Racism and social inequality don’t just affect adults. Here's why they have a profound impact on the mental health of children of color.
Roisin and Danny Huang took their 6-year-old daughter to cultural celebrations and dim sum restaurants in Seattle’s Chinatown-International District, cultivating her Chinese identity and cultural pride.
To Roisin, who is White, and her husband, who is Chinese and first-generation American, that was an important part of their parenting. Despite some internalized racism their daughter was experiencing, she had come to accept and celebrate the Chinese part of her identity and culture.
In the week after Chinese New Year in late January, Huang’s daughter attended school dressed in a traditional outfit to celebrate. Several weeks later in March, one of her teachers showed the kindergarten students a news segment on handwashing to prevent contracting the coronavirus that came from China — without the context that people of Chinese and Asian descent weren’t to blame.
Huang hadn’t yet had a nuanced conversation with her daughter about the coronavirus. The news crushed the little girl, who was the only student in her class of Asian descent. She came home to her mother announcing what she had learned, full of disappointment and feeling like she was partly to blame for the spread of the virus.
“I said, ‘Yes, honey, the virus came over from China. But that doesn’t mean that it’s people from China’s fault. Viruses come from all over.’ I had to give her context,” said Huang, who is from Seattle. “She had a really hard time. You could tell she was really sad about it.”
Huang explained to her daughter the prejudiced comments that kids might say and prepared her to stand up for herself. She also met with the teacher to explain the significance of the missing context. Since the students were pulled from school about six weeks later, Huang’s daughter was shielded from any future possible discrimination in class.
Months later, the distance hasn’t alleviated her daughter’s struggle with her half-Chinese identity. She has asked her parents, “Why are we China?” (in her 6-year-old patois); shown favoritism toward dolls with lighter skin tones; and once declared, “I’m White” during in-depth conversations about identity — which hurt her father.
“As many conversations as I have (with her), it doesn’t take away societal impacts about what’s good or what’s pretty,” Huang said.
The sadness, resentment, anger and confusion her daughter now feels toward her Chinese identity have shaken her positive identity and cultural pride — two factors that are predictive of the quality of one’s mental health.
The internalized racism that Huang’s daughter is facing stems from the racism children of color regularly experience, which can lead them to question their worth and place. Internalized racism is the “acceptance, by marginalized racial populations, of the negative societal beliefs and stereotypes about themselves,” as defined by researchers.
The concept of institutional racism is the systematic distribution of “resources, power and opportunity in our society to the benefit of people who are White and the exclusion of people of color,” according to Solid Ground, a social justice organization in Washington state.
Institutional racism has been blamed for the higher likelihood of poverty, food insecurity, poor overall health, environmental injustice and incarceration among Native Americans in the United States and among Black, Latinx and Asian people in both the US and the United Kingdom.
It’s separate but related to the bigotry or racial bias of individuals, according to Solid Ground, because it entails “systematic policies and practices within institutions that effectually disadvantage certain racial or ethnic groups.”
These race-based social disadvantages don’t just hurt adults. Since they expose children to discrimination and hamper a family’s ability to adequately support their children, they are “really intertwined with a child’s mental health,” said Dr. Tania Maria Caballero, an assistant professor of pediatrics at the Johns Hopkins School of Medicine in Baltimore.
“In the setting of the pandemic, those pieces of the family roots are really affected,” Caballero said.
Low-income and immigrant families who already experienced disparities or difficulties in accessing basic needs like food, shelter, education and transportation to work have seen their challenges exacerbated, Caballero said. Children with parents whose first language isn’t English may be struggling with virtual homeschooling.
People of color are at greater risk for serious illness and death from Covid-19, Caballero said — so witnessing family members fall sick or grapple with the risk of going to work and financial struggles can also add considerable depression and anxiety to the whole family unit.
Basic needs “are the foundation of a family and a family unit and being able to nurture and grow a child within all those different factors,” she added.
The imprisonment of Edna Maxwell’s father launched a chain of events that ping-ponged Maxwell and her siblings between their aunt’s house, foster care and adoption.
A life of hardship preceded her father’s drug possession and dealing, including his mother’s death when he was 19 and living in low-income housing. Through most of her childhood, her father was in prison for possession, Maxwell said. Foster care led her to an abusive adoptive parent who severed contact from Maxwell’s biological family, and whose physical, emotional and mental abuse interfered with her education.
