Jeanne Marconi, MD, talks difficulties of implementing mental health screenings

Efforts to expand mental and emotional health screening in pediatrics continue to grow, but barriers remain, according to Jeanne Marconi, MD, pediatrician and senior vice president for business development and strategic partnerships at Brightline.

The American Academy of Pediatrics (AAP) has long emphasized developmental screening for motor skills, language, and social milestones, with pediatricians now accustomed to integrating these assessments into well visits. The newly updated AAP clinical report extends this guidance to mental, emotional, and behavioral (MEB) health, calling on pediatric primary care clinicians (PPCCs) to screen for conditions such as depression, anxiety, ADHD, and substance use. While screening rates for developmental concerns rose significantly between 2002 and 2016, research shows detection of MEB issues remains inconsistent, with sensitivity as low as 14% when based on clinical judgment alone.

“I would say that between 2004 and 2010, mental health screening began to emerge and gain popularity,” she said. “Around 2015, the Academy released statements recommending at least depression screening in teenagers, along with symptom checklists for parents to help identify concerns with their children.”

Since then, expectations for well visits have multiplied.

“Over the years, the number of items expected to be covered in a checkup has become voluminous, making it difficult to prioritize,” Marconi said. The AAP report echoes this concern, noting that lack of time, limited referral options, and the shortage of child and adolescent mental health specialists are significant obstacles for pediatricians.

“In the last 4 years since COVID, the number of children and youth screening positive has escalated, consuming much of a pediatrician’s day,” Marconi noted.

Technology adds another layer of challenge, "as seen with EHRs and system incompatibility, technology has not evolved to make these screenings simple or efficient," she added.

Despite these challenges, both the AAP and Marconi stress the importance of early detection. The AAP report highlights that children identified through screening are more likely to receive treatment, and Marconi pointed to the need for continued innovation so pediatricians can realistically meet the rising demand for mental health care in children.

Marconi reports no relevant disclosures.

Reference:

Weitzman C, Guevara J, Curtin M, Macias M. Promoting Optimal Development: Screening for Mental Health, Emotional, and Behavioral Problems: Clinical Report. Pediatrics. September 2025. doi:10.1542/peds.2025-073172