Children may soon be routinely screened by their pediatricians for anxiety and depression, if the advice of a panel of medical experts takes hold.
For the first time ever, the U.S. Preventive Services Task Force has called for all children ages 8 to 18 to be screened for anxiety and all children ages 12 to 18 to be screened for depression.
“Developing an anxiety disorder during childhood or adolescence increases the likelihood of a future anxiety disorder (the same disorder or another anxiety disorder) or secondary depression,” the task force writes in the recommendation. (Find the full report at uspreventiveservicestaskforce.org.) “These mental health conditions have long-term effects that may include chronic mental and physical or somatic health conditions, psychosocial functional impairment, increased risk for substance abuse, and premature mortality.”
The independent, all-volunteer task force doesn’t have regulatory power, but its recommendations carry weight with policymakers and clinicians. And with kids’ mental health in crisis — 5.8 million children have been diagnosed with anxiety; 2.7 million with depression; suicide rates in young Black males have increased by 60% since 2017 — the recommendation strikes me as both wise and urgent.
But the best-laid plans of mice and men … you know the saying. And our kids’ psyches have been beaten up plenty over the past few years of school shootings and pandemic losses and climate crises and all the rest. The last thing they need is a would-be solution gone awry.
I called clinical psychologist John Duffy, my podcast partner and a family therapist who specializes in teen anxiety, to get his take.
“I breathe a sigh of relief when an agency commits itself to the mental well-being of kids,” Duffy said. “It’s a reminder that we haven’t made the youth mental health crisis a blip on our cultural radar — that this is something we’re committing to solving on a deeper-than-usual level.”
And for most kids, Duffy said, the topics of anxiety and depression are already very much on their radar.
“They’re learning about this stuff from each other, from TikTok,” he said. “To pretend they don’t know about anxiety and depression is foolhardy. So it’s smart to go toward it, instead of pretending it doesn’t exist.”
All that being said, he cautions that clinicians — and parents and other grown-ups in kids’ lives who decide to tackle this topic — should take care to do so from a solutions-oriented approach. Handing kids a questionnaire and telling them it will help diagnose them as anxious or depressed is not, alone, going to be helpful, Duffy warns. And it may even be harmful.
“Without even hearing the results, some kids are going to think, ‘I can tell my scores are high on all of these questions. I have a problem,’” he said. “The inclination might be to self-diagnose and overidentify, without that being balanced within a larger discussion about what makes a kid nervous, when they feel most comfortable, how we deal with this stuff most effectively.”
The task force report notes that 76% of primary care physicians believe in the importance of talking to adolescent patients about their mental health, but only 46% said they always ask their patients about it. Increasing those rates is a good thing, Duffy said. But it’s not the only thing.
“The best-case scenario is kids learn, ‘When you’re struggling, here are some tools you can use. You can go talk to the school social worker. You can work on deep breathing. You can download the Calm app. You can get some exercise. You can change your setting, essentially,’” he said. “That kids learn this is something you have agency over. You are not powerless over this.”
The worst-case scenario?
“A rush of anxiety diagnoses, where kids are getting medicated and feeling helpless,” Duffy said.
Duffy said he almost always broaches the topic of anxiety with kids by sharing his own experiences with it.
“I usually tell them, ‘When I was your age I had these panic attacks. Here’s what that was like for me. Describe yours,’” he said. “We’re trading stories. We’re in a conversation that’s all the way outside the realm of diagnostic.
“We’re figuring out ways to manage anxiety,” he continued, “and sometimes our goal isn’t to get rid of it all. The sweet spot is helping them discover, ‘In different situations, if I’m feeling anxious, that’s not a weakness. I can channel that. I know what to do with that.’ It’s understanding yourself and your emotional states.”
We can’t solve what we don’t see. And better, more frequent screenings will, hopefully, leave a lot of kids (and the people who love them) feeling less alone, less lost, less powerless in the face of some emotions that can be paralyzing when left unchecked.
I like Duffy’s nudge toward hope and healing and emotional intelligence, on our paths to figure out what our kids, what all kids, need in this moment.
