AAP Recommends Annual Mental Health Screenings For Children Following Illinois Executive Order

The American Academy of Pediatrics (AAP) has issued new guidelines recommending that children and adolescents receive annual mental health screenings, which align closely with an executive order signed by Illinois Governor JB Pritzker to require all school districts to conduct annual mental health screenings for all students. The AAP has been heavily criticized by HHS Secretary Robert F. Kennedy Jr. and others for having pharmaceutical conflicts of interest, including Pfizer, Moderna, Merck, Sanofi, and many more.

The latest guidance doesn’t talk about the use of antidepressants as treatment for depression or other mental, emotional, and behavioral (MEB) issues, but focuses on the benefits of regular screenings for adolescents and children.

The AAP website states, “SSRIs are the first line of psychopharmacologic treatment for anxiety and depressive disorders.” The evaluation starts with the PHQ-9 form that contains nine questions that each have a rating from 0-3 based on the number of days the patient experienced this symptom over the last two weeks. This questionnaire, which was created with a grant from Pfizer, has a potential for 27 points, and patients who receive 10 or higher are considered to have moderate depression, which typically calls for intervention.

A 2022 article published in American Family Physician explored the clinical question of whether universal depression screening is helpful for patients. “There is considerable uncertainty, which is reflected in the disparate guidelines, about whether screening for depression is helpful to patients (rather than a way to label them as being depressed or not),” the authors wrote. “Most of the positive scores on the Patient Health Questionnaire-9 tool will be falsely positive (77%) for patients screened in primary care, and many of those who have mild depression will not benefit from treatment. (Level of Evidence = 5).”

Antidepressant prescriptions for adolescents increased by 65% from January 2016 to December 2022, with a more substantial increase occurring during the COVID-19 pandemic lockdowns. The United Kingdom also utilizes the PHQ-9 questionnaire for mental health evaluations. A 2022 survey of 2,007 young people found 37% of 12-18 year olds have been prescribed antidepressants at some point in their lives, and 43% of 19-21 year olds.

Jefferey Jaxen reported for The HighWire that there is a recent push to provide SSRIs over the counter. Jaxen also discussed study findings of increased mortality risk for long-term SSRI usage, including congenital heart disease and cardiovascular disease. As antidepressant prescriptions have increased, so have mental health-related emergency room visits for adolescents and suicidal ideation. The HighWire also covered the order on a recent segment.

Tracy Beanz and Michelle Edwards reported for The HighWire about Pfizer’s role in creating the depression checklist that was never meant to serve as a diagnostic tool for primary care physicians, but it has since been widely used and cited in more than 11,000 scientific papers. Beanz and Edwards also reported about a father who learned the school gave his daughter Pfizer’s Zoloft in an unmarked baggie without parental knowledge or consent.

While the AAP promotes antidepressants as a first line of defense for adolescents with moderate to severe depression, it does mention the importance of evaluating other factors. “An assessment of a child’s sleep hygiene, nutrition, exercise, and media exposure should also be ascertained, because problems in any of these areas can mimic or exacerbate MEB (Mental Emotional Behavioral) problems,” 

Sleep difficulties, feeling tired, and a lack of focus are three of the questions on the PHQ-9 form. The AAP guidance recommends that health professionals assess patient-caregiver relationships and identify potential social determinants of health (SDOH). Positive screens should also include a physical examination “if indicated” to look for “potential organic or medical causes” including “prior injuries, patterned scarring, suspicious bruising, defensive wounds, or evidence of self-harm.

Journalist Abigail Shrier, author of “Bad Therapy: Why The Kids Aren’t Growing Up,” appeared on Fox News to discuss the problems she sees with universal mental health screenings following the executive order in Illinois earlier this month.

“Whenever you screen large numbers of people for a low-incidence condition – and depression, anxiety, and suicidality, these are still low-incidence conditions –  you will produce an overwhelming number of false positives,” Shrier said. “The vast number of kids flagged for suicidality and depression will be false positives. Nonetheless, we can forever upend the way they see themselves. 10s of thousands of kids in Illinois will get the false impression that they have suicidality or depression, and it will push them into the mental health funnel. We’re talking about a lifetime of dependency on psychiatric medication and therapy.”

A study published in the BMJ last year found that exercise is twice as effective for treating depression as antidepressants. Studies and lawsuits have linked increased teen mental health disorders with the higher prevalence of smartphones and social media usage.

A 2024 study found an association between consumption of sugary sweetened beverages (SSB) and increased depressive and anxiety symptoms for adolescents. The same study found an association between fruit and vegetable consumption and positive mental health. A 2021 survey found 57% of children aged 1-5 drank an SSB on any given day. In addition, 49% did not eat a daily vegetable, and 32% did not eat a daily fruit.

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