Generalized Anxiety Disorder (GAD) in Children

Some kids are worriers. They might become anxious when their parents are away or feel uneasy when experiencing something for the first time. But generalized anxiety disorder in children (GAD) can become a problem when kids worry too much.

Unlike phobias, GAD in children causes worry over daily occurrences—failing a test, forgetting their things at school, or encountering bad people. Fortunately, there are many things a parent can do to support a child with GAD.

What is Generalized Anxiety Disorder in Children?

GAD in children is characterized by excessive and uncontrollable worry over seemingly simple aspects of daily life. It might manifest as obsessive anxiety over:

• Academic performance
• Peer relationships
• Parental relationships
• The future
• How people perceive them
• Financial stability

Childhood anxiety disorders, including GAD, affect one in eight children annually with girls being twice as likely to develop it than boys [*].

A child may be at greater risk of developing GAD if they are predisposed to worrying behavior, have a negative mindset, or have overbearing parents.

How is GAD Different from Typical Childhood Worry?

GAD is different from typical childhood worry or “regular” anxiety in children in that it happens excessively and can disrupt regular activities.

In some ways, typical childhood worry can benefit children as it acts like a built-in warning system for dangerous situations. In fact, a UK study found that adolescents who experienced worry or anxiety had fewer accidents or sudden deaths in early adulthood than those who didn’t [*].

However, anxiety isn’t always helpful, especially when a child becomes diagnosed with GAD. When a child has GAD, their anxiety may feel debilitating, and fail to provide valuable information about the situation.

A child’s anxiety may exceed “normal” occurrences when they become unable to control their feelings, experience physical symptoms, have panic attacks, or struggle to function normally.

What Causes GAD in Children?

While the core causes of GAD in kids is unknown, the condition may be linked to the following factors:

• Genetics and biology. Children whose parents have an anxiety disorder are likely to inherit the same conditions [*]. According to modern research, a third of GAD diagnoses are genetic. Biologically, a child can develop GAD if they don’t produce enough serotonin and dopamine.
• Environment. Children exposed to trauma like divorce, abuse, neglect, or death can develop early-onset anxiety [*]. They might also inherit anxious traits if their family members are constantly worried.
• Temperament. Children may be prone to developing GAD if they are naturally timid and avoidant.

What are the Symptoms of GAD in Children?

Children with GAD worry chronically and experience the following symptoms simultaneously:

• Trouble falling and staying asleep
• Constant restlessness and irritability
• Physical fidgeting and skin-picking
• Indecisiveness and apprehensiveness
• Difficulty concentrating
• Becoming easily fatigued

GAD criteria in children also include perfectionism. For example, a child with GAD may study obsessively despite being familiar with the topic. They might self-flagellate or become avoidant if they achieve anything less than perfect.

How is GAD Diagnosed in Children?

If you want to get a GAD diagnosis for your child, you can consult a mental health clinician (e.g., a child psychologist/psychiatrist or psychiatric social worker). These clinicians will conduct a comprehensive assessment, typically involving diagnostic exams and interviews.

Diagnosticians also interview the child’s parents to get insight into the child’s anxiety symptoms and related behavior. Often, you must also provide your child’s medical history.

What are the Treatment Options for GAD in Children?

While generalized anxiety disorder in kids can be chronic, there are ways to treat it. Treating GAD as early as possible reduces the risk of the disorder becoming chronic and prevents children from developing related conditions. Here are the treatment options you can consider.

Cognitive Behavior Therapy (CBT)

CBT for anxiety is one of the most effective treatments for children with GAD [*]. Through cognitive behavior therapy, children learn to cope with anxious thoughts by reminding themselves that their fears are not based on fact.

CBT also entails safe exposure therapy. For example, a child whose GAD manifests most during social situations might benefit from social exposure. A therapist might discuss complex topics with the child and challenge their irrational thoughts. The therapist can teach the child coping skills like breathing exercises and cognitive restructuring throughout exposure.

Acceptance and Commitment Therapy (ACT)

Acceptance and commitment therapy (ACT) is most effective for teenagers struggling with GAD. Unlike CBT, which is about recognizing negative thought patterns and replacing them with positive ones, ACT involves accepting these thoughts as valid.

