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Pediatric Generalized Anxiety Disorder Clinical Presentation

  • Author: Dennis A Nutter, Jr, MD; Chief Editor: Caroly Pataki, MD  more...
 
Updated: Nov 14, 2014
 

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 diagnoses, such as the Diagnostic Interview Schedule for Children (DISC) and the Anxiety and Related Disorders Interview Schedule for DSM-5 (ADIS-5) - Adult and Lifetime Version can be employed.

Questionnaires, such as the Revised Children's Manifest Anxiety Scale (RCMAS), the Multidimensional Anxiety Scale for Children (MASC),[5] and the Screen for Child Anxiety Related Emotional Disorders (SCARED) child and parent versions, can be used to further assess anxiety symptoms.

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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, American Psychiatric Association

Disclosure: Nothing to disclose.

Chief Editor

Caroly Pataki, MD Health Sciences Clinical Professor of Psychiatry and Biobehavioral Sciences, University of California, Los Angeles, David Geffen School of Medicine

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

Disclosure: Nothing to disclose.

Acknowledgements

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.

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.

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.

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