“His imprisonment mainly affected me because I couldn’t get to know him, so it was harder to get to know myself,” Maxwell, who is Black, Mexican and Samoan and from San Jose, California, said via email. “Other people would open their homes to me, but the trauma was so deep I’d mess up the placement, and ended up back with my adoptive mom.”
Because of California Proposition 57, which was approved in 2016 and allowed parole consideration for nonviolent felons, her father has been out of prison since 2017.
“Mass incarceration has effects (on) individuals, families, and communities,” said Dr. Nia Heard-Garris, an assistant professor of pediatrics at Northwestern University in Evanston, Illinois, and a pediatrician and researcher at Ann & Robert H. Lurie Children’s Hospital of Chicago, via email. “Youth who have had a parent incarcerated are more likely to become involved in the juvenile justice system.”
Young adults with histories of parental incarceration and juvenile justice involvement have been more likely than their peers to have depression, anxiety and post-traumatic stress disorder, Heard-Garris’ 2019 study found. Black and Latinx adults are more likely to be incarcerated than White adults and as a result, their children have a greater likelihood of experiencing depression, post-traumatic stress disorder and anxiety.
The oppression of Native Americans and resulting intergenerational trauma have led to adverse childhood experiences for Native American children, which contribute to higher rates of depression, suicide and anxiety.
Mental health status varies across children from the nearly 600 federally recognized tribes — but historical trauma and cultural loss “seem to have varying impacts across generations,” said Melissa Walls, an associate professor of international health at the Johns Hopkins Bloomberg School of Public Health and director of the Great Lakes Hub for the Johns Hopkins Center for American Indian Health.
“For example, elders in one study with Alaska Natives cited cultural loss due to colonization as a stressor, whereas youth there more often internalized blame for not engaging with their Native culture,” she added via email. “Native youth exist within this context of ‘traditional’ ways and modern societal influence, so that can be tough to navigate.”
When family roots that are nurtured by values, experiences, history and culture that keep families strong, proud and resilient are put “into a soil that has elements of discrimination (and) systemic racism,” Caballero said, a child’s prospective success can be dashed.
“We say children are resilient,” Caballero said — but for that characteristic to develop, those fundamental protective factors need to be there.
Ari Lawson’s anxiety, depression and possible PTSD traces back a decade, when she was 12 years old and witnessed a policeman pull a gun on her grandfather.
Lawson and her late grandfather, brother and a female relative — who are all Black — were road-tripping from Ohio to Alabama so her grandfather could meet his biological father for the first time in 2011. As they drove through one of the Bible Belt states, approaching sirens led Lawson’s grandfather to instruct her and her brother to lay on the car floor and not say or do anything that could be alarming.
“My granddad obviously was raised during the civil rights era, so he was already a little paranoid of police,” said Lawson, who resides in Boca Raton, Florida. At that point in Lawson’s childhood, she had learned enough from news reports and Black history to feel “a little scared” about the potential outcome.
As her grandfather searched for his wallet, the cop screamed at him to exit the car, Lawson said. Anxiety, adrenaline and claustrophobia coursed through her as she remained still. “I felt like I needed to run away,” Lawson added.
At some point, the officer drew his gun on her grandfather, to her mother or aunt’s (Lawson couldn’t remember which) protests.
After questioning — of her grandfather by the cop and toward the policeman by her mother or aunt — Lawson’s grandfather headed toward Alabama, with a ticket he’d later address in court. She and her brother remained hunkered down on the car floor for two more miles, where they held one another close.
A decade later, Lawson is seeing a therapist for anxiety and depression. “We’re working together on determining if I have post-traumatic stress from the incident. Because pretty much every time I see a cop in public, I try to get out of the area fairly quickly. It gets a little nerve-racking and makes me feel the same way as I did (then). Very small and very afraid.”
Experiencing racism has been linked to mental health problems, faster aging and smoking uptake among youth. Chronic stress can lead to “increased and prolonged levels of exposure to stress hormones and oxidative stress at the cellular level,” said an American Academy of Pediatrics policy statement on the impact of racism on youth. “Prolonged exposure to stress hormones, such as cortisol, leads to inflammatory reactions that predispose individuals to chronic disease.”
—Nevin J. Heard
And it’s already in our children’s classrooms. Prospective teachers are nearly twice as likely to interpret the facial expressions of Black children as being angry, even when they are not, while giving White children the benefit of the doubt, one study found. That unconscious bias might contribute to the disciplinary discrepancies observed in schools, another form of systemic racism, the authors said in a news release.
