Pediatric Generalized Anxiety Disorder Differential Diagnoses
- Author: Dennis A Nutter, Jr, MD; Chief Editor: Caroly Pataki, MD more...
Substance-induced anxiety disorder, anxiety disorder due to a general medical condition, an adjustment disorder, or psychotic disorder also should be considered.
Distinguishing anxiety from developmentally appropriate fears is important. Throughout childhood and early adolescence, children experience various transitory fears occurring concurrently with their ability to recognize and understand potential dangers in their environment. A progression occurs from immediate, tangible fears (eg, separation from caregiver, strangers) to anticipatory, less tangible fears (eg, bad dreams, getting hurt, school failure). Children are expected to overcome and resolve these fears as part of the developmental process.
Distinguishing anxiety from realistic worry is also imperative. Worry can be thought of as a feeling of unease or concern about something. It represents an internal representation of a realistic threat. For example, a child with a learning disability may worry about an upcoming examination, or a child with a medical condition may worry about an upcoming surgery. This kind of worry is expected to be specific to a situation, and it is expected to subside once the situation has passed. Thus, the temporal requirement for generalized anxiety disorder (GAD) diagnosis (6 mo) is not met. Of course, persistent and changing realistic worries should be treated if these worries result in significant functional impairment.
Conditions to consider in the differential diagnosis of GAD, in addit
Conditions to consider in the differential diagnosis of GAD, in addition to those in the next section, include the following:
Oppositional defiant disorder
Peptic ulcer disease
Social phobia and selective mutism
Obstructive sleep apnea syndrome
Substance abuse, including caffeine and tobacco
Child Abuse & Neglect: Posttraumatic Stress Disorder
Pediatric Obsessive-Compulsive Disorder
Substance Abuse (both legal and illicit)
Barrios BA, Hartmann DB. Fears and anxieties. Marsh EJ, Terdal LG, eds. Behavioral Assessment of Childhood Disorders. 2nd ed. New York, NY: Guilford; 1988. 196-264.
Kendall PC. Childhood Disorders. London, England: Psychology Press; 2000.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 5th ed. Arlington, VA: American Psychiatric Association; 2013.
Last CG, Perrin S, Hersen M, Kazdin AE. A prospective study of childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry. 1996 Nov. 35(11):1502-10. [Medline].
March JS, Parker JD, Sullivan K, Stallings P, Conners CK. The Multidimensional Anxiety Scale for Children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry. 1997 Apr. 36(4):554-65. [Medline].
Kendall PC, Chu BC, Pimental SS. Treating anxiety disorders in youth. Kendall PC, ed. Child & Adolescent Therapy: Cognitive-Behavioral Procedures. 2nd ed. New York, NY: Guilford; 2000. 235-87.
Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT, et al. Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med. 2008 Dec 25. 359(26):2753-66. [Medline]. [Full Text].
Barrett PM, Dadds MR, Rapee RM. Family treatment of childhood anxiety: a controlled trial. J Consult Clin Psychol. 1996 Apr. 64(2):333-42. [Medline].
Last CG, Hansen C, Franco N. Cognitive-behavioral treatment of school phobia. J Am Acad Child Adolesc Psychiatry. 1998 Apr. 37(4):404-11. [Medline].
Silverman WK, Kurtines WM, Ginsburg GS, Weems CF, Lumpkin PW, Carmichael DH. Treating anxiety disorders in children with group cognitive-behaviorial therapy: a randomized clinical trial. J Consult Clin Psychol. 1999 Dec. 67(6):995-1003. [Medline].
Ginsburg GS. The Child Anxiety Prevention Study: intervention model and primary outcomes. J Consult Clin Psychol. 2009 Jun. 77(3):580-7. [Medline].
McGrath PJ, Lingley-Pottie P, Thurston C, et al. Telephone-based mental health interventions for child disruptive behavior or anxiety disorders: randomized trials and overall analysis. J Am Acad Child Adolesc Psychiatry. 2011 Nov. 50(11):1162-72. [Medline].
Cymbalta (duloxetine) [package insert]. Indianapolis, IN 46285: Lilly USA, LLC. October 29, 2014. Available at [Full Text].
Simon GE, Savarino J, Operskalski B, Wang PS. Suicide risk during antidepressant treatment. Am J Psychiatry. 2006 Jan. 163(1):41-7. [Medline].
Bridge JA, Iyengar S, Salary CB, et al. Clinical response and risk for reported suicidal ideation and suicide attempts in pediatric antidepressant treatment: a meta-analysis of randomized controlled trials. JAMA. 2007 Apr 18. 297(15):1683-96. [Medline].
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 3rd ed. Elk Grove, Ill: APA; 1987.
American Psychiatric Association. Diagnostic and Statistical Manual of Mental Disorders. 4th Edition, Text Revision. 4th ed. Washington, DC: APA Press; 2000.
Keeton CP, Kolos AC, Walkup JT. Pediatric generalized anxiety disorder: epidemiology, diagnosis, and management. Paediatr Drugs. 2009. 11(3):171-83. [Medline].
Manassis K. Keys to Parenting Your Anxious Child. Hauppage, NY: Barron's Educational Series; 1996.
Spence S. Helping Your Anxious Child: A Step-By-Step Guide for Parents. Oakland, Calif: New Harbinger Publications; 2000.