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Why a US task force is recommending anxiety screening in kids 8 and older

Up to 20% of US children have an anxiety disorder, and many suffer in silence.

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1 year ago

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Anxiety is the most common mental health problem affecting U.S. children. Brian A. Jackson/iStock via Getty Images

The U.S. Preventive Services Task Force issued a draft statement in April 2022 recommending screening for anxiety in children and adolescents between the ages of 8 and 18. This recommendation – which is still open for public comment – is timely, given the impact of the COVID-19 pandemic on children’s mental health. The Conversation asked Elana Bernstein, a school psychologist who researches child and adolescent anxiety, to explain the task force’s new draft recommendations and what they might mean for kids, parents and providers.

1. Why is the task force recommending young kids be screened?

Nearly 80% of chronic mental health conditions emerge in childhood, and when help is eventually sought, it is often years after the problem’s onset. In general, recommendations to screen for mental health disorders are based on research demonstrating that youths do not typically seek help independently, and that parents and teachers are not always skilled at correctly identifying problems or knowing how to respond.

Anxiety is the most common mental health problem affecting children and adolescents. Epidemiological studies indicate that 7.1% of children are diagnosed with anxiety disorders. However, studies also estimate that upwards of 10% to 21% of children and adolescents struggle with an anxiety disorder and as many as 30% of children experience moderate anxiety that interferes with their daily functioning at some time in their life.

This tells us that many kids experience anxiety at a level that interferes with their daily functioning, even if they are never formally diagnosed. Additionally, there is an established evidence base for treating childhood anxiety.

The opportunity to prevent potentially chronic lifelong mental health conditions through a combination of early identification and evidence-based treatment certainly informed the task force’s recommendation. Untreated anxiety disorders in children result in added burdens to the public health system. So from a cost-benefit perspective, the cost-effectiveness of screening for anxiety and providing preventive treatment is favorable, while, as the task force pointed out, the harms are negligible.

The task force recommendation to screen kids as young as age 8 is driven by the research literature. Anxiety disorders are most likely to first show up during the elementary school years. And the typical age of onset for anxiety is among the earliest of all childhood mental health diagnoses.

Anxiety disorders can persist into adulthood, particularly those disorders with early onsets and those that are left untreated. Individuals who experience anxiety in childhood are more likely to deal with it in adulthood, too, along with other mental health disorders like depression and an overall diminished quality of life.

A discussion of the differences between normal worry and anxiety.

2. How can care providers identify anxiety in young kids?

Fortunately, in the past three decades, considerable advances have been made in mental health screening tools, including for anxiety. The evidence-based strategies for identifying anxiety in children and adolescents are centered on collecting observations from multiple perspectives, including child, parent and teacher, to provide a complete picture of the child’s functioning in school, at home and in the community.

Anxiety is what’s called an internalizing trait, meaning that the symptoms may not be observable to those around the person. This makes accurate identification more challenging, though certainly possible. Therefore, psychologists recommend including the child in the screening process to the degree possible based on age and development.

In general, it is easier to accurately identify anxiety when the child’s symptoms are behavioral in nature, such as refusing to go to school or avoiding social situations. While the task force recommended that screening take place in primary care settings, the research literature also supports in-school screening for mental health problems, including anxiety.

Among the youths who are actually treated for mental health problems, nearly two-thirds receive those services at school, making school-based screening a logical practice.

3. How would the screening be carried out?

Universal screening for all children is a preventive approach to identifying youths who are at risk. This includes those who may need further diagnostic evaluation or those would benefit from early intervention.

In both cases, the aim is to reduce symptoms and to prevent lifelong chronic mental health problems. But it is important to note that a screening does not equal a diagnosis. Diagnostic assessment is more in-depth and costs more, while screening is intended to be brief, efficient and cost-effective. Screening for anxiety in a primary care setting may involve completion of short questionnaires by the child and/or parent, similar to how pediatricians frequently screen kids for attention-deficit/hyperactivity disorder, or ADHD.

