U.S. experts urge anxiety screening for children 8 and older

By Julie Steenhuysen

CHICAGO (Reuters) – An influential panel of U.S. experts recommended for the first time on Tuesday that primary care doctors screen all children ages 8 to 18 for anxiety, even if there are no symptoms.

The recommendations by the U.S. Preventive Services Task Force, a group of disease prevention and medical experts assembled by the U.S. Department of Health and Human Services (HHS), come at a time of rising rates of diagnosed mental health disorders among American young people.

“Anxiety is the most common mental health condition in children and youth,” said task force member Dr. Martha Kubik, a professor at George Mason University’s nursing school.

The task force defined anxiety as a group of related conditions characterized by excessive fear or worry that manifest as emotional and physical symptoms. It recommended using screening questionnaires to identify children at risk, noting that studies show that children with such conditions benefit from treatment that may include cognitive behavioral therapy or psychotherapy.

Experiencing anxiety can be debilitating for a young person and it increases the risk for anxiety in adulthood as well as other conditions such as depression, Kubik said. Screening can identify children who should be referred for a formal evaluation, Kubik added.

The screening for anxiety received what is called a “B” recommendation, meaning the task force concluded with “moderate certainty” that the benefits of screening outweigh the harms. The task force said there was not enough evidence for screening children under age 8.

The recommendations, published in the Journal of the American Medical Association, were based on a review of evidence on screening and treatment for anxiety in children and adolescents, the task force said. A draft version of the recommendations was unveiled in April.

In an editorial accompanying the task force’s advice, Dr. John Walkup of the Ann and Robert H. Lurie Children’s Hospital in Chicago and colleagues noted that the majority of psychiatric disorders, including the anxiety disorders, arise in childhood and adolescence, and welcomed the screening recommendations.

The number of U.S. children ages 3-17 diagnosed with anxiety rose by 29% from 2016 to 2020 and those diagnosed with depression rose by 27% during the same time period, an HHS study released in March showed. Experts have said the trend has been worsened by issues relating to the COVID-19 pandemic.

The task force issued similar draft guidelines last month recommending screening adults ages 64 and younger for anxiety. Those are still subject to revision prior to being finalized.

In addition, the task force reaffirmed its previous recommendation for screening of children starting at age 12 without symptoms for depression but determined there was not enough evidence to endorse such screening in younger children.

The task force similarly found insufficient evidence to recommend routine screening of asymptomatic children or adolescents for suicide risk.

Suicide is the second-leading cause of death among Americans ages 15-24, behind only accidents. The American Academy of Pediatrics, American Foundation for Suicide Prevention and experts from the U.S. government’s National Institute of Mental Health in March recommended suicide screening for children starting at age 12.

Dr. Oscar Bukstein, a professor of psychiatry who trains pediatricians in mental health screening at Harvard-affiliated Boston Children’s Hospital, said the biggest challenge in addressing U.S. youth suicide is not identifying those at risk.

“The crisis is having the appropriate treatment settings to treat all of these kids who are suicidal,” said Bukstein, who wrote an editorial in the journal accompanying the depression and suicide recommendations.

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