Understanding Generalized Anxiety Disorder in Children

A certain amount of anxiety is a normal part of a child’s healthy development. Brief separation anxiety and fears of the dark, strangers, loud noises, or storms are all common worries children may experience as they grow and mature.

However, if your child starts to experience more consistent anxiety across a range of topics and areas of their life, such as around school, friends, family, health, and sports, it may be time to consider exploring the possibility of generalized anxiety disorder (GAD).

As a parent or caregiver, don't let the possibility alarm you. Once you seek help and receive a diagnosis, you're bringing your child one step closer to an improved quality of life.

Prevalence

Approximately 15% to 20% of youth in the general population struggle with anxiety disorders. Among children with ADHD, the rate appears to be even higher.

Symptoms and Diagnosis

Children with generalized anxiety experience excessive, unrealistic worry and fear about everyday things. They often anticipate disaster or worst-case scenarios.

They may also experience symptoms such as:

• Difficulty concentrating
• Difficulty swallowing
• Fatigue
• Irritability
• Muscle tension
• Need for frequent urination
• Restlessness
• Sleep difficulties
• Stomachaches

The tension and stress are chronic and debilitating, affecting multiple areas of the child's life. Just getting through the day can be a struggle.

The Diagnostic and Statistical Manual of Mental Disorders (5th edition), often referred to as the DSM-5, outlines specific criteria to be met in order to be properly diagnosed with GAD. For one, symptoms need to be experienced for at least six months in order to be appropriately diagnosed.

To make sure that your child is properly diagnosed and cared for most effectively, it is best to have a trained mental health provider to assess your child. There are providers who work specifically with children and adolescents and those who are also trained in working with anxiety disorders.

Causes and Risk Factors

There is no singular identified cause of generalized anxiety disorder in children or adults.

Children who have experienced challenging life situations or maltreatment may be at greater risk for developing GAD. These experiences can leave children feeling uncertain of people and their surroundings, unsafe, and out of control of their environment.

It is common for people of all ages who have been through experiences of challenge, loss, humiliation, or abandonment to feel anxious in future situations of uncertainty—children are no different.

Puberty can bring on additional stressors and feelings of self-consciousness that can add to feelings of anxiety. Frustrations and repeated difficulties in social relationships and school performance can lead to increased anxiety about being embarrassed in front of peers, as well as fears about letting down parents or teachers.

Though these feelings are all normal, if they don't subside with time and, instead, escalate or begin to interfere with your child's daily activities, there may be more cause for concern.

Treatment

Treatment plans for GAD in children and adolescents are tailored based on their unique situation. There are a variety of options to choose from.

Counseling Psychotherapy

Psychotherapeutic interventions are important in the treatment of GAD in children and adolescents. Counseling offers children a place to share their worries without fear of judgment, rejection, or feeling dismissed. Through the process, a trained mental health clinician will help your child with things such as:

• Developing and using relaxation techniques
• Developing positive self-talk to help reduce anxiety
• Identifying fears and worries
• Increasing coping skills like socialization, physical activity, and self-assurance
• Openly sharing thoughts and feelings

As a caregiver, you and your family will likely be asked to participate in your child's treatment. The counseling professional will often use this time to help educate parents about generalized anxiety disorder, suggest helpful techniques, and allow time for the family to process together some of the child's anxious thoughts and feelings in an effective, healthy way.

Medication

For situations when a child's anxiety is mild to moderate in terms of the severity and the impact the symptoms are having on daily living, medication may not be necessary. When the anxiety symptoms are moderate to severe, however, your provider may begin to educate you and your family about options for medication to help control symptoms.

Selective serotonin reuptake inhibitors (SSRIs) tend to be the more commonly prescribed medications prescribed for children and adolescents with anxiety. SSRIs include medications such as:

• Celexa (citalopram)
• Lexapro (escitalopram)
• Prozac (fluoxetine)
• Zoloft (sertraline)

Coping Skills

There are a variety of coping techniques that children and teens can use to help ease the uncomfortable symptoms of anxiety, socially, behaviorally, and emotionally. Learning what works well for your child is key.

You may want to suggest the following ideas and allow your child, depending on age, to choose which ones they would like to try first. Let them know that it is time to explore what works well for them.

If a technique doesn't seem to be helping after a period of time, that is OK. Giving them the freedom to let you know what is helping and what doesn't seem to be helping can be beneficial and help to minimize stress.

Slowing Down

Anxiety keeps us focused on the "what ifs" of the future and can rob us of the opportunity to live in the present. Slowing the process down with intentional and peaceful action can be helpful.

There are a variety of mindfulness exercises, prayers, meditations, progressive relaxation, and breathing exercises available that can help slow down your child's anxious thoughts and emotional responses.

Social Connection

Anxiety can make children and teens want to isolate themselves from peers and family members. Help your child feel safe to connect with others, offering opportunities to be with family and enjoy each other's company by playing games, spending time outdoors together, or finding a common interest or hobby.

Volunteering in the community can be another wonderful way to help your child stay connected to others. Allow them to explore and identify something they feel passionate about and help them seek out related opportunities in the community to help.

Self-Care

Sleep routines, eating habits, and physical activity all contribute to your child's well-being. Your child might struggle in a certain area like sleep or physical activity, especially if they experience restlessness, muscle tension, or fatigue due to their anxiety.

Tips for Parents and Caregivers

A first step in helping your child manage and overcome anxiety is recognizing it, but this can be difficult. Children struggling with GAD can sometimes be quiet, shy, and cautious. They may be very compliant and eager to please adults.

On the other hand, an anxious child may "act out" with tantrums, crying, avoidance, and disobedience. These behaviors may be misinterpreted as oppositional and "difficult" when they are actually anxiety related.

As a caregiver, it is important to be aware of some of the ways severe anxiety can show up in children. With an increased understanding of generalized anxiety disorder, you will be better able to intervene early and find the necessary help.

Early intervention and treatment can make a world of difference for your child and can prevent further complications around the anxiety. If you have concerns or questions about possible symptoms of generalized anxiety disorder in your child, be sure to talk with your pediatrician or trained mental health professional.