The task force found that screenings, which consist of a standard set of questions, helped identify anxiety in children and adolescents who are not showing signs or symptoms, allowing them to be connected with treatment early, said task force member Lori Pbert. Pbert is a clinical psychologist and professor at the University of Massachusetts Chan Medical School.
Questions focus on avoidant behaviors — or when a child avoids certain people, places or situations — which are an important sign of anxiety, said Oscar Bukstein, the vice chair of psychiatry at Boston Children’s Hospital. Other questions focus on the common symptoms of anxiety, such as panic, worry and trouble concentrating, experts say.
The task force mentioned two screenings — Screen for Child Anxiety Related Disorders (SCARED) and Social Phobia Inventory — as being widely used in clinics. Both have questions about the fears and worries children may have. Some questionnaires, the task force said, may not be feasible for primary-care visits because of their length.
Other experts suggested the commonly used Generalized Anxiety Disorder screening, or GAD-7, and the Patient Health Questionnaire, or PHQ-9. The GAD-7 asks if a patient has been feeling nervous, anxious, or on edge; not been able to stop or control worrying; or has had trouble relaxing over the two weeks before their visit. The screening works on a scale of 0 to 3 for each of the seven problems listed. The PHQ-9 asks about issues such as trouble sleeping and poor appetite.
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The screening your child gets will depend on their physician’s preference. But clinicians will probably start with a general screening that covers multiple mental health conditions, then use narrower questionnaires based on the results to prevent overloading parents and patients, Bukstein said. Some screenings ask both the parent and the child to fill out the questionnaire.
“If you gave a lot of questions of each area, it would be more than parents and kids would be able to tolerate, more than primary care doctors could accomplish within a visit,” he said.
During the visit, as a parent, you may be able to sit with your child during the screening, or you may be asked to leave the room, said Jennifer Bernard, a pediatrician and internist at Saint Luke’s Health System in Overland Park, Kan. She said she decides based on what she, the child and their parent agree would be best — a process she calls shared decision-making.
If the child wants their parent in the room, Bernard allows them to stay. If not, she asks them to leave and fills them in on the results at the end of the visit. She typically gives the screening to patients on paper, so they can check boxes, which she said is easier than having to verbalize their feelings.
Bernard said she has been doing mental health screenings for years to help families navigate care and connect them with treatment plans. “I always feel like mental and physical health go together,” she said.
Bukstein’s advice to parents is “to not be afraid to bring this up” with their pediatricians or primary care physicians, as not all clinicians routinely ask patients about mental health. A survey of physicians found that fewer than half always asked their patients about mental health, according to research cited by the task force.
The task force acknowledged some weaknesses of screening methods such as “false-positive” results, which, they said, could “lead to unnecessary referrals (and associated time and economic burden), treatment, labeling, anxiety, and stigma.”
Charity Ruch, 39, said she pushed for help from a therapist after she noticed one of her children feeling more sad and irritable, and having trouble focusing. Ruch’s friends suggested the child’s symptoms were normal reactions to recent events. Pandemic isolation had been going on for more than a year. And in May 2019, Ruch’s child was at STEM School Highlands Ranch, in Colorado, when one student was killed and eight others were injured in a shooting.
Ruch took her child to see a therapist in 2021 through a center that the school established for mental health support after the shooting. The therapist did a screening, which indicated anxiety. That helped the child “learn about it and how to cope with it,” Ruch said, and be “able to put together a toolbox of strategies.”
Ruch has taken her children to annual visits every year, she said, but mental health screenings had never been offered to them. She called the task force’s new recommendation a “huge victory,” a step to generating more awareness around mental health and anxiety disorders.
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In recent years, more children and teens have been affected by anxiety, depression or other mental health conditions, and it has been worsened by the pandemic. In the first year of the pandemic, global prevalence of anxiety and depression jumped 25 percent, according to the World Health Organization.
In its recommendation, the task force cited the 2018-2019 National Survey of Children’s Health, which found that 7.8 percent of children ages 3 to 17 had an anxiety disorder.
In suggesting that anxiety screening be part of pediatric care, the task force acknowledged that it would be an added burden on a system already straining to provide mental health care — a concern within adult care as well.
“We absolutely recognize that that is a challenge,” Pbert said. “And what we’re hoping is that this set of recommendations on mental health within children and adolescents can help bring awareness of the need to create greater access to mental health care.”
If an anxiety screening yields positive results, clinicians will interview the child or teen to confirm a diagnosis and then come up with a treatment plan, which is discussed with the parent, Pbert said.
The task force noted that after diagnosis, treatment options can include counseling, medication or both. Treatment can also include “collaborative care,” meaning a child’s physician would work with a psychiatrist and behavior health care manager on treatment.
Ultimately, Pbert said, it’s important to understand that anxiety disorders are treatable, and screenings for children and teens are one step in getting the care they might need.
Elizabeth Spencer, 52, sought counseling for one of her children for the teen’s disordered eating. The screenings, which were part of the counseling, showed that the teen was suffering from anxiety, and the eating struggles were probably a symptom.
Before that, the teen had not been offered screenings during doctor’s visits, which Spencer said might have helped them find treatment options earlier.
“Maybe if we had had some of those screenings and been able to say, ‘Oh there are some flags here for possible anxiety,’ ” Spencer said, maybe her child would not have had disordered eating.
After the diagnosis, the counselor recommended medication, therapy and a self-help workbook, which helped the teen manage their struggles with eating and sleeping. Now in college, the teen has continued counseling and is studying applied health science, with a focus on exercise science — a path that was inspired by their experience with anxiety and recovery, Spencer said.
And last month, Spencer received a text from the teen that ended with: “I’m so thankful for the place I’m in now.”
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