By Keath Low
Reviewed by Steven Gans, MD
July 5, 2018
A certain amount of anxiety is a normal part of a child’s healthy development. Brief separation anxiety, 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 if they struggle with generalized anxiety disorder (GAD).
As a parent or caregiver, don't let the possibility alarm you. Once you seek appropriate help and, if appropriate, a diagnosis, you're bringing your child one step closer to appropriate treatment and improved quality of life.
Approximately 5 percent to 10 percent of children in the general population struggle with anxiety disorders. Among children with ADHD, the rate appears to be even higher. As with adults who experience generalized anxiety disorder, females are twice as likely as their male peers to be diagnosed with GAD.
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 restlessness, difficulty concentrating, irritability, muscle tension, fatigue, difficulty swallowing, a need for frequent urination, stomach aches, and sleep difficulties.
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.
And, though a child may even recognize that their anxiety is exaggerated, he or she still can have great difficulty controlling it or managing it.
The Diagnostic and Statistical Manual, 5th edition, often referred to as the DSM-5, outlines specific criteria to be met in order to be properly diagnosed with generalized anxiety disorder. It is important to note that there are no panic attacks experienced with GAD and 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 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. It has been found that there are a variety of factors that influence the development and onset of GAD, including genetic predisposition, family dynamics, life experiences, and neurobiological factors.
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, and 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 plans for GAD in children and adolescents are tailored based on their unique situation. There are a variety of options to choose from.
Counseling: Therapeutic 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:
- Openly sharing thoughts and feelings
- Identifying fears and worries
- Developing positive self-talk to help reduce anxiety
- Increasing coping skills like socialization, physical activity and self-assurance
- Developing and using relaxation techniques
As a caregiver, you and your family will likely be asked to participate in your child's treatment, in the form of family counseling sessions during this process. The counseling professional will often use this time to help educate parents about generalized anxiety disorder, suggest helpful techniques and to 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 is not usually suggested. When the anxiety symptoms are moderate to severe, your provider may begin to educate you and your family about options for medication to help control symptoms.
Selective serotonin reuptake inhibitors, also referred to as SSRI's, tend to be the more commonly prescribed medications prescribed for children and adolescents with anxiety. SSRI's include medications such as:
- Prozac (fluoxetine)
- Celexa (citalopram)
- Zoloft (sertraline)
- Lexapro (escitalopram)
As with all medications, prescriptions used to treat anxiety have risks. They are prescribed, however, when a physician or psychiatrist believes the benefits of the medication outweigh those risks.
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 some of 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 a time to explore what works well for them.
If a technique doesn't seem to be helping after a period of time, that is okay. Giving them 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: Mindfulness, prayer, relaxation, and breathing exercises are all practices that can help slow down your child's anxious thoughts and emotional responses. 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.
Social Connection: Anxiety can make children and teens want to isolate 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. Helping them create a plan of self-care can be valuable in their ability to cope and effectively manage their stress.
Tips for Parents/Caregivers
A first step in helping your child manage and overcome anxiety is recognizing it and sometimes 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 increased understanding of generalized anxiety disorder, you will be better able to intervene early and find necessary help.
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. Early intervention and treatment can make a world of difference for your child and can prevent further complications around the anxiety.