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In the waiting room of a quiet Montreal clinic, four-year-old Cory Mercier is drawing ghosts on a blackboard.

Watching him are his parents, Guy and Tracy Mercier, who have waited five months and driven 70 kilometres from their Laval home for Cory's appointment. They arrived 45 minutes early.

After years of troubling signs in Cory's behaviour, the Merciers are leaving nothing to chance. They're desperate for help to tackle the demons that haunt their son.

From the time he was a toddler, Cory seemed unusually shy - clamming up around strangers and enduring painful medical examinations with barely a whimper. Now he expresses his terror in other ways. Every morning, he begs not to go to daycare. He insists on wearing plain clothes so he blends into crowds, and often wets his pants at daycare rather than ask permission to go to the toilet.

"It sounds like he's shy, but there's a difference," says Ms. Mercier, 36. "It's fear."

At home, Cory's parents have noticed other odd behaviours. Cory's room has to be spotless, everything in the same place as the day before, or else he becomes distressed. At dinner, he must always sit in the same chair, and no foods can touch on his plate.

In the waiting room at the anxiety clinic at Montreal Children's Hospital, Cory cheerfully draws, hums and skips like any other preschooler.

But when he is led into an observation room and spots 10 strangers - a team of doctors, medical students and therapists here to assess him - he squeezes his eyes shut and ducks behind his mother, pressing his face into her back.

"It's the beginning of, hopefully, treatment," says veteran child psychiatrist Klaus Minde, the clinic's director who will assess Cory and attempt to treat him with some combination of medication, therapy and family counselling. It's help the Merciers have been seeking for almost two years.

Anxiety disorders are the most common mental illness in children aged 4 to 17. Canadian research suggests 6.4 per cent of kids have some form of the condition - more than the number suffering from hyperactivity and attention-deficit disorder (4.8 per cent).

But at a time when increasing numbers of young children are being diagnosed with this and other psychiatric problems, access to mental health-care services in Canada remains at a critical shortage.

One of the reasons is a lack of doctors - there are only 418 child and adolescent psychiatrists registered with the Canadian Academy of Child and Adolescent Psychiatry, a dearth that is projected to worsen if something isn't done to attract more physicians to the field.

"Roughly two-thirds of children who have a mental illness never get help," says former Liberal senator Michael Kirby, head of the new federal Mental Health Commission, which has been tasked with developing recommendations for the country's first national mental health strategy. "Tell me any part of the health-care system where [even] one-third of the patients would go untreated. ... It is a huge challenge."

Patients wait an average of six months for an initial visit at the Montreal anxiety clinic, the only one of its kind in Quebec, said Dr. Minde, a professor of psychiatry and pediatrics at McGill University.

Some can't sleep because they are tormented by phobias. Others are carefree kids at home, but are mute outside it - too afraid to speak to teachers, other children, even grandparents.

By the time they arrive at his clinic, many will have already been "through the mill," as Dr. Minde described it in Cory's case -cycling through family doctors, pediatricians, psychologists and social workers in a quest for the proper diagnosis and treatment.

Assessing whether a child has an anxiety disorder is often more art than science, with professionals relying on observations, clinical guidelines and interviews with parents and caretakers to try to distinguish odd or difficult youngsters from those with debilitating problems.

The Merciers began their quest for answers the summer Cory turned 3. He had been in daycare almost a year when his caretaker revealed that he never spoke while in her care.

Then came the crippling fear. "He's even thrown up before daycare because he doesn't want to go," Ms. Mercier said.

Cory was assessed for autism because his 10-year-old half-brother, Connor, has the genetic cognitive disorder. After autism was ruled out, two other experts suggested he had selective mutism, an anxiety disorder in which children refuse to speak in social situations.

But after two hours of observation and in-depth interviews with both parents and Cory's 11-year-old sister, Courtney, Dr. Minde's preliminary assessment is that Cory may have separation anxiety disorder along with obsessive-compulsive disorder.

Ms. Mercier, a researcher at a medical company, says the label doesn't matter as long as treatment comes with it.

"For me, it's like, label him with something so we can help him," she said.

Over the following months, Dr. Minde will continue to meet with Cory and his family, assessing the boy. Once the diagnoses have been cemented, he will receive treatment that could include cognitive-behavioural therapy, help with strategies for his parents and, in the short term, anti-anxiety medication.

"A little medication would help, I think, to soften things up," Dr. Minde said, meaning Cory might be calmer and more responsive to treatment if he received some medication during the initial stages of treatment.

The concept of medicating children raises difficult questions for parents and doctors. Most psychiatrists say they prefer not to use medications on small children because of limited research into their effects on young minds and a lack of clinical guidelines.

Yet most say at least a small fraction of their young patients will be prescribed medication, including about 10 per cent of the patients at Dr. Minde's clinic.

"Everything we do in child psychiatry is off-label," explains Vikram Dua, a child and adolescent psychiatrist at BC Children's Hospital and co-director of the British Columbia Autism Assessment Network, referring to the practice of prescribing drugs for reasons that aren't explicitly outlined by a drug manufacturer.

"You are confronted in the office with a dilemma. Okay, we don't have a lot of research, but I have a kid who's really struggling here."

For children with anxiety problems, drugs may increase the pace of recovery, he said. This can be desirable because the longer they suffer from their social fears and phobias, the longer the dysfunction becomes part of their life and personality.

"The clock is ticking on this kid's development," he said. "I'm not always happy to wait."

Research has shown that early intervention can make a huge difference in the lives of children with mental disorders, and in some cases, spare them difficulties later in life, such as problems at school, substance abuse and trouble with the law.

"We know that early intervention is the key for many childhood disorders," said Pratiba Reebye, a child-and-infant psychiatrist at Children's and Women's Hospital in Vancouver. "It has been proven that early intervention will help improve not only their quality of life, but their family's as well."

The Merciers say they just want Cory to feel good about himself in public. They want him to be able to order pizza, join a swim team or dial 911 if he's in trouble.

And it feels like time is of the essence, Ms. Mercier told the medical team in Montreal, because Cory is slated to start kindergarten this September.

"I don't want him lost in a class of 30 kids," she said.

Online resources

If your child seems to be suffering from anxiety or any other mental illness, there are many online sources with information on symptoms and possible treatments. Here are a few:

The "facts for families" section of the American Academy of Child and Adolescent Psychiatry website, aacap.org

The Anxiety Disorders Association of Canada, anxietycanada.ca

Anxiety BC, anxietybc.com

Hayley Mick