October, 2016

In a recent study in the Journal of Developmental and Behavioral Pediatrics, Dr. Nerissa Bauer, MD, MPH, along with Drs. Rachel Yoder MD, Aaron Carroll MD, MPH, and Steve Downs MD, MS, examined the prevalence of potential anxiety disorder diagnoses among children and adolescents, taking into account the children's race/ethnicity/cultural background. Children in the study were brought into the pediatrician's office because parents were concerned about "disruptive behaviors." When the children were screened for ADHD, parents were also asked a set of questions about anxiety indicators. 

Anxiety disorders are common in children and adolescents. Nearly a quarter of teens and young adults show symptoms of an anxiety disorder. It is less common among younger children but still a significant mental health concern. Anxiety symptoms are especially common in conjunction with other mental health disorders like depression, addiction, behavioral disorders and ADHD. However, anxiety is not always a mental health disorder that parents acknowledge in their children. Parents of some ethnic/cultural backgrounds are more likely to acknowledge anxiety symptoms than others. Because of this, pediatricians may not always know to examine and treat anxiety symptoms in their young patients.

Pediatricians also may not always screen for anxiety because they are already facing countless other symptoms and health concerns in the screening process. Managing what concerns to address in screening is a challenge, even with helpful electronic tools such as the Child Health Improvement through Computer Automation (CHICA) system, developed by Indiana Children’s Health Services Research (CHSR) and used in this study. As the study’s primary author, Dr. Nerissa Bauer, explains, “Pediatricians are stressed about having ‘one more thing I have to screen for.’ We sought to examine how well anxiety symptoms were picked up in kids disruptive behavior. So it was an effective way to find kids with anxiety.”

Dr. Bauer conducted a study looking at anxiety disorder symptoms in children and adolescents who were visiting their pediatricians because of “disruptive behaviors.” The study examined a tool that diagnoses ADHD, the Vanderbilt ADHD Diagnostic Rating Scale (VADRS), which has a subsection on anxiety symptoms. Dr. Bauer’s goal in the project was to find a way to alert doctors of anxiety concerns in the patients, without adding more screening and diagnostic testing for either parents or pediatricians.

The VADRS screening relies on parents reporting on their children’s behaviors and symptoms. The study found that 16% of kids brought in because of “disruptive behaviors” screened positive for potential anxiety disorders based on the parents reporting. However, there was a lot of variation in the results based on ethnicity and cultural background. For instance, Spanish-speaking Hispanic children were the least likely to present anxiety symptoms, based on reports by their parents. English-speaking children were more likely, but not as likely as European-American children, whose parents were the most likely to mark anxiety symptoms on the VADRS screening tool.

Dr. Bauer considers the study a success. It was very effective in telling the authors what they needed to know: that the VADRS ADHD tool wasn’t complete enough as a diagnostic tool for anxiety. Importance of screening but may need to be supplemented, in particular for Hispanic youth. Research suggests physical symptoms would raise more red flags to Hispanic parents than emotional symptoms. As a result, may want to use an anxiety screener so that can take into account physical symptoms, because it will be more appropriate for different cultural influences. 

The article is free to the public at the Journal of Developmental and Behavioral Pediatrics website: Racial/Ethnic Differences in Anxiety

Bauer NS, Yoder R, Carroll AE, Downs SM. Racial/Ethnic Differences in the Prevalence of Anxiety Using the Vanderbilt ADHD Scale in a Diverse Community Outpatient Setting. J Dev Behav Pediatr 37(8):610-618, 2016.