How early anxiety detection can put a stop to long-term mental health issues

The US Preventive Services Task Force, an independent panel of primary care and prevention experts, issued a final recommendation on October 11, 2022, published in JAMA magazine, stating that all children and adolescents between 8 and 18 years of age should undergo anxiety screening, regardless of whether they have symptoms. The recommendation follows a systematic review that assessed 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 children, parents and providers.

1. Why does the task force recommend that young children be screened?

Nearly 80% of chronic mental health conditions arise in childhood, and when help is finally sought, it is often years after the onset of the problem. In general, recommendations for screening for mental health disorders are based on research showing that young people often do not seek help independently, and than the parents Y teachers they are not always adept at correctly identifying problems or knowing how to respond.

anxiety is the more common mental health problem that affects 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 as many as 30% of children experience moderate anxiety that interferes with your daily functioning at some point in your life.

This tells us that many children 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 the treatment of childhood anxiety.

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 additional charges to the public health system. So, from a cost-benefit perspective, the cost-effectiveness of anxiety screening and preventive treatment is favorable, while, as the task force pointed out, the harms are negligible.

The task force’s recommendation to screen children beginning at age 8 is driven by the research literature. Anxiety disorders are most likely to first appear during the elementary school years. And the typical age of onset of anxiety is one of the first of all childhood mental health diagnoses. The panel also noted the lack of accurate screening instruments available to detect anxiety among younger children; as a result, it concluded that there is insufficient evidence to recommend screening children aged 7 years and younger.

Anxiety disorders can persist into adulthood, particularly early-onset and untreated disorders. People who experience anxiety in childhood are more likely to face it in adulthood as well, along with other mental health disorders like depression and an overall decreased quality of life. The task force considered these long-term impacts in making its recommendations, noting that screening children as young as 8 years old can alleviate a preventable burden on families.

2. How can care providers 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 refusing to go to school or avoiding social situations. While the task force recommended that screening be done in primary care settings, such as a pediatrician’s office, the research literature also supports school screening for mental health problemsincluding anxiety.

Fortunately, in the last three decades, considerable progress has been made in mental health screening tools, including for anxiety. Evidence-based strategies for identifying anxiety in children and adolescents focus on collecting observations from multiple perspectives, including the child, parents, and teacher, to provide a complete picture of the child’s functioning in school, home, and community. .

Anxiety is what is called an internalizing trait, which means that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, although certainly possible. Therefore, psychologists recommend including the child in the selection process as much as possible based on age and development.

Among youth receiving treatment for mental health problems, nearly two-thirds receive those services at schoolmaking screening at school a logical practice.

3. How would the selection be carried out?

Universal screening for all children, including those without symptoms or diagnoses, is a preventative approach to identifying youth who are at risk. This includes those who may need further diagnostic evaluation or those who would benefit from early intervention.

In both cases, the goal is to reduce symptoms and prevent lifelong chronic mental health problems. But it’s important to note that a screening test does not equate to a diagnosis, something the task force highlighted in its advisory statement.

Diagnostic evaluation is deeper and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve the child and/or parents completing short questionnaires, similar to how pediatricians frequently examine children by attention deficit/hyperactivity disorder, or ADHD.

The working group did not recommend a single method or tool, nor a particular time interval, for detection. Instead, care providers were advised to consider the evidence in the task force’s recommendation and apply it to the particular child or situation. The working group noted multiple screening tools available, such as the Detect emotional disorders related to childhood anxiety and the Evaluators of the Patient Health Questionnaire for generalized anxiety disorder, they accurately identify anxiety. These assess overall emotional and behavioral health, including specific questions about anxiety. Both are available at no cost.

4. What do care providers look for when assessing anxiety?

A child’s symptoms may vary depending on the type of anxiety they have. For example, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children often do not fit neatly into one category.

But psychologists do see some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me” and emotion regulation difficulties, such as increased tantrums, anger, or sensitivity to criticism. Other typical patterns include avoidance behavior, such as reluctance or refusal to participate in activities or interact with others.

Anxiety can also appear as physical symptoms that lack a physiological root cause. For example, a child may complain of stomach aches or headaches or general malaise. In fact, studies suggest that detecting anxious youth in pediatric settings may occur simply through identification of children with medically unexplained physical symptoms.

The distinction we seek in screening is to identify the magnitude of symptoms and their impact. In other words, how much do the symptoms interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful.

5. What are the recommendations to support children with anxiety?

The key to an effective screening process is that it is connected to evidence-based care.

The good news is that we now have decades of high-quality research showing how to intervene effectively to reduce symptoms and help anxious youth cope and function better. These include either medications or therapeutic approaches such as cognitive behavioral therapy, which studies show it is safe and effective.

This is an updated version of a article originally published on May 13, 2022.

elana bernsteinAssistant Professor of School Psychology, University of Dayton

This article is republished from The conversation under a Creative Commons license. Read the Original article.

Also read: How do pain relievers work? From ibuprofen to fentanyl: it’s about meeting pain where it is