Why a US task force is recommending anxiety screening in kids 8 and older

US Preventive Services Task Force issued a draft statement in April 2022 and recommended screening for anxiety in children and adolescents between 8 and 18 years. This recommendation – which is still open to public comment – is timely, given the effects of COVID-19 pandemic on children’s mental health. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the working group’s new proposals for recommendations and what they can mean for children, parents and caregivers.

1. Why does the working group recommend that young children be screened?

Almost 80% of chronic mental conditions appear in childhood, and when help is eventually sought, it is often years after the problem arose. In general, recommendations for screening for mental disorders are based on research showing that adolescents do not usually seek help independently, and that parents and teacher are not always skilled at correctly identifying problems or knowing how to react.

Anxiety is most common mental health problems affecting children and adolescents. Epidemiological studies suggest that 7.1% of children are diagnosed with anxiety disorder. However, studies also estimate that up to 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as 30% of children experience moderate anxiety that disrupts their daily functioning at some point in life.

This tells us that many children experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. In addition, there is one established evidence base to treat childhood anxiety.

The possibility of preventing potentially chronic lifelong mental conditions through a combination of early identification and evidence-based treatment really gave the intervention group’s recommendation. Untreated anxiety syndrome in children result in additional burdens to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventative treatment is favorable, while, as the working group pointed out, the damage is negligible.

The working group’s recommendation to screen children as young as 8 years old is driven by the research literature. Anxiety disorders are most likely to appear only during primary school. And the typical debut age for Anxiety is among the earliest of all childhood diagnoses for mental health.

Anxiety disorders can persist into adulthood, especially those disorders that debut early and those left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, along with other mental disorders as depression and a generally deteriorating quality of life.

A discussion of the differences between normal anxiety and worry.

2. How can caregivers identify anxiety in young children?

Fortunately, significant progress has been made over the last three decades in screening tools for mental health, including anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are aimed at collecting observations from several perspectives, including children, parents and teachers, to provide a complete picture of the child’s function in school, at home and in society.

Anxiety is what is called an internalizing trait, which means that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, although it is indeed possible. Therefore, psychologists recommend including the child in the screening process to the extent possible based on age and development.

In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. Although the working group recommended that screening should take place in primary care environments, the research literature also supports it screening in school for mental health problemsincluding anxiety.

Among the young people who are actually treated for mental health problems, almost two thirds get these services in schoolwhich makes school-based screening a logical practice.

3. How would the screening go?

Universal screening for all children is a preventive approach to identifying young people who are at risk. This includes those who may need further diagnostic evaluation or who would benefit from early intervention.

In both cases, the aim is to reduce the symptoms and to prevent lifelong chronic mental problems. But it is important to note that a screening is not the same as a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be short, effective and cost-effective. Screening for anxiety in a primary care environment may involve the child and / or parent filling in short questionnaires, similar to how Pediatricians often check children for attention deficit hyperactivity disorder or ADHD.

The working group did not recommend a single method or tool, nor a specific time interval, for screening. Instead, it pointed to several tools such as The screen for child anxiety-related emotional disorders and that Pediatric symptom checklist. These assess general emotional and behavioral health, including issues specific to anxiety. Both are available free of charge.

A youth anxiety psychologist who experienced severe anxiety as a child tells about how to raise children who can overcome anxiety.

4. What do caregivers look for when screening for anxiety?

A child’s symptoms can vary depending on the type of anxiety they have. For example, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children do not usually fit into one category.

But psychologists usually observe some common patterns when it comes to anxiety. These include negative self-talk such as “I will fail my math test” or “Everyone will laugh at me” and difficulty regulating emotions, such as increased outbursts, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.

Anxiety can also manifest itself as physical symptoms that lack a basic physiological cause. For example, a child may complain of stomach or headache or general malaise. In fact, studies suggest that detecting adolescents with anxiety in pediatric settings may simply occur identification of children with medically unexplained physical symptoms.

The distinction we strive for in screening is to identify the extent of the symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and actually necessary and helpful.

5. What are the recommendations for supporting children with anxiety?

The key to an effective screening process is that it is linked to evidence-based care. A strategy that is quite clear with the support of research is for schools to establish a continuum of care that involves universal screening, school-wide preventive programming and evidence-based treatment options.

The good news is that we have decades of high-quality research that shows how to effectively intervene to reduce symptoms and help troubled young people cope and function better. These include both medical and non-medical interventions such as cognitive behavioral therapy, which Studies show that they are safe and effective.

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