What are the diagnostic criteria for generalized anxiety disorder (GAD) in pediatric patients?

From the Guidelines

Diagnosing generalized anxiety in children requires a comprehensive evaluation by a qualified mental health professional, typically a child psychiatrist or psychologist, using standardized screening instruments and a developmentally sensitive approach, as recommended by the American Academy of Child and Adolescent Psychiatry 1. The process begins with gathering information from multiple sources, including the child, parents, teachers, and other caregivers, about the child's worries, fears, and physical symptoms. Children with generalized anxiety typically show excessive worry about multiple areas of life that persists for at least 6 months, is difficult to control, and causes significant distress or impairment.

Key Considerations

• Physical symptoms may include restlessness, fatigue, difficulty concentrating, irritability, muscle tension, and sleep disturbances.
• Assessment tools like the Pediatric Symptom Checklist or the Difficulties Questionnaire can help quantify symptoms, as suggested by the Journal of the American Academy of Child and Adolescent Psychiatry 1.
• It's essential to rule out medical conditions that might mimic anxiety symptoms through appropriate physical examinations and sometimes laboratory tests.
• The diagnosis should follow DSM-5 criteria but consider developmental appropriateness of fears and worries.
• Children may express anxiety differently than adults - through behavioral problems, somatic complaints like stomachaches or headaches, or school refusal rather than verbalizing their worries.

Evaluation Structure

• A diagnostic interview for anxiety includes the parent/guardian and patient, either separately or together or both as developmentally and clinically indicated, as outlined in the clinical practice guideline for the assessment and treatment of children and adolescents with anxiety disorders 1.
• Family assessment can reveal environmental reinforcements for anxiety, and observations of parenting styles and behaviors can identify those that are potentially anxiogenic.
• Input from collateral sources, including other family members, teachers, primary care and behavioral health clinicians, and/or child agency workers, can add depth and breadth to diagnostic information. The use of standardized screening instruments, such as the Level 1 Cross-Cutting Symptom Measures, can help systematically and efficiently gather information about presenting problems prior to the evaluation, as recommended by the American Psychiatric Association 1.

From the Research

Diagnosis of Generalized Anxiety in Children

To diagnose generalized anxiety in children, a comprehensive assessment is necessary, which includes:

• Semistructured interviews 2, 3
• Child and informant questionnaires 2, 3
• Collateral information from parents, teachers, pediatricians, and school psychologists 2, 3
• Behavioral observations 2

Importance of Differential Diagnosis

Consideration of a differential diagnosis is crucial, as anxiety symptoms can include:

• Avoidance behaviors
• Somatic complaints
• Social difficulties
• Sleep disturbances 2, 3

Treatment Options

Available treatment options for generalized anxiety in children include:

• Cognitive-behavioral therapy (CBT) 2, 3, 4, 5
• Exposure-based therapies 2
• Pharmacological interventions, such as selective serotonin reuptake inhibitors (SSRIs) 2, 3, 4, 6
• Combination of CBT and medication, which has been shown to be the most effective treatment for youths ages seven to 17 2