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.
Association of childhood anxiety and irritability strongly correlate across child gender and age. Pediatric anxiety and irritability were similar across children with and without GAD. This suggests that the anxiety–irritability association remains relevant across pediatric anxiety disorders and not uniquely to GAD. [6]
An evaluation for 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), [7] and the Screen for Child Anxiety Related Emotional Disorders (SCARED) child and parent versions, can be used to further assess anxiety symptoms.
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.