The task force did not recommend a single method or tool, nor a particular time interval, for screening. Instead, it pointed to multiple tools such as The Screen for Child Anxiety Related Emotional Disorders and the Pediatric Symptom Checklist. These assess general emotional and behavioral health, including questions specific to anxiety. Both are available at no cost.

A youth anxiety psychologist who experienced severe anxiety as a child talks about how to raise kids who can overcome anxiety.

4. What are care providers looking for when screening for anxiety?

A child’s symptoms can vary depending on the type of anxiety they have. For instance, social anxiety disorder involves fear and anxiety in social situations, while specific phobias involve fear of a particular stimulus, such as vomiting or thunderstorms. However, many anxiety disorders share symptoms, and children typically do not fit neatly into one category.

But psychologists typically observe some common patterns when it comes to anxiety. These include negative self-talk such as “I’m going to fail my math test” or “Everyone will laugh at me,” and emotion regulation difficulties, like increased tantrums, anger or sensitivity to criticism. Other typical patterns include behavioral avoidance, such as reluctance or refusal to participate in activities or interact with others.

Anxiety can also show up as physical symptoms that lack a root physiological cause. For example, a child may complain of stomachaches or headaches or general malaise. In fact, studies suggest that spotting youths with anxiety in pediatric settings may simply occur through identification of children with medically unexplained physical symptoms.

The distinction we are aiming for in screening is identifying the magnitude of symptoms and their impact. In other words, how much do they interfere with the child’s daily functioning? Some anxiety is normal and, in fact, necessary and helpful.

5. What are the recommendations for supporting kids with anxiety?

The key to an effective screening process is that it be connected to evidence-based care. One strategy that is clearly supported by research is for schools to establish a continuum of care that involves universal screening, schoolwide prevention programming and evidence-based treatment options.

The good news is that we have decades of high-quality research demonstrating how to effectively intervene to reduce symptoms and to help anxious youth cope and function better. These include both medical and nonmedical interventions like cognitive behavioral therapy, which studies show to be safe and effective.

Elana Bernstein has received funding from her organization to examine school-based practices for youth with anxiety. She is currently working collaboratively on a federally funded (HRSA) grant aimed at improving behavioral health workforce education and training. Additionally, as part of a national research team focused on improving mental health screening practices, she is collaborating to develop a screening tool for emotional well-being in teens. This project was recently funded through the Institute for Collaboration on Health, Intervention, and Policy at the University of Connecticut via their Mechanisms Underlying Mind-Body Interventions & Measurement of Emotional Well-Being (M3EWB) Network, which is funded through the NIH (Grant #: NIH U24AT011281).

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Nike Making a Surprising Return to Macy’s

After a brief break, Nike and Macy’s rekindle their partnership.

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32 mins ago

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June 4, 2023

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Retail is a tough industry and it’s really fickle right now post covid pandemic. Macy’s  (M) - Get Free Report retail footprint has been similar to the likes of recently failed retailers like Sears, Kmart, Bed Bath and Beyond, but also similar to Target  (TGT) - Get Free Report, who is considered a leader in the retail industry. How is it that similar business models fail, and others seem to succeed at the same time?

The struggles Macy’s is facing is multifaceted as it lost its wholesale partnership with Nike  (NKE) - Get Free Report to sell the brand’s apparel in 2021. Nike was focused on selling directly to customers rather than having retailers reach their customer base, according to Retail Dive. Macy’s like all retailers was already struggling after 2020 and the pandemic, and losing a major brand like Nike would prove to be a hard hit. Customers were definitely disappointed that they could no longer buy the Nike brand apparel at Macy’s stores, according to Jeff Gennette, Macy’s CEO.

Macy’s is facing changes in leadership as well; its long-term CEO is retiring after four decades with the company and Macy’s has already selected his replacement. Bloomingdale’s CEO Tony Spring will replace Gennette to lead the department store. Spring also has a long retail tenure, he has been with Bloomingdale’s for 35+ years, according to CNN Business.

