Understanding Generalized Anxiety Disorder in Children

Brief separation anxiety and fears of the dark, strangers, loud noises, and storms are common, normal childhood experiences. However, consistent anxiety over a wide variety of settings, groups, and objects can indicate childhood generalized anxiety disorder (GAD).

As a parent or caregiver, don't let the possibility alarm you. A diagnosis puts you and your child one step closer to the resources available—and to an improved quality of life.

Prevalence

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

Symptoms and Diagnosis

Generalized anxiety disorder in childhood involves excessive, unrealistic worry and fear about everyday things. The child often anticipates disaster or worst-case scenarios and experiences symptoms such as:

• Difficulty concentrating
• Difficulty swallowing
• Fatigue
• Irritability
• Muscle tension
• Frequent urination
• Restlessness
• Sleep difficulties
• Stomachaches

The effects of chronic stress are 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 for a GAD diagnosis. The symptoms must be experienced for at least six months.

To make sure that your child is diagnosed and cared for effectively, consult a trained mental health provider to assess them. Some providers work specifically with children or those with anxiety disorders.

Causes and Risk Factors

No single cause of generalized anxiety disorder in children or adults has been determined.

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 brings additional stressors and self-consciousness that can add to anxiety. Frustrations and repeated difficulties with social relationships and academic performance can lead to increased anxiety around peers, as well as fears about letting down parents or teachers.

These feelings are normal. However, if they interfere with your child's daily activities and don't subside with time, there may be cause for concern.

Treatment

Every treatment plan for childhood generalized anxiety disorder is tailored to the individual. There are a variety of options.

Counseling Psychotherapy

Psychotherapeutic interventions are important in treating childhood generalized anxiety disorder. Counseling offers children a place to share their worries without fear of judgment, rejection, or feeling dismissed. A trained mental health clinician can help your child with:

• 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 use this time to help educate parents about childhood 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 mild to moderate childhood GAD symptoms, medication may not be necessary. If they're moderate to severe, however, your provider may suggest medication.

Selective serotonin reuptake inhibitors (SSRIs) are commonly prescribed for children and adolescents with anxiety. SSRIs include:

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

Coping Skills

Proven coping techniques can help ease the uncomfortable symptoms of childhood anxiety. Learning what works best for your child is key.

Explain that it's time to explore some GAD management strategies. Help your child decide which ones to try, and encourage them to say what helps and what doesn't. Here are a few to start with.

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."

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. If you have concerns or questions about possible symptoms of generalized anxiety disorder in your child, talk with your pediatrician or mental health professional.