New Guidelines Say Screening for Anxiety Should Begin at Age 8

An influential task force now recommends all children ages 8 and up receive screenings for anxiety. The U.S. Preventive Services Task Force released these new guidelines on October 11, 2022. This task force is an independent panel of health experts authorized by Congress to provide evidence-based recommendations about preventative health services. The task force continues to recommend that children 12 and up be screened for depression.

“This is the first time that the task force has put forth a recommendation about anxiety screening in young people,” says Martha Kubik, PhD, RN, a member of the task force and a professor in the School of Nursing in the College of Health and Human Services at George Mason University. She says there was strong evidence for anxiety screenings in children even without symptoms.

There was also substantial evidence anxiety can be successfully treated in young people, once it’s identified. “We had a really strong, very robust evidence base looking at treatment for anxiety in young people, and specifically psychotherapy and cognitive behavioral therapy,” she described. “There’s a very well-established evidence base that supports its effectiveness in treating young people with anxiety.”

Why These New Guidelines Are Important

According to the Centers for Disease Control and Prevention (CDC), between 2016 and 2019, about 9.4% of kids between the ages of 3 and 17 experienced anxiety, and 4.4% have been challenged by depression. Those numbers have been rising over the past decade. As Ilan Shapiro, MD, chief health correspondent, and medical affairs officer at AltaMed Health points out, kids’ mental health has become an even more pressing issue since the pandemic.

“Sadly, just as parents have experienced toxic stress during the pandemic, children have as well,” says Dr. Shapiro. “But the difference is that young children don't have tools to protect themselves from all the feelings and experiences that adults have.” This is one of the reasons he thinks these new recommendations are important, and why taking a preventative approach to children’s mental health is imperative.

“It’s so important to understand the gravity of what's happening among our children and be able to act upon it,” Dr. Shapiro describes. “If we can screen youth for anxiety and depression early on, we can understand what is impacting our patients and help them. This is crucial to the health of future generations.”

Teresa T. Hsu-Walklet, PhD, assistant director of the pediatric behavioral health integration program at Montefiore Medical Group emphasizes that certain youth are more vulnerable to mental health challenges than others. “Children from historically marginalized communities, including BIPOC families and those who identify on the LGBTQIA+ spectrum, are often underdiagnosed and undertreated,” she explains. Normalizing mental health through screening is a great way to increase the likelihood that these families will receive proper treatment, she says.

When Should Anxiety Screenings Begin for Children?

Currently, there are no universal protocols for screening children without anxiety symptoms. Usually, a parent will only seek help if their child starts to show anxiety symptoms. “In general, parents often turn to their pediatricians and school professionals initially if they see their child struggling with anxiety,” says Scott Roth, PsyD, founder and clinical director of Applied Psychological Services of New Jersey.

Universal anxiety screenings could help put the issue of anxiety in kids on the radar of pediatricians and encourage providers to help their patients seek more specialized care. “Often, pediatricians can give general intervention techniques; however, they may lack the precision that a trained mental health clinician might utilize,” Dr. Roth notes.

After combing through the available research and data, the task force came to the conclusion that 8 years old is the age children should start to be screened for anxiety. The idea is that these screenings would typically take place in a primary care facility. So your pediatrician, pediatric nurse-practitioner, or family practice provider would offer the screening, says Dr. Kubik.

Again, these screening guidelines are for children who aren’t currently experiencing signs of anxiety—kids who may seem just fine. But as Dr. Kubik notes, often signs of anxiety in young children are hard to detect, so screenings can reach a lot of struggling children.

“Anxiety is often an internalizing behavior,” Dr. Kubik says. “Children can hold feelings inside and not share or open up.” Sometimes, depending on what else is going on, or how old they are, they may not even understand that there is help out there that can address their struggles. “That’s where screening can be really helpful, in assisting us in identifying those kids and connecting them to care,” Dr. Kubik describes.

Should My Child Be Screened for Depression and Suicide Risk?

As Dr. Kubik notes, the task force’s recommendations for depression screening have not changed. They are still recommending children be screened for depression starting at age 12. The task force doesn’t have any specific recommendations for suicide risk screenings, Dr. Kubik says. But depression and suicide risk are linked, so screening for depression could help lower the risk of suicide.

“While the evidence base is not sufficient for us to make a recommendation for or against the suicide screening, we do have the screening for depression and we know that depression is often a precursor of suicide risk,” Dr. Kubik explains. “So knowing that we can identify depression early in young people without signs and symptoms, and connect them to care, will certainly have an impact on suicide risk for some of those young people.”

Dr. Roth agrees screening for depression is of utmost importance, and it can help with the increased depression and suicide risks that kids face these days. Suicide is one of the most preventable public health risks, Dr. Roth points out, and having a history of both anxiety and depression increases that risk.

“Universal screening for depression and suicide risk combined with increased funding for programs that target these children at risk could significantly reduce the number of adolescents and adults who die by suicide,” he explains. Dr. Roth emphasizes along with screenings like these, we need more skilled mental health providers available for these kids. Additionally, he says, we need to address the economic, geographic, and sociocultural barriers many kids face to accessing effective treatment.

Importance of Early Intervention

Treating anxiety and depression in its earliest stages—sometimes even before your child has any obvious symptoms—has important protective benefits, says Dr. Hsu-Walklet. “Treating at an earlier stage allows for more time practicing and using skills for emotion regulation,” she says. “It decreases the possibility of, for example, developing spiraling negative thoughts that prevent effective time management,” she describes. In other words, early intervention decreases the chances of your child’s symptoms worsening and increases the effectiveness of mental health care.

So what happens if your child’s anxiety or depression screening comes up positive? As Dr. Hsu-Walklet points out, these tests don’t diagnose your child with a mental health condition. They just alert you that there may be a possible issue.

“If a screening reveals that your child has anxiety or depression, the pediatrician can use this information to tailor the visit and discuss mental health symptoms,” she explains. “They may then refer you to a psychologist or other behavioral health specialist for a more in-depth evaluation and discussion.”