The US Preventive Services Task Force recently recommended that children ages 8 to 18 should be screened for anxiety disorder by their primary care physician, even if they show no signs or symptoms of anxiety. This is the first time the task force has made a recommendation on anxiety screenings, and it speaks to the seriousness of the mental health crisis which has already devastated children and teenagers in the United States
The task force consists of a volunteer panel of experts in preventive medicine and does not have any regulatory authority, but its recommendations may influence standards of care in the United States.
Why do we screen children for anxiety disorders?
Dr. Lori Pbert, clinical psychologist and member of the task force, told Yahoo News that pediatric anxiety has been named as a priority in 2018. So, while COVID-19 has increased the need to address health mentally, the task force had begun to work. his recommendation before the pandemic.
“This has been a growing problem for many, many years, even before COVID,” Pbert said of anxiety in teenagers. “But we also know that the COVID pandemic has taken a tremendous toll on the mental health of our children and adolescents.”
Pbert says there wasn’t enough evidence to support or recommend against screening children under 8, so the task force called for more research on that age group.
She reiterated that experiencing some anxiety is normal and healthy, but by screening for anxiety disorders, the task force hopes to eliminate cases where it affects a child’s functioning and well-being.
“Many children and teenagers have fears and worries and feel anxious from time to time,” she said. “When we’re examining anxiety disorders, we’re really looking for excessive fear or worry that interferes with normal daily activities at home, at school, with friends and with family.”
Almost 1 in 10 children and adolescents were diagnosed with anxiety from 2016 to 2019, according to the Centers for Disease Control and Preventionand anxiety disorders are the most common mental health condition in the United States
“Anxiety disorder is the most common disorder in child psychiatry. More than ADHD, more than anything,” Boris Birmaher, a professor of psychiatry at the University of Pittsburgh, who is not a member of the task force, said told Yahoo News.
The median age for developing an anxiety disorder is around 11 years, although some children and adolescents may keep their worries and fears to themselves, or may show symptoms sometimes not associated with the disorder. anxiety, such as irritability and anger. This causes experts to worry that without screening, many cases of anxiety disorders in children today go unnoticed.
“Sometimes they are not detected, and the child will suffer,” said Birmaher. “And these children are at high risk for developing depression, and they are at high risk for developing substance abuse when they are teenagers.”
“We know that there is a real delay in starting treatment for anxiety disorders – up to 23 years,” explains Pbert. “And so this screening recommendation is really hoping to be able to catch children, teenagers and young adults early so that they don’t have to suffer for so many years in their adulthood.”
How do doctors screen children for anxiety disorders?
The task force did not recommend a method for anxiety screening, but the process is often done with a questionnaire. The two most commonly used questionnaires for teenagers are called SCARED, or Screen for Child Anxiety Related Disorders, and SPIN, or Social Phobia Inventory. Both have been found to be accurate in identifying youth with and without anxiety.
SCARED is a more general screening tool that looks for signs of any anxiety disorder, including symptoms of generalized anxiety disorder, separation anxiety, social anxiety, panic, and school avoidance. This screener has two versions – one asking the parents questions about their child, and the other asking the same questions to the child directly.
“We know that you get different kinds of reports from the child versus the parents. We’ve seen that the children’s reports tend to give higher SCARED scores than the parents’ reports,” Pbert said. “So it’s important to note that symptoms can be missed if we don’t make sure to get the perspective of the child and the parents on SCARED.”
The questions ask about any debilitating symptoms, such as if the child has an intense worry about bad things happening; sudden fear that is accompanied by physical symptoms such as a pounding heart, difficulty breathing or feeling dizzy, trembling or sweating; or if they fear being away from a parent or losing important people in their lives.
SPIN specifically looks for evidence of social anxiety and is completed only by the child. He wonders if they avoid doing things or talking to people for fear of embarrassment; if they are afraid of social events; or if they experience somatic symptoms such as heart palpitations when around people.
Birmaher says these questionnaires can usually be answered in the waiting room and take less than 10 minutes to complete. Then, the parents and the child go over their answers with the pediatrician and see if there are any concerns.
Sometimes even a high SCARED or SPIN score can be a false alarm, so Pbert and Birmaher say it’s important to remember that screening is only a first step.
“A screening test alone is not enough to diagnose anxiety,” Pbert said. “If your child or adolescent shows positive, a structured clinical interview is necessary to make a diagnosis.”
If your child is diagnosed with an anxiety disorder, what’s next?
Pbert and Birmaher emphasize that anxiety disorders are treatable conditions, and that doctors and parents, together with the child, can determine which course of action may be best if a diagnosis is made. Usually that involves cognitive behavioral therapy (CBT) or medication, and sometimes a combination of the two.
Birmaher says that the medications often used for anxiety in children are the same that are used for depression and that studies show that they are effective in children as young as 7 or 8 years old with minimal, if any, side effects.
CBT can improve and potentially resolve anxiety in children and adolescents, and Birmaher notes that it usually takes 12 to 15 sessions.
“It’s not forever,” he said of CBT. “It’s like the coach who teaches you tricks on how to manage anxiety and how to prevent anxiety. Therapists are like the coach, parents are like the coach’s assistants, and [the child] is the player. And you have to practice. Because if you don’t practice, you won’t learn.”