Anxiety detection in early childhood lowers risk for mental health issues
Expert panel recommends screening starting at age 8
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The US Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on Oct. 11, 2022, published in the journal JAMA, stating that all children and adolescents between the ages of 8 and 18 should be screened for anxiety, regardless of whether they have symptoms. The recommendation follows a systematic review that evaluated 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 kids, parents and providers.
1. Why is the task force recommending young kids be screened?
Nearly 80% of chronic mental health conditions emerge in childhood, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and that parents and teachers are not always skilled at correctly identifying problems or knowing how to respond.
Anxiety is the most common mental health problem affecting children and adolescents. Epidemiological studies indicate that 7.1% of children are diagnosed with anxiety disorders. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as 30% of children experience moderate anxiety that interferes with their daily functioning at some time in their life.
This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is a well-established evidence base for treating childhood anxiety.
Functioning
The task force evaluated the best available research and concluded that, while there are gaps in the evidence base, the benefits of screening are clear. Untreated anxiety disorders in children result in added burdens 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, as the task force pointed out, the harms are negligible.
The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for anxiety is among the earliest of all childhood mental health diagnoses.
The panel also pointed to a lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is not sufficient evidence to recommend screening children age 7 or younger.
Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders like depression and an overall diminished quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening in children as young as 8 may alleviate a preventable burden for families.
2. How can care providers identify anxiety in young kids?
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. While the task force recommended that screening take place in primary care settings – such as a pediatrician’s office – the research literature also supports in-school screening for mental health problems, including anxiety.
Advances
Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidencebased strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including the child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community.
Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.
Among the youths who are actually treated for mental health problems, nearly two-thirds receive those services at school, making school-based screening a logical practice.
3. How would the screening be carried out?
Universal screening for all children, including those with no symptoms or diagnoses, is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention.
In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equate to a diagnosis, something that the task force highlighted in its recommendation statement.