Through ACT, teenagers can accept that their thoughts, however outlandish, are real and valid without getting caught up in them.

Mindfulness plays a significant role in the ACT process. It promotes psychological flexibility, which allows individuals to accept the full range of their emotions, become present at the moment, and let go of any negative feelings.

Dialectic Behavior Therapy (DBT)

Dialectic behavior therapy (DBT) for GAD helps identify triggers and manage physical and emotional symptoms. While CBT focuses on changing negative thought patterns, DBT is about accepting the thoughts, embracing them, and letting them go gracefully.

Therapists will incorporate the four modules—mindfulness, emotion regulation, interpersonal effectiveness, and distress tolerance—into a DBT program for GAD. They might also teach your child grounding techniques like the 5-4-3-2-1 method to keep them calm during a panic attack or distressing situation.

Medication

Children suffering from severe instances of GAD might benefit from specific anxiety medications. Clinicians typically prescribe antidepressants called serotonin reuptake inhibitors (SSRIs) [*]. These medications, including Zoloft, Prozac, and Paxil, increase the amount of serotonin the brain produces and come with minimal side effects.

A clinician might also prescribe serotonin-norepinephrine reuptake inhibitors (SNRIs) to increase serotonin and norepinephrine production in the brain. Examples of SNRIs include Effexor XR and Cymbalta.

Medication is most effective in combination with CBT, as it allows children to become comfortable enough to participate in therapy.

How Can Parents Support a Child with GAD?

Parents play a significant role in a child’s journey with GAD. Getting your child the help they need while being supportive at home is essential. Here’s what parents can do to support a child with GAD:

• Validate their feelings but don’t empower them. You can validate a child’s feelings without making them “too real.” For example, if your child is afraid to attend weekend camp, you can motivate them by saying, “I know you’re afraid to go to weekend camp alone, and I know you’ll overcome the fear.” Replacing “but” with “and” communicates that you understand their feelings are valid while instilling confidence.
• Provide your child with educational materials. Learning about GAD can help children understand why they feel and act a certain way. Give your child avenues for learning about GAD through books, movies, and activities.
• Build your child’s toolbox. What coping mechanism works for one child may not work for yours. Thus, it is fundamental to show them how to manage their anxious emotions. You can teach them to slow their breathing when overwhelmed or calm their anxiety through progressive muscle relaxation.
• Model healthy behavior. Children take after their parents. If your child sees you can manage your emotions with dignity and grace, you’ll inspire them to tackle their anxiety head-on.

The Bottom Line

While GAD is a relatively common condition among children and teens, it can quickly become debilitating when left untreated. It can start gradually and worsen as a child faces adversity and traumatizing experiences.

Through early identification and regular treatment of generalized anxiety disorder in children, you can help your child manage their emotions, experience fewer anxiety attacks, and become self-reliant.

If you’re looking for a place to start, use our anxiety worksheets to help your child stay calm and mindful during trying times.

Sources:

1. Wang Z, Whiteside S, Sim L, et al. “Introduction: Anxiety in Children.” NIH, 2017.
2. Lee We, Wadsworth Mej, Hotopf M. “The protective role of trait anxiety: a longitudinal cohort study.” Psychological Medicine, 2006.
3. Ahmadzadeh YI, Eley TC, Leve LD, et al. “Anxiety in the family: a genetically informed analysis of transactional associations between mother, father, and child anxiety symptoms.” Journal of Child Psychology and Psychiatry, 2019.
4. De MD and Zisk A. “The Biological Effects of Childhood Trauma.” Child and Adolescent Psychiatric Clinics of North America, 2014.
5. James AC, James G, Cowdrey FA, Soler A, Choke A. “Cognitive behavioural therapy for anxiety disorders in children and adolescents.” Cochrane Database of Systematic Reviews, 2015.
6. Strawn JR, Geracioti L, Rajdev N, Clemenza K, Levine A. “Pharmacotherapy for generalized anxiety disorder in adult and pediatric patients: an evidence-based treatment review.” Expert Opinion on Pharmacotherapy, 2018.