When a child is diagnosed with a psychiatric disorder, there often follows a wave of parental guilt: What caused the problem? Could it have somehow been prevented?
Although doctors are not able to pinpoint the cause of an individual child’s ADHD, depression or anxiety, we do know that genetics and environment both play a role in the development of such disorders.
A new study shines light on how stress during pregnancy can affect a child’s mental health, and how climate change is taking a toll on kids today.
The study looked at kids who were in utero during Superstorm Sandy
By the time Superstorm Sandy made landfall in New York City in October 2012, Yoko Nomura, a professor of psychology at Queens College, and her colleagues had already embarked on the “Stress In Pregnancy Study,” funded by the National Institutes of Health, to understand the effects of maternal stress during pregnancy on children’s development.
“When the study was underway, Superstorm Sandy happened,” Nomura told HuffPost. That gave researchers an opportunity to study how the storm affected New York children who were in utero when it hit.
In the storm’s aftermath, hundreds of thousands of New Yorkers were left for days without electricity. Some suffered damage to their homes. The college where Nomura teaches opened up its gymnasium to be used as a shelter. Seeing people sleeping on the floor of the gymnasium, Nomura said, “really made me think, ‘This is much more stressful than I had anticipated.’”
“Because I do human research, I can’t manipulate a stressor. I cannot assign a baby to a more abusive mother,” Nomura explained. The storm, she said, “provided an unparalleled opportunity to conduct a study of psychosocial stress.”
Nomura and her colleagues quickly added questionnaires to their study to measure the hardships faced by pregnant people during the storm. People who needed to deliver, for example, were left with only one open hospital labor and delivery ward, citywide. One pregnant woman described being trapped in an elevator for hours due to a power outage.
Nomura hypothesized that the children’s exposure to their mothers’ stress hormones — even though the placenta converts cortisol into an inactive form, cortisone — would have an effect on children’s brains. But she was surprised by the initial data that researchers collected regarding children’s stress response.
“The difference was humongous. It was literally like over 20 times [the] difference in anxiety and aggression,” Nomura said. She and her colleagues wondered if they were “exaggerating the differences” somehow, perhaps because they were using a self-reported scale.
However, in follow-up interviews where children were thoroughly assessed by trained clinicians, the numbers held.
There were 163 preschool-aged children enrolled in the study, of whom 66 were exposed to Superstorm Sandy in utero and 97 were not. Eighty-five percent of the children were non-white, and 35% came from families with low socioeconomic status.
The overall rate of any disorder in the Sandy-exposed group of children was significantly higher (69.2%) than in the control group (51%). Exposed children had five times the risk for anxiety disorders and ADHD, and 16 times the risk for dysthymia, also known as persistent depressive disorder.
The results were even more striking when broken down by gender. Girls in the exposed group had 20 times the risk for generalized anxiety disorder. Boys had 15 times the risk for oppositional defiant disorder, 20 times the risk for conduct disorder and 62 times the risk for ADHD.
“It was just so clear-cut, there was no room for arguing,” Nomura said. “[The] magnitude of difference is so strong in terms of the risks.”
While it is unclear how the stress of Sandy caused these increases, it is clear that the effect on the children’s psychiatric health was substantial, and that it was mediated significantly by gender.
What we know about kids’ mental health and exposure to stress
Dr. Helen Egger is a child psychiatrist, former director of the Child Study Center at New York University and co-founder of Little Otter, a company that provides online mental health care to children.
The results of this study, Egger told HuffPost, are remarkable but not entirely surprising. (Egger is not one of the study’s authors.) She believes psychiatric disorders in children this age are generally under-diagnosed, as evidenced by the high rate of such issues in both groups of children involved in the study.
Egger explained that by isolating other variables, the study is able to show a link between the stress these children experienced in utero and the way their brains work. We know that genetics and environmental stressors encountered after birth have an impact on kids’ mental health, but this study indicates that stressors in utero also play a role.
“What we really are seeing, and [what] I think this study emphasizes, is that when moms are experiencing significant stress, that it’s actually getting into the architecture of the babies’ brains,” Egger said.
“One in five preschool children has a clinically significant mental health challenge,” she said, noting that this is the same rate as seen in older children, although kids are not generally screened for mental health issues while they are this young.
Egger believes this must change. Just as we are now more aware of the benefits of early intervention for children with autism, and children are carefully screened by their providers for autism risk, Egger believes that mental health checkups should become the norm for younger children, too.
People are quick to talk about kids’ resilience, but we need to understand that this resilience isn’t infinite, she said.
“There are experiences that young children have ― it’s true of older people, too ― that no human being could remain intact and not be impacted,” Egger said. “I think that’s where the resilience discussion needs to be nuanced, because those children didn’t fail to be resilient.”
