Universal Screening Advised

 

Earlier this month, the U.S. Preventive Services Task Force (USPSTF) issued recommendations on universal screening for anxiety, depression, and suicide risk in all children and adolescents.

USPSTF recommends pediatric health providers screen children for anxiety every year beginning at 8 years old:

Anxiety disorder, a common mental health condition in the US, comprises a group of related conditions characterized by excessive fear or worry that present as emotional and physical symptoms. The 2018-2019 National Survey of Children’s Health (NSCH) found that 7.8% of children and adolescents aged 3 to 17 years had a current anxiety disorder. Anxiety disorders in childhood and adolescence are associated with an increased likelihood of a future anxiety disorder or depression.

 

Screening for depression should begin at age 12:

Depression is a leading cause of disability in the US. Children and adolescents with depression typically have functional impairments in their performance at school or work, as well as in their interactions with their families and peers. Depression can also negatively affect the developmental trajectories of affected youth. Major depressive disorder (MDD) in children and adolescents is strongly associated with recurrent depression in adulthood; other mental disorders; and increased risk for suicidal ideation, suicide attempts, and suicide completion.

 

The American Academy of Pediatrics and the American Foundation for Suicide Prevention endorse universal screening for suicide risk beginning at 12 years of age. However, the USPSTF found insufficient evidence “to assess the balance of benefits and harms of screening for suicide risk” at any age, and so routine screening for suicidal thoughts and behaviors is not recommended unless warning signs are present.

Jill Jin, M.D. says all children sometimes feel anxious during their young lives in which they grow and develop quite rapidly. However, some kids are more at risk for developing anxiety disorders that feature excessive and persistent emotional distress, resulting in problems with normal daily functioning at home, in school, and with friends:

Risk factors for anxiety disorders include genetic, personality, and environmental factors, such as attachment difficulties, conflict between parents, parental overprotection, early parental separation, and child maltreatment. Certain groups are at increased risk of anxiety disorder, including lesbian, gay, bisexual, transgender, and queer (LGBTQ) youth and older children (aged 12-17 years).

Treatment for anxiety in children and adolescents includes psychotherapy (cognitive behavioral therapy) and sometimes medications.

 

Dr. Jin reassures parents that feeling sad, hopeless, unmotivated, and irritable can also be normal reactions kids have to people, situations, and events encountered while navigating the scary and uncertain territory of childhood and adolescence. But when those feelings become strong and persistent, and a depressive disorder is diagnosed, treatment is required:

Risk factors for depression include a family history of depression, prior episodes of depression, childhood abuse or neglect, exposure to traumatic events or stress, bullying, maltreatment, adverse life events, and a difficult relationship with parents. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) teens are at increased risk of depression. Depression increases risk of suicidal thoughts, suicide attempts, and suicide completion, which is the second leading cause of death among youths aged 10 to 19 years.

Treatment for depression in children and adolescents includes psychotherapy and medications, typically selective serotonin reuptake inhibitors (SSRIs).

 

Kristen Monaco describes the backlash over the USPSTF’s decision to not advise universal suicide risk screening in children and teens:

“Youth may keep suicidal thoughts to themselves and will not bring up the topic unless directly asked,” said May Lau, MD, MPH, a member of the AAP Section on Adolescent Health Executive Committee, in astatement after the draft guidelines were released. “By screening all youth for suicide, we can identify those that are at risk and connect them with the services they need.

“The American Psychological Association also voiced concerns, “strongly urging” the USPSTF to modify the report to include suicide risk screening.

 

Check out the commonly used SCARED (Screen for Childhood Anxiety Related Disorders) screening tool here and the PHQ-9 (Patient Health Questionnaire-9) for depression screening here.

 

(JAMA Patient Page for Screening for Anxiety in Children and Adolescents and Screening for Depression and Suicide Risk in Children and Adolescents.)

 

source http://www.thepediablog.com/2022/10/19/universal-screening-advised/