HYANNIS – Pediatrician Kenneth Colmer, MD, has seen a big change in teens since he started practicing 28 years ago.
“When I started, we didn’t see much anxiety or depression,” he said. “It just wasn’t very prevalent.”
Sadly, that’s no longer true. The American Academy of Pediatrics (AAP) estimates that one out of five children suffers from depression at some point during the teen years. And Dr. Colmer, who sees patients at Bass River Pediatric Associates in South Yarmouth, thinks that may be on the low side.
“In our practice, it might be more like 25 or 30 percent of our teens with either anxiety or depression,” he said.
In response to this national crisis, the AAP recently published its first updated guidelines in 10 years to help primary care doctors identify and treat adolescent depression. The guidelines were published in the March 2018 issue of Pediatrics.
Among the recommendations, which are aimed at helping children 10 to 21, are:
Provide a treatment team that includes the patient, family and access to mental health expertise
Offer education and screening tools to identify, assess and diagnose patients
Provide counseling on depression and options for management of the disorder
Develop a treatment plan with specific goals in functioning in the home, peer and school settings.
Develop a safety plan, as needed, which includes restricting lethal means, such as firearms in the home, and providing emergency communication methods.
While the guidelines suggest ways to involve family members in a teen’s mental health treatment, they also recommend that the pediatrician spend time alone with the adolescent.
“A lot of parents go to their pediatrician for the scraped knees and sore throats but don’t think of them when it comes to seeking help for emotional and behavioral issues,” Rachel Zuckerbrot, MD, FAAP, a lead author of the guidelines, said in a press release.
For the first time, the AAP guidelines endorse a universal adolescent depression screening for children age 12 and over. That practice is already in place at Bass River Pediatric Associates, where teens fill out the Pediatric Symptom Checklist before they go into the exam room, said Dr. Colmer, who is vice chief of pediatrics at Cape Cod Hospital.
The checklist asks teens to respond to 35 descriptions (including “are afraid of new situations,” “feel sad or unhappy,” “seem to be having less fun and “feel hopeless”) by checking off “never,” “sometimes” or “often.” The results can indicate whether a teen has significant impairments in overall psychosocial functioning, including difficulties with attention, anxiety, depression or conduct.
Dr. Colmer called it a helpful tool that should be used nationally.
“Without the checklist, a lot of times teens aren’t willing to offer information,” he said. “The checklist helps them to understand that we are concerned and that we are willing to help in anyway we can.
“If they come in and talk to us and let us know how they’re feeling, it’s going to help. In general, teenage girls are more willing to talk about how they’re feeling than the boys. The boys more or less just want to get the physical exam done and get out of there.”
For teens who need specialized help, Dr. Colmer will refer them to Bart Main, MD, a Cape Cod Healthcare child psychiatrist in Hyannis. In addition to seeing young patients, Dr. Main often consults with Dr. Colmer and his colleagues by phone.
Another resource is the Massachusetts Child Psychiatry Access Project in Middleboro.
“They have psychiatrists who are on duty during the day and if we need them for a consult, we’ll call and they get right back to us,” said Dr. Colmer. “We can discuss the case and they’ll give us advice, or if they need to see the patient, they’ll say that.”
Parents have an important role in identifying teens who are suffering from anxiety or depression.
“They should try to keep the lines of communication with their children as open as possible,” said Dr. Colmer. “They should talk with other parents and see what they’re going through. We also can also steer them toward a counselor, if need be.”
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