Anxiety screening can happen at your child’s next pediatrician appointment

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Your child’s next visit to the pediatrician might include something new: questions about their concerns and fears.

Doctors across the country are likely to be screening their patients for anxiety after an influential group of experts last week recommended it for children ages 8 to 18, signaling the need for early intervention during the worsening national mental health crisis. The US Preventive Services Task Force’s final recommendation followed similar guidance issued last month for anxiety screening in adults ages 19 to 64. The task force’s advice is not binding, but its recommendations often change the way physicians practice medicine in the United States.

The task force found that the screens, which consist of a standard set of questions, helped identify anxiety in children and teens who don’t have signs or symptoms, allowing them to be connected with treatment early, said Lori Pbert, member of the Task force. Pbert is a clinical psychologist and professor at Chan Medical School at the University of Massachusetts.

The questions focus on avoidant behaviors — or when a child avoids certain people, places or situations — that are a key sign of anxiety, said Oscar Bukstein, vice president of psychiatry at Children’s Hospital Boston. Other questions focus on common anxiety symptoms such as panic, worry and difficulty concentrating, experts say.

The task force mentioned two screens—Childhood Anxiety-Related Disorders Screening (SCARED) and Social Phobia Inventory—as being widely used in clinics. Both have questions about the fears and concerns that children may have. Some questionnaires, the task force said, may not be feasible for primary care visits because of their size.

Other experts have suggested the commonly used Generalized Anxiety Disorder Screen, or GAD-7, and the Patient Health Questionnaire, or PHQ-9. The GAD-7 asks whether the patient has been feeling nervous, anxious, or tense; not been able to stop or control the worry; or had trouble relaxing in the two weeks prior to the visit. The triage works on a scale of 0 to 3 for each of the seven problems listed. The PHQ-9 asks about problems such as trouble sleeping and poor appetite.

For the first time, the health panel calls for routine anxiety screening in adults

The screening your child receives will depend on the doctor’s preference. But clinicians will likely start with a general screening that covers multiple mental health conditions, and then use narrower questionnaires based on the results to avoid overwhelming parents and patients, Bukstein said. Some screenings ask the parent and child to complete the questionnaire.

“If you asked a lot of questions from each area, it would be more than parents and children would be able to tolerate, more than primary care physicians could accomplish in one visit,” he said.

During the visit, as a parent, you may sit with your child during 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, Kansas. She said she decides based on what she, the child and the parent all agree would be best – a process she calls shared decision-making.

If the child wants the parents to stay in the room, Bernard allows them to. If not, she asks them to leave and informs them of the results at the end of the visit. She usually gives patients triage on paper so they can tick boxes, which she said is easier than having to verbalize her feelings.

Bernard said he has been doing mental health screenings for years to help families navigate care and connect them to treatment plans. “I always feel that mental and physical health go hand in hand,” she said.

Bukstein’s advice to parents is to “don’t be afraid to bring it up” with your pediatrician or primary care physician, as not all physicians routinely ask patients about mental health. A survey of physicians found that less than half ever 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 turned to a therapist for help after she noticed that one of her children was feeling sadder and more irritable and had trouble concentrating. Ruch’s friends suggested that the child’s symptoms were normal reactions to recent events. The pandemic isolation had lasted more than a year. And in May 2019, Ruch’s son was at the STEM School Highlands Ranch in Colorado when a student was killed and eight others were injured in a shooting.

Ruch took her son to a therapist in 2021 through a center the school established for post-shooting mental health support. The therapist did a screening, which indicated anxiety. This helped the child “learn about it and how to deal with it,” Ruch said, and be “able to assemble a toolbox of strategies.”

Ruch takes her children for annual visits every year, she said, but mental health screenings have never been offered to them. She called the task force’s new recommendation a “huge win,” a step toward generating more awareness about mental health and anxiety disorders.

In a devastating pandemic, teens are ‘more alone than ever’. Many struggle to find help.

In recent years, more children and teens have been affected by anxiety, depression or other mental health conditions, and this has been exacerbated by the pandemic. In the first year of the pandemic, the global prevalence of anxiety and depression jumped 25%, according to the World Health Organization.

In its recommendation, the task force cited the 2018-2019 National Survey of Child Health, which found that 7.8% of children ages 3 to 17 had an anxiety disorder.

By suggesting that anxiety screening be part of pediatric care, the task force recognized that it would be an additional burden on a system already struggling to provide mental health care – a concern in adult care as well.

“We absolutely recognize that this is a challenge,” Pbert said. “And what we hope is that this set of recommendations on mental health for children and adolescents can help raise awareness of the need to create greater access to mental health care.”

If an anxiety screening yields positive results, doctors will interview the child or teen to confirm a diagnosis and then come up with a treatment plan, which is discussed with the parents, Pbert said.

The task force noted that after diagnosis, treatment options may include counseling, medication, or both. Treatment may also include “collaborative care,” meaning a child’s doctor would work with a psychiatrist and behavioral health 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 toward getting the care they need.

Elizabeth Spencer, 52, sought counseling for one of her children for the teen eating disorder. The screenings, which were part of the counseling, showed that the teen suffered from anxiety and struggles to eat were likely a symptom.

Prior to this, the teen had not been tested during doctor appointments, which Spencer said could have helped them find treatment options sooner.

“Maybe if we’d done some of those tests and been able to say, ‘Oh, there are some signs here for possible anxiety,’” Spencer said, maybe her son wouldn’t have an eating disorder.

After the diagnosis, the counselor recommended medication, therapy and a self-help workbook, which helped the teenager deal with his difficulties with eating and sleeping. Now in college, the teen has continued counseling and is studying applied health sciences, with a focus on exercise science — a path inspired by his experience with anxiety and recovery, Spencer said.

And last month, Spencer received a message from the teen that ended with, “I’m so grateful for where I’m at right now.”

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Anxiety screening can happen at your child’s next pediatrician appointment

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