Recognizing and treating anxiety in early childhood can reduce the risk of long-term mental health problems

The US Preventive Services Task Force, an independent panel of experts in primary care and prevention, issued a final recommendation on October 11, 2022, which is published in the journal JAMA, which states 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 assessed the potential harms and benefits of screening.

1. Why does the task force recommend screening young children?

Almost 80% of chronic mental illnesses occur in childhood, and when help is sought it often takes years for the problem to emerge. In general, recommendations for screening for mental health disorders are based on research showing that adolescents do not typically seek help on their own and that parents and teachers are not always able to properly identify problems or know how to respond.

Anxiety is the most common mental health problem in children and adolescents. Epidemiological studies indicate that 7.1% of children are diagnosed with anxiety disorders. However, studies also estimate that more than 10% to 21% of children and adolescents struggle with an anxiety disorder, and up to 30% of children experience moderate anxiety that interferes with their everyday lives at some point in their lives.

This tells us that many children experience anxiety at levels that interfere with their day-to-day functioning, even if they are never formally diagnosed. In addition, there is a well-established evidence base for treating anxiety in children.

The task force evaluated the best available research and concluded that while the evidence base is flawed, the benefits of screening are clear. Untreated anxiety disorders in children place additional burdens on the public health system. From a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventative treatment is favorable, while the task force emphasized that the harms are negligible.

The task force’s recommendation to screen children as young as 8 years of age is based on the research literature. Anxiety disorders are most likely to appear in elementary school. And the typical age at which anxiety occurs is among the earliest of any childhood mental health diagnosis. The panel also noted a lack of accurate screening tools available to detect anxiety in younger children; As a result, it concluded that there was insufficient evidence to recommend screening children aged 7 years or younger.

Anxiety disorders can persist into adulthood, especially those that start early and go untreated. Individuals who experience anxiety in childhood are more likely to continue to struggle with it in adulthood, along with other mental health disorders such as depression and an overall reduced quality of life. The task force considered these long-term implications when making its recommendations, noting that screening children as young as 8 years old can reduce an avoidable burden on families.

2. How can caregivers identify anxiety in young children?

In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as: B. refusing to go to school or avoiding social situations. While the task force recommended screening be conducted in primary care settings – such as in a pediatric practice – the research literature also supports school-based screening for mental health problems, including anxiety.

Fortunately, significant advances have been made in screening tools for mental health, including anxiety, over the last three decades. The evidence-based strategies for identifying anxiety in children and adolescents focus on gathering observations from multiple perspectives, including the child, the parent, and the teacher, to create a complete picture of how the child is functioning in school, at home, and in the community to obtain.

Anxiety is what is known as an internalizing trait, meaning the symptoms may not be observable to those around the person. This makes accurate identification more difficult, although certainly possible. Therefore, psychologists recommend involving the child in the screening process as much as possible, depending on their age and development.

Among adolescents who are actually being treated for mental health problems, nearly two-thirds receive these 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 at-risk youth. This includes those who may need further diagnostic work-up or would benefit from early intervention.

In both cases, the goal is to reduce symptoms and prevent lifelong chronic mental health problems. However, it is important to note that screening does not equate to a diagnosis, which the task force emphasized in its statement of recommendations.

Diagnostic assessment is more thorough and costs more, while screening aims to be brief, efficient, and inexpensive. Primary care anxiety screening may involve completion of short questionnaires by the child and/or parents, similar to how pediatricians often screen children for attention-deficit/hyperactivity disorder or ADHD.

The task force did not recommend a single method, instrument, or time interval for screening. Instead, caregivers were advised to consider the evidence in the task force’s recommendation and apply it to the specific child or situation. The task force referred to several available screening tools, such as the Screen for Child Anxiety Related Emotional Disorders and the Patient Health Questionnaire Screeners for Generalized Anxiety Disorders, which accurately identify anxiety disorders. These assess overall emotional and behavioral health, including anxiety-specific issues. Both are available for free.

4. What do healthcare providers look for when screening for anxiety?

A child’s symptoms can vary depending on the type of anxiety. 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 thunderstorms. However, many anxiety disorders share common symptoms, and children don’t usually fit neatly into one category.

But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk, such as “I’m not going to pass my math test” or “everybody’s going to laugh at me,” and difficulties with emotion regulation, such as increased temper tantrums, anger, or sensitivity to criticism. Other typical patterns include behavior avoidance, such as reluctance or refusal to participate in activities or interact with others.

Anxiety can also present itself as a physical symptom that has no physiological cause. For example, a child may complain of stomach pains, headaches, or general malaise. In fact, studies suggest that identifying adolescents with anxiety in pediatric settings can be done simply by identifying 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 the symptoms interfere with the child’s day-to-day functioning? Some anxiety is 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 coupled with evidence-based care.

The good news is that we now have decades of quality research showing how to intervene effectively to reduce symptoms and help anxious adolescents cope and function better. This includes both medications and therapeutic approaches such as cognitive behavioral therapy, which studies have shown to be safe and effective.

This article was republished by The Conversation under a Creative Commons license. Read the original article.