Phobias

Last reviewed: 5 Jan 2023
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

  • anticipatory anxiety
  • behavioral avoidance
More key diagnostic factors

Other diagnostic factors

  • onset during childhood
  • onset during early adulthood
  • nausea
  • dizziness
  • disgust
  • fainting
  • tachycardia
  • hyperventilation
  • exaggerated startle
  • sleep disruption
Other diagnostic factors

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
More risk factors

Diagnostic investigations

1st investigations to order

  • self-report
  • behavioral observation and approach tests
More 1st investigations to order

Investigations to consider

  • structured/semi-structured clinical interview
More investigations to consider

Treatment algorithm

ONGOING

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.

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