Generalized Anxiety Disorder

What is it?

Generalized anxiety disorder (GAD) in children is characterized by pervasive worry or undue distress about everyday things, most often school or athletic performance, and may drive extreme studying or practicing.

Signs and Symptoms

Children with GAD focus their anxiety internally, making them feel restless, fatigued, tense, or irritable. GAD is distinguished from typical worry in its excessiveness, longer duration, lack of precipitating events, and occurrence even when the performance or activity is not being evaluated. Children with GAD may have trouble concentrating or sleeping.

Children with GAD tend to seek reassurance in an attempt to assuage their fears and worries (will we get there on time?). Their anxiety can make them irritable and restless and can manifest physically with fatigue, stomachaches, and headaches. For GAD to be present, a child must also have one of these symptoms: restless, an on-edge feeling, fatigue, loss of focus, irritability, muscle tension, or trouble sleeping. GAD rarely emerges before adolescence and is more prevalent in girls than boys.

Diagnosis and Treatment

A GAD diagnosis can be made when a child’s anxiety is beyond her control, is focused on many different activities, causes significant distress, and is present for at least 6 months.

Treatment for GAD may involve therapy and/or medication. Families play a key role helping the child control her anxiety and its effects. Two effective treatments for GAD are cognitive behavioral therapy and exposure therapy, when a therapist exposes a child to stressors in gradual increments and teaches her techniques to manage the anxiety response. Therapy for GAD can be relatively short-term—10 or 20 sessions. The child and her family can practice learned skills in real-life situations.

GAD responds well to selective serotonin reuptake inhibitors, or SSRIs. Anti-anxiety drugs are often prescribed if these do not relieve symptoms.

What are the risk factors for children?

GAD has some genetic factors. Children who develop the disorder are more likely to be avoidant and have inhibited behaviors and negative temperaments; they are also more likely to be diagnosed with depression. Girls are at higher risk.

A child with GAD’s anxieties are exaggerated but usually focus on tangible, real-life issues. A child with GAD may be so worried about various things at school—tests, performances, sporting events, appearance, friends, popularity—that she attempts to avoid it entirely. Children with GAD may find their education adversely affected. And unlike adults with GAD, who realize that their pervasive anxiety is not an appropriate response to their actual situation, children with GAD don’t immediately recognize that their fears are outsized. Many symptoms of GAD are also symptoms of other, more specific anxiety disorders and identifying them can be difficult.