Table 1.

Considerations when determining whether further screening for anxiety disorders is warranted

DSM-IV Anxiety Disorders	Symptoms indicative of normal/developmentally appropriate fears and worries	Symptoms indicating that threshold for disorder may be met
Separation anxiety disorder	mild distress/apprehension regarding separation from primary caregivers (e.g., on the first day of school)	catastrophic thoughts and/or recurrent bad dreams about being kidnapped, lost, or harm befalling parents if separated reluctance or refusal to be separated from parents abdominal pain, chest pain, headaches, nausea or vomiting prior to or upon separation; older children/adolescents may experience panic attacks when separated
Generalized anxiety disorder	mild/occasional worries about grades, health, world events, etc. child can be easily consoled/distracted when worried worries are not in excess of what most same-age peers experience	worry is excessive and difficult to control (e.g., constant worrying about grades even when child has straight As) in some cases child may be described as perfectionistic by adults trouble sleeping, restlessness, irritability, trouble concentrating, or muscle tension are present when worrying
Social anxiety disorder	shyness or performance fears that do not overly distress the child or interfere with the child’s activities	excessive fears of being judged negatively or embarrassed in social situations (e.g., when the center of attention, with adults, when meeting new people) child may attempt to avoid such situations (e.g., refusal to go to school or extracurricular activities, skipping class when a presentation is scheduled) physical symptoms such as flushing or tremor, especially upon exposure to social cues, may be observed
Panic disorder w/or w/o agoraphobia	occasional concerns about symptoms of physiological arousal (e.g., transient concern about possible recurrence after an episode of vertigo)	unexpected panic attacks which include symptoms like rapid heart rate, shortness of breath, trembling or shaking, dizziness, lightheadedness, and gastrointestinal discomfort persistent fear of having future attacks or catastrophic thoughts about the consequences of future attacks (e.g., heart attack) avoidance of situations in which panic or panic-like sensations are anticipated (e.g., avoidance of exercise/sports)
Obsessive compulsive disorder	mild obsessive thoughts without compulsions (e.g., occasional “germ-phobic” thoughts that are not associated with excessive hand-washing or cleaning) child can easily be distracted from these thoughts/behaviors thoughts and behaviors are not time-consuming	obsessions are persistent and may be distressing to the child child feels driven to perform repetitive or ritualistic behaviors (compulsions) physical evidence of compulsions may be present (e.g., dry, cracked hands due to excessive washing)
Specific phobia	mild fear reaction to a particular object or situation (e.g., briefly clinging to parent when confronted with a friend’s pet dog) child very rarely encounters the feared situation and has no need to (e.g., fear of heights when in a tall building, but lives in a rural area with few or no tall buildings) child does not go out of her way to avoid the situation	fear significantly impacts the child’s life or family function (e.g., family trips avoided due to child’s fear of flying; necessary medical evaluations or treatment delayed due to child’s fear of needles) strong affective and behavioral reactions, which may include a panic attack, upon exposure to the feared stimulus (e.g., shaking, crying and hyperventilating at the doctor’s office when a vaccination is imminent)

Note. Symptoms which may come to the attention of medical providers are bolded.