Image source: Shutterstock

Macy’s Brings Back Nike

Nike and Macy’s are bringing the Nike apparel back to the department store as well as online. Both Nike and Macy’s have been faced with retail challenges, and working togethe,r both companies may benefit during this tumultuous time for retailers.

“It is imperative that we have the right assortment, including the appropriate mix of private and national brands that our customers care about, with compelling value and price points that appeal to our diverse, fashion-conscious base,” said Macy’s CEO and Chairman Jeff Gennette in the most recent earnings call. “Value does not mean the lowest price. It means offering the right brands, fashion content, and elevated omnichannel shopping experiences.”

“This morning, we are excited to share that we are bringing Nike back to the Macy's nameplate this fall. This mutually beneficial relationship reflects our strategy to provide customers with an enhanced and elevated offering. Starting in October, an expanded Nike selection including apparel, plus size women's, big and tall men's, kids' bags, and gear will be available online and in key locations nationwide. Footwear will continue to be sold in our Finish Line licensed locations,” Gennette said.

Retail chains and department stores alike are struggling to work through staffing their stores during this unprecedented labor shortage. Other retail chains like Dollar General  (DG) - Get Free Report have noted that they have inventory, but not the staff to be able to move it to the retail floor. Staffing continues to be an ongoing challenge across industries. Building and maintaining positive business partnerships and relationships may be the right choice to help weather the storm for the long-term success of both Nike and Macy’s.

Making the Most of Competitions Downfalls

Macy’s and Nike have the opportunity to make the most of rivals’ challenges right now. Nike has the chance to step ahead while Adidas  (ADDDF)  was stuck figuring out what to do with its unsold inventory of shoes from its terminated partnership with Kayne West, aka “Ye.” Adidas decided to sell the rest of the Yeezy inventory exclusively through its website and donate the proceeds to the charities that were hurt by the antisemitic statements he made on social media.

Macy’s sells similar products that Bed Bath and Beyond sold, which filed for bankruptcy and will close all of its stores. Bed Bath and Beyond closures include its Buy Buy Baby stores. As the home goods store winds down its operations and sells off the remaining inventory, shoppers will have one less storefront to visit when it comes to buying products for the home.

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This Hack Makes Flying Spirit Better Than JetBlue Or Southwest

It’s possible to make the no-frills, low-cost carrier as nice as flying much more expensive airlines (for less money).

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3 hours ago

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June 4, 2023

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It may seem impossible that the low-cost, no-frills air carrier could be an improvement over Southwest Airlines or its would-be merger partner JetBlue, but it’s possible.

Before the covid pandemic, I flew Southwest Airlines fairly religiously in order to maintain my A-List status. You need 25 one-way flights each year (or 35,000 miles) to keep that status and I flew just enough to keep eking out my renewal each year.

A-List has some meaningful perks for Southwest Airlines  (LUV) - Get Free Report passengers. You get same-day standby for free, which was very convenient when I was flying for work and a meeting got canceled allowing me to leave earlier. In addition, A-List members can change their flights with no fees or penalties, and most importantly, they get priority boarding status.

Southwest boards based on its A, B, and C boarding groups with 60 slots in each group. A-List members got checked in early and were guaranteed that if they don’t get an “A” spot, they could check in between the A and B groups. They can also do that if they fly standby and missed the check-in window altogether.

Every year, I tried really hard to keep those perks, but in 2022, it simply was not possible. I didn’t travel anywhere close to the amount I did before covid and had to let my A-List status expire as the year ended.

I was not super happy about it, but as my travel ramped up, I was being forced to fly like a regular person with no status. That changed, however, when Spirit Airlines ran a quick promotion where people with top-tier status at a number of major airlines and hotels could buy Spirit’s top-tier Gold loyalty status for $100.

It’s the best $100 I have ever spent because it elevates the experience on the no-frills airline.

Spirit is a low-cost carrier.

