Initial Anxiety Workup Approach

Initial Screening and Assessment

The American Academy of Child and Adolescent Psychiatry recommends using standardized screening instruments, such as the Generalized Anxiety Disorder-7 (GAD-7) scale, to identify anxiety concerns in primary care settings, which categorizes anxiety severity as mild (0-9), moderate (10-14), and moderate to severe/severe (15-21) 1, 2
The American Academy of Child and Adolescent Psychiatry suggests considering freely available general social-emotional screening instruments like the Pediatric Symptom Checklist or Difficulties Questionnaire for systematic identification of anxiety concerns in primary care or school settings 1
The American Psychiatric Association recommends using Level 1 Cross-Cutting Symptom Measures (parent and self-rated versions) in intake packets to efficiently gather information about presenting problems 1

The American Academy of Child and Adolescent Psychiatry recommends conducting interviews with both the patient and parent/guardian (if applicable), either separately or together as clinically indicated, and using developmentally sensitive approaches that may include direct and indirect questioning, interactive techniques, and symptom rating scales 3
The American Academy of Child and Adolescent Psychiatry suggests obtaining input from collateral sources (with patient consent) including family members, teachers, primary care providers, and other relevant individuals to add depth to diagnostic information 3
The American Academy of Child and Adolescent Psychiatry recommends considering conducting the evaluation in the language in which the patient is most proficient, using interpreter services when necessary 3

The American Academy of Child and Adolescent Psychiatry recommends distinguishing clinically significant anxiety from everyday worries and fears that are common to human experience and normative in specific developmental stages, and ruling out medical conditions that can present with anxiety symptoms, including thyroid disorders, respiratory disorders, metabolic disorders, substance use or withdrawal, neurological conditions, and chronic pain/illness 1, 2, 3
The American Academy of Child and Adolescent Psychiatry suggests considering appropriate laboratory testing (e.g., glucose, thyroid function) in collaboration with primary care if medical conditions are suspected 3
The American Academy of Child and Adolescent Psychiatry recommends assessing for comorbid conditions, particularly depression, as anxiety disorders frequently co-occur with depressive disorders 2

The American Academy of Child and Adolescent Psychiatry recommends evaluating for the following anxiety disorders according to DSM-5 criteria: Separation Anxiety Disorder, Selective Mutism, Specific Phobia, Social Anxiety Disorder, Panic Disorder, Agoraphobia, and Generalized Anxiety Disorder 1, 2, 3

The American Academy of Child and Adolescent Psychiatry recommends providing education, active monitoring, self-help resources based on cognitive behavioral therapy principles, and structured physical activity for mild anxiety symptoms (GAD-7 score 0-9), referring to educational and support services and considering low-intensity psychological interventions for moderate anxiety symptoms (GAD-7 score 10-14), and implementing high-intensity interventions including cognitive behavioral therapy, behavioral activation, structured physical activity, and considering pharmacotherapy for moderate to severe/severe anxiety symptoms (GAD-7 score 15-21) 2

The American Academy of Child and Adolescent Psychiatry recommends Cognitive Behavioral Therapy (CBT) as the psychological treatment with the strongest evidence of efficacy for anxiety disorders and should be considered first-line treatment 2
The American Academy of Child and Adolescent Psychiatry suggests selective serotonin reuptake inhibitors (SSRIs) and serotonin-norepinephrine reuptake inhibitors (SNRIs) as first-line medications for pharmacotherapy 2

The American Academy of Child and Adolescent Psychiatry recommends establishing regular follow-up appointments to monitor treatment response, and monthly assessment is recommended until symptoms have subsided to evaluate compliance with psychological interventions, assess medication adherence and side effects, and monitor symptom relief 2

The American Academy of Child and Adolescent Psychiatry highlights that only about 20% of people with anxiety disorders seek care for these conditions, highlighting the importance of proactive screening, and cautiousness and avoidance are cardinal features of anxiety, which may lead to poor follow-through with treatment recommendations 2, 4