New guidelines outline how to diagnose anxiety in children as waitlists for mental health support grow

The Canadian Pediatric Society on Thursday released new guidelines for diagnosing and treating anxiety disorders in children and adolescents.

The guidelines, set out in two documents, are the organization’s first to specifically address anxiety disorders, which are among the most common mental illnesses affecting Canadian children and adolescents.

“We hoped that by developing these guidelines, we could help healthcare providers and caregivers start conversations and know where to find resources for next steps,” said Susan Bobbitt, Saskatoon Developmental Pediatrician and lead author, adding Add Mental health care is an important part of pediatric health care.

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Early detection and treatment of anxiety disorders is critical to avoiding more serious problems later in life, said Dr. Bobbitt. However, the demand for child and adolescent mental health services in the country far exceeds the care that doctors and other professionals can provide.

The Pediatric Society found that psychotherapy and education programs offered by accredited providers, such as clinical psychologists and social workers, are often only accessible to families who are privately insured or otherwise able to pay for them. Most Canadian children and adolescents are unable to receive timely, high-quality initial treatment for anxiety disorders, it said.

A 2020 Children’s Mental Health Ontario report found that children under the age of 18 in that province waited up to 2.5 years for mental health treatment, and the time and number of young patients waiting had peaked. Similar wait times are likely to occur across the country, said Dr. Bobbitt.

Data available so far during the pandemic gives an incomplete picture of the current situation. According to the Canadian Institute for Health Information (CIHI), the number of hospital admissions and emergency room visits for children and adolescents (5 to 24 years) with mental disorders decreased slightly in the first year. However, when viewed as a proportion of hospitalizations for all conditions in this age group, the percentage increased from 21 percent in 2019 to 23 percent in 2020.

“That really says demand is pretty stable,” said Tracy Johnson, director of health system analytics at CIHI. Despite an overall decline in hospital admissions, “we still admitted these children more than other conditions.”

Before the pandemic, the incidence (or rate at which a diagnosis is made) and prevalence (the number of children already living with an illness) of mental health disorders were relatively low, Ms Johnson said. However, from around 2017 until the onset of the pandemic, hospital admissions for mental illness and drug use among children and adolescents increased each year, suggesting that these patients are not receiving adequate care in the community, she added.

Although the reasons are unclear, the decline in hospital admissions that CIHI saw in the first year of the pandemic could be partially explained by improvements in some children’s mental health as they were not exposed to stressors associated with peer interactions, said Ms . suggested Johnson. Additional resources, such as expanding online mental health services, could also be a factor, she said.

It remains to be seen whether hospitalizations for mental illness will return to pre-pandemic levels and whether the incidence and prevalence of anxiety disorders in children has changed after personal healthcare has resumed and school and social activities are fully allowed.

While the Canadian Pediatric Society’s new guidelines won’t necessarily improve access to mental health services, they do outline concrete steps doctors and caregivers can take to help children manage their anxiety, said Dr. Bobbitt. This includes, for example, tips for parents on how to help children and young people to recognize their feelings and to strengthen positive routines such as shared meals, regular sleep and exercise.

They also outline a step-by-step approach to maintaining, by Psychotherapy as first-line treatment for patients with mild to moderate symptoms to medication for patients with moderate or more severe symptoms.