash your hands very frequently.

You're going to be doing lunch in gym class maybe a little bit differently. But if you can provide that kind of just plausible story first and again, short or less words usually is better, so that kids have an opportunity to just digest what you're telling them, and then wait. Usually afterwards, the child will ask relevant questions as they're trying to piece together a story in their own mind about what to expect. Between that dialogue, between you and the child, you can start to construct really what your child can picture in his or her mind as they are returning to school.

Deanna Pogorelc:  That's great. For kids who are going to have some kind of virtual learning component in their schedule for the fall. I want to ask you about Screen Time, because I know when we talk about kids and technology, we talk about the importance of putting healthy limits and boundaries on Screen Time. This situation kind of blurs the lines a little bit. Do you think virtual learning should count towards Screen Time limits? Or how should parents think about navigating that, when kids are doing some of their schoolwork online?

Dr. Ethan Benore:  Again, this is an opportunity for parents to be a little bit compassionate with themselves and forgiving the school system as well. This is tough. We are a very digital society right now, and so much is happening online. While there are recommendations to limit the number of hours that a child is online, that is very difficult when so much of the child's activities are also limited as well. The guiding principle I would use is, what is safe for the child from a health standpoint, and what also can help the child with academic development, social development, emotional development. If the Screen Time is being used for any of those purposes, whether it's a classroom that they're participating in, whether it is a worksheet that they're completing online, whether it's just social group that they're connecting with. Those can all be healthy for a child despite the fact that they may go over the predetermined hour limit that you have for your child. Things that I would be cautious about is, your child spending endless hours looping through videos or endless hours playing through video games where they're not getting any physical activity.

They're not getting any social activity, they're not working on academics. Those are times where I think as a parent, you can step in and try to set some limits. The important thing to think about though, especially given the current climate that we're in right now is, what are you going to replace it with? Encourage your child to read a book and then talk about that book with your child, go outside and play with your child, or encourage your child to do some type of physical activity, and then find ways to praise or reinforce your child for doing something else that doesn't involve electronics.

Deanna Pogorelc:  Yeah. Kind of piggybacking on your earlier comment about parents giving themselves some grace in this time. I know that the parent child relationship is often much different from a teacher student relationship, and for parents who have kind of been thrust into this role and don't necessarily feel like they make a great teacher when it comes to distance learning. Do you have any tips to help parents, how to manage this role that they're being asked to take?

Dr. Ethan Benore:  Yes. I'm glad you started with talking about grace, right? We're not teachers. One of the benefits of utilizing a school, whether it's in-person or whether it's virtual is, these are trained educators. They spent several years learning how to do this. It's often unsettling and a little anxiety provoking or overwhelming for parents when they have to sit down and be the teacher for their child. A couple of things that I would think about. Number one, I would use time in place to structure the situation.

If your child is working from home, have a set office space or desk space that they work from, so that it's easy for them to shift to student mode, for you to shift to instructor mode. Have set times that they're working. Again, so you don't have to be the teacher and the parents at the same time. The other is, have conversations with your child that we're learning this together and my job is to facilitate and to help you. But I may not know all of the answers. Again, allow your child to have a little bit of patients and compassion in this time as well. It is going to be frustrating and if we're not mindful about that level of frustration, that can lead to more conflict between children and parents, whether it's related to school or whether it's related to other issues at the current time.

Deanna Pogorelc:  Some reports have come out recently showing an increase in Cyberbullying during the COVID-19 pandemic, with more kids spending more time online, what should parents be on the lookout for, when it comes to Cyberbullying? What are some of the signs or different behaviors they might see?

Dr. Ethan Benore:  Whether it's Cyberbullying, whether it's an increase in anxiety or depressed mood, I think it's important for parents to pay attention to their child right now. I say this because it's not just children that are going through this situation. I fully understand that parents may be struggling with issues at work, issues with other family members, issues with their marriage maybe. It is a stressful time, but pay attention to your child. Things to be on the lookout for? One, would be any increase in reports of pain. I've been saying to other people, "We're going to have more stomachaches and more headaches currently." Physical complaints are often a sign that children are developing more stress. Take that as an opportunity to then talk with the child about what they're experiencing. Other things would be, changes in behavior such as more irritable or cranky, more withdrawn or stolen, pay attention if your child is spending much more time in their room.

