Abstract
Examine whether children with a primary diagnosis of generalized anxiety disorder (GAD) differ from children with a secondary diagnosis of GAD on clinician, parent, teacher, and youth-report measures. Based on consensus diagnoses, 64 youth referred to a general outpatient assessment clinic were categorized as having either a primary or secondary diagnosis of GAD. A semi-structured diagnostic interview was used to guide diagnostic decisions and assign primary versus secondary diagnostic status. We predicted that youth with a primary GAD diagnosis would present with greater anxiety symptomatology and symptom impairment on a variety of anxiety-related measures than youth with a secondary GAD diagnosis. Contrary to our hypotheses, no differences were found between those with primary versus secondary GAD diagnoses on measures of symptom severity and clinical impairment, comorbid diagnoses, or youth and teacher-report measures. Our findings have potential implications for the current practice of requiring primary anxiety diagnostic status as an inclusion criterion in clinical research and treatment outcome studies. Assuming our findings are confirmed in larger samples and with other anxiety disorders, future clinical trials and basic psychopathology research might not exclude youth based on absence of a particular anxiety disorder as the primary disorder but rather include individuals for whom that anxiety disorder is secondary as well.
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References
American Psychiatric Association (2000) Diagnostic and statistical manual of mental disorders, fourth edition, text revision. Am Psychiatr Pub, Washington
American Psychiatric Association (2013) Diagnostic and statistical manual of mental disorders, 5th edn. Am Psychiatr Pub, Arlington
McLeod BD, Jensen-Doss A, Ollendick TH (eds) (2013) Diagnostic and behavioral assessment in children and adolescents: a clinical guide. Guilford Publications Inc, New York
First MB (2014) DSM-5 handbook of differential diagnosis. Am Psychiatr Pub, Arlington
Rapee RM, Bogels SM, van der Sluis CM, Craske MG, Ollendick TH (2012) Annual research review: conceptualizing functional impairment in children and adolescents. J Child Psychol Psychiatry 53:454–468
Walkup JT, Albano AM, Piacentini J, Birmaher B, Compton SN, Sherrill JT et al (2008) Cognitive behavioral therapy, sertraline, or a combination in childhood anxiety. N Engl J Med 359:2753–2766
Kendall PC (1994) Treating anxiety disorders in children: results of a randomized clinical trial. J Consult Clin Psychol 62:100–110
Kendall PC, Puliafico AC, Barmish AJ, Choudhury MS, Henin A, Treadwell KS (2007) Assessing anxiety with the child behavior checklist and teacher report form. J Anxiety Disord 21:1004–1015
Ollendick TH, Öst LG, Reuterskiöld L, Costa N, Cederlund R, Sirbu C et al (2009) One-session treatment of specific phobias in youth: a randomized clinical trial in the United States and Sweden. J Consult Clin Psychol 77:504–516
Ollendick TH, Halldorsdottir T, Fraire MG, Austin KE, Noguchi RJP, Lewis KM et al (2015) Specific phobias in youth: a randomized controlled trail comparing one-session treatment to a parent-augmented one-session treatment. Behav Ther 46:141–155
Silverman WK, Kurtines WM, Ginsburg GS, Weems CF, Rabian B, Serafini LT (1999) Contingency management, self-control, and education support in the treatment of childhood phobic disorders: a randomized clinical trial. J Consult Clin Psychol 67:675–687
Wood JJ, Piacentini JC, Southam-Gerow M, Chu BC, Sigman M (2006) Family cognitive behavioral therapy for child anxiety disorders. J Am Acad Child Adolesc Psychiatry 45:314–321
Alfano CA, Beidel DC, Turner SM, Lewin DS (2006) Preliminary evidence for sleep complaints among children referred for anxiety. Sleep Med 7:467–473
Silverman WK, Albano AM (1996) Manual for the ADIS-IV-C/P. Psychological Corporation, New York
Manassis K, Hood J (1998) Individual and family predictors of impairment in childhood anxiety disorders. J Am Acad Child Adolesc Psychiatry 37:428–434
Mychailyszyn MP, Mendez JL, Kendall PC (2010) School functioning in youth with and without anxiety disorders: comparisons by diagnosis and comorbidity. School Psych Rev 39:106–121
Grills-Taquechel AE, Fletcher JM, Vaughn SR, Stuebing KK (2012) Anxiety and reading problems in early elementary school: evidence for unidirectional- or bidirectional relations? Child Psychiatry Hum Dev 43:35–47
Jarrett MA, Black AK, Rapport HF, Grills-Taquechel AE, Ollendick TH (2015) Generalized anxiety disorder in younger and older children: implications for learning and school functioning. J Child Fam Stud 24:992–1003
Silverman WK, Ollendick TH (2005) Evidence-based assessment of anxiety and its disorders in children and adolescents. J Clin Child Adolesc Psychol 34:380–411
Silverman WK, Saavedra LM, Pina AA (2001) Test–retest reliability of anxiety symptoms and diagnoses with the anxiety disorders interview schedule for DSM-IV: child and parent versions. J Am Acad Child Adolesc Psychiatry 40:937–944
Rey JM, Starling J, Wever C, Dossetor DR, Plapp JM (1995) Inter-rater reliability of global assessment of functioning in a clinical setting. J Child Psychol Psychiatry 36:787–792
Achenbach TM (2001) Manual for the child behavior checklist 4-18 and 2001 profile. University of Vermont, Department of Psychiatry, Burlington
March JS (1997) Manual for the multidimensional anxiety scale for children (MASC). Multi-Health Systems, Toronto
March JS, Parker JDA, Sullivan K, Stallings P, Conners CK (1997) The multidimensional anxiety scale for children (MASC): factor structure, reliability, and validity. J Am Acad Child Adolesc Psychiatry 36:554–565
Grills-Taquechel AE, Ollendick TH, Fisak B (2008) A re-examination of the MASC factor structure and discriminant ability in a mixed clinical outpatient sample. Depress Anxiety 25:942–950
Achenbach TM (2001b) Manual for the teacher report form 4-18 and 2001 profile. Burlington: University of Vermont, Department of Psychiatry
Little RJ (1988) A test of missing completely at random for multivariate data with missing values. J Am Stat Assoc 83:1198–1202
Allison PD (2001) Missing data. Sage, Thousand Oaks
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Ollendick, T.H., Jarrett, M.A., White, B.A. et al. Primary Versus Secondary Diagnosis of Generalized Anxiety Disorder in Youth: Is the Distinction an Important One?. Child Psychiatry Hum Dev 47, 548–553 (2016). https://doi.org/10.1007/s10578-015-0588-1
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DOI: https://doi.org/10.1007/s10578-015-0588-1