Pediatric Focus: Kids Worry Too!

Pediatric Focus: Kids Worry Too!
By: Indira Maurer, DNP, MSN, FNP-C

Provision of healthcare is more than just a quick auscultation of the heart and lungs. Mental health is a large factor in general well-being. Mental health disorders affect individuals of all ages, race, and gender; inclusive of our pediatric and adolescent patients². The incidence of mental health disorders in children and adolescents continues to increase over time, with a significant uptick associated with the pandemic³.  

More than 1 in 5 children and adolescents in the United States are afflicted with a mental, behavior or emotional health disorder¹. More than 7% of children between the ages of 3-17 years, experience symptoms of depression and more than 3% experienced anxiety¹. In 2018, suicide was reported as the 2^nd leading cause of death among children and adolescents ages 10-24 years².

The recent pandemic caused significant strain on access to health care, the quality of education, limited digital access, and reduced availability of affordable housing. These factors all created added stress for many families in our communities³. These stressors, along with long term physical and social isolation, and fears of COVID infection, lead to an increase in emotional and behavioral symptoms³. These symptoms include:

• Infants and children between the ages of 3-18 have shown signs of disruptions of physiologic processes such as sleep, toileting and feeding³. They have demonstrated separation anxiety and become more socially withdrawn³.
• Worldwide, the incidence of anxiety and depression in children and adolescents has more than double what they once were pre-pandemic. One in 4 children are experiencing increased symptoms of depression while 20% are experiencing anxiety³.
• During the pandemic, there has been an increase rate of emergency department visits by adolescent females between the ages of 12-17 years³.
• During 2021, they had an increase in eating and tic disorders.
• During 2021, there was an increase in depression, eating, tic, and obsessive-compulsive disorders.
• In January of 2022, there was an increase of anxiety, trauma and stressor-related, eating, tic and obsessive-compulsive disorders, and overall mental health visits, compared with January of 2019.

As primary care providers, we are at the frontline to offer preventative efforts across all levels. The American Academy of Pediatrics (AAP) recommends promoting and educating on social-emotional health and healthy relationships, screening for mental health disorders, and treatment and co-management as needed with mental health professionals².

There are a multitude of resources available for mental health screening. Among those, there are screening tools that are fast, free of charge and effective at identifying existing disorders, at risk individuals, or assist in starting the conversation of mental and emotional health¹.

DSM-5 Online Assessment Measures (APA)

• Contains 25 questions to screen for depression, anger, irritability, mania, anxiety, somatic symptoms, inattention, suicidal ideation/attempt, psychosis, sleep disturbance, repetitive thoughts and behaviors, substance use.

Patient Health Questionnaire (PHQ) Screeners

• Multiple questionnaires that range from 2-83 questions. The longer versions address mood problems, anxiety, eating disorders, alcohol abuse, somatoform disorders.

Generalized Anxiety Disorder 7-Item Scale (GAD-7) 

• 7 questions focused on generalized anxiety symptoms.

Pediatric Symptom Checklist (PSC-17, PSC, PSC-Y/Y-PSC)

• 17 or 35 question versions. Screens for internalizing and externalizing behaviors, and attention.

Strengths and Difficulties Questionnaire (SDQ)

• 25 questions. Screens for problems with attention, anxiety/depression, conduct, peer relationships, and prosocial behaviors.

Screen for Child Anxiety Related Disorders (SCARED)

• 41 questions screening for anxiety disorders. 

Spence Children’s Anxiety Scale (SCAS)

• 35-45 questions. Screens for anxiety.

Mental health screening must be a priority component of every pediatric patient encounter. Screening tools provide an opportunity for providers to identify any existing mental health disorders and allow to engage in conversation that promotes and support the understanding of mental well-being.

References

1. Jennifer Goldman, Goldman J. Mental Health Screening for Children & Teens. Medical Home Portal – Mental Health Screening for Children & Teens.
2. Mental Health Initiatives. American Academy of Pediatrics. 2023.
3. Interim guidance on supporting the emotional and behavioral health needs of children, adolescents, and families during the COVID-19 pandemic. American Academy of Pediatrics. 2022.