Screening for Anxiety in Children and Adolescents

The new recommendation from the United States Preventive Services Task Force (USPSTF) addresses screening children and adolescents for anxiety disorders, a topic not previously evaluated by the group.¹ The targeted population is healthy pediatric patients without symptoms of anxiety or previously diagnosed anxiety disorders. After systematically examining the availability and accuracy of screening tests and the potential benefits and harms of early detection and treatment, the task force concluded that screening for anxiety disorders is recommended for healthy children and adolescents between 8 and 18 years of age.

The Research

Anxiety disorders are prevalent within the pediatric population, with one recent study finding that 7.8% of children in the United States have current anxiety disorders.² Although few medications are FDA approved to treat anxiety in this age group, both research studies and my own personal experience support the efficacy of cognitive-behavioral therapy and selective serotonin reuptake inhibitors in the treatment of anxiety disorders in these patients.

The review also finds efficacy for a combination of both psychotherapy and medications, as well as for collaborative care, a team-based approach between the primary care clinician and the mental health team. Given the potential benefits of early detection and intervention, the USPSTF concludes that there is a moderate net benefit to screening children between 8 and 18 years of age, although the frequency of screening is not specified.

The Bottom Line

I am not certain that I will be implementing the recommendation for anxiety screening in my patients. The technical report accompanying the statement provides details about the literature on screening instruments.3 It offers support for two commonly used questionnaires, the Screen for Child Anxiety Related Emotional Disorders (SCARED) and the Social Phobia Inventory (SPIN). In my view, both have limitations. Although the SCARED has proven useful to me in the diagnosis and follow-up of my patients with anxiety disorders, I participated in a trial testing its use as a screener. My experience was that it was cumbersome as a screening instrument, difficult for families, and consistently disliked by the nurses in the office who needed to input the results (we had access to electronic scoring but only paper versions of the questionnaires).

The SPIN seems a reasonable screen for social phobia but not for anxiety disorders more broadly. Finally, the technical statement reports that public comment advocated for other screeners (such as the Pediatric Symptom Checklist), but the group was unable to find good studies using these as screening tools for pediatric anxiety disorders.

References:

1. Mangione CM, Barry MJ, Nicholson WK, et al; US Preventive Services Task Force. Screening for anxiety in children and adolescents: US Preventive Services Task Force recommendation statement. JAMA. 2022;328(14):1438-1444. doi:10.1001/jama.2022.16936
2. National survey of children’s health. United States Census Bureau. September 26, 2022. Accessed November 10, 2022. https://www.census.gov/programs-surveys/nsch.html

Scott T. Vergano, MD is a pediatrician in the Department of Pediatrics, Children’s Hospital of The King’s Daughters, Norfolk, VA