By the time your child is a preteen or teen, pediatrician appointments can seem both simpler than they were when your kid was a squalling, squirming newborn and yet so much more complicated.
For example, the early teens years are when some kids start grappling with mental health issues, but recognizing the signs can be a challenge. Only about 50 percent of adolescents with depression get diagnosed before reaching adulthood and as many as two out of three depressed teens don't get the care that could help them.
That's why new clinical practice guidelines from the American Academy of Pediatrics (AAP) released this week state that all kids, starting at age 12, should be screened for depression by their doctor during a well visit, a sports physical, or any other office visit. The new recommendations also call for families with a depressed teen to develop a safety plan to restrict the young person's access to "lethal means of harm," such as guns, medications or knives.
It has been more than 10 years since the AAP initially called for early identification of depression risk factors and using a formal screening tool for those with risk factors. Yet many primary-care pediatricians are still not asking adolescent patients about depression, and some even say it is not in their scope of practice despite the AAP endorsement, says Rachel Zuckerbrot, associate professor of clinical psychiatry at Columbia University's Irving Medical Center in New York City, who co-authored the guidelines. In addition, sometimes pediatricians are worried that they won’t have the time and resources to help patients if they do get positive answers [to]," says Zuckerbrot. The hope is that with a stream-lined depression screening protocol, it will make it easy and efficient to screen everyone.
Doctors can do the screening with a paper questionnaire, or have the questions on a computer or tablet. Teens being teens, sometimes it's easier for them to use non-face-to-face communication—for instance, on paper or electronic media, says Zuckerbrot. "We know that teens are often more honest to a screen or paper than to a person asking questions," says Zuckerbrot. "In addition, sometimes doctors don’t pursue the questions in the same way if they don’t suspect depression, but everyone needs to be fully screened as teens may be suffering in silence."
While Zuckerbrot notes that age 12 is the age at which experts endorse formal screening, it can begin sooner. "Age 12 is not a magic number. While we endorse formal universal screening at age 12, we do say the guidelines can be applied down to the age of 10 if a child is developmentally an adolescent. We want to pick up depression as early as we can to help teens navigate their adolescence, but recognize that depression is not as common in prepubertal children."In the end, Zuckerbrot hopes that the new guidelines helps both parents and doctors get the most out of the doctor-patient relationship. "Parents often think about the pediatrician for vaccinations or sore throats," she says, "but it is important for them to know that primary-care providers can be an important resource for behavioral and emotional issues as well."