Assessment of Anxiety

Primary Screening Tool

The American Academy of Child and Adolescent Psychiatry recommends using the GAD-7 (Generalized Anxiety Disorder-7) as the primary screening instrument for adults, which is a 7-item self-report scale assessing nervousness, inability to control worry, excessive worry, trouble relaxing, restlessness, irritability, and fear over the past 2 weeks 1, 2, 3
Interpret GAD-7 scores as follows: 0-4 indicates none/mild anxiety, 5-9 indicates moderate anxiety, 10-14 indicates moderate to severe anxiety, and 15-21 indicates severe anxiety, according to the Journal of Clinical Oncology 1, 4

The American Academy of Child and Adolescent Psychiatry recommends using the SCARED (Screen for Child Anxiety Related Emotional Disorders) or SCAS (Spence Children's Anxiety Scale) for children and adolescents, both available in parent and child versions with acceptable psychometric properties 2, 3
The GAD-7 can be used for adolescents, while the Preschool Anxiety Scale should be used for younger children, as suggested by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

The American Academy of Child and Adolescent Psychiatry considers the Anxiety Disorders Interview Schedule (ADIS) as the gold standard in research settings, addressing all DSM anxiety disorders plus screening sections for comorbidities 2, 3
The K-SADS-PL DSM-5 interview guide is a freely available alternative that includes sections for panic, agoraphobia, separation anxiety, social anxiety, selective mutism, specific phobia, and generalized anxiety disorders, according to the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

The Beck Anxiety Inventory (BAI) is a 21-item self-report scale assessing somatic symptoms of anxiety, with scores ≥10 suggesting mild anxiety and ≥19 suggesting moderate anxiety, as recommended by the Journal of Clinical Oncology 1, 5
The Hospital Anxiety and Depression Scale (HADS) is a 14-item self-report with separate anxiety and depression subscales, with a score ≥8 on the anxiety scale indicating a probable disorder, according to the Journal of Clinical Oncology 1, 5, 6

The American Academy of Child and Adolescent Psychiatry recommends looking for specific anxiety-related signs during examination, including appearance, motor signs, speech, thought process, and affect 2, 3
These signs are nonspecific and may be absent, serving as adjunctive rather than primary diagnostic information, as suggested by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

Systematically gather information from the patient, family members, teachers (for children), and review medical records to obtain a comprehensive picture, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3
Conduct diagnostic interviews with both the patient and family members, separately or together, using developmentally appropriate techniques, according to the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

Immediately evaluate for risk of harm to self or others, including suicidal ideation, self-harm behaviors, and impulsivity, as recommended by the Journal of Clinical Oncology 1, 2, 4
Any patient identified as at risk requires immediate referral to appropriate emergency services, with facilitation of a safe environment and one-to-one observation, according to the Journal of Clinical Oncology 5, 6, 7

Rule out medical causes that can mimic or cause anxiety, including hyperthyroidism, caféinism, asthma, diabetes, hypoglycemia, cardiac disorders, migraines, and chronic pain, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3
Assess for psychiatric comorbidities, including depression, ADHD, conduct disorders, and learning/language disorders, according to the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

Document specific impairments in home, relationship, social, educational, or occupational functioning using standardized measures like the Medical Outcomes Study Short Form, as recommended by the Journal of Clinical Oncology 1, 4
Increasing anxiety severity is strongly associated with progressive functional impairment across multiple domains, according to the Journal of Clinical Oncology 1, 4

Develop a biopsychosocial formulation identifying biological, psychological, and social/environmental factors contributing to the patient's anxiety, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3
Biological factors include family history of anxiety disorders, autonomic hyperreactivity, temperament, and chronic medical conditions, according to the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3

Re-screen at critical timepoints, including initial diagnosis/start of treatment, regular intervals during treatment, and at 3, 6, and 12 months after treatment initiation, as recommended by the Journal of Clinical Oncology 1, 4
Reassess during times of personal transition, family crisis, or disease status changes, according to the Journal of Clinical Oncology 1, 4

Don't rely solely on self-report without corroborating information from multiple sources, especially in pediatric populations, as recommended by the Journal of the American Academy of Child and Adolescent Psychiatry 2, 3
Don't assume rating scales alone establish diagnosis—they support but don't replace clinical diagnostic assessment, according to the Journal of Clinical Oncology 1, 2, 3