The deteriorating mental health state of children has prompted an influential group of experts to recommend for the first time that all children between the ages of 8 and 18 be screened for anxiety, one of the most common mental health disorders of childhood.
The draft of the new guidelines, which are open for public comment, are likely to be completed later this year. It was released Tuesday by the US Preventive Services Task Force, a committee of volunteer experts appointed by a federal government agency to make recommendations to health care providers about clinical preventive care.
The task force, created by Congress in 1984, has no regulatory authority. However, their recommendations do have weight among clinicians.
Stephen Whiteside, a child psychologist, said screening more children for anxiety is “really important.” Director of the Pediatric Anxiety Disorder Clinic at Mayo Clinic in Rochester, Minnesota, he is not a member of staff. “Most children who need mental health care don’t get it.”
This may be especially true of those who suffer from anxiety, he added.
Children with behavioral problems are more likely to be identified as needing help, but if children with anxiety disorders are not causing problems at school or at home, they can easily “slip through the cracks.”
The epidemic has continued to exacerbate the problems facing children.
Why is early detection important?
The US Task Force recommended screening for anxiety regardless of whether a physician referred any signs or symptoms.
“It’s critical to be able to intervene before life is disrupted,” said task force member Martha Kubik who is also a professor at George Mason University School of Nursing in Fairfax, Virginia.
Anxiety disorders in children have been linked to an increased risk of depression, anxiety, behavior problems, and substance abuse later in life, according to a report from the Child Mind Institute, a nonprofit organization that provides treatment and other services to children and families with mental health and learning disorders. .
The task force said it did not have enough evidence yet to recommend or not conduct anxiety screening in children under the age of 8. The expert panel continues to recommend depression screenings for children 12 years of age and older.
How will the examination work?
Dr. Kubik said there are many different surveys and questionnaires that can be used to screen for anxiety in primary care.
Some of these tools may target specific anxiety disorders, while others may screen for a variety of disorders – and the length of each examiner can vary. “What our review found is that these screening tools are effective in picking up anxiety in young people before they can present with overt signs and symptoms,” she said.
Children would ideally be screened during annual pediatric health checks, Dr. Kubik said, but doctors should also remain open to screening opportunities during other visits.
If the examiner indicates that the child needs additional support, this is not a diagnosis, experts said, but rather a starting point for a larger conversation for further follow-up that may include a referral to a mental health provider.
“Psychotherapy is the first line of treatment,” said Tammy D. Benton, MD, a general psychiatrist for child and adolescent psychiatry and behavioral sciences at Children’s Hospital of Philadelphia. Medications may also be needed, she added, if anxiety is harming a child’s ability to function as usual or if psychotherapy alone has not been effective.
Experts said finding a mental healthcare provider isn’t necessarily a quick or easy task, but screening is just as important.
As more young people are identified in need of help, Dr. Carol Weitzman, co-director of the Autism Spectrum Center, said it “is already starting to put pressure on many of the decision makers and the people who hold the reins,” including insurance companies. at Boston Children’s Hospital and a spokeswoman for the American Academy of Pediatrics. “We need to shine a bright light on the mental health needs of children, youth and adolescents in this country, and we need to advocate for better access to mental health care.”
Other organizations have their own processes for making recommendations separate from those of the US Task Force.
Dr. Whitsman said the American Academy of Pediatrics is working to develop more tools and resources to support pediatricians in screening for anxiety.
What about suicide risk?
While the task force stressed the need for more research, it said it did not have enough evidence to recommend automatic screening for suicide risk in asymptomatic children and adolescents.
However, the American Academy of Pediatrics recommends regular screening for suicide risk in children 12 and older. Suicide is the second leading cause of death among children aged 10-19 years.
“A lot of kids will keep suicidal thoughts to themselves – they won’t talk about the topic unless asked – so when you screen all kids 12 or older it helps create a sense of a safety net, that’s okay,” said Dr. Weitzman, who is A pediatrician specializing in growth and behavioral development.
How common is anxiety among children?
According to the Centers for Disease Control and Prevention, more than 7 percent of children ages 3 to 17 have diagnosed anxiety. “Many children with anxiety may not necessarily be diagnosed,” Dr. Benton said. For example, a nationally representative household survey found that approximately one in three teens, or about 30 percent, meet criteria for an anxiety disorder.
A study published in JAMA Pediatrics found that between 2016 and 2020 there were significant increases in diagnoses of anxiety and depression among children as well as decreases in the emotional well-being of caregivers.
How do you know that your child needs help?
If you are concerned that your child may be experiencing anxiety, experts recommend that you speak with your child’s pediatrician or other primary care physician, who may be able to help distinguish between typical anxiety and the type that indicates an emerging problem or disorder.
Experts have said that some degree of anxiety is perfectly normal, and anxiety can also provide benefits by helping to keep us safe and conscientious. In addition, there may be periods in our lives when anxiety may become stronger; These are also normal, and regardless of the circumstances, some children are more prone to anxiety than others.
But constant worry that affects a child’s daily life can be indicative of an anxiety disorder. Experts said to look for the following signs, especially if they reflect changes from past behavior:
Eating too much or too little
Sleeping more or less than usual
sensitivity to criticism
Loss of interest in activities
Physical symptoms, such as headaches or stomachaches
Problems being separated from caregivers and resistance to going to school or sleeping alone