Regular screening for anxiety in their doctor’s office is one way to help children before their problems escalate. Vladimir Vladimirov/Vladimir Vladimirov/Getty Images Hide Caption
toggle caption Vladimir Vladimirov/Vladimir Vladimirov/Getty Images
Regular screening for anxiety in their doctor’s office is one way to help children before their problems escalate.
Vladimir Vladimirov/Vladimir Vladimirov/Getty Images
An influential panel of experts says all children ages eight to 18 should be regularly screened for anxiety. This draft recommendation by the United States Preventative Task Force comes at a time when mental health problems in children have escalated and are overwhelming the health system.
The task force also recommends that children ages 12 and older be screened for depression, a recommendation that has been in effect since 2016.
The screenings are usually done by general practitioners using standardized questionnaires that parents and/or children answer, depending on their age.
“We’ve already seen rising rates of anxiety, depression and also suicidal behavior and suicide in our young people,” said Martha Kubik, a professor of nursing at George Mason University and a member of the task force.
The goal of the screenings, she says, is to help doctors and other health care providers identify at-risk children early in the trajectory of their disease so they can be treated before symptoms escalate.
Mental health experts for children and adolescents welcome the recommendations.
It’s becoming increasingly clear that most mental illness manifests itself in childhood and adolescence, says Dr. Jennifer Havens, the chair of child and adolescent psychiatry at NYU’s Grossman School of Medicine.
But an anxiety disorder, one of the most common mental illnesses in children, can go unnoticed for a long time.
“It can be quiet. Children who are anxious are often very self-conscious and won’t necessarily share it with their family or their doctor. So screening is a very, very good idea.”
Most cases of anxiety in children can be treated with psychotherapy, she adds. Only children with severe anxiety need medication. That’s why, she says, the earlier a child is diagnosed, the easier it is to treat.
Children with anxiety disorders are at higher risk for anxiety disorders and depression in adulthood, along with related risks such as substance abuse, the recommendation notes said.
Pediatricians have long recognized the need for screening, says Dr. Sandy Chung, president-elect of the American Academy of Pediatrics, as they have seen an increasing number of their patients struggle for years with a range of psychological symptoms. These grew to alarming numbers during the pandemic.
“We are really in a mental health crisis,” she adds.
In the fall of 2021, the AAP, along with the American Academy of Child and Adolescent Psychiatry and the Children’s Hospital Association, issued a statement calling children’s mental health a national emergency.
The AAP had already recommended screening teens for emotional and behavioral problems such as anxiety and depression, and many pediatricians are already screening their patients for anxiety and depression, Chung adds.
“We appreciate the task force making the recommendation, but in reality, many pediatricians are already doing the job [already],” she says.
Many of those pediatricians are connected by phone with psychiatrists and psychologists through so-called mental health access programs, adds Chung, who helped establish the Virginia Mental Health Access program.
Some pediatric clinics that perform mental health screens may provide follow-up care through in-house caregivers. For example, Montefiore Medical Center, which screens some 86,000 children annually for emotional and behavioral problems.
“In our primary care practices, where children go to their pediatrician, we already screen for childhood anxiety, depression, and also attention problems that start as early as children are four years old,” said Miguelina German, a child psychologist at the center who has integrated behavioral therapists like herself into practice.
Anyone who screens positive is referred to German or one of her behavioral therapy colleagues.
And the younger a child is when they screen positive for a mental health problem, the easier it is for her and her colleagues to treat them, she adds, because mental health problems worsen with age, if left untreated.
“If I have a 15-year-old who is anxious, there’s a very high chance that she will also become depressed,” says German. “But there was once that 15-year-old was 10 years old, and let’s say when she was 10 years old, she had some social anxiety. She had some trouble making friends.”
Also, if health care providers are treating children’s problems when they are younger when symptoms start to crop up, she says, it often takes fewer sessions than treating a more complex problem in an older child.
Therefore, she hopes that this model of integrating mental health care into pediatric practices, along with universal screening for mental health symptoms, will become the standard of care across the country.
The panel also examined the evidence behind suicide screening and found insufficient evidence to support the idea.
But that decision worries Dr. Christine Yu Moutier, the medical director of the American Foundation for Suicide Prevention.
“We are very concerned that the task force is not looking at the more recent data that actually shows that suicide risk screening can be done effectively and safely,” Moutier said.
There are more than six recent studies showing that asking kids if they’ve had thoughts of hurting themselves can really help open up a safe space for them to talk about their distress, she adds.
“We know that many young people who think about suicide don’t tell anyone,” she says. “And so we have to screen.”
The AAP and AFSP recently released a blueprint for youth suicide prevention that recommends screening adolescents for suicide.
The draft recommendations are open to public comment until May 9, Kubik says, and the final recommendations are likely to be released by the end of 2022.
Moutier hopes that the final advice will include a recommendation to also screen children for suicide.
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