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Differential diagnosis and co-existing conditions

  • Depressive disorder - F32# often co-exists with anxiety and can be very difficult to distinguish in this age group. Marked sleep disturbance, disturbed appetite, dysphoric mood, or tearfulness in the absence of direct anxiety provocation could indicate that a child is depressed.
  • Obsessive-compulsive disorder (OCD) - F42 (adult), indicated by the presence of marked rituals or compulsive behaviours. Most children have phases of ritualized behaviour, which can usually be distinguished from OCD by the degree of distress caused if a ritual is interrupted, and the number of rituals present at any one stage.
  • Post-traumatic stress disorder - F43.1 (adult) if the onset of anxiety was preceded by an extremely distressing experience.
  • Maltreatment -  children who have experienced physical, emotional or sexual abuse are at high risk of developing emotional difficulties; this possibility should always be borne in mind. Concern should be raised when anxiety onset occurs over a short period subsequent to relatively normal development and when no other explanation (eg change of school/family circumstances) is apparent.
  • Physical illness - it is important to exclude an organic cause for emotional difficulties, particularly where the child presents with mostly physical symptoms. When physical symptoms occur only in specific situations (eg severe headaches on weekdays, but symptom free at weekends and during school holidays), this is a good indication that they might be anxiety-related. It is then usually safe to conclude that symptoms have a psychological origin.
  • Normal behaviour - it is often difficult to diagnose anxiety disorder in young children, because a moderate level of anxiety is normative at certain developmental stages. For example, most toddlers show some anxiety when separated from their primary caregiver; a large minority of pre-school and infant school-aged children will express fears of the dark, animals, monsters/ghosts and the like. These worries should not, on their own, raise too much concern, unless they are causing marked distress for the parent or child, or they interfere with the child’s ability to engage in developmentally important activities (eg a child who is unable to sleep in their own bed because they are afraid of the dark).

Last edited: 17/2/2004

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