Again, for some children, that can be developmentally appropriate. But if you notice it as a sudden change, please keep on the lookout for that. Look for changes in eating habits, whether they're eating much more frequently or frequently going after the wrong foods, what we might call stress eating. Whether they're sleeping in appropriately. Staying up very late at night and unable to sleep, sleeping during the day. Sometimes children will actually use sleep as a way to avoid a social stress or just social withdrawal.

Any of those situations are a good opportunity just to check in with your child. One thing I would think about, when you're checking in with your child, a lot of parents and a lot of TV shows that have these little huddles, these sideline huddles between parents and children. I think it's a wonderful thing to do. Please do that with your children periodically throughout the day. Many parents wait to do it just at bedtime, to say, "How is your day, sleep it off, it'll be better tomorrow." I really encourage you to have these conversations earlier with your children so they can process any stress, process any emotions. End the day feeling much better, much more relieved, much more on top of whatever stress the day presented with themselves.

Deanna Pogorelc:  Okay. I want to shift a little bit and talk about parents of kids who are going back to school, either for that first day or on a delayed start, but are actually going back for in-person classes. You talked a little bit about how to prepare for that, how to talk to your child. But can we talk a little bit more about some of the things that might be asked of children when they go back to school? For example, wearing a mask, how do we explain to them why they need to wear one and encourage compliance with some of these measures?

Dr. Ethan Benore:  Sure. There's been a lot of public discussion about this as well, which is why I think it's important to have your own family discussion. There are rules that will apply to everybody and then there are rules that families beside, that apply just to them. Oftentimes you may say, "Yes, what the Johnson's are doing over there works for the Johnson's. We're not the Johnson's. We're going to do it our way." When you're talking about rules, especially rules that are mandated, so state mandates or rules for restaurants or rules for schools. It's important to introduce these as hard and fast rules that we're expected to follow. Again, putting it in context to something that the child can relate to. When you ride in a car, you have to wear a seatbelt. It is the state law. When we're out in public or in certain restaurants, there is no smoking. In certain areas, there's no cell phone when you're in a car.

These are newer laws that have come up recently that people struggled with at first, until we got used to them. Teaching children to understand that, "Yes, it's a little bit uncomfortable and unsettling because it's new, but it's there for your safety. It's there for the safety of others. We're going to follow this rule for those purposes." Go over specifically what the child should be expected to do, so where, when and how to where the mask is going to be important, making sure that your child know. Practice with your child, demonstrate for your child, practice with your child, reinforce when your child is doing it. Same thing goes with hand-washing. There's some great videos out there about the appropriate way to hand wash, which is very helpful in times like this. Using hand sanitizer and when to use hand sanitizer, is going to be very helpful. Talk about it openly with your children, and you'll know you're doing a good job because your child will catch you when you slip up as well. But those specific behaviors I would do over.

Deanna Pogorelc:  Okay. I know another challenging part is going to be kind of the social distancing and not just running up and hugging their friends on the first day of school. How can we show compassion for kids with all of that?

Dr. Ethan Benore:  Another thing in line with compassion is, we're going to make mistakes. These are not specific rules that children need to be panelized, "You need to go to the penalty box because you hug your friend." It's a teaching moment. A little bit of compassion if that happens, but one of the things that's important, and this was initially brought up way back in March and April was, trying to find replacement behaviors. Whether you're bumping elbows, whether you're air-five and it doesn't really matter, as long as it kind of adheres to those rules. What I like about that is, people are trying to have some fun with this. I think kids will start to develop their own kind of fun replacement behaviors so that they can have appropriate greetings with their friends.

Deanna Pogorelc:  Great. Is there anything else that we should be doing to prepare kids for going back to physical school for in-class teaching?

