All children aged 8 and older should be tested for anxiety, says the American working group

Deteriorating mental health among children has led an influential group of experts to recommend screening for the first time all children aged 8 to 18 for anxiety, one of the most common childhood mental health disorders.

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

The Working Group, established by Congress in 1984, has no regulatory body; however, their recommendations carry weight among clinicians.

Screening more children for anxiety is “really important,” said Stephen PH Whiteside, a child psychologist and director of the Mayo Clinic for Children’s Anxiety Disorders in Rochester, Minnesota, who is not on the task force. “Most children in need of mental health care do not receive them.

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 do not cause problems at school or at home, they could easily “get out through the cracks,” he said.

The pandemic only continues to exacerbate the problems facing children.

The US Task Force recommended anxiety screening, regardless of whether the clinician was surrounded by any signs or symptoms.

“It is crucial that you can intervene before life is disrupted,” said Martha Cubic, a member of the working group who is also a professor at the George Mason School of Nursing in Fairfax, Virginia.

Child anxiety disorders are associated with an increased risk of later depression, anxiety, behavioral 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 disorders. in learning. .

The working group said there was still not enough evidence to recommend for or against screening children under the age of 8 for anxiety. The expert group continues to recommend screening for depression for children 12 and older.

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

Some of these tools may target specific anxiety disorders, while others may check for different disorders – and the duration of each screening may vary. “Our review found that these screening tools are effective in capturing anxiety in young people before they can show obvious signs and symptoms,” she said.

Ideally, children would be screened during their annual medical examinations of children, Dr. Kubik said, but clinicians should also remain open to screening opportunities during other visits.

If the screening shows that the child needs extra support, it is not a diagnosis, experts said, but rather a starting point for a wider conversation for further follow-up, which could include referral to a mental health provider.

“Psychotherapy is a first-line treatment,” said Tammy D. Benton, chief psychiatrist in child and adolescent psychiatry and behavioral science at Philadelphia Children’s Hospital. Medication may also be needed if anxiety impairs the child’s ability to function normally or if psychotherapy alone has not been effective, she 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 are identified, “this is putting pressure on many decision-makers and portfolio holders,” including insurers, said Dr. Carol Weizmann, co-director of the Center for 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, young people 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 that are separate from those of the US Task Force.

Dr Weizmann said the AAP was in the process of developing more tools and resources to support pediatricians in anxiety screening.

Stressing the need for further research, the working group said there was not enough evidence to recommend automatic screening for suicide risk in children and adolescents who are asymptomatic.

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

“Many children will keep thinking about suicide – they won’t raise the issue unless asked to – so when you look at all children 12 and older, it helps create a sense of safety net, that’s good to talk about.” said Dr. Weizmann, who is also a pediatrician in terms of development and behavior.

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

A study published in JAMA Pediatrics found that between 2016 and 2020, there was a significant increase in diagnosed anxiety and depression among children, as well as a decrease in the emotional well-being of those caring for them.

If you are worried that your child may be struggling with anxiety, experts have recommended talking to your child’s pediatrician or other primary care physician, who can help distinguish between typical anxiety and the type of problem you are experiencing. disorder.

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

But constant anxiety, which affects a child’s daily life, may be indicative of an anxiety disorder. Experts said they are watching for the following signs, especially if they reflect changes in previous behavior:

  • Eating too much or too little

  • He sleeps more or less than usual

  • Falling grades

  • Changes in relationships

  • Irritability

  • Anger

  • Sensitivity to criticism

  • Loss of interest in activities

  • Physical symptoms such as headache or stomach pain

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

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