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Pediatric group releases guidelines for detecting anxiety in kids and youth

Canadian Paediatric Society says COVID-19 heightened pressures on many children and youth

The Canadian Paediatric Society has new advice for clinicians on how to assess and manage anxiety in children and adolescents as the pandemic escalates concerns over mental health.

The lead author of two papers released Thursday says this is the first time the CPS has formalized its position, in part to address a “great demand for comprehensive guidance.”

While mental health was an increasing problem before the pandemic, Dr. Benjamin Klein says COVID-19 heightened pressures on many children and youth as lockdowns and containment measures closed schools and cancelled playdates.

He says medical professionals should have clear advice on how to differentiate between an age-appropriate response to stress and something more serious.

“I think people generally are aware (that) the treatments for anxiety are medications and therapy. But exactly when do you do what? Which medications should you use? When do you call it anxiety? What questions can you ask parents and children to come to the diagnosis?” says Klein, a developmental pediatrician based in Brantford, Ont.

“I would guess that there was a fair amount of variability in terms of the details of how it was approached.”

Klein says a similar tip sheet is being prepared to help parents and caregivers recognize signs worth mentioning to a doctor.

Fears during childhood and adolescence are part of normal development, the guidelines note. However, symptoms of anxiety disorders go well beyond typical behaviour and can include persistent, disproportionate, or distorted responses that hinder everyday life.

For instance, a child’s concerns about their grades could be considered normal if it doesn’t impact school or family activities. But if the worries are constant and excessive and include social withdrawal, trouble sleeping and concentrating, they could point to deeper issues.

Notably, the CPS does not recommend screening for anxiety if a child or youth doesn’t show signs or symptoms.

That was a recent recommendation by the US Preventive Services Task Force, which expressed “moderate certainty” that screening kids aged eight to 18 years old has “a moderate net benefit.”

Klein says there’s a “big downside” to general screening if it finds false positives and further strains the health-care system’s already limited capacity to assess and treat more severe cases.

“Screening is something that is kind of pretty fiercely debated,” he says.

“The usual problems with screening is identifying a lot of false positives that now you’re taking through more assessment and possible treatment that may be harmful.”

The guidelines suggest anxiety is on the rise in Canada, pointing to a 2018 study that found disorders diagnosed in youth 12 to 24 years old more than doubled to 13 per cent in 2018 from six per cent in 2011.

Klein says it’s hard to tease out to what degree the pandemic may have contributed to anxiety but he expects it has played a role. He says age-appropriate activities with friends, family and the school community can buffer against mental health problems and encourage healthy normal development.

“Obviously with the pandemic there’s a great deal of restriction from those enriching experiences and so then you’re going to see mental health issues and suboptimal development,” he says.

“Somebody’s reading and math hasn’t progressed as much as maybe it should have, and now they’re in school and it’s not going as well. So they’re experiencing more stress and it’s more anxiety-provoking, which kind of adds to the load.”

—Cassandra Szklarski, The Canadian Press

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The shadow of a school employee escorting a student is cast on the wall as they walk to a classroom in Davie, Fla., Friday, Oct. 9, 2020. THE CANADIAN PRESS/AP-Wilfredo Lee