Dr. Ethan Benore:  There's a couple of things that I've been thinking about. One thing that as a psychologist I often talk about with individuals, is just kind of your attitude or your state of mind. For parents, really with the school, the attitude that I would recommend is to be patient, but also to focus on collaboration. That you two are working together to help your child. It is not me against you kind of situation here. It is just two different groups working together for the same goal. With other parents, be supportive of other parents, but also be respectful. Some people may have their own rules that are a little bit different from yours. In with kids, we've mentioned this already, but please be compassionate.

Remember, in this situation, they're just kids. They understand this less than you and they have even less control of this situation than you. Please consider that as you're working with your children. With children, when you check in with your child, there's a couple of tips that I usually tell parents. Rule number one I tell parents is, just listen, just be quiet, listen to your child. After that, validate the emotion, "I'm sorry that you're feeling sad, angry, frustrated." Reassure them and then start to problem solve with them on what they could do to help the situation get better or what you're going to do to help respond to your child.

Deanna Pogorelc:  I think you've talked about this a little bit already, but maybe you can reiterate. We know when they go back to school and some of those signs that, maybe there's some anxiety or stress that needs to be addressed.

Dr. Ethan Benore:  Yes. Again, it's a great time when you're having those conversations with the child to really pay attention to any words that they say. But again, sometimes children really struggle understanding their own emotions. Pay attention to how they're talking about the situation. Pay attention to their behaviors. You know your child. You will know if your child is acting more restless than usual, more irritable or snappy or sassy towards you than normal. Those are all indications that something else is under the surface and it's a good idea just to pause and have a nice conversation with your child and see if you can get to the heart of it, then look for the resources that are out there for support.

Deanna Pogorelc:  Have there been any positives to this whole situation?

Dr. Ethan Benore:  That's a really good question. Again, this was unsettling for all of us and yet when the world shut down for a while, it gave families and individuals time. It's been really interesting to look at how individuals have spent that time. Many families have just had more time to connect. They haven't been holed out, whether it be to work, whether it be to professional sporting events, whether it be to restaurants. People are spending less time actually in commutes and so, having this time has been positive for some families. I think it's important to look at that and see what you can learn from that to continue using, as we move into this next stage of living with COVID. There's been many more people that have been playing games with their children, whether it's board games, whether it's putting together puzzles, many more children and adults have gotten back into arts and crafts, and then sharing these with each other.

When you have less interruptions from life, you have more opportunities to focus on some of these other tasks that maybe were lower on your priority list. There's a lot more flexible time that people have learned to create, so that they can be with their family when they want to be or when they can be. Kids, I think have had a little bit better sleep because they've been able to flex their schooling a little bit more and haven't had to wake up at 6:00 to get onto a bus. For some children, when there is some social stressors, they've had an opportunity to take a break from some of that.

All of these things are positive, even though it's not the way that we wanted to get to these. I think that the lesson for families is to pay attention, what positive changes they've enacted since we've moved into this new lifestyle and see as we move forward, how they can still maintain some of those. As you move back to getting back to work, getting back to school, getting back to sports, how can you still capture some of this important positive time that you did have, either with yourself or with your child?

Deanna Pogorelc:  Great. Well, this has been fantastic. Are there any last words of wisdom or advice that you want to leave parents with?

Dr. Ethan Benore:  When I think about a narrative, as I was talking about before for children. The one thing that I would think about explaining to your child is, this will not forever. But it will last for a while. It will last for several more months. The initial plan of waiting in our homes was working, but we need to shift to a new plan, so that you can live and grow and go to school and socialize as appropriately, but live in a world with COVID-19 right now, and until we have improved treatments or vaccines, it's important for us to follow these rules from our leaders and our scientists and medical professionals. But to follow these rules, to take the responsibility, to keep ourselves and our society as safe as possible, as we move forward to what we hope will be functioning as normal as possible.

Deanna Pogorelc:  Great. Well, thank you so much, Dr. Benore, for being here today. If you'd like to schedule an appointment with Cleveland Clinic Center for Pediatric Behavioral Health, call 216444 kids. For more podcasts with our Cleveland Clinic experts, go to clevelandclinic.org/hepodcast. For more health tips, news and information, follow at clevelandclinic on Facebook, Twitter, and Instagram. Thanks for joining us.