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Pediatric Generalized Anxiety Disorder
Key points about generalized anxiety disorder (GAD) in children and teens
- 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.
- A child with GAD may worry about things such as future events, past behaviors, and family matters.
- The child may not realize his or her worry is more intense than the situation calls for
- GAD is caused by both biological and environmental factors.
- A mental health evaluation is needed to diagnose GAD.
- Treatment includes therapy and medicines.
Prevention and Risk Assessment
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:
- Future events
- Past behaviors
- Social acceptance
- Family matters
- Their personal abilities
- School performance
All children and teens have some anxiety. It is 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 GAD 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 GAD. 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 GAD. Children who seem more restrained as toddlers may be at more risk for GAD.
Unlike adults with GAD, children and teens often don’t realize that their anxiety is more intense than the situation calls for. Children and teens with GAD 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 GAD 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
- Inability to relax
The symptoms of GAD may seem like other health problems. Make sure your child sees his or her health care provider for a diagnosis.
Before a mental health referral is made, your child's health care provider will want to rule out any other health problems. Once this is done, a child psychiatrist or other mental health expert can diagnose GAD. He or she 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 GAD can’t just pull themselves together and get better. They often need treatment. In many cases, treatment is key to recovery. Untreated, GAD 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 GAD in children. If you see signs of GAD in your child, you can help by getting an evaluation as soon as possible. Early treatment can ease symptoms and enhance your child’s normal development. It can also improve his or her 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 health care provider.
- Reassure your child. With GAD, your child may not realize his or her worry is more intense than the situation calls for. Your child will need more reassurance from you and other adults.
- Talk with your child’s health care 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 his or her needs and how serious GAD is.
- Tell others about your child’s GAD. Work with your child’s health care provider and school to create a treatment plan. Remind teachers that your child will need extra reassurance.
- If GAD greatly interferes with your child’s ability to succeed in school, he or she 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 GAD may be helpful.
Call the health care 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
GAD 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.
Director, Research in Anxiety Disorders Program
Director, Psychology and Patient Care Services for CCBD
Director, Whole Bear Care, Primary Care Behavioral Health Services
Division Chief, Psychiatry and Behavioral Sciences
Co-Director, Anxiety Disorders Program
Co-Director, Mood Disorders Program
Director, CPP Services
Medical Director, Ambulatory Psychiatry and Takoma Theatre Outpatient Clinic
Child and Adolescent Psychiatrist
Co-Director, Anxiety Disorders Program
DCMAP Children's National Hospital Site Lead
Child and Adolescent Psychiatrist
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