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.
Generalized anxiety disorder (GAD) is a common condition defined as chronic, excessive worry for at least 6 months that causes distress or impairment.
At least three key symptoms out of a possible six are required to make a diagnosis of GAD in adults according to the Diagnostic and statistical manual of mental disorders, fifth edition text revision, (DSM-5-TR) criteria. These include restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, and/or sleep disturbance. One key symptom is required to make the diagnosis in children.
It is in part a diagnosis of exclusion: physical health conditions, other mental health disorders, and medications or other substances should be ruled out as a primary cause.
Physical examination and laboratory studies are generally normal if no co-existing physical or mental health conditions or substance misuse issues exist.
Treatment is primarily with psychotherapy (cognitive behavioral therapy or cognitive therapy), serotonergic antidepressants, or a combination of these approaches.
Generalized anxiety disorder (GAD) is defined as at least six months of excessive worry about everyday issues that is disproportionate to any inherent risk, causing distress or impairment. The worry is not confined to features of another mental health disorder, a result of substance misuse, or relating only to a physical health condition.
At least three of the following symptoms are present most of the time: restlessness or nervousness, being easily fatigued, poor concentration, irritability, muscle tension, or sleep disturbance. In children, at least one key symptom should be present most of the time.
Other common complaints are autonomic in nature, such as sweating, lightheadedness, palpitations, dizziness, and epigastric discomfort. Anxiety may be "free-floating" (i.e., not restricted to, or even strongly predominating in, any particular environmental circumstances). Examples of worries include fears that the patient or a relative will shortly become ill or have an accident.
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
- poor concentration
Other diagnostic factors
- gastrointestinal symptoms
- muscle aches
- increased heart rate
- shortness of breath
- exaggerated startle response
- chest pain
- family history of anxiety
- physical or emotional stress
- history of physical, sexual, or emotional trauma
- other anxiety disorder
- chronic physical health condition
- female sex
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
anxiety symptoms meeting DSM-5-TR criteria
anxiety symptoms not meeting DSM-5-TR criteria
- Panic disorder
- Social anxiety disorder
- Obsessive-compulsive disorder
- 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
Anxiety: what is it?
Anxiety: what treatments work?More Patient leaflets
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