“The labels that children receive in childhood stick with them and can be internalized,” said Nevin J. Heard, an assistant professor of clinical counseling at Roosevelt University in Illinois, via email.
“When a child is labeled ‘aggressive’ or ‘a problem’ that can become a self-fulfilling prophecy.
These labels can contribute to both delays in learning and cognitive diagnoses and also overdiagnosis, which may lead to adverse mental health outcomes over the lifespan.”
Youth incarceration rates have decreased, but Black, Latinx and Native American youth are disproportionately represented and are more likely to experience solitary confinement and abuse — which have the potential to shape mental health, socioemotional development and ultimate function in society.
When Tatiana Henriquez was 12, she had no way of knowing that one October day was the last time she would see her father.
Her father had lived in California since he was 7, when he immigrated from El Salvador. Shortly after Henriquez began seventh grade, her father was pulled over and fingerprinted but released since the technology was down. Their day went on uneventfully, until a few weeks later when her mother heard a knock at the door around 4 or 5 a.m.
Henriquez’s father hadn’t renewed his residency in time. While Henriquez was sleeping, US Immigration and Customs Enforcement officers told her mother that if her husband didn’t exit the house, they would cause a scene. He left with ICE, and Henriquez’s mother and grandmother came to her room, crying and frantic as they delivered the news. Henriquez never got to say goodbye.
“I feel like that’s a time in a girl’s life, and honestly, any child’s life, where they need both of their parents to show them how they deserve to be loved,” Henriquez said. “Growing up like that, without my dad, was really hard — especially the way that it happened, having to go to school and not being able to tell anybody what was going on (because they wouldn’t understand) was the worst.”
She also didn’t want anyone to make fun of her or call her father a racial slur.
Immigration agents arrested about 143,000 immigrants and removed more than 267,000 immigrants in the US from fiscal year October 2018 to September 2019. Some of those people were parents who were deported without their children, and ICE has been criticized for arresting parents as they dropped children off at school.
Children thrive on routines, predictability, familial closeness and social connections. The challenges of immigration may threaten those fundamentals: The economic ceiling of immigrant families may be limited based on their ability to access continuous and well-paying jobs, Caballero said.
Soon after her father was taken away, Henriquez started experiencing anxiety attacks. They were serious enough to warrant emergency room visits until her family and professionals realized anxiety was the problem.
“My attacks started from my sleep because I was asleep when my mom had told me that my dad got deported,” Henriquez said. “I kept having anxiety attacks from dreams that somebody was taking something away from me. I would freak out of my dreams. I would wake up crying, (I) couldn’t breathe. Honestly, my anxiety has just gotten worse.”
Bipolar depression and confusion followed, manifesting in anger that led her to act out in school, sit in detention and almost flunk or repeat seventh grade. “I was angry at the world,” she said. Her mother lost their house, so they had to move.
“I’m 21 years old,” said Henriquez, who stays in touch with her father via Skype occasionally. “It’s been nine years and I’m still dealing with stuff like that. So, it’s forever. It never goes away.”
The loss of a parent and provider means some adolescents return home from school to their other occupation: tutoring their younger siblings and cleaning the house, making having a normal childhood difficult. “Poverty can really affect family connectedness,” Caballero added. “It can affect a child’s ability to have access to extracurricular activities as well.”
Even without deportation problems, immigrant children can experience stress when their customs are in stark contrast to the cultures, values, languages and expectations of other children of the same age in their new home.
“You may have a child from the Dominican Republic, who (attended) a school with all other Black children who all speak Spanish, (come) into a US school, and they are labeled Black when they identify as Hispanic because they speak Spanish,” Caballero said.
Ethnic identity and pride have really positive effects on the mental health of children, whereas being redefined in other people’s terms can stress the child — leading to isolation, duality of identity and search for their place in new settings.
While children are young, they put their parents on pedestals. To see another adult treat their parents poorly or like children can be devastating and stressful. It “makes them question their safety in the society of other adults who treat their parents in a poor manner,” Caballero said.
Children can experience trauma symptoms of anger, sadness, withdrawal and loneliness if their parents have been deported. Even hearing stories about deportation can stoke “a lot of fear around the potential for separation.”
And if parents were traumatized during their migration process, their children might face the repercussions, Caballero said: Without support, parents may not be able to process their trauma in a way that leaves them able to lovingly, positively and consistently parent.
