Non-obsessive-compulsive anxiety disorders in child and adolescent mental health services -
Are they underdiagnosed, and how accurate is referral information?
Sammanfattning
Background: Previous studies have reported low prevalence of non-obsessive-compulsive (OCD)
anxiety disorders in child and adolescent mental health services (CAMHSs), suggesting that these
disorders may go unrecognized. Possible reasons may be lack of routinely used standardized
diagnostic instruments, and/or an under-reporting of anxiety symptoms in the referral information.
Aims: To examine the frequency of non-OCD anxiety disorders in referred children based on a
standardized diagnostic interview, to compare the results with data from the Norwegian Patient
Register (NPR), and to explore the correspondence between anxiety as a referral symptom and
anxiety as a diagnosis, and the influence of heterotypic co-morbidity on this correspondence.
Methods: Parents of 407 consecutive referrals to CAMHS aged 7-13 years were interviewed with the
semi-structured diagnostic interview Kiddie-SADS-PL at the time of admittance. Referral symptoms
were collected from national referral forms. Results: A total of 133 referred children (32.7%) met the
criteria for a non-OCD anxiety disorder compared with about 5% in the NPR. Half of those who met
diagnostic criteria for an anxiety disorder did not have anxiety as a referral symptom. Co-morbid
ADHD or disruptive disorder was significantly associated with a lower probability of having anxiety
as a referral symptom. Conclusions: The use of a standardized diagnostic interview in consecutively
referred children yielded significantly higher rates of anxiety disorders than the NPR prevalence
rates. Co-morbid ADHD or disruptive disorder may contribute to the underdiagnosing of anxiety
disorders. Diagnostic instruments covering the whole range of child psychiatric symptoms should be
implemented routinely in CAMHS.