Generalized Anxiety Disorder in Children and Adolescents

Generalized anxiety disorder (GAD) involves excessive and uncontrollable worry about many things such as health, school performance, safety, the future, and family matters. Usually, the child’s worries are not about true-life circumstances or are out-of-proportion compared to actual difficulties.

Causes and Risk Factors

As with many behavioral or mental health conditions, the causes of GAD are not fully understood. Researchers believe that it may involve naturally occurring chemicals in the brain called neurotransmitters. However, it is likely that the condition has a complex set of causes that may include the body's biological processes, genetics, environment and life experiences.

All children and adolescents experience some anxiety. It is a normal part of growing up. However, when worries and fears do not go away and interfere with a child or adolescent's usual activities (like school, friends, family functioning), an anxiety disorder may be present. Children of parents with an anxiety disorder are more likely to develop an anxiety disorder.

Symptoms and Types

The following are the most common symptoms of GAD in children and adolescents. However, each child may experience symptoms differently.

Symptoms may include:

• Many worries about things before they happen (“What if…” thoughts)
• Many worries about friends, family, school, or activities
• Frequent thoughts and fears about safety of self and/or safety of parents
• Excessive worry about being away from home
• Clingy behavior with family members
• Reassurance seeking or repeatedly asking the same question in an effort to feel less worried
• Frequent stomachaches, headaches, or other physical complaints
• Muscle aches or tension
• Sleep disturbance
• Lack of concentration
• Being easily fatigued
• Restlessness
• Irritability

Unlike adults with GAD, children and adolescents may not realize that their anxiety is more intense than the situation warrants.

Diagnosis and Tests

A child psychologist or other qualified mental health professional usually diagnoses anxiety disorders in children or adolescents following a comprehensive diagnostic evaluation. Parents who note symptoms of severe anxiety in their child or teen can help by seeking an evaluation and treatment as soon as possible. Early treatment may help prevent future problems.

A diagnosis of GAD requires that the child’s excessive anxiety and worry cause significant distress or impairment in daily life. To receive a diagnosis, the child/adolescent must have shown excessive anxiety and worry, occurring more days than not, for at least 6 months. The anxiety and worry are about a number of events or activities, and are associated with at least one of the physical symptoms listed above.

Treatment

Studies that have been done with children and adolescents have shown that cognitive- behavioral therapy (CBT) can be a very effective treatment for anxiety. CBT is a short-term, problem-focused approach. Children and parents are educated about the role of anxiety in the specific symptoms the child is experiencing. The goal of CBT is to help the child manage emotional distress, physical symptoms, negative thoughts, and problematic behaviors that often accompany anxiety in ways that promote bravery. With CBT, children with GAD are taught to learn to recognize the physiological symptoms of anxiety, and are taught to use realistic “self-talk” rather than negative self-talk. Parents are included to provide reinforcement and rewards for children’s success, and to learn to implement and practice the skills with their children at home and in the community. When the symptoms are severe, antidepressant or antianxiety medication may be included as part of the treatment plan.