Anxiety Case Summary

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​Anxiety Case Summary

​​​Summary:
  • Siu, an eight year old girl, lives in Chinatown with her family who speak predominantly Cantonese at home.

  • During a regular check-up, Siu's mother reports that Siu is having difficulties in school and gets nervous about tests.

  • Siu's mother also notes that Siu is very shy and does not spend much time with friends.

  • During this visit, Siu appears distressed and hides when addressed directly by the pediatrician.

  • To further assess these issues, the pediatrician schedules a follow-up appointment in one week and asks Siu's mother to bring in a report card and to complete the PSC-17, a shortened version of the PSC-35 with subscales for internalizing, attention and externalizing problems.

  • Due to a positive internalizing score and history, the pediatrician suspects an anxiety problem.

  • While discussing the scores, the pediatrician learns that the family has experienced several recent stressors-on 9/11 Siu's family lost some friends and Siu's mother lost her job.

  • The pediatrician also uses the PSC-17 scores to focus her assessment and administers the Vanderbilt Assessment Scale (Parent and Teacher versions) to further examine the borderline attention score.


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 Key Teaching Points
  1. Siu's case may exemplify the experience of some children who have problems with learning, ADHD and/or anxiety disorders. Parents may experience shame if their child's academic work is poor and may not discuss the problem until it is at a more urgent level. This could occur, for example, after the school contacts the parent to discuss the child's academic progress. Parents may not volunteer this information unless asked specifically because they do not think school problems belong in the realm of a medical checkup. Scheduling a specific follow-up appointment to address psychosocial issues can convey the importance of these issues and help ensure timely follow-up.

  2. Mental health problems, especially internalizing disorders like depression and anxiety, often go unrecognized. Families may believe that children are too young to have such problems and caregivers may not recognize that their own mental distress may transfer to their children, parents may cope better with a concrete physical problem than with a mental health problem that needs prolonged counseling and/or may wax and wane with environmental changes. Parent-child-physician partnership in addressing these complex issues is critical.

  3. Linguistic and cultural competencies are critical in any encounter; this is particularly true when dealing with children's mental health issues. The vignette is presented in Chinese and English with the dialogue occurring directly between the parent or child and the clinician. In many clinical situations an interpreter may be needed, but it is vitally important that the interpreter not be the child. In addition, availability of screening tools in the parent and child's native language can also prove invaluable.

View additional information on the prevalence, symptoms, diagnosis, and treatment of anxiety.
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