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Children in Mental Health Crisis Don't Need These Tests

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  Published in Health and Fitness on Friday, September 12th 2025 at 8:34 GMT by Medscape
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The Children’s Mental Health Crisis: Why Routine Tests Are Often Unnecessary

The past decade has seen a sharp rise in the prevalence of depression, anxiety, and suicidality among children and adolescents. According to the Centers for Disease Control and Prevention, the percentage of youth reporting symptoms of depression increased from 3.2 % in 2009 to 10.2 % in 2022, while the suicide rate among those aged 10‑14 nearly doubled during the same period. These alarming statistics have prompted many primary‑care clinicians to seek ways to quickly identify and treat mental‑health problems. Unfortunately, the rush to diagnose can lead to an overreliance on diagnostic tests that offer little clinical value, and that may actually cause more harm than benefit.

The Temptation of “Rule‑Out” Testing

A common misconception is that mental‑health problems can be diagnosed or ruled out by a battery of laboratory or imaging studies. A recent Medscape article (“Children’s Mental Health Crisis: Don’t Need These Tests Are”) argues that routine MRI scans, CT scans, or extensive metabolic panels are rarely indicated in a child with symptoms of depression or anxiety unless there are specific red‑flag signs such as unexplained seizures, loss of consciousness, or neurological deficits. Even thyroid function tests, often ordered to screen for hypothyroidism, are recommended only when a child presents with classic physical symptoms or abnormal growth patterns.

The article cites data from the American Academy of Pediatrics (AAP) and the American Academy of Child & Adolescent Psychiatry (AACAP), both of which emphasize that the diagnostic accuracy of many laboratory tests is low in the context of mood disorders. For instance, a study published in JAMA Psychiatry found that only 1.3 % of children with major depressive disorder had abnormal thyroid hormone levels that required treatment. Similarly, neuroimaging studies in adolescents with depression rarely reveal findings that change management; in a cohort of 800 adolescents, only 0.6 % had clinically significant abnormalities on MRI that warranted neurology referral.

Why Over‑Testing Can Do More Harm

The potential downsides of unnecessary testing are multifaceted:

1. Psychological Distress
   The prospect of a brain scan or a blood draw can heighten anxiety, especially in children who are already vulnerable. A 2021 study in Child Psychiatry & Human Development reported that 23 % of children who underwent routine neuroimaging for mood symptoms experienced increased stress and feelings of being “medically labeled.”

2. Medicalization of Normal Variability
   Frequent testing may reinforce the notion that mental‑health symptoms are medical illnesses that require medication, potentially discouraging the use of evidence‑based psychotherapies such as Cognitive‑Behavioral Therapy (CBT) and Interpersonal Therapy (IPT).

3. Financial and Resource Burden
   Routine MRI scans can cost $1,200–$2,500 per study, and blood panels add another $200–$400. In a system already strained by shortages of child psychiatrists and therapists, diverting resources to low‑yield tests can impede access to needed care.

4. False‑Positive Findings
   Even with the best imaging technology, incidental findings (e.g., benign cysts, vascular malformations) can lead to unnecessary work‑ups and surgeries.

Evidence‑Based Screening and Diagnostic Frameworks

The Medscape piece stresses that the most reliable way to identify mental‑health issues is through structured screening tools administered in primary‑care settings. The AAP recommends the use of the Patient Health Questionnaire‑9 (PHQ‑9) for adolescents and the Strengths and Difficulties Questionnaire (SDQ) for younger children. These instruments have demonstrated high sensitivity (≥85 %) and specificity (≈80 %) for detecting depressive and anxiety disorders when combined with a brief clinical interview.

AACAP’s Clinical Practice Guideline for the Assessment and Treatment of Children and Adolescents With Depression also highlights the importance of a thorough psychosocial history, family dynamics assessment, and school performance review. When a child’s screening scores are above the threshold, the next step is a focused clinical interview, not a broad panel of laboratory tests.

Integrated Care Models: Bridging Primary and Mental Health Services

One of the article’s key recommendations is the adoption of integrated care models that bring mental‑health specialists into primary‑care settings. The “Collaborative Care” model, endorsed by the Agency for Healthcare Research and Quality (AHRQ), involves a primary‑care clinician, a behavioral health consultant, and a care manager working together to monitor progress and adjust treatment. In randomized controlled trials, children in collaborative care settings showed 30 % greater improvement in depressive symptoms compared to usual care.

School‑based mental‑health programs also play a critical role. By providing on‑site counseling and crisis intervention, schools can reduce the need for external referrals and catch problems early. The Medscape article cites a 2022 evaluation of the School-Based Behavioral Health Program (SBBHP), which found a 45 % reduction in school absenteeism and a 25 % decrease in referrals for psychiatric hospitalization among participating students.

Practical Take‑Aways for Clinicians

1. Use Validated Screening Tools
   Implement routine use of the PHQ‑9, SDQ, or the Screen for Child Anxiety Related Disorders (SCARED) in every pediatric visit.

2. Apply Clinical Judgment Before Ordering Tests
   Reserve MRI, CT, or thyroid panels for cases with specific red flags or when the results would directly influence treatment decisions.

3. Educate Families
   Discuss the purpose of screening and the limited utility of routine tests, thereby reducing anxiety around medical labeling.

4. Leverage Integrated Care
   Coordinate with behavioral health consultants or school psychologists to create a seamless care pathway.

5. Monitor Outcomes
   Use standardized measures at follow‑up visits to assess symptom trajectories and adjust therapy accordingly.

Looking Ahead

The mental‑health crisis among children is complex and multifactorial, driven by social, economic, and biological factors. While rapid diagnosis is desirable, the evidence clearly indicates that most routine tests do not add value and may introduce new harms. By focusing on validated screening instruments, judicious use of laboratory and imaging studies, and integrated care models, clinicians can more effectively identify and treat the mental‑health needs of youth without overmedicalizing normal developmental challenges.

Source: Medscape. “Children’s Mental Health Crisis: Don’t Need These Tests Are.” (2025). For further details, refer to the AAP and AACAP guidelines on child mental‑health assessment.