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American Academy of Pediatrics

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New two-part guidelines have been published online by the American Academy of Pediatrics in Pediatrics. The guidelines were developed by the American Academy of Pediatrics, the Canadian Pediatric Society, and psychiatric associations from both countries.

Guidelines for Adolescent Depression in Primary Care: Practice Preparation, Identification, Assessment, and Initial Management

Guidelines for Adolescent Depression in Primary Care Treatment and Ongoing Management

Updated guidelines for the diagnosis and treatment of depression in adolescents now endorse universal yearly screening from 12 years of age onward. The new guidelines suggest that for a teenager presenting with a mild depression, physicians should consider a period of “active support and monitoring” before initiating evidence-based treatment with medication and psychotherapy. Only if symptoms persist should treatment be initiated. Rachel Zuckerbrot, MD, lead author of the Guidelines for Adolescent Depression in Primary Care, notes that “We know that more than 50% of cases of adolescent depression do not get identified, and even fewer get treated. Since pediatricians and primary care providers are at the front line, seeing these kids either for a well visit, school physicals, camp physicals, sports physicals, or just for common illnesses, they are in a really good position to identify depression as well as manage and treat it.”

The American Academy of Pediatrics (AAP) has issued updated screening and assessment recommendations for children’s preventive health care. The AAP also continued to emphasize the need for “unfragmented continuity of care” in comprehensive health supervision. Published online in Pediatrics, the 2017 policy statement contains changes to 11 areas of care, relative to the 2016 revision of the Bright Futures Periodicity Schedule, which cover care from birth to age 21. The recommendations note that “developmental, psychosocial, and chronic disease issues for children and adolescents may require frequent counseling and treatment visits separate from preventive care visits,” they caution, adding that unusual family circumstances may necessitate additional visits.

Changes include such care areas as:

  • Depression: Screening for adolescents should begin at age 12 years. In addition, physicians should ask about maternal depression at infants’ 1-, 2-, 4-, and 6-month medical visits.
  • Psychosocial-behavioral: The update underscores that assessment should be family-centered and, in addition to a child’s social and emotional health, may include evaluation of caregivers and social determinants of health.