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) has released draft recommendations that providers begin screening children for anxiety at age 8. Note that this recommendation is for children not experiencing symptoms. Children of any age who are exhibiting symptoms of anxiety should be evaluated immediately.
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 Martha Kubik, a professor with the School of Nursing, College of Health and Human Services at George Mason University, in a statement released by the task force.
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.