Social anxiety disorder

Last reviewed: 6 Nov 2022
Last updated: 26 Oct 2022
26 Oct 2022

US Preventive Services Task Force recommends screening children 8 and older for anxiety

For the first time, the US Preventive Services Task Force (USPSTF) has recommended universal screening for anxiety in children ages 8-18 in pediatric primary care settings:

  • This applies to children without symptoms of anxiety, as well as those without a diagnosis of a mental health condition.

  • Specific recommendations on screening tests are absent from the evidence report; primary care settings are encouraged to develop their own protocols after considering the types of anxiety disorders their clinicians might typically encounter, and also taking into account feasibility of available screening tools.

  • The USPSTF could find no evidence on optimal screening intervals; they suggest that repeated screening may be most productive in adolescents with risk factors for anxiety.

  • Opportunistic screening may be a practical approach for adolescents, who often present infrequently to primary care.

  • For now, the USPSTF found that the evidence is insufficient to assess the balance of benefits and harms of screening for anxiety in children 7 years or younger.

The USPSTF is an independent panel of US experts in disease prevention and evidence-based medicine. Their recommendations are based on a review of the evidence on screening for anxiety, which concluded with moderate certainty that it has a moderate net benefit in children ages 8-18. The report states that in 2018-2019, an estimated 7.8% of US children and adolescents had a current anxiety disorder. An important rationale for early detection and treatment of anxiety disorders in children and adolescents is that they are associated with an increased risk of anxiety and depression in later life.

See Diagnosis: screening

Original source of update

Summary

Definition

History and exam

Key diagnostic factors

  • history of psychiatric comorbidity
  • positive family history of social anxiety
  • anticipatory anxiety and worry
  • tachycardia
  • hyperventilation
  • sweating
  • flushing
  • muscle tension
More key diagnostic factors

Other diagnostic factors

  • post-event processing
  • attentional biases
  • social skills deficits
  • crying, tantrums, or "freezing"
  • selective mutism
Other diagnostic factors

Risk factors

  • psychiatric comorbidity (e.g., anxiety, mood, and substance-use disorders)
  • genetic
  • temperamental factors
  • parenting style
  • psychological disorder
  • life stressors
  • environmental factors
More risk factors

Diagnostic investigations

1st investigations to order

  • clinical diagnosis
More 1st investigations to order

Investigations to consider

  • blood glucose
  • serum thyroid-stimulating hormone
  • toxicology screen (urine and blood)
More investigations to consider

Treatment algorithm

ONGOING

adults: no comorbidity

adults: comorbidities

children and adolescents

Contributors

Authors

Craig N. Sawchuk, PhD
Craig N. Sawchuk

Professor

Department of Psychiatry and Psychology

Mayo Clinic

Rochester

MN

Disclosures

CNS declares that he has no competing interests.

Jason P. Veitengruber, MD
Jason P. Veitengruber

Associate Professor

Department of Psychiatry and Behavioral Sciences

University of Washington School of Medicine

Seattle

WA

Disclosures

JPV is an author of a reference cited in this topic.

Bunmi O. Olatunji, PhD
Bunmi O. Olatunji

Professor

Department of Psychological Sciences

Vanderbilt University

Nashville

TN

Disclosures

BOO declares that he has no competing interests.

Stacy Shaw Welch, PhD
Stacy Shaw Welch

Director

Anxiety and Stress Reduction Center of Seattle

University of Washington

Seattle

WA

Disclosures

SSW declares that she has no competing interests.

Peer reviewers

Richard P. Swinson, MD, FRCPC, FRCPsych

Emeritus Professor

Medical Director

Anxiety Treatment and Research Centre

McMaster University and St Joseph’s Hospital

Hamilton

Canada

Disclosures

RPS declares that he has no competing interests.

Jeffrey M. Lohr, PhD

Professor

Department of Psychology

University of Arkansas

Fayetteville

AR

Disclosures

JML declares that he has no competing interests.

David F. Tolin, PhD

Professor

Institute of Living

Yale University

New Haven

CT

Disclosures

DFT declares that he has no competing interests.

David Baldwin, MD

Professor of Psychiatry

University of Southampton

Southampton

UK

Disclosures

DB has acted as a consultant for and held research grants from Cephalon, Eli Lilly, GSK, Lundbeck, Organon, Pfizer, Pharmacia, Roche, and Wyeth and has also acted as a consultant to Asahi, AstraZeneca, Grunenthal, Pierre Fabre, Servier, Sumitomo, and Wyeth. He has accepted paid speaking engagements in industry-supported satellite symposia and is co-author of the BAP evidence-based guidelines on the treatment of anxiety disorders. He is also a Medical Patron of Anxiety UK.

  • Differentials

    • Phobias
    • Panic disorder
    • Agoraphobia
    More Differentials
  • Guidelines

    • Diagnostic and statistical manual of mental disorders, 5th edition, text revision (DSM-5-TR)
    • Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders
    More Guidelines
  • Patient leaflets

    Anxiety

    Panic attacks

    More Patient leaflets
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