title: Non-obsessive-compulsive anxiety disorders in child and adolescent mental health services--Are they underdiagnosed, and how accurate is referral information?
abstract: 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.
  
  
  OBJECTIVE
  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.
authors.affiliation: a Berit Hjelde Hansen, Division of Mental Health Services , Akershus University Hospital , Lørenskog , Norway.
authors.forename: Berit Hjelde
authors.initials: BH
authors.lastname: Hansen
authors.affiliation: b Beate Oerbeck, Division of Mental Health and Addiction , Oslo University Hospital , Oslo , Norway.
authors.forename: Beate
authors.initials: B
authors.lastname: Oerbeck
authors.affiliation: c Benedicte Skirbekk, Nic Waals Institute, Lovisenberg Diakonale Hospital , Oslo , Norway.
authors.forename: Benedicte
authors.initials: B
authors.lastname: Skirbekk
authors.affiliation: d Hanne Kristensen, Center for Child and Adolescent Mental Health, Eastern and Southern Norway , Oslo , Norway.
authors.forename: Hanne
authors.initials: H
authors.lastname: Kristensen
mesh_terms: D000293:Adolescent; D016497:Adolescent Health Services; D001008:Anxiety Disorders / Q000175:diagnosis* / Q000523:psychology; D002648:Child; D002662:Child Health Services; D003951:Diagnostic Errors; D005260:Female; D006760:Hospitalization; D006801:Humans; D008297:Male; D008605:Mental Health Services; D010290:Parents / Q000523:psychology; D012017:Referral and Consultation
keywords: Childhood anxiety disorders; Diagnostic interviews; Kiddie-SADS-PL; Referral symptoms