KIDS' STUFF
EVERY CASE IS DIFFERENT: IDENTIFYING CHILDHOOD
ANXIETY DISORDERS
AUTHOR Pat Purcell, MD
P
arents often bring their child to the
office due to physical complaints that
can vary, therefore making a spe-
cific diagnosis difficult. Examples
include a child who has abdominal
pain in the morning prior to school
or again in the evening at bedtime,
or the child that complains of pain at school
requiring a parent to facilitate leaving school. Additionally, a child
may require the parent to be in the room for initiation of sleep or to
maintain sleep throughout the night. Some children are unable to
go into the school environment unaccompanied and cannot remain,
thus avoiding school. Various other anxious complaints can manifest
with test taking, inability to speak in front of others or participate
in social situations. Is this an organic pathological process? Or is
this the “dreaded” manifestation of an anxiety disorder?
The definition of anxiety can be differentiated into worry and fear
with extreme manifestations that may lead to changes in the child’s
behavior. This dysfunctionality can create changes in a child’s mood,
sleeping patterns and eating habits, and their overall behavior. This
worry and fear can be accompanied by a feeling of dread which leads
to the body’s autonomic responses. Apprehension in anticipation of
20
LOUISVILLE MEDICINE
a dangerous occurrence can lead to sweating, shortness of breath,
palpitations, loss of appetite and vomiting.
Many times, the child cannot identify or verbalize what pre-
cipitated such fear. The child cannot articulate it properly or even
recognize it for what it is. The fears may be compounded and coexist
with other fears. Some fears are typical and expected in a child’s
developmental process, even while the child is living in a supportive
environment.
Anxiety is a common experience, but not all anxiety can be
characterized as an “anxiety disorder.” Anxiety can be rational,
occurring with a promotion or becoming a new parent. We become
even more anxious when faced with life and financial changes. Most
individuals are able to cope with this; some anxiety can be beneficial.
The need to put an extra amount of effort into studying for a test
or memorize lines for a school play produces a helpful anxiety; the
key question is: Has the anxiety become dysfunctional? Can it be
a psychiatric diagnosis?
Anxiety associated with physical illnesses, as well as other psy-
chiatric disorders, compound the diagnosis due to the variety of
causes and the scope of disorders. When investigating for an organic
cause, care must be given to support the need for an investigation