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.
