Approach Considerations
Excessive medical workup without clear indication by history and physical examination is contraindicated because it can exacerbate anxiety.
The relatively rare medical causes of panic in pediatric patients, such as hyperinsulinemia or hyperthyroidism, should be documented with appropriate laboratory studies.
A comprehensive review of medications is indicated to ascertain the potential influence of any illicit or over-the-counter substances in the presentation of the patient’s symptoms. [12]
Structured Interview
A structured interview, such as 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), [13] and the Screen for Child Anxiety Related Emotional Disorders (SCARED), [14] child and parent versions, can be used to further assess anxiety symptoms.
The Anxiety Disorders Interview Schedule for Children is a comprehensive semistructured interview administered by clinicians to children age 7-17 years. It differentiates between each type of childhood anxiety disorder. It assures the collection of high-quality data, enables clinicians to indicate a primary or most-impairing diagnosis, and has good inter-rater reliability.
Preliminary studies have demonstrated the Autonomic Nervous System (ANS) Questionnaire as another screening test that is sensitive for panic disorder in the adolescent patient population. [7]
Self- and parent-report measures used in evaluating pediatric panic disorder include the School Refusal Assessment Questionnaire and the Social Phobia and Anxiety Inventory for Children.
