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An influential panel of experts says all children between the ages of eight and 18 should be tested regularly for anxiety. The draft recommendation of the United States Preventive Task Force comes at a time when mental health problems among children are on the rise and making the health care system irresistible.
The task force recommends that children 12 years of age or older continue to be screened for depression, a recommendation that has been in place since 2016.
Screenings are usually performed by primary care physicians using standardized questions that parents and / or children answer depending on their age.
“We are already seeing an increasing rate of anxiety, depression and suicidal behavior and suicide among our young people,” said Martha Kubick, a professor of nursing at George Mason University and a member of the task force.
The goal of the screening, he said, is to help doctors and other providers identify at-risk children early in the course of their illness so that they can be treated before symptoms develop.
Child and adolescent mental health experts welcome the recommendations.
It is becoming increasingly clear that most mental illnesses manifest in childhood and adolescence, says Dr. Jennifer Havens, chair of child and adolescent psychiatry at NYU’s Grossman School of Medicine.
But anxiety disorder, one of the most common mental illnesses in children, has not been diagnosed for a long time.
“It can be calming. Kids who are anxious are often very self-conscious and can’t necessarily share it with their family or their doctors. So screening is a very, very good idea.”
Most cases of anxiety in children can be treated with psychotherapy, he added. Only children with severe anxiety need medication. That’s why, he said, the sooner a child is diagnosed, the easier it is to treat.
Recommended notes for children with anxiety disorders, such as risk of anxiety disorders and depression in adulthood, as well as related risks such as substance abuse.
Dr. Sandy Chung, president-elect of the American Academy of Pediatrics, says pediatricians have long acknowledged the need for screening because they have seen their patients struggle with a growing number of mental health symptoms year after year. These have increased in alarming numbers during the epidemic.
“We’re really in a crisis with mental health,” he added.
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 declaring children’s mental health a national emergency.
The AAP has already recommended screening adolescents for psychological and behavioral problems such as anxiety and depression, and many pediatricians are already screening their patients for anxiety and depression, Chung added.
“We appreciate the recommendations of the task force, but in reality, many pediatricians are already doing the job. [already]He says.
Chung, who helped launch the Virginia Mental Health Access Program, added that many of these pediatricians connect with psychiatrists and psychologists by telephone through the Mental Health Access Program.
Some pediatric clinics that screen mental health are able to provide follow-up care through in-house providers. For example, the Montefiore Medical Center, which examines approximately 86,000 children annually for mental and behavioral problems.
“In our primary care practice, where children go to their pediatrician, we already screen children for anxiety, depression and attention problems when children begin at the age of four,” said Miguelina German, a child psychologist at the center. Providers have come together in practice.
Anyone with a positive screening is referred to a German or one of his or her behavioral health colleagues.
And the younger a child is screened for a mental health problem at an early age, the easier it is for him and his colleagues to treat, he adds, because mental health problems get worse with age, if not treated.
“If I have a 15-year-old who is worried, he or she is more likely to be depressed,” says German. “But there was a time when a 15-year-old was 10 years old, and let’s say when he was 10, he had some social concerns. He had some problems making friends.”
Also, if providers treat children’s problems when they begin to show symptoms at a young age, he said, it often requires fewer sessions than treating more complex problems in an older child.
For this reason, he hopes that this model of integrating mental health care into the office of a pediatrician will become the standard of care throughout the country, including universal screening for mental health symptoms.
The panel also looked at the evidence behind the screening for suicide and found insufficient evidence to support the idea.
But that decision hurt Dr. Christine U. Moutier, chief medical officer of the American Foundation for Suicide Prevention.
“It is of great concern to us that the task force is not looking at the latest information that actually shows that screening for suicide risk can be done effectively and safely,” Moutier said.
There are more than six recent studies showing that asking children if they have thoughts of harming themselves can really help open up a safe place for them to talk about their plight, he added.
“We know a lot of young people who are thinking about suicide don’t tell anyone,” he says. “And so we have to screen.”
The AAP and AFSP recently released a blueprint for youth suicide prevention, which recommends screening adolescents for suicide.
The draft recommendations are open to public comment until May 9, and final recommendations are likely to be published by the end of 2022, Kubik said.
Moutier hopes the final advice will include recommendations for screening children for suicide.