Pediatric Generalized Anxiety Disorder Clinical Presentation

  • Author: Dennis A Nutter Jr, MD; Chief Editor: Caroly Pataki, MD   more...
 
Updated: Feb 8, 2012
 

History

Children with generalized anxiety disorder (GAD) may experience somatic symptoms such as shortness of breath, rapid heartbeat, sweating, nausea or diarrhea, frequent urination, cold and clammy hands, dry mouth, trouble swallowing, or a "lump in the throat." Problems with muscle tension also can occur, including trembling, twitching, a shaky feeling, and muscle soreness or aches. Patients often complain of stomachaches and headaches. Despite these symptoms, few findings are noted on physical examination.

An evaluation for generalized anxiety disorder (GAD) should include data gathering through diagnostic interviews with the child and parent, direct observation, and questionnaires. Family history of anxiety and mood disorders, the child's early temperament and adjustment to school, and life stressors or disruptions are among important factors to consider in GAD.

Structured interviews yielding DSM-IV diagnoses, such as the Diagnostic Interview Schedule for Children (DISC) and the Anxiety Disorders Interview Schedule for DSM-IV Child and Parent Versions (ADIS-C/P), can be employed.

Questionnaires, such as the Revised Children's Manifest Anxiety Scale (RCMAS), the Multidimensional Anxiety Scale for Children (MASC),[8] and the Screen for Child Anxiety Related Emotional Disorders (SCARED) child and parent versions, can be used to further assess anxiety symptoms.

The DSM-IV requires the following to satisfy a diagnosis of GAD:

  • Excessive anxiety and worry, occurring more days than not for at least 6 months, about a number of events or activities
  • Difficulty controlling the worry
  • One of the following symptoms in association with the worry: restlessness, fatigue, poor concentration, irritability, muscle tension, or sleep disturbance
  • Focus of worry that is not confined to features of another Axis I diagnosis, eg, worry about having a panic attack, social embarrassment, or separation from caregiver
  • Clinically significant distress or impairment experienced in social, school, or other important areas
  • Disturbance that is not due to a substance or general medical condition and that does not occur exclusively during a mood disorder, a psychotic disorder, or in association with a pervasive developmental disorder
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Physical Examination

As previously mentioned, children with generalized anxiety disorder (GAD) may experience somatic symptoms, including shortness of breath, rapid heartbeat, sweating, nausea or diarrhea, frequent urination, cold and clammy hands, dry mouth, trouble swallowing, or a "lump in the throat." Problems with muscle tension, such as trembling, twitching, a shaky feeling, and muscle soreness or aches, may also occur, and patients often complain of stomachaches and headaches. Despite these symptoms, few findings are noted on physical examination.

Nonetheless, a thorough physical examination is necessary to determine possible physical illnesses indirectly or directly contributing to anxiety manifestations. Somatic complaints and associated anxiety that may be part of an individual’s clinical presentation may also be addressed by reassurance of normal physical examination findings, to include vital signs.

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Contributor Information and Disclosures
Author

Dennis A Nutter Jr, MD  President and Director, North Georgia Neuropsychiatry, PC

Dennis A Nutter Jr, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry and American Psychiatric Association

Disclosure: Nothing to disclose.

Coauthor(s)

Carrie Sylvester, MD, MPH  Senior Child and Adolescent Psychiatrist, Sound Mental Health

Carrie Sylvester, MD, MPH is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD  Professor of Clinical Psychiatry and Behavioral Sciences, Department of Psychiatry, Division Chair, Child and Adolescent Psychiatry, Keck School of Medicine of the University of Southern California

Caroly Pataki, MD is a member of the following medical societies: American Academy of Child and Adolescent Psychiatry, New York Academy of Sciences, and Physicians for Social Responsibility

Disclosure: Nothing to disclose.

Additional Contributors

Chet Johnson, MD Professor and Chair of Pediatrics, Associate Director, Developmental Pediatrician, Center for Child Health and Development, Shiefelbusch Institute for Life Span Studies, University of Kansas School of Medicine; LEND Director, University of Kansas Medical Center

Chet Johnson is a member of the following medical societies: American Academy of Pediatrics

Disclosure: Nothing to disclose.

Lene Holm Larsen, PhD Instructor, Department of Child and Adolescent Psychiatry, Children's Memorial Hospital of Chicago

Disclosure: Nothing to disclose.

Mary L Windle, PharmD Adjunct Associate Professor, University of Nebraska Medical Center College of Pharmacy; Editor-in-Chief, Medscape Drug Reference

Disclosure: Nothing to disclose.

References

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