Mental Health Crisis Magnified in 2020

A virtual ECHO Autism classroom

Photo: A virtual ECHO Autism classroom

While the COVID-19 pandemic has caused health care chaos in many parts of the United States and world, another less-visible epidemic has been brewing under the surface for decades: the behavioral and mental health crisis among children and adolescents.

Dr. Laurel Leslie“Going into 2020, we already knew we were in a mental health crisis, with escalating rates of anxiety and depression among children, adolescents, and young adults,” says Laurel Leslie, MD, MPH, ABP Vice President for Research. “Today, experts are documenting a ‘second wave’ of challenges with COVID-19, not related to the physical consequences of the virus, but the emotional, financial, social, and educational consequences.”1

Dr. Leslie notes that parents, already stressed due to the pandemic, may not personally have the emotional capacity or time to work, facilitate education, and help their children cope. Other adults who have provided support for families in the past, including teachers, guidance counselors, after-school program mentors, and sports coaches, are less available when schools operate remotely.

On top of the pandemic, children also see and feel the impact of racial injustice and social unrest. They heard vicious political debates and ads. They heard reports of wildfires out of control in the western United States and a near-record number of hurricanes hitting land in the eastern United States — and many children live in areas affected by these natural disasters.

Yet, in a recent survey of pediatric residents, only one in three self-reported high competence in behavioral and mental health assessment skills and only one in five self-reported high competence in treatment.2

To help pediatricians build their skills in diagnosing and treating behavioral and mental health issues, the ABP provides several Maintenance of Certification (MOC) resources (see below).

Board-certified pediatricians also are working to make a difference by sharing their stories about how to help children with behavioral and mental health challenges.

Dr. Kristin SohlFor example, Kristin Sohl, MD, a pediatrician at the University of Missouri Health Care system, founded ECHO Autism, a virtual learning network of providers. The network offers real-time access to autism and behavioral experts and MOC credit for meaningful participation. She shared her story in the ABP blog with Keith Mann, MD, MEd, ABP Vice President for Continuing Certification.

Dr. Eugenia ChanEugenia Chan, MD, MPH, Assistant Professor of Pediatrics at Harvard Medical School and an attending physician in the Division of Developmental Medicine at Boston Children’s Hospital, spoke with Dr. Leslie in October about the role of quality improvement (QI) in developmental-behavioral pediatrics and addressing stigma in mental health care.

Video conversations with Drs. Sohl and Chan and related MOC projects can be found on the ABP blog at and Additional behavioral and mental health resources during the coronavirus pandemic can be found at

Maintenance of Certification (MOC) resources

MOC Part 2 Self-Assessments:
Emotional Health and Resilience for Patients and Families with Chronic Pediatric Conditions; Adolescent Substance Abuse; Attention Deficit and Hyperactivity Disorder; Youth Suicide Prevention (in ABP Portfolio)

MOC Part 2 Question of the Week:
Targeted questions on mental health and racism (

MOC Part 4 Performance Improvement Modules:
Developmental and Behavioral Screening; Initial Diagnosis of Attention Deficit Hyperactivity Disorder; Follow-up Care of Pediatric Patients with Attention Deficit Hyperactivity Disorder; Screening for Adolescent Depression (in ABP Portfolio)

MOC Part 4 Exemplar Projects:
Examples of outstanding quality improvement (QI) projects that pediatricians can adapt to their practice (

1Norris T, Well Being Trust. Framework for Excellence informing COVID-19 response to flatten the 2nd curve and lay a foundation for long-term recovery. Accessed Dec. 17, 2020.

2Green C, Leyenaar JK, Turner AL, Leslie LK. Competency of future pediatricians caring for children with behavioral and mental health problems. Pediatrics Jul 2020, 146 (1) e20192884; doi: 10.1542/peds.2019-2884.