Assessment for anxiety should start at age 8, says US task force

The worsening mental health status of children has led an influential group of experts to recommend, for the first time, that all children and adolescents between the ages of 8 and 18 be screened for anxiety, one of the most common mental health disorders. in the childhood.

The draft text of the new guidelines, which is open to public comment, will likely be finalized 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 outline recommendations to healthcare providers on preventive clinical care.

Created by Congress in 1984, the task force has no regulatory authority, but its recommendations are often heard by physicians.

Screening more children for anxiety is “really important,” said child psychologist Stephen PH Whiteside, director of the Pediatric Anxiety Clinic at the Mayo Clinic in Rochester, Minnesota, who is not part of the task force. “Most children who need mental health care don’t get it.”

This may especially apply to children with anxiety, he said.

It’s more common for children with behavioral problems to be identified as needing help, but according to Whiteside, if children with anxiety disorders aren’t causing problems at school or at home, their difficulties can easily go unnoticed.

The pandemic only exacerbated the problems that children were already suffering.

Why is early detection of anxiety important?

The US task force recommended that children be screened for possible anxiety regardless of whether a doctor has identified any signs or symptoms.

“Being able to intervene before the child’s life is jeopardized is crucial,” explained Martha Kubik, a member of the task force and also a professor at the George Mason University School of Nursing in Fairfax, Virginia.

Childhood anxiety disorders are linked to an increased risk of depression, anxiety, behavioral problems and substance abuse later in life, according to a report by the Child Mind Institute, a nonprofit organization that provides therapy and other services to children and families with disabilities. mental health and learning problems.

The task force said it still doesn’t have enough evidence to recommend whether or not to screen children under 8 for anxiety. Experts continue to recommend depression screenings for children as young as 12.

How would this screening work?

There are already several different surveys and questionnaires that can be used in general practice to detect anxiety, Kubik said.

Some of these tools may target specific anxiety disorders, while others may capture a range of disorders. “Our review found that these screening tools are effective in capturing anxiety in children and adolescents before they show obvious signs and symptoms,” he said.

According to Kubik, ideally children would be examined during their annual child health check-ups, but doctors should also be open to opportunities to examine children during other visits.

If one of the instruments used indicates that a child needs further assistance, that is not a diagnosis, experts said, but rather the starting point for broader discussion and follow-up, which may include referral to a mental health professional. .

“Psychotherapy is the first treatment option,” said Tami D. Benton, director of child and adolescent psychiatry and behavioral sciences at Children’s Hospital of Philadelphia. If the anxiety is hampering the child’s ability to live normally or if psychotherapy alone has not worked, she added, medication may be needed.

Finding a mental health professional is not necessarily an easy or time-consuming task, but it is no less important for children to be examined.

As more children and teens who need assistance are identified, “it starts to put pressure on a lot of decision makers and people who control the money,” including insurance companies, said Dr. Carol Weitzman, co-director of the Autism Spectrum Center at Children’s Hospital Boston and spokesperson for the AAP (American Academy of Pediatrics).

“We need to shed a lot of light on the mental health needs of children, adolescents and youth in this country and we need to fight for better access to mental health care.”

Other organizations have their own processes for drafting recommendations that are distinct from the US task force.

Weitzman said the AAP is in the process of developing more tools to help pediatricians screen for anxiety.

How is the risk of suicide?

While highlighting the need for more research, the task force said it does not have enough evidence to recommend systematic screening for suicide risk among children aged 12 and over. Suicide is the second leading cause of death among children aged 10 to 19 years.

“Many children hide their suicidal thoughts from other people, only talking about it if someone asks,” said Dr. Weitzman, who is also a developmental and behavioral pediatrician. “So when you screen all children age 12 and over, it helps create a sense that there’s a safety net, that it’s okay to talk about it.”

How common is childhood anxiety?

According to the CDC (Centers for Disease Control and Prevention), more than 7% of children ages 3 to 17 have diagnosed anxiety. But, Benton said, “many children and teens who suffer from anxiety may not have been diagnosed.” For example, a representative US survey of families found that nearly one in three teenagers — about 30 percent — meets criteria for an anxiety disorder.

And a study published in the journal JAMA Pediatrics found that between 2016 and 2020 there was a significant increase in diagnosed cases of anxiety and depression among children, as well as a drop in the emotional well-being of those responsible.

How do you know if your child needs help?

If you are concerned that your child may be experiencing anxiety, experts recommend that you consult your child’s pediatrician or general practitioner, who may be able to distinguish between normal anxiety and the type of anxiety indicative of an emerging problem or disorder.

Some degree of anxiety is normal, experts said, and anxiety can even have benefits in that it helps keep us safe. Also, there may be periods in life when anxiety increases, which is also normal. And, regardless of the circumstances, some children tend to be more worried than others.

But persistent anxiety that affects a child’s everyday life can be indicative of a disorder. Experts recommend that parents watch out for the following signs, especially if they reflect a change from previous behavior:

• Eating too much or too little
• Sleep more or less than usual
• Drop in school performance
• Changes in relationships
• Irritability
• Rage
• Sensitivity to criticism
• Loss of interest in activities
• Physical symptoms such as headache or abdominal pain
• Difficulty separating from parents or guardians and resistance to going to school or sleeping alone