Millions of kids are struggling with anxiety. How is it being treated?

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• Geoff Bennett:

  We're going to shift our focus now to the topic of kids and mental health. An influential national panel of health experts is recommending for the first time that children ages eight and up be screened for anxiety. The CDC estimates that in 2020, nearly 6 million kids in the U.S. were diagnosed with anxiety. But the pandemic has put a spotlight on the severity of the problem given the combination of mental health issues and isolation. This past week, we spoke with parents about their experiences and challenges accessing mental health care for their kids.

• Abby Olsen:

  My oldest was, I think he was in first grade. So, he would have been six. We moved to Boise, Idaho, and he started having a lot of anxiety with that move. And we weren't 100% sure how to help him and kind of what was going on.

• Anja Bentson:

  I don't know why it's always been hard for me to talk to my parents about like, deep things or things I've been feeling as well. And I would just say like, it's all about, it's mostly about, like whenever you're ready, and it's not about whenever you feel like your parents or your peers or your friends are going to be ready. It's about like when you're ready to share it whatever you feel like sharing.

• Katrina Collins Bentson:

  It was really difficult to find a therapist for her because she's younger. There are a lot of resources through the schools. So, if parents feel overwhelmed, and maybe they don't have insurance, you know, that's another piece, is therapy can be really expensive and feel like it's not accessible.

• Abby Olsen:

  You just want them to be OK, right? You want your kids to be happy to have like a normal childhood, when you know they're struggling and you don't have the tools or the time or the money or the help you need. It definitely feels overwhelming. But hopefully, hopefully, we can find what we need sooner rather than later.

• Geoff Bennett:

  Joining us now to talk about this is Dr. Lee Beers, she's the former president of the American Academy of Pediatrics and specializes in Child Mental Health. And Elana Bernstein is with us. She's a Professor of School Psychology at the University of Dayton and a licensed school psychologist in Ohio. Thanks to you both for joining us.

  And Dr. Beers, how does anxiety show up in children and how to help professionals actually screen for it?

  Dr. Lee Beers, American Academy of Pediatric: Anxiety can show up in children in a variety of different ways. You know, we may see kids who are having, you know, some stomach pain or changes in behavior or, you know, retreating into their rooms. But it's not always as typical as we think of in adults. And in the pediatrician's office there's a wide variety of ways we can screen for it but as the recommendations discuss really, the best way is to use a very straightforward, short, structured screener that could really get at some of those questions that we can ask for kids to identify whether they're experiencing anxiety.

• Geoff Bennett:

  And Professor Bernstein, is age eight, is that an appropriate age to start screening kids for anxiety? Or should it start even younger?

  Elana Bernstein, University of Dayton: The panel's recommendation was a really driven from the research literature that shows most mental health problems, but particularly anxiety emerge, typically in those early kind of mid out elementary school years. So, they made that specific distinction in the recommendations. But they did talk about family history and being aware of the kids, their own risk factors and their family's background as being important to consider.

• Geoff Bennett:

  So, Dr. Beers, I mean, what are some simple basic steps that parents can take right now to help support their children's mental health?

• Dr. Lee Beers:

  So, I think one of the first and most important things is just making sure that you can have an open dialogue about these things in your house. Really going back to the basics of, you know, making sure your kids are getting enough sleep and eating regularly and good nutrition and getting exercise all of which I know can be — I'm a parent too, can be hard to do. But then also really focusing in on the things that your children love to do, and trying to find those opportunities. But then if you do have concerns, don't hesitate to reach out to a professional like you're a pediatrician or a mental health professional or someone at the school.

• Geoff Bennett:

  And on that point, Professor Bernstein, I mean, you have the practical experience of being a school psychologist, how can schools help support children with anxiety?

• Elana Bernstein:

  I think in schools, what we can focus on is delivering services and what we kind of — what we consider a multi-tiered system of support. And so, what that looks like is providing wellness and emotional wellness for all kids in the building, regardless of their background or their risk factors. But then what we call kind of tiered services where once we can identify or screen kids and identify need, then we can provide services and a little bit more of an intensive or small group setting. And then we can also work with community providers, medical providers, is really going to be the best way to see the best outcomes for kids.

• Geoff Bennett:

  And Dr. Beers, as I understand it, nearly 80% of chronic mental health conditions emerge in childhood. So, what does that say really about the overall importance of addressing mental health concerns at a really young age?

• Dr. Lee Beers:

  I think there's a couple important pieces of that. The first is to know as a family that if you're worried about your child, you're not alone. And that this is the time when we do start to see concerns. I think the second piece, and I tell parents this, you know, just like every single other health condition or concern that I treat, the earlier we identify it and begin to address it, the better. You know, I think about with asthma, if I can pick up early that a child is having signs of asthma, I can do, you know, simple treatments that we can take care of, you know, in the office or at home in it and it doesn't get to an emergency department visit or hospitalization. It's the same for mental health concerns, if we can identify it early, we can really focus on supportive treatments, we can focus on, you know, things that can really help the child be well. And if it does get worse, and it does escalate. And then we can make sure that that gives us the time to make sure we can get kids into the care that they need.

• Geoff Bennett:

  And Professor Bernstein, I mean, given that there are some barriers to accessing mental health care for children, help us understand more about the economic and the racial aspects of some of those barriers.

• Elana Bernstein:

  Yeah, so we know, and I think it was mentioned, but we know that, you know, a good portion of kids, if not, maybe three quarters of kids that need mental health supports aren't really receiving them. And then of those that do receive them, they mostly 70% to 80% of them, they receive those services in school. And so, we know from research as well, that if we provide that multi-tiered system or that kind of comprehensive prevention oriented, you know, services in a school setting, that by doing that we can reduce disparities in health access, you know, access to health care, access to mental health care.

• Geoff Bennett:

  And Dr. Beers as we wrap up this conversation, I mean, what are some of the best practices in terms of thinking about equity when we talk about access to child mental health care?

• Dr. Lee Beers:

  I'm glad we're talking about this because it really is such an important issue. And we know that that actually, I think all children and families who need mental health care struggle with access, but it is much worse for many populations. And so, I think some of the things that we need to think about are really prioritizing that we make sure that mental health services are available in the places where children live, learn and play. So, in their pediatrician's office, in their schools, in their communities and really focusing on that I think it's also important to remember that the financial barriers are really significant for children who live in low-income households. And so, making sure that we're thinking about how do we make those services available for children whose families really can't afford to pay out of pocket.

• Geoff Bennett:

  Dr. Lee Beers and Professor Elana Bernstein, thank you both for your time and your insights. I appreciate it.

• Dr. Lee Beers:

  Thank you.

• Elana Bernstein:

  Happy to do it.