Diagnostic Considerations
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 addition to those in the next section, include the following:
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Oppositional defiant disorder
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Peptic ulcer disease
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Avoidant personality
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Hypochondriasis
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Social phobia and selective mutism
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Specific phobia
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Trichotillomania
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Asthma
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Depression
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Dysthymic disorder
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Obstructive sleep apnea syndrome
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Somatization
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Panic disorder
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Substance abuse, including caffeine and tobacco
Go to Pediatric Obsessive-Compulsive Disorder, Pediatric Panic Disorder, and Anxiety Disorders for complete information on these topics.
Differential Diagnoses
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Child Abuse & Neglect: Posttraumatic Stress Disorder
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Pediatric Obsessive-Compulsive Disorder
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Substance Abuse (both legal and illicit)