Image source: Shutterstock

Why Spirit Airlines Gold Status Is So Valuable

A low-cost carrier, Spirit charges for everything. Your basic fare gives you the right to get on the plane with a personal item (think a purse or a small backpack). Fares are very low because you pay for everything from checked bags to a full-size carry-on to getting an actual seat assignment. Spirit passengers even pay for water and soda, and they can opt to pay for snacks and perks like being able to get through airport security faster.

As a Gold member, I pay the basic fare price and then get bags and a premium seat assignment for free. On the three Spirit flights I have booked, I was able to get an exit row seat, with much more legroom for no extra charge. I also got access to a priority security line at the airport and got to board in the first group.

In addition, I also got one flight change (for each leg of my trip) free (which I did not need to use on this trip).

What It’s Like Flying As a Spirit Gold Member

Spirit tends to fly out of the least convenient terminal at every airport (at least that has been my experience). That was true of my Fort Lauderdale flight where the airline flies from Terminal 4, which has a small parking lot that never seems to have any spaces. That forces you to park in a garage that’s farther away, but it’s well marked and walkable or there’s a tram if you are willing to wait.

My flight was a 9:30 p.m. non-stop to Las Vegas on a Saturday night. There were very few people in the security line and while I had access to a priority Spirit line, I’m also a Clear member and opted to go with that experience instead.

Once I cleared security, I made my way to my gate passing a few shops and some restaurants. I stopped to buy some snacks, as my first boss drilled the idea of never getting onto a plane without an emergency snack into my head before my first business trip 30 years ago (I was 19).

The gate had plenty of seats and we were scheduled to board at 8:45. When boarding was called, at roughly 8:47, the woman at the desk called for people needing extra assistance, families flying with kids under two, and active military members. There were none of those, so she then called for Group 1 and since I was standing near the gate, I was literally the first person on the plane.

In my multiple years of being Southwest A-List, I had never had fewer than 20 people board before me. I found my seat and while the actual seat was hard and not all that comfortable (Spirit skimps on the padding to save on fuel) the exit row legroom was impressive. In fact, the distance between my seat and the seat in front of me was so great that I actually had to lean forward to type on my laptop given the very narrow fold-down tray.

My flight was not without problems. It did not have WiFi, which the airline did not announce until we were in the air (so I could not text my wife to let her know I would be out of touch for five hours). Aside from that, however, my Gold status also got me a free soda, water, coffee, or juice, as well as a choice of snacks.

So, for my very lucky $100 purchase of Gold status, I had a roomier seat than I have ever had on Southwest. I was also paying a price that was less than half what I would have paid on Southwest or JetBlue, neither of which offered a comparable direct flight.

Spirit may be no-frills for infrequent flyers, but for its elite passengers, the airline offers value and meaningful perks. It also offers 10X points for Gold members, so even with the cheap fares I’m paying, the first two Spirit flights I have booked will earn enough points to allow me to keep my status for another year.

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Who Can You Trust?

Who Can You Trust?

Authored by James Howard Kunstler via Kunstler.com,

“I’m sick and tired of hearing Democrats whining about Joe Biden’s…

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4 hours ago

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June 4, 2023

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Who Can You Trust?

Authored by James Howard Kunstler via Kunstler.com,

“I’m sick and tired of hearing Democrats whining about Joe Biden’s age. The man knows how to govern. Just shut up and vote to save Democracy.”

- Rob Reiner, Hollywood savant

Perhaps you’re aware that the World Health Organization (WHO) is cooking up a plan to impose its will over all the sovereign nations on this planet in the event of future pandemics.

That means, for instance, that the WHO would issue orders to the USA about lockdowns, vaccines, and vaccine passports and we US citizens supposedly would be compelled to follow them.

Why the “Joe Biden” regime would go along with this globalist fuckery is one of the abiding mysteries of our time - except that they go along with everything else that the cabal of Geneva cooks up, such as attacks on farmers, and on oil production, and on relations between men and women, and on personal privacy, and on economic liberty throughout Western Civ, as if they’re working overtime to kill it off. And all of us with it.

