Pediatric Generalized Anxiety Disorder

Generalized anxiety disorder (GAD) is a mental health problem. A child with GAD has a lot of worry and fear that seems to have no real cause. The worry may be more intense than the situation calls for. Children or teens with GAD often worry about many things, such as:

• Physical appearance
• Future events
• Past behaviors
• Social acceptance
• Family matters
• Failing to meet parents' expectations
• Their personal abilities
• School performance

All children and teens have some anxiety. It's a normal part of growing up. But sometimes worries and fears don’t go away. They may interfere with a child’s normal activities. In these cases, an anxiety disorder may be present.

Experts believe generalized anxiety disorder is caused by both biological and environmental factors. A child may inherit a tendency to be anxious. An imbalance of two chemicals in the brain (norepinephrine and serotonin) most likely plays a part.

A child can also learn anxiety and fear from family members and others. For example, a child with a parent who is afraid of thunderstorms may learn to fear thunderstorms. A traumatic event may also cause general anxiety. This can include things such as the death of a parent, a divorce, or a serious family accident or illness.

Children who have parents with an anxiety disorder are more likely to have anxiety. Children who seem more restrained as toddlers may be at more risk for anxiety.

Unlike adults with general anxiety, children and teens often don’t realize that their anxiety is more intense than the situation calls for. Children and teens with anxiety often need a lot of reassurance from the adults in their life.

Symptoms may be a bit different for each child. But the most common symptoms of general anxiety are:

• Many worries about things before they happen
• Many worries about friends, school or activities
• Almost constant thoughts and fears about the child’s safety or the parents’ safety
• Refusing to go to school
• Frequent stomachaches, headaches or other physical complaints
• Muscle aches or tension
• Sleep problems
• Lots of worry about sleeping away from home
• Clingy behavior with family members
• Feeling as though there is a lump in the throat
• Extreme tiredness (fatigue)
• Lack of concentration
• Being easily startled
• Being grouchy or irritated
• Inability to relax

The symptoms of GAD may seem like other health problems. Make sure your child sees his or her healthcare provider for a diagnosis.

Before a mental health referral is made, your child's healthcare provider will want to rule out any other health problems. Once this is done, a child psychiatrist or other mental health expert can diagnose anxiety. They will do a mental health assessment of your child. It may include a complete emotional and social history, interviews with you and your child, and standardized testing.

Children and teens with general anxiety can’t just pull themselves together and get better. They don't choose to act or feel anxious. They often need treatment. In many cases, treatment is key to recovery. Untreated, anxiety can get worse or become a long-term problem. Treatment will depend on your child’s symptoms, age and general health. It will also depend on how severe the condition is.

Treatment for GAD may include:

• Cognitive behavioral therapy. This helps a child learn how to better manage anxiety. The goal is also to help a child master the situations that may lead to the anxiety.
• Medicines. Antidepressant or anti-anxiety medicine may help some children feel calmer.
• Family therapy. Parents play a vital role in any treatment.
• School input. A child’s school may also be included in care.

Experts don’t know how to prevent generalized anxiety disorder in children. If you see signs of anxiety in your child, you can help by getting an evaluation as soon as possible. Remember that the symptoms are not attention seeking, but a sign of a serious problem. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve their quality of life.

As a parent, you play a key role in your child’s treatment. Here are things you can do to help:

• Keep all appointments with your child’s healthcare provider. If medicine is prescribed, make sure it's taken as directed. Alert your child's provider if there are any signs of side effects.
• Reassure your child. With general anxiety, your child may not realize their worry is more intense than the situation calls for. Your child will need more reassurance from you and other adults.
• Listen to your child. Find out about school, activity on social media and relationships. Bullying, both in person and on social media, is a serious problem many children face. Let your child know that they can talk to you about anything, especially if they are so anxious or sad that self-harm is being considered.
• Spend enjoyable, non-stressful time with your child. Go for a walk, dinner or out to a movie.
• Talk with your child’s healthcare provider about other providers who will be included in your child’s care. Your child may get care from a team that may include counselors, therapists, social workers, psychologists, teachers and psychiatrists. Your child’s care team will depend on their needs and how serious anxiety is.
• Tell others about your child’s anxiety. Work with your child’s healthcare provider and school to create a treatment plan. Remind teachers that your child will need extra reassurance.
• If generalized anxiety disorder greatly interferes with your child’s ability to succeed in school, they may be eligible for specific protections and reasonable accommodations under the Americans with Disabilities Act (ADA) or Section 504 of the Civil Rights Act. Ask your school's principal or your child’s teacher for more information.
• Reach out for support from local community services. Being in touch with other parents who have a child with generalized anxiety disorder may be helpful.

Call the healthcare provider right away if your child:

• Feels extreme depression, fear, anxiety or anger toward him or herself or others
• Feels out of control
• Hears voices that others don’t hear
• Sees things that others don’t see
• Can’t sleep or eat for three days in a row
• Shows behavior that concerns friends, family or teachers, and others express concern about this behavior and ask you to get help

Anxiety may increase a child’s risk for suicide. Threats of suicide are a cry for help. Always take such statements, thoughts, behaviors or plans very seriously. Any child who expresses thoughts of suicide should be evaluated right away.

Call 911 if your child has suicidal thoughts, a suicide plan and the means to carry out the plan.

If your child is older, make sure they have emergency numbers in their phone. These would include parents, other trusted adults, their healthcare provider and the 988 Suicide and Crisis Lifeline (formerly the National Suicide Prevention Lifeline): Call or text 988, available 24 hours a day, 7 days a week. Help your child understand that reaching out for help is the most important thing to do if self-harm is being considered.