Pediatricians should screen children as young as 8 for anxiety and kids 12 and older for depression during routine well checks, the U.S. Preventive Services Task Force said Tuesday.
The recommendation from the independent panel of experts applies to children who aren't showing any signs or symptoms of a mental health problem. Children who are — regardless of age — should be referred for specialized care, task force member Lori Pbert said.
"We can't not be screening children and teens," said Pbert, a clinical psychologist and behavioral scientist. "We have to identify them early. We don't want them struggling."
The health panel's new guidance represents a final set of recommendations for mental health screening for children. It is consistent with the group's draft recommendations released in April.
The screenings are not meant to diagnose a child with either anxiety or depression; they're meant to identify those who may need extra support in mental health care.
Pediatricians aren't required to follow the guidelines, but often do based on the influential group's recommendations.
The problem, however, is that there is a dearth of mental health professionals trained to help such children.
"A pediatrician might be able to flag somebody, but they might not always have a place to send that person who needs help," said Jenna Glover, a child and adolescent psychologist at Children's Hospital Colorado. She is not a member of the task force.
Still, she applauded the recommendations as a "positive step forward."
"This is a way where we can get ahead of the ongoing mental health crisis to identify these kids and get them hooked into services," Glover said. "We know that early intervention really is the key to better outcomes."
Young children may not always understand their emotions. So doctors have several standardized questionnaires they can use to screen children for anxiety and depression, such as the Screen for Child Anxiety Related Disorders and what's called the PHQ-9 questionnaire.
They aim to separate kids who are having a rough couple of days from those who are experiencing ongoing and excessive mental health issues that disrupt their daily activities, such as going to school or attending birthday parties and other social events.
Anxiety and depression have been growing in young people for years. A study released in February found that 1 in 5 teenagers had experienced an episode of major depression, even before the Covid pandemic hit. A second report found that emergency room visits related to children’s mental health rose dramatically in 2020, compared with 2019.
"Our hope is that by putting these recommendations forward, that they will help to really bring awareness to the need for greater access to evidence-based mental health care for children and adolescents," Pbert said.
The task force did not find enough scientific evidence to support screening for suicidal thoughts in children of any age, and called for more research in this area. The issue is especially important, as suicide rates are once again rising.
A September report from the National Center for Health Statistics found that young men ages 15 to 24 are at highest risk of suicide compared to any other groups. And though the overall numbers were small, the percentage of girls ages 10 to 14 dying by suicide rose 16% from 2020 to 2021.
A certain level of anxiety or sadness is common and even normal in kids, experts say. Having to do a math problem in front of the class, for example, can lead to a fleeting sense of anxiety.
But Pbert said that true mental health problems in children can result in excessive behavior changes.
Signs of anxiety or depression in children include:
- Refusal to attend school or social events.
- Ongoing feelings of hopelessness.
- A concerning uptick in headaches and stomach aches.
Sometimes, however, "children and teens keep their worries to themselves, so symptoms can be missed," she said. "That's why it's so important that we screen children in primary care."
"We're not catching these kids early. It is getting more severe and it's getting to the point of crisis," Glover said. "They're engaged in aggressive behavior or severe eating disorder behavior, and they're showing up in the emergency department."
"Had we caught them earlier, we could have been able to treat them on an outpatient basis," she said.
If you or someone you know is in crisis, call 988 to reach the Suicide and Crisis Lifeline. You can also call the network, previously known as the National Suicide Prevention Lifeline, at 800-273-8255, text HOME to 741741 or visit SpeakingOfSuicide.com/resources for additional resources.
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