Schoolchildren in Malta are experiencing behavioural and mental health issues that psychologists say can be linked to the COVID-19 pandemic five years ago.

In March 2020, as the pandemic reached Malta, all schools were closed for the remainder of the school term.

The decision was taken as part of strict containment measures to reduce community transmission of COVID-19. Both educators and students had to rapidly adjust to remote learning on digital platforms.

State schools began to reopen seven months later, albeit with conditions like a great emphasis on hygiene, wearing masks, smaller classrooms and distancing of desks. And while on the whole, lockdown conditions in Malta were not as strict or prolonged as in other countries, the effects of social isolation were still felt.

Anthea D’Amico, a counsellor and lecturer at the University of Malta, said that while the impact of the pandemic on children whose first years of life were defined by COVID-19 had yet to be fully understood, certain trends were noticeable.

“The years between birth and six years old are crucial for a child’s development. At these ages, children learn to regulate their emotions and move through the world in a variety of ways, including doing physical activities, doing arts and crafts, playing outside, and so on,” she said.

Since opportunities to do these things with people outside their immediate family were limited, D’Amico explained, some children were having problems processing sensory information.

“You had a situation in which socialisation wasn’t happening in a normal way, while society itself was in a state of alert with people obsessing over their health.

"Many families also suffered financial hardship, which often led to marital problems. All of this meant that children couldn’t rely on adults to provide the sense of safety they normally would, because they were dysregulated too,” D’Amico said.

“Having said all this, children are very resilient, so we need to see how it all pans out,” she added.

Increase in anxiety and depression among children

These observations were echoed by fellow psychologist Stephanie Borg Bartolo, who said that while establishing a direct link between the pandemic and children’s mental health was not straightforward, professionals had seen an increase in anxiety and depression among children.

“Young kids didn’t understand why they had to wear masks or why the adults were fussing about hand sanitiser. All of this caused a lot of frustration and stress, and when children are overwhelmed, they act out,” she said.

The pandemic particularly affected children with learning difficulties who previously benefitted from the structure and routine that school provided.

“It was also hard for children who already struggled with facial cues because when they started school, their teachers would have been wearing masks.”

Luckily, Borg Bartolo said, research abroad showed that despite their parents wearing face masks, babies were still able to recognise them from their eyes.

Bartolo herself has a son who was born a year before the pandemic and another who was born during.

“Before the pandemic, if we went to a playground, my oldest son would be the first to approach other kids to play with them.

"Fast forward to when he was three-and-a-half, and the restrictions were being lifted, he was very hesitant. It wasn’t because of his character but because he’d learned to keep his distance,” she said.

Reliance on technology for learning

Both D’Amico and Borg Bartolo noted that another consequence of the COVID-19 restrictions was a reliance on technology for learning.

“Under normal circumstances, children shouldn’t be exposed to tablet and phone screens to the extent they were, but there was no choice because everything had to move online,” D’Amico said.

“Screen time is very addictive in nature, so kids get confused when you suddenly try to take that away from them,” Borg Bartolo said.

When it comes to how they go about treating the trauma related to the pandemic, D’Amico said every child is unique.

“It helps to go through the timeline of the trauma and talk about how they can change the narrative from negative to positive,” she said.

“When it comes to helping them to improve how they process the world, parents and caregivers should encourage kids to engage with life outside the screen. Occupational therapy, which focuses on how children move, play and communicate with the world around them, can also help.”

Borg Bartolo said her approach depended on the age of the child.

“If they’re very young, I opt for play work. For example, I’ll create a story in a sand pit with animals, in which one of the animals is scared to go to the circus again. In this way, the child doesn’t feel threatened because the story isn’t about them directly.”

Meanwhile, a learning support educator who works at a primary school said she had been seeing these issues first-hand among children who were now around 10 years old.

“A lot of kids struggle with sharing, taking turns and group play. Many also have separation anxiety due to spending so much time with their parents and grandparents during the pandemic,” she said, listing short attention spans and an inability to deal with conflict as other common problems.