Generalized anxiety disorder
Title: US Preventive Services Task Force recommends screening children 8 years and older for anxiety
For the first time, the US Preventive Services Task Force (USPSTF) has recommended universal screening for anxiety in children aged 8 to 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 aged 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.
Summary
Definition
History and exam
Key diagnostic factors
- excessive worry for at least 6 months
- anxiety not confined to another mental health disorder
- anxiety not due to medication or substance
- muscle tension
- sleep disturbance
- fatigue
- restlessness
- irritability
- poor concentration
Other diagnostic factors
- headache
- sweating
- dizziness
- gastrointestinal symptoms
- muscle aches
- increased heart rate
- shortness of breath
- trembling
- exaggerated startle response
- chest pain
Risk factors
- family history of anxiety
- physical or emotional stress
- history of physical, sexual, or emotional trauma
- other anxiety disorder
- chronic physical health condition
- female sex
Diagnostic investigations
1st investigations to order
- clinical diagnosis
Investigations to consider
- thyroid function tests
- urine drug screen
- 24-hour urine for vanillylmandelic and metanephrines
- pulmonary function tests
- ECG
Treatment algorithm
anxiety symptoms meeting DSM-5-TR criteria
anxiety symptoms not meeting DSM-5-TR criteria
Contributors
Authors
Christopher Gale, BHB, MPH, MBChB, FRANZCP
Research Director
Consultant Psychiatrist
Southern District Health Board
Senior Lecturer
Department of Psychological Medicine
Dunedin School of Medicine
Otago University
Dunedin
New Zealand
Disclosures
CG is an author of the Royal Australian and New Zealand College of Psychiatrists clinical practice guideline on social phobia, panic disorder, and generalized anxiety disorder. Otago University has commercial and research relationships with multiple pharmaceutical companies. He is an author of a number of references cited in this topic.
Acknowledgements
Dr Christopher Gale would like to gratefully acknowledge Dr Richard P. Swinson, Dr Elizabeth Hoge, and Dr Phebe Tucker, previous contributors to this topic.
Disclosures
RPS has personally received royalties for articles published in UpToDate (Wolters Kluwer) and the Compendium of Therapeutic Choices, 2nd edition (Canadian Pharmacists Association). EH is an author of a number of references cited in this topic. PT has done research for GlaxoSmithKline, Bristol-Myers Squibb, Wyeth Pharmaceuticals, Astra-Zeneca, Cephalon, Inc., and Ortho-McNeil. She has also consulted for Forest Pharmaceuticals and received honoraria from Pfizer, Inc. and Forest Pharmaceuticals.
Peer reviewers
Lori Davis, MD
Research Director
University of Alabama
School of Medicine Tuscaloosa Campus
College of Community Health Sciences
Tuscaloosa
AL
Disclosures
LD declares that she has no competing interests.
Arianna Di Florio, MD, PhD
Senior Clinical Lecturer
Division of Psychological Medicine and Clinical Neurosciences
Cardiff University
United Kingdom
Disclosures
ADF declares that she has no competing interests.
Elaine Lockhart, MB, BCH, BAO
Consultant in Paediatric Liaison Psychiatry
Royal Hospital for Children
Glasgow
United Kingdom
Disclosures
EL declares that she has no competing interests.
Differentials
- Panic disorder
- Social anxiety disorder
- Obsessive-compulsive disorder
More DifferentialsGuidelines
- Royal Australian and New Zealand College of Psychiatrists clinical practice guidelines for the treatment of panic disorder, social anxiety disorder and generalised anxiety disorder
- Evidence-based pharmacological treatment of anxiety disorders, post-traumatic stress disorder and obsessive-compulsive disorder: a revision of the 2005 guidelines from the British Association for Psychopharmacology
More GuidelinesPatient leaflets
Anxiety: what is it?
Anxiety: what treatments work?
More Patient leaflets
Log in or subscribe to access all of BMJ Best Practice
Use of this content is subject to our disclaimer