Why is early screening for anxiety so important?
Dr. Ritholtz: One of the major benefits of screening kids earlier is that it provides the opportunity for early intervention when necessary. An untreated anxiety disorder is associated with a higher chance of anxiety, depression, substance abuse, and suicidal ideation later in life. If we can catch it early, we can not only provide immediate relief to the child who may be suffering but also hopefully prevent a lot of future suffering.
What does this screening entail?
The screening would take place during annual well-child checkups with a pediatrician, who likely would use a validated measure designed to screen for childhood anxiety. These screeners involve a set of questions for the child, the parent, or both, like:
- Do you worry about other people liking you? How often?
- Do you get stomachaches at school?
- Do you worry about the future?
Based on the responses, a clinician makes recommendations on the next steps to take, if any. This screening is not intended to diagnose. It’s intended to raise a flag that an assessment with a mental health provider may be needed.
How does anxiety manifest in young kids? How is it different from depression?
Kids experiencing anxiety and depression may present as irritable, oppositional, or tearful at times. Typically, kids who primarily have anxiety will try to avoid difficult situations and become upset when asked to face a situation they deem scary. In contrast, depression primarily manifests as low energy, irritability, or the feeling that things just don’t seem fun anymore.
The tricky thing about anxiety is that the symptom of avoidance can make the anxiety worse in the long term. Let’s imagine there is a child who is socially anxious: They’re going to avoid social situations. While this may feel better for them in the moment, it reinforces the idea in their brain that social situations are dangerous. So they never get the chance to learn that they can tolerate hard things.
When is it just normal anxiety that is natural to experience vs. an anxiety disorder?
Everybody experiences the emotion of anxiety, which is not a bad thing. A healthy level of anxiety can keep us safe from harm. If a child is feeling anxious but still able, with encouragement, to do what they need to do, that’s a typical part of development. It becomes an anxiety disorder when anxiety interferes with the child’s ability to function in the world.
For example, it’s age-appropriate for young children to be scared of the dark. But if it’s preventing your child from getting a good night’s sleep, that’s when it becomes functionally impairing. Or if your child is so anxious about separating from you that they’re unable to attend school, go to a play date, or stay with a babysitter, assessing for an anxiety disorder may be recommended.
Why is age 8 the recommended age to begin screening?
The typical age of onset for anxiety disorders is in the younger elementary school years. This is younger than the typical age of onset for depression, which is in adolescence or young adulthood.
Separation anxiety often shows up in the early preschool years. Social anxiety has an average age of onset of 13 years, with 75% of cases diagnosed between 8 and 15 years of age. Age 8 captures kids who may be on the lower end of that range before anxiety has a chance to progress.
The tricky thing about anxiety is that these kids, especially when younger, are typically not the squeaky wheels in class. Kids with anxiety are often quiet and don’t disturb the class. The result? Their challenges may be missed, as well as their opportunity for a diagnosis or treatment until much later.
What does this screening mean for caregivers?
Early detection of anxiety gives parents an opportunity to work with providers to learn how to gently encourage their child to do things even if they’re feeling anxious. A good clinician will be able to give a child skills to cope with that uncomfortable feeling they may initially experience, and also coach the parents on how to support their child.
While your clinician may be the expert on childhood anxiety, you are the expert on your child. As a parent, you should speak up if the screening results come back positive or negative and that doesn’t fit with what you’re seeing.