All children 8 years of age and older should be screened for anxiety, the U.S. task force says

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

A draft of the new guidelines, which is open to public comment, is likely to be finalized by the end of the year. It was issued Tuesday by the U.S. Preventive Services Working Group, a group of volunteer experts appointed by a federal government agency to make recommendations to health care providers about preventive clinical care.

The working group, set up in 1984 by Congress, has no regulatory authority; however, their recommendations carry weight among physicians.

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

This may be especially true for those with 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 could easily “slip through the cracks,” he said. .

The pandemic has only continued to aggravate the problems that children have suffered.

The U.S. Working Group recommended the detection of anxiety, regardless of whether a physician has been connected to any signs or symptoms.

“It’s important to be able to intervene before a life is interrupted,” said Martha Kubik, a member of the task force who is also a professor at George Mason University School of Nursing in Fairfax, Virginia.

Childhood anxiety disorders have been linked to an increased risk of depression, anxiety, behavior problems and substance abuse, according to a report by the Child Mind Institute, a non-profit organization that provides therapy and other services to children. and families with mental health and learning disorders. .

The working group said it did not yet have enough evidence to recommend for or against the detection of anxiety in children under 8 years of age. The panel still recommends depression tests for children 12 and older.

There are several different surveys and questionnaires that can be used to detect anxiety in primary care, Dr. Kubik said.

Some of these tools may target specific anxiety disorders, while others may detect a variety of disorders, and the duration of each screening may vary. “What our review found is that these screening tools are effective in detecting anxiety in young people before they can show obvious signs and symptoms,” he said.

The ideal would be to examine children during their annual child health reviews, said Dr. Kubik, however, doctors should also remain open to detection opportunities during other visits.

If an examiner indicates that a child needs additional support, it is not a diagnosis, experts said, but a starting point for a broader conversation for follow-up that may include a referral to a mental health provider.

“Psychotherapy is the first-line treatment,” said Tami D. Benton, chief psychiatrist in child and adolescent psychiatry and behavioral science at Philadelphia Children’s Hospital. Medication may also be needed if anxiety is impairing a child’s ability to function normally or if psychotherapy alone has not been effective, he added.

Finding a mental health provider is not necessarily a quick or easy task, but screening is no less important, experts said.

As more and more young people in need of help are identified, “many are beginning to put pressure on decision-makers and people with lanyards,” including insurers, said Dr. Carol Weitzman, co-director of the Center. Autism Spectrum. at Boston Children’s Hospital and a spokeswoman for the American Academy of Pediatrics. “We need to shed 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 other than those of the U.S. task force.

Dr. Weitzman said the PAA is in the process of developing more tools and resources to support pediatricians in detecting anxiety.

The working group, while stressing the need for further research, said it did not have enough evidence to recommend automatic detection of suicide risk in asymptomatic children and adolescents.

However, the AAP recommends regular monitoring of suicide risk in children 12 years of age and older. Suicide is the second leading cause of death among children aged 10 to 19 years.

“Many children will keep suicidal thoughts to themselves; they won’t raise the issue unless asked to do so; “To talk about it,” said Dr. Weitzman, who is also a behavioral pediatrician.

According to the Centers for Disease Control and Prevention, more than 7% of children ages 3 to 17 have been diagnosed with anxiety. But “many children struggling with anxiety will not necessarily be diagnosed,” Dr. Benton said. A nationally representative household survey, for example, found that nearly one in three teens, or about 30 percent, meet the criteria for an anxiety disorder.

And a study published in JAMA Pediatrics found that between 2016 and 2020 there were significant increases in diagnosed anxiety and depression among children, as well as decreases in the emotional well-being of caregivers.

If you’re concerned that your child may be struggling with anxiety, experts recommend talking to your child’s pediatrician or other primary care physician, who can help distinguish between typical anxiety and the indicative type. of an emerging problem or disorder.

A certain degree of anxiety is perfectly normal, experts said, and anxiety can even offer benefits in helping us stay safe and aware. In addition, there may be times in our lives when anxiety can become stronger; they are also normal and, regardless of the circumstances, some children are more likely to worry than others.

But persistent anxiety that affects a child’s daily life may be indicative of an anxiety disorder. Experts said they were paying attention to the following signs, especially if they reflect changes in previous behavior:

  • Eating too much or too little

  • Sleep more or less than usual

  • Dropping notes

  • Relationship changes

  • Irritability

  • Boredom

  • Sensitivity to criticism

  • Loss of interest in activities

  • Physical symptoms, such as headache or stomach ache

  • Problems separating from caregivers and resistance to going to school or sleeping alone

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