Generalized anxiety disorder (GAD) is part of a cluster of diagnoses called the anxiety disorders. Anxiety disorders are a group of psychiatric conditions that include:
These disorders are characterized primarily by the experience of excessive fear and anxiety.
Children with generalized anxiety disorder spend a lot of time worrying about a lot of different things. Children with social anxiety disorder feel very anxious around other people, including their peers, because they are afraid of embarrassing themselves or being disliked. Children with panic disorder have sudden rushes of intense fear or discomfort called panic attacks. They often worry about having another panic attack and might avoid certain situations that might trigger a panic attack. Children with agoraphobia are afraid of going into certain situations because they are afraid it might be difficult to escape or because they might experience panic-like symptoms or embarrassing symptoms. Commonly avoided situations are using public transportation, being in open spaces like parking lots, being in enclosed places like movie theaters, or being in a crowd. Children with a specific phobia are very afraid of one or more objects or situations, such as flying, heights, animals, or seeing blood. Children with separation anxiety disorder are afraid of being away from a certain person or people, often a parent, often because they are afraid that something bad might happen to them or the other person if they are separated. Children with selective mutism do not speak in situations where it would be socially appropriate for them to speak, such as at school.
The anxiety disorders are characterized by excessive fear and anxiety, along with behavioral disturbances, like avoiding certain places, people, or situations. The anxiety disorders differ from each other in the target or focus of the fear. In some anxiety disorders, like specific phobia, the child is only excessively fearful of narrow range of objects or situations. In other anxiety disorders, like GAD, the child may feel anxious a great deal of the time or about a lot of different things.
GAD affects approximately 1% of the pediatric population. GAD is characterized primarily by worry that is excessive (out of proportion to the actual threat) and uncontrollable (unwanted or hard to stop).
Worry involves thinking about things that could go wrong in the future, usually in a way that makes the person anxious.
Some common worry topics in children and adolescents are listed below:
Children and adolescents with GAD also experience other symptoms besides worry. To be diagnosed with GAD, a child or adolescent needs to have at least one of the following six symptoms:
To be diagnosed with GAD, the child or adolescent needs to have these symptoms more days than not for six months or more. The worry and symptoms also need to be distressing (upsetting) or impairing (getting in the way of the child's life).
GAD severity can range from mild to very impairing. In severe cases, GAD can lead to serious problems at school. GAD can also cause problems in relationships with family members and peers, particularly if the child engages in excessive reassurance-seeking (repeatedly asking others to assure them that everything is okay).
Although not required for diagnosis, children and adolescents with GAD are often described as shy, withdrawn, or perfectionistic. Children and adolescents with GAD also often have other psychiatric conditions, most commonly depression and other anxiety disorders.
We are beginning to learn about the neurobiology of GAD. GAD seems to be characterized by abnormalities in certain brain regions, particularly regions related to self-reflection (precuneus) and error processing (anterior cingulate cortex), which are thought to contribute to symptoms. Early childhood adversity and overprotective parenting have also been associated with GAD. The disorder has a genetic component, although having a genetic predisposition to GAD does not necessarily mean that someone will develop GAD.
Currently there are no published guidelines specifically for pediatric GAD. However, published guidelines for pediatric anxiety, broadly defined, are provided by the Society of Clinical Child and Adolescent Psychology. The American Academy of Child and Adolescent Psychiatry offers historical practice parameters (last updated in 2007); new parameters are being developed.
Clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in GAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.
Clinical research suggests that the following treatments are effective for pediatric anxiety:
For more information about drug prescribing in GAD, click here.
Other Treatments to Consider
In the event of non-response to established treatments, the following treatments have shown some evidence of efficacy in the treatment of pediatric anxiety:
Note: benzodiazepine treatment has generally not been found to be effective in pediatric anxiety disorders, despite evidence of short-term efficacy in adults.
Among young people, the most common mental health concerns are depression and anxiety.
This video from Psych Hub explores how to recognize these challenges and ways to support children and adolescents who may be struggling.
Learn more at PsychHub.com
Psych Hub is an educational service. The information provided in this video is not a substitute for professional advice, diagnosis, or treatment. If you believe you or someone you know may be experiencing mental health symptoms, please seek help from a qualified medical or behavioral health professional.
If you or someone you know is in immediate danger, call 911 (U.S.).