A new report from the American Academy of Pediatrics (AAP) has issued significant guidance aimed at addressing the escalating issue of mental health, emotional, and behavioral (MEB) problems in children. The report highlights the alarming statistic that children with MEB issues have an eight-fold increased risk of suicide compared to their peers, underscoring the urgent need for early and frequent screening.
The updated guidelines call for MEB screenings to begin as early as six months of age and continue until the child reaches 21 years. These screenings should occur at six, 12, 24, and 36 months of age, followed by annual check-ups. The report also emphasizes the importance of screening caregivers for MEB issues, such as perinatal depression and caregiver-child relational problems, to provide a comprehensive approach to mental health.
Rising Concerns and Statistical Insights
The AAP’s recommendations come amid rising concerns about youth mental health. Suicide has become the second leading cause of death among children aged 10 to 14 and the third leading cause among youths aged 15 to 24. From 2000 to 2017, the suicide rate in these age groups increased by more than 40%.
Incorporating findings from the US Preventive Services Task Force and other mental health organizations, the AAP report stresses the need for early intervention. The report cites a 2023 study where annual MEB screenings from ages two to six revealed that nearly 34% of children showed increasing severity in MEB issues as they aged.
Global and Local Perspectives
Globally, mental health issues in children are a growing concern. Professor Harriet Hiscock from the Murdoch Children’s Research Institute referenced the 2014 Young Minds Matter survey, which found that 14% of Australian children aged 4-17 met the criteria for a mental health disorder within a year. She noted that the upcoming 2024 Australian Early Development Census showed an increase in developmental vulnerabilities among children starting school.
Professor Hiscock highlighted the inadequacies in current healthcare systems, noting that regular touchpoints for discussing young children’s MEB are lacking. Although some regions, like Victoria, have good attendance at maternal and child health visits, this tends to decline significantly after the child’s first year.
Challenges and Recommendations for Effective Screening
Professor Hiscock emphasized the need for annual checks from birth to school entry to detect early MEB issues and associated risk factors, such as parental mental health problems. She pointed out that while the US system includes regular well-child visits, the uptake of these services varies.
The AAP report estimates that nearly 40% of US children will be diagnosed with an MEB disorder by age 16, with common diagnoses including ADHD, anxiety, and mood disorders. The report stresses that effective screening requires commitment from both caregivers and clinicians, as well as appropriate resources and referral pathways.
“There is no point, and in fact harm, in screening without having support pathways available to families,” Professor Hiscock stated.
Screening Tools and Their Application
The report acknowledges that MEB screening tools vary based on age and that no single tool is appropriate for all children and diagnoses. While standardized tools can reduce bias, they are not diagnostic but rather categorize risk levels. Professor Hiscock noted that screening tools, such as the PEDS-R (Parent Evaluation of Developmental Status-revised), become more reliable as children age.
The PEDS-R is a parent-completed tool that identifies developmental, behavioral, social-emotional, and mental health concerns in children under eight. It facilitates engagement between parents and health practitioners, helping to identify early developmental challenges.
The AAP advises clinicians to familiarize themselves with the sociodemographic characteristics of the populations used in the validation of these tools to ensure they are used effectively within specific patient populations.
As the AAP report underscores, addressing child mental health requires a holistic approach, involving early screening, caregiver involvement, and robust support systems. As mental health issues continue to rise, these guidelines provide a critical framework for early intervention and support.
