Detecting and treating anxiety in childhood can reduce the risk of long-term mental health problems – an expert panel now recommends screening starting at age 8

Published in JAMA Journal, states that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of symptoms. The recommendation follows a systematic review that assessed the potential harms and benefits of screening.

The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s recommendations and what they might mean for children, parents and providers.

1. Why is the task force recommending screening young children?

About 80% of chronic mental health conditions Appears in childhood, and when help is finally sought, it is often years after the problem began. In general, recommendations to screen for mental health disorders are based on research showing that youth typically do not seek help independently, and that father And the teacher Not always skilled at correctly identifying problems or knowing how to respond.

The concern is Very common Mental health problems affect children and adolescents. Epidemiological studies indicate that 7.1% of children suffer from anxiety disorders. However, studies also estimate that 10% to 21% of children and adolescents struggle with an anxiety disorder, and as many as 30% are children Experience moderate anxiety that interferes with their daily activities at some point in their lives.

This tells us that many children experience anxiety at a level that interferes with their daily activities, even if they have never been formally diagnosed. In addition, there is a Well established evidence base For treating childhood anxiety.

The task force evaluated the best available research and concluded that, although there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children As a result of overloading to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while the harms are negligible, as the task force noted.

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The task force’s recommendation to screen 8-year-olds is driven by the research literature. Anxiety disorders are most likely to first appear in the elementary school years. and typical age of onset Anxiety is in the early stages All childhood mental health diagnoses. The panel also pointed to the lack of accurate screening tools available to detect anxiety in young children; Consequently, it concluded that there is insufficient evidence to recommend screening children 7 years of age and younger.

Anxiety disorders can persist into adulthood, especially those that begin early and go untreated. People who experience anxiety in childhood are also more likely to deal with it in adulthood along with other mental health disorders Like depression And an overall reduction in life. The task force considered these long-term effects in making its recommendations, noting that screening children younger than age 8 can reduce the preventable burden on families.

2. How can caregivers identify anxiety in young children?

In general, when a child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations, it is easier to accurately identify anxiety. Although the task force recommended that screening be performed in primary care settings—such as a pediatrician’s office—the research literature also supports this. School screening for mental health problemswith anxiety.

Fortunately, over the past three decades, considerable progress has been made in mental health screening tools, including anxiety. Evidence-based strategies for identifying anxiety in children and adolescents focus on collecting observations from multiple perspectives, including children, parents, and teachers, to provide a complete picture of the child’s functioning at school, home, and in the community.

Anxiety is what is called an internalizing trait, meaning that the symptoms may not be noticeable to those around the person. This makes accurate identification more challenging, although certainly possible. Hence, psychologists recommend including the child in the screening process based on age and development.

About two-thirds of youth actually receive treatment for mental health problems Receive these services at schoolMaking school-based screening a rational practice.

3. How will screening be done?

Universal screening of all children, including those with no symptoms or diagnoses, is a preventive approach to identify at-risk youth. These include those who may need further diagnostic evaluation or who would benefit from early intervention.

In both cases, the goal is to reduce symptoms and prevent lifelong chronic mental health problems. But it’s important to note that a screening is not equivalent to a diagnosis, something the task force highlighted in its recommendation statement.

Diagnostic evaluation is more thorough and costs more, while screening is intended to be brief, efficient, and cost-effective. Screening for anxiety in the primary-care setting may involve the completion of brief questionnaires by the child and/or parent, such as Pediatricians often screen children for Attention-deficit/hyperactivity disorder, or ADHD.

The task force did not recommend a single method or tool or a specific time interval for screening. Instead, care providers were advised to consider the evidence in the task force’s recommendations and apply them to specific children or situations. The task force pointed to several available screening tools viz Screen for child anxiety-related mental disorders And Patient Health Questionnaire Screeners For generalized anxiety disorder, which accurately identifies anxiety. These assess general mental and behavioral health with questions specific to anxiety. Both are available free of charge.

4. What do care providers 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 specific stimulus, such as vomiting or lightning. However, many anxiety disorders share symptoms and children do not usually fit neatly into one category.

However, psychologists generally observe some common patterns in anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and problems with emotion regulation, increased irritability, anger, or sensitivity to criticism. Other common patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.

Anxiety can also manifest as physical symptoms that have no underlying physiological cause. For example, a child may complain of stomach ache or headache or general malaise. In fact, studies suggest that seeing youth with anxiety in pediatric settings may occur more easily Identification of children with medically unexplained physical symptoms.

The difference we aim for in screening is to identify symptom levels and their impact. In other words, how much do the symptoms interfere with the child’s daily activities? Some concerns are normal and indeed necessary and helpful.

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

The key to an effective screening process is that it is aligned with evidence-based care.

The good news is that we now have decades of high-quality research showing how to effectively intervene to reduce symptoms and help anxious youth cope and function better. These include medications or therapeutic approaches such as cognitive behavioral therapy, which Research shows it to be safe and effective.

This is an updated version Article originally published on May 13, 2022.

Reprinted from this article the conversation, an independent nonprofit news site dedicated to sharing ideas from academic experts It wrote: Elana Bernstein, University of Dayton. Conversations are different Interesting free newsletter.

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Elana Bernstein received funding from her organization to test school-based practices for anxious youth. He is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for adolescent mental well-being. This project was recently funded by the University of Connecticut’s Institute for Collaboration on Health, Intervention, and Policy through their Mechanisms Underlying Mind-Body Interventions and Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (grant). #: NIH U24AT011281).