In the case group, 93 children with anxiety disorders were assessed and compared with 100 children without an anxiety disorder. There was no statistically significant difference between both groups concerning age and sex (Table 1). Based on Beighton’s diagnostic criteria 52.7% of the children in the case group and 16% of the children in the control group had generalized joint hypermobility. Moreover, based on Shiari-Javadi criteria, 49.5% and 13% of the children in the case and control groups had generalized joint hypermobility, respectively. A significant difference was found between the rate of generalized joint hypermobility based on the two criteria in the case and control groups (Kapp = 0.834, P < 0.001, Table 1). Moreover, the internal correlation between the two criteria was 0.91 showing almost complete compatibility between the two (95%CI: 0.88–0.93, P < 0.001). Sensitivity, specificity, positive and negative predictive values, effectiveness, and area under ROC curve were 96.9%, 84.6%, 92.5%, 93.2%, 92.7%, and 0.907%, respectively.
Table 1
Characteristic data and diagnosis of joint hypermobility syndrome in case and control’s children
| Case group n = 93 | Control group n = 100 | P-value |
Sexa Male | 59 (63.4) | 59 (59) | 0.55 |
Ageb Year | 10.3 ± 2.1 | 10.6 ± 2.0 | 0.14 |
Hypermobility syndrome | | | |
Beightona | 49 (52.7) | 16 (16) | < 0.001 |
Shiari-Javadia | 46 (49.5) | 13 (13) | < 0.001 |
a = n(%), b = Mean ± SD |
With respect to the severity of anxiety disorders in the case group, 37 (39.8%) children had mild anxiety and 56 (60.2%) had moderate anxiety. With respect to type, 63 (67.7%) children had separation anxiety, 30 (32.3%) had social phobia, 45 (48.4%) had obsessive-compulsive disorder, 40 (43%) had panic/agoraphobia, 68 (73.1%) had specific anxiety, and 85 (91.4%) had generalized anxiety. Moreover, in clinical examination, other psychiatric disorders were also diagnosed such as Attention Deficit/Hyperactivity Disorder (ADHD, n = 30, 32.3%), mood disorders (n = 9, 9.7%), Stereotypic Movement Disorders (n = 3, 3.2%), school refusal (n = 2, 2.2%), motor tic (n = 2, 2.2%), somatic symptom disorder (n = 1, 1.1%), learning disability (n = 1, 1.1%), and functional constipation (n = 1, 1.1%).
We found that based on Beighton’s criteria, in children with anxiety disorders, those who were younger had a higher risk of suffering from generalized joint hypermobility (Table 2). As shown in Table 2, other variables such as sex, severity and type of anxiety disorders, and ADHD, were not predictors of generalized joint hypermobility. Repeating the evaluations using the Shiari-Javadi criteria yielded similar results to those of Beighton’s criteria (Table 3).
Table 2
Risk factors of JHS in children with AD based on Beighton criteria
| JHS n = 49 | Non JHS n = 44 | Sig | OR | 95% CI |
Lower | Upper |
Sexa male | 28 (57.1) | 31 (70.5) | 0.07 | 0.39 | 0.14 | 1.09 |
Ageb year | 9.69 ± 1.93 | 10.89 ± 2.13 | 0.02 | 0.75 | 0.59 | 0.95 |
AD Severity | | | | | | |
Milda | 22 (44.9) | 15 (34.1) | 0.06 | 0.27 | 0.06 | 1.08 |
Moderatea | 27 (55.1) | 29 (65.9) |
AD Type | | | | | | |
Separation anxiety | 34 (69.4) | 29 (65.9) | 0.25 | 2.20 | 0.57 | 8.43 |
Social phobia | 17 (34.7) | 13 (29.5) | 0.22 | 2.05 | 0.65 | 6.50 |
OCD | 22 (44.9) | 23 (52.3) | 0.92 | 0.95 | 0.36 | 2.48 |
Panic/agoraphobia | 19 (38.8) | 21 (47.7) | 0.77 | 0.82 | 0.23 | 2.95 |
Specific phobia | 36 (73.5) | 32 (72.7) | 0.70 | 0.79 | 0.25 | 2.55 |
Generalized anxiety | 44 (89.8) | 41 (93.2) | 0.88 | 1.14 | 0.18 | 7.12 |
ADHD | 12 (24.5) | 18 (40.9) | 0.05 | 0.36 | 0.12 | 1.03 |
a = n(%), b = Mean ± SD. Abbreviations: JHS = Joint Hypermobility Syndrome, AD = Anxiety Disorders, OCD = Obsessive-Compulsive Disorder |
Table 3
Risk factors of JHS in children with AD based on Shiari-Javadi criteria
| JHS n = 46 | Non JHS n = 47 | Sig | OR | 95% CI |
Lower | Upper |
Sexa male | 26 (56.5) | 33 (70.2) | 0.06 | 0.38 | 0.13 | 1.04 |
Ageb year | 9.55 ± 1.92 | 10.95 ± 2.06 | 0.01 | 0.72 | 0.56 | 0.92 |
AD Severity | | | | | | |
Milda | 20 (43.5) | 17 (36.2) | 0.06 | 0.26 | 0.06 | 1.10 |
Moderatea | 26 (56.5) | 30 (63.8) |
AD Type | | | | | | |
Separation anxiety | 34 (73.9) | 29 (61.7) | 0.09 | 3.24 | 0.82 | 12.82 |
Social phobia | 16 (34.8) | 14 (29.8) | 0.32 | 1.77 | 0.57 | 5.53 |
OCD | 21 (45.7) | 24 (51.1) | 0.97 | 0.98 | 0.37 | 2.57 |
Panic/agrophobia | 18 (39.1) | 22 (46.8) | 0.70 | 0.78 | 0.21 | 2.82 |
Specific phobia | 35 (76.1) | 33 (70.2) | 0.86 | 0.90 | 0.27 | 2.94 |
Generalized anxiety | 41 (89.1) | 44 (93.6) | 0.73 | 1.38 | 0.21 | 8.76 |
ADHD | 13 (28.3) | 17 (36.2) | 0.29 | 0.57 | 0.20 | 1.60 |