We know that the stress caused by the pandemic and the social distancing required to minimize infection have taken a toll on everyone’s mental health, especially our children, who rely on interactions with peers and the outside world for healthy emotional development. And in October, the American Academy of Pediatrics declared a national emergency in children’s mental health, citing evidence from the CDC of an increase in mental health visits to emergency rooms during the pandemic.
Many children are suffering, and, as with any medical condition, early detection and intervention can prevent a crisis. We know that children with anxiety are more likely to later develop depression, substance abuse, and behavior problems.
To combat this issue, the U.S. Preventive Services Task Force (USPSTF) officially recommends that providers begin screening children for anxiety at age 8.
This means that children and adolescents who are not already being routinely screened for anxiety and depression will now be during their annual checkups. “We are talking about screening young people who are not presenting with explicit signs or symptoms of anxiety or depression at the time that they come to their primary care physician for a visit,” Martha Kubik, a professor in the School of Nursing in the College of Health and Human Services at George Mason University in Virginia, and a member of the task force, explained to the The New York Times.
The task force bases its recommendation on the relative frequency of anxiety among children. Before the pandemic began, the 2018-2019 National Survey of Children’s Health found that 7.8% of kids 3-17 had an anxiety disorder. This number is certain to have risen over the course of the pandemic.
The task force also reviewed studies to evaluate the accuracy of screening tools. In the case of anxiety and other mental health concerns, the screen is generally a list of questions that a healthcare provider asks a child, and sometimes their parent. They found that these screening tools were accurate enough to be of benefit to children 8-18, but did not find sufficient evidence to recommend screening in children 7 and younger.
“Fortunately, we found that screening older children for anxiety and depression is effective in identifying these conditions so children and teens can be connected to the support they need,” said Kubik said in a statement released by the task force.
There are a variety of surveys and questionnaires that pediatricians can use to screen kids for anxiety and depression. However, Dr. Kubik and the rest of the task force intentionally did not recommend one tool over another because of the varied resources and flexibility of pediatricians.
“There are a variety of screening options, and I think it depends on the population, it depends on the setting, and I think it depends on the amount of time clinicians have,” said Joseph McGuire, a child psychologist with the Johns Hopkins Children’s Center in Maryland told The New York Times. “We want these tools to be usable, and what’s going to work will vary across settings.”
It is also important to note that screening tools like surveys and questionnaires can help indicate whether a child may need additional support, but they do not offer an official diagnosis.
Parents might wonder what downside there could be in screening a child for anxiety or other mental health issues. The task force states in their recommendations that while “psychological interventions are likely to have minimal harms,” these include unnecessary “treatment, labeling, anxiety, and stigma.” At issue is also the limited time that pediatricians have with each patient per visit to address a broad range of issues that a child and family may be facing.
This is the first time that the USPSTF has made a recommendation regarding screening for anxiety in children. The task force also recommends screening for depression in children 12 and older.
In addition to assessing children 7 or younger who do show symptoms of anxiety, the task force acknowledges that providers have to weigh a number of other risk factors such as family history and environmental stressors when deciding which patients to screen. Females and LGBTQ+ youth have a higher prevalence of anxiety, and anxiety is being diagnosed in more Black youth now than in the past.
“Healthcare professionals should use their clinical judgment based on individual patient circumstances when deciding whether or not to screen,” says Task Force member Lori Pbert.
Of course, no screening tool can replicate the power of a parent’s knowing. If you sense a change in your child’s mental health, reach out to your healthcare provider as soon as you can.
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