Are children with "pure" generalized anxiety disorder impaired? A comparison with comorbid and healthy children.

Despite the approach of the Diagnostic and Statistical Manual of Mental Disorders (5th ed.), generalized anxiety disorder (GAD) of childhood continues to face questions as to whether it should be considered a distinct clinical disorder. A potentially critical issue embedded in this debate involves the role of functional impairment which has yet to be demonstrated in children with "pure" GAD. Participants included 41 children between the ages of 6 and 11 years who met diagnostic criteria for primary GAD. Children with pure GAD (n = 17) were compared to children with comorbid GAD (n = 24) as well as a healthy control group (n = 20) in terms of clinician-rated severity and impairment and child-reported adaptive functioning across four domains. On average, children with pure GAD were more likely to be male and younger than children with comorbid GAD. Based on traditional significance testing, global impairment was greater in the comorbid compared to pure GAD group, although functioning in both groups was in the "variable" range. Both clinical groups reported less adaptive family relationships than controls, whereas only the comorbid group reported lower levels of home-based functioning. Equivalence testing nonetheless indicated a lack of comparability (i.e., nonequivalence) across the three groups for each of the domains examined. Findings indicate children with pure GAD to be functionally impaired compared to their healthy peers, though not to the same extent as children with secondary psychiatric diagnoses. Child functioning within the family domain specifically may be among the most vulnerable when GAD is present. Results support consideration of childhood GAD as a distinct clinical disorder.