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.
Summary
Definition
History and exam
Key diagnostic factors
- anticipatory anxiety
- behavioral avoidance
Other diagnostic factors
- onset during childhood
- onset during early adulthood
- nausea
- dizziness
- disgust
- fainting
- tachycardia
- hyperventilation
- exaggerated startle
- sleep disruption
Risk factors
- somatization disorder
- anxiety disorders
- mood disorders
- first-degree relative with phobia
- twin with phobia
- aversive experiences
- stress and negative life events
- female sex
- white ethnicity
- parental anxiety and overprotectiveness
- negative affectivity and behavioral inhibition
- cognitive/attentional bias
Diagnostic investigations
1st investigations to order
- self-report
- behavioral observation and approach tests
Investigations to consider
- structured/semi-structured clinical interview
Treatment algorithm
adults with subclinical symptoms and infrequent interference with usual activities
adults with frequent symptoms interfering with usual activities
children with ongoing symptoms interfering with usual activities
Contributors
Authors
Amy Huberman, MD
Instructor of Psychiatry
Johns Hopkins University School of Medicine
Baltimore
MD
Disclosures
AH declares that she has no competing interests.
Acknowledgements
Dr Amy Huberman would like to gratefully acknowledge Dr Eve Friedl, Dr E. Blake Zakarin, Dr Craig N. Sawchuk, and Dr Bunmi O. Olatunji, previous contributors to this topic.
Disclosures
EKF and EBZ declare that they have no competing interests. CNS is an author of a reference cited in this topic. BOO is an author of a reference cited in this topic.
Peer reviewers
Jeffrey M. Lohr, PhD
Professor
Clinical Training Program
Department of Psychology
University of Arkansas
Fayetteville
AR
Disclosures
JML declares that he has no competing interests.
David F. Tolin, PhD
Associate Professor
Institute of Living
Yale University
New Haven
CT
Disclosures
DFT declares that he has no competing interests.
Differentials
- Agoraphobia
- Panic disorder
- Social anxiety disorder (social phobia)
More DifferentialsGuidelines
- Clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders
- Exposure-based interventions for the management of individuals with high levels of needle fear across the lifespan: a clinical practice guideline and call for further research
More GuidelinesPatient leaflets
Phobias
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