Results

Staff Survey (Table 1)

Of the 40 staff surveyed, 37 returned forms. Of these, 23 were physicians (child psychiatrists and trainees), 2 were psychologists, 9 were allied health professionals working in a psychiatric setting (for example, nursing, social work, and occupational therapy), and 3 were administrative staff regularly interacting in the clinic with children suffering from anxiety. Of those surveyed, 29/37 (78.4%) believed that children with anxiety were somewhat more or very much more oppositional than typical children, 3/37 (8.1%) believed they were the same, and only 5/37 (13.5%) believed that they were somewhat less or very much less oppositional than typical children. Further, 12/37 (32.4%) believed that children with anxiety had higher oppositionality than did children with other psychiatric diagnoses, 18/37 (48.7%) believed that they were similar, and 7/37 (18.9%) believed that such children were less oppositional than children with other psychiatric diagnoses.

Chart Review (Table 2)

In total, we reviewed 145 charts: 81 boys and 64 girls with a mean age of 9.98 years (SD 1.85). Of these children, 66 had at least 1 anxiety disorder (45%), whereas 79 had no anxiety disorder. The most common other diagnoses in the clinic, including those comorbid with anxiety disorders, were all forms of ADHD combined (22%), learning disorders (20%), and mood disorders (18%). Other diagnoses included adjustment disorders (10%), pervasive developmental disorders (9%), tic disorders (5.5%), conduct disorder (CD), and posttraumatic stress disorder; 13 children (9%) had no current psychiatric diagnosis. Relatively pure anxiety disorders were not uncommon in this sample: 36 of the 66 children with anxiety (54.5%), or 25% of the entire sample, did not have any other diagnosis. Further, 72% of the children with anxiety had only 1 anxiety disorder.

Of the 36 children with “pure anxiety” (no other diagnosis), however, 15 (42%) had more than 1 anxiety disorder diagnosis. Overall, the most common anxiety disorder diagnoses were GAD or anxiety disorder not otherwise specified (NOS) (36/66 or 54%). Not all children with anxiety disorder diagnoses were symptomatic at the time of assessment. Some were subclinical or in remission on medication but had been referred specifically for group treatment. Also, many children without anxiety disorder diagnoses had anxiety symptoms that contributed to their referral to this clinic rather than to one of the department’s other specialty clinics.

Of the 145 children, 16 (11%) were clinically diagnosed with ODD, and these were highly comorbid cases. Overall, 11 of these 16 diagnosed ODD cases had 3 or more diagnoses. Of those diagnosed with ODD, 5 had a comorbid anxiety disorder, 7 had a current diagnosis of major depressive disorder (MDD) or depressive disorder NOS, and 1 had a past diagnosis of MDD. Ten of the 16 children with ODD had comorbid ADHD; of these, 5 had comorbid depressive disorder, and all but 1 had at least 1 additional diagnosis apart from ADHD and ODD.

The CSI report for ODD symptoms revealed a different picture. Consistent with DSM-IV, the CSI categorical cut-off for ODD is 4 symptoms seen “often” or “very often.” On the parent CSI, 65 children (44.8%) met this cut-off, including the 16 children clinically diagnosed with ODD. Notably, of these 65 children, 41 (63%) also met the inventory cut-off criteria for GAD, and most had clinical anxiety disorder diagnoses. Teacher CSI reports were available for 94 of the 145 children. Teacher scores for oppositional behaviours were generally lower and appeared to reflect a different group of children.