Despite the fact that Middle Eastern and Arab people in the United States have faced “adversities such as hate crimes, stigma, and harmful social policies, particularly since 9/11,” studies on the impact on children’s mental health are lacking, said Maryam Kia-Keating, a clinical psychologist and professor of clinical psychology at the University of California, Santa Barbara, via email.
“Researchers rarely include Middle Eastern and Arab children as a sub-group. This ‘invisibility problem’ has arisen in large part because of the limits of the way we tend to categorize race in very broad and socially constructed groupings.”
Erasure from the US Census, discrimination and hate crimes faced by Middle Eastern and Arab people have led to adverse childhood experiences; negative, long-term impacts on mental health; and insufficient mental health services for these groups, Kia-Keating said.
The stress of vicariously experiencing racial violence stems from knowing it could happen to you. Depending on a child’s age, that constant adrenaline can negatively affect developmental outcomes and his ability to trust people and concentrate in school.
Data on the mental health impacts of anti-Chinese bias during the pandemic is already being collected, which could help Huang’s 6-year-old daughter someday.
Some people have cast blame for the crisis on Asian Americans and Asian British people. Chinese American parents and their children have reported being directly targeted by pandemic-based racial discrimination online and in person, found a study prepublished in the journal Pediatrics.
Higher levels of perceived racism and discrimination were associated with poorer mental health reports in parents and youth.
“The anger from hearing those kinds of comments and that anxiety around the impact of those hurtful comments but also anxiety about, potentially, some of those comments becoming physical, are cause for anxiety and depression,” said Dr. Tina Cheng, a professor at the Johns Hopkins School of Medicine’s department of pediatrics and its director.
Stigma among many Asian communities can mean that children’s anxieties aren’t widely accepted as being legitimate, added Cheng, who is also pediatrician in chief of The Johns Hopkins Hospital.
Though the onus for change is on societal institutions, there are ways parents can support children if racism or social disadvantages are harming their mental health. Reconnect with family values, history, culture, racial and ethnic pride, and the support of communities with similar experiences.
To understand how to support your child, get to know how he seeks and feels comfort, Caballero said. Maybe it’s in music, friends, writing or parents.
If a child experiences discrimination, talk about it with respect to her age. There are books and resources for children based on their abilities to understand according to their ages. Help your child to reflect upon and process the incident by asking her to name and describe the events and her feelings. Doing so can also help you to know how she’s processing it according to her maturity level and personality.
Aid them in recognizing that some kids may not know much about their background or race and might say insensitive things. Help them establish who they can go to when people treat them badly or when anything happens that doesn’t feel right or is confusing, so that they don’t feel alone.
At the same time, don’t put the burden of solving discrimination on them. When another family is involved, talk to your child’s school about the appropriate way to handle racial discrimination and chip away at the larger structural problems that led to the incident, Caballero said.
Exposing kids to dolls, characters and writers of color who reflect their appearance, experiences and culture “can be very powerful (and) a barrier against the long-term impact of racism and discrimination,” Caballero said.
“They may not be able to stop racism and discrimination from happening to them, but they may have the strength, self-esteem and positive community to help them get through those experiences and then thrive and dismantle those systems that have put those experiences on them.”
Children of color tend to be diagnosed with mental health disorders less often and later than others. Identifying and treating mental health issues in all children early on is important so they can get accustomed to treatment plans while their brains are still adaptable and plastic, Caballero said. It’s an effort that would be helped by more time for screening in pediatric care, but one that is difficult given short appointment times and competing concerns such as height, weight, nutrition and family life.
“We know that societies and communities function more strongly and better the more diverse we are,” Caballero said. “Being able to prevent those experiences from happening by having more equitable access to insurance, food, shelter, education and workforce and supporting our families” can help stem long-term effects of not addressing mental health disparities.
“Kids are not smarter than other kids coming from other racial or ethnic backgrounds,” she added. “It’s the access to resources they need to thrive in order to get to the same place as other children.”
Parents should “seek out the mental health care and treatment their children and teens need,” Heard-Garris said. “Parents can also find age-appropriate ways for their children to get involved in activism to make their world better. This affords them some agency in knowing they can make a difference.”
And most importantly, she added, “parents must first make sure they are caring for their own mental health and emotional health needs.”
The American Psychological Association's RESilience (Racial and Ethnic Socialization) program offers a few resources for parents:
Editors: Katia Hetter, Faye Chiu, Damian Prado and David Allan
Illustrator: Charlotte Edey
Digital design and development: Tiffany Baker, Gabrielle Smith and Ivory Sherman