Screening Young Children for Depression and Anxiety

Last month, the U.S. Preventive Services Task Force recommended primary care screening in children as young as 8 years old for anxiety and continued its prior recommendations to screen children 12 and up for depression.

The task force announcement was based on a massive literature review published recently in the Journal of the American Medical Association. It concluded that the relative balance and harm of extra screening of children 8 and above is unclear but opted to err on the side of caution in view of rising rates of mental health conditions and even suicide attempts in teens and pre-teen children.

The youth mental health crisis

This recommendation follows a recent surgeon general warning in December of 2021 on the youth mental health crisis and a recent report from the Annie E. Casey Foundation that rates of anxiety and depression jumped by over 25 percent during the COVID-19 pandemic, amounting to over 1 million additional affected children. The report noted that by July of 2022, over 200,000 children had lost a parent or primary caregiver to the COVID-19 pandemic (which has killed over 1 million Americans in the past 3 years).

The particular vulnerability of children with ADHD

This is of concern to parents of children with ADHD because children with ADHD are particularly vulnerable to anxiety and depression, including in response to life stressors, traumas, and losses. Thus, it is difficult to argue with the precautionary approach recommended by the task force. It is also important to underscore the need for up-to-date research on rates of anxiety and depression in children with and without ADHD.

In our own recent national survey (just published in the Journal of the American Academy of Child and Adolescent Psychiatry), we found that among all 9- to 10-year-old youth, 12 percent had an anxiety or fear disorder (very close to the 11 percent estimated by the Annie E. Casey survey), but for non-ADHD youth, the rate was 10 percent; for youth with ADHD, the rate was 38 percent—more than three times the likelihood. Thus, youth with ADHD, even in the 9- to 10-year-old range, are particularly important to screen for anxiety disorders. The recommendation to screen for depression after age 12 is also particularly germane to ADHD, where the risk of depression is doubled versus typically developing children.

Overall, I endorse the precautionary approach recommended by the task force but add a particular alert of the need to screen children presenting with symptoms of or diagnosis of ADHD. Fortunately, behavioral and parent guidance counseling for anxiety in children can be quite effective—all the more reason not to miss the clinical-level problems if they emerge.

Please note: Dr. Nigg cannot advise on individual cases for ethical, legal, and logistical reasons.