Kids’ risk of mental health issues goes up for every stressful event, whether it’s a natural disaster or a death in the family, she said.
“Once a child has experienced five or more significant stressors, 100% of those children have a clinically significant problem,” Egger said.
Is climate stress different from other kinds of stress?
In quantifying the psychological impact of a hurricane, Nomura’s study suggests that other stressful events, such as the COVID-19 pandemic, may have a similar effect. And if natural disasters provoke this kind of a stress response, then we can expect further mental health implications as climate change intensifies, causing more storms like Sandy and Hurricane Ian.
Is this different, somehow, from existential threats that humans have faced in other times?
“The way in which climate change is different is that there is so much evidence that it is irreversible, and that this generation of adults are not trying to preserve the world for the next generation,” Andrew Solomon, whose book “Far From The Tree” explores parents’ relationships with children who differ from them in a significant way, told HuffPost. “But there have been arguments of similar urgency before.”
Ours is not the first generation to confront a doomsday scenario, Solomon explained, citing instances of naturally occurring devastation like the bubonic plague, as well as human-created catastrophes like slavery and the Holocaust.
“Parents of children with psychiatric disorders tend to blame themselves — wrongly in general. They are likewise blamed by the people around them.”
Even the knowledge that a disaster during pregnancy can affect a child’s brain is not new. Children whose mothers were pregnant during the Dutch famine at the end of World War II were found to have more than twice the risk of developing schizophrenia as adults.
Climate change presents a unique threat, but when it comes to mental health, we have more ability than ever to screen, diagnose and treat psychiatric conditions in children. Our understanding of the complex interplay of biology and environment has advanced considerably, allowing us to identify those children who are most at risk.
How can this information help parents, instead of just making them feel guilty?
The study’s findings might make some parents feel like it’s their responsibility to avoid all stress during pregnancy — an impossible feat. Parents of kids who do have psychiatric diagnoses might also wonder what they could have done to prevent them.
These feelings of guilt are nothing new. “Parents of children with psychiatric disorders tend to blame themselves — wrongly in general,” Solomon said. “They are likewise blamed by the people around them.”
Part of this guilt stems from old, now disproven theories.
“The midcentury psychiatrists who said that schizophrenia, for instance, was caused by withholding mothers, are now viewed as naive,” Solomon said. “But these disproved theories have a long tail, and the question of blame haunts the conversation.”
Likewise, Egger noted, “the field of child psychiatry is rife with blaming mothers.”
Of course, there’s nothing the mothers in the study could have done to stop Superstorm Sandy, just as there’s nothing a child can do to erase a genetic risk or an environmental stressor.
What these high rates of psychiatric conditions should encourage is screening and treatment for affected families.
“This is about what we don’t have in place to support mothers and families and children, not about a personal failing,” Egger said.
“Being guilty is a waste of time,” Nomura said. It is the responsibility of policymakers, not individual parents, to provide solutions.
“Community health really directly is influencing individual health… so that’s the kind of thing we really have to invest [in] for future generations,” she said.
The COVID-19 pandemic has shown us the importance of thinking about health at the community level, Nomura noted. And now we can add it to the list of stressors that have affected children’s mental health, whether they were in utero or in kindergarten when the pandemic hit.
Rather than getting caught up in our guilt, or in trying to isolate the cause of a child’s struggle, Egger suggests that parents “realize that the earlier we identify when our child is having challenges, the more effective intervention can be.”
Egger speaks of mental health diagnoses the way a teacher might describe a learning disability: a challenge to learn to work around and cope with, rather than a sentence to being unsuccessful or unhappy.
“When children are identified and treated properly, as early as possible, you’re in some ways really preventing the impairment,” Egger explained.
What to do if you suspect your child is having mental health problems
If you have concerns about your young child, you can start by discussing them with your pediatrician, who can help you find a mental health professional who can do a psychological evaluation.
It can be tricky to pick up on what a preschooler is feeling when they aren’t able to articulate it themselves. And signs of struggle can be difficult to interpret: Tantrums, for example, are normal for young children.
“However, if a child hits, bites, kicks, or breaks something during a tantrum… they are seven times more likely to have a clinically significant mental challenge,” Egger said. These “aggressive tantrums,” as Egger calls them, predict not behavior problems but depression and anxiety.
When hunting for a therapist, you want someone who doesn’t treat your child in isolation, but includes you in a family-centered approach. Two promising therapeutic models, according to Egger, are parent-child interaction therapy, designed to address behavior problems, and child-parent psychotherapy, designed to address trauma. You can look for a therapist trained in one of these models.
While we may be powerless to prevent events like hurricanes, “we’re not powerless in how we respond,” Egger said. “We’re not powerless in the world that we create, and how we support ourselves and our kids.”