I think they are working overtime at that because the sore-beset citizens of Western Civ are onto their game, and getting restless about it. So, the Geneva cabal is in a race against time before the center pole of their circus tent collapses and the nations of the world are compelled to follow the zeitgeist in the direction of de-centralizing, foiling all their grand plans.

The “Joe Biden” regime is pretending to ignore the reality that this WHO deal is actually a treaty that would require ratification by a two-thirds vote in the senate, an unlikely outcome. In any case, handing over authority to the WHO — in effect, to its chief Tedros Adhanom Ghebreyesus — to push around American citizens like a giant herd of cattle would be patently unlawful.

That center pole of the circus tent is the wobbling global economy. It’s barely holding up the canvas over the three rings of the circus. In the center ring, the death-defying spectacle of the Biden Family crime case is playing out before a huge audience (us). This week, a gun went off at the FBI and smoke is curling out of the barrel. FBI Director Christopher Wray was forced to verify that he’s been sitting on an incriminating document for three years from a “trusted” confidential human source, i.e., an informant, stating that the Biden Family received a $5-million bribe from a foreign entity when “JB” was vice-president.

That’s only one bribe of many others, of course, as documented in the Hunter Biden laptop, and it must be obvious it represents treasonous behavior that will demand resignation or impeachment. As this spools out in the weeks and months ahead, do you think Americans will be in the mood to accept further insults such as “Joe Biden” surrendering our national sovereignty to the WHO?

Anyway, you must ask yourself: why on earth should I trust the WHO about anything? Did they not participate in laying a trip on the world with Covid-19? How did those lockdowns work out? Do you think they destroyed enough businesses and ruined enough households? How’s the vaccination program doing? Effective? Safe? Yeah, maybe not so much. Maybe killing a lot of people, wrecking immune systems, sterilizing reproductive organs, causing gross disabilities, shattering lives.

Of course, in over three years neither the WHO nor the US medical authorities showed the slightest interest in helping to figure out how the Covid-19 virus was made in a lab, and exactly how it got loose in the world. Lately, Dr. Ghebreyesus has warned the world about much worse future pandemics supposedly coming down at us. Oh? Really? What does he know that we don’t? That possibly new efforts to concoct chimeric diseases are ongoing in labs around the world? (You know that dozens of such labs were discovered in Ukraine as the war got underway there in 2022.) What’s Dr. Ghebreyesus doing to stop that?

If US orgs and citizens are involved in this “research,” why doesn’t the WHO alert our government leaders so they can stop it? (Would they? I’m not so sure.) And, who is behind it this time? The Eco-Health Alliance again, like with Covid-19? By the way, that outfit got another whopping grant last fall from the NIH to “study” bat viruses — right after the NIH terminated a previous grant on account of The Eco-Health Alliance failing to turn over notebooks and other records.

No, you cannot trust the WHO about anything. The “trust horizon” (a concept introduced by the great Nicole Foss, late of The Automatic Earth dot com) is shrinking. You can no longer trust any distant authorities. You also cannot trust the US federal government (especially the executive branch behind “Joe Biden”). And notice: the trust horizon is shrinking just as the world is de-centralizing. This, you see, is the main contradiction behind all the Globalists’ twisted ambitions to control everything, including you. They are working against the current tide of human history which is pushing everything toward down-scaling, re-localization, and re-assertion of the sovereign individual person.

That trend will become increasingly evident as things organized at the giant scale start to implode — giant retail chains, medical behemoths, hedge funds, big banks, you name it. The world no longer has the mojo for globalism. There’s reason to wonder these days whether the USA has the mojo to remain a unified national polity of states. Our federal government is not only financially bankrupt beyond any coherent reckoning, it is also morally bankrupt, and it has decided to make war against its own people. None of this is satisfactory and none of this is working. It’s time to figure out who and what you can trust and act accordingly.

Tyler Durden Sun, 06/04/2